Running Head: HEROIN

Page 1

Heroin
Helen McDonald
April 24, 2015
State University of New York Polytechnic Institute Utica Rome

HEROIN

Page 2
Heroin
Focus group/Learner assessment

Utica, New York is the focused group. It has a population of 61,808 people, 51.9 percent
female, living in 16.76 square miles of land; 3,713.5 people per square mile (Utica, 2015). The
area has 14.8 percent people over the age 65; 24.7 percent of people are under the age of 18
(Utica, 2015). There is 64.5 percent of the population who are white, non-Hispanic or Latino,
15.3 percent African American and 7.4 percent Asian (Utica, 2015). Of the Utica population 78.4
percent are graduated from high school and 15.9 percent has earned a bachelors degree or higher
(Utica, 2015). There are approximately 24,041 households, each with 2.45 people (Utica, 2015).
The median household income in 2009-2013 was 30,942 dollars. There were 29.6 percent of
people living below poverty level in 2009-2013 (Utica, 2015).
Developmental goals will be based on young adults, age 18 to 24, with college and peer
based pressures. Pressures for the college age adult include; social and sexual, alcohol, drugs,
unhealthy food choices, stress, friends, homework, jobs, athletics and leadership (Family, 2014).
The teaching will be based on drug pressures with a focus on heroin.
Learner needs/Project goals
The main goal for the project is to raise awareness of heroin abuse in the community. The
project is intended, not only to teach the community about heroin but also subsequently identify
members of that community, either personally or interrelated, effected by heroin. Once
identified, treatment solutions are introduced with behavioral and pharmacological therapy
options; identification of treatment centers, medication therapy options and medical treatment

HEROIN

Page 3

and availability for overdose. Emotional support and confirmation will be provided to those
members of the community that require the assistance.
Behavior objectives
The learner will be able to describe basic information about heroin. The learner will be
able to verbalize that heroin use, overdose and fatality is increasing. The learner will be able to
identify overdose symptoms. The learner will be able to verbalize basic understanding of
naloxone (Narcan). The learner will be able to verbalize one way they can gain access to the
medication if they or someone around them is experiencing an overdose. The learner can identify
one resource to obtain help for addiction.
Teaching environment
The teaching environment was community based in Utica, New York. It was
performed at the State University of New York Polytechnic Institute Utica Rome at a large health
and wellness fair. The poster presentation was placed on a table at eye level. There was plenty of
lighting. Pencils and sharpeners were provided as favors to entice participants at the fair to come
and read the poster and ask questions. When pencils ran out Hershey kisses were provided. Two
fake candles were placed on the table to make the environment more comfortable and intimate
for holistic care of mind, body and spirit.
The poster board presentation had a large, red printed heroin so health fair participants
were able to clearly recognize what was being presented and walk to the booth with interest. The
design of the board was used to teach learners with diverse educational backgrounds. The muted
colors of the rest of the board were used to keep the learners calm and comfortable during their
learning experience.

HEROIN

Page 4
Content coverage

Content covered heroin education as described in the literature review. Signs and
symptoms of both withdrawal and overdose were provided. Treatment for heroin overdose was
presented simply in writing then further verbal information was provided. Treatment approaches
were again presented simply in writing and then discussed in further detail upon request.
Medication options for treatment were listed. Pictures were used to allow for deeper
understanding of the consequences of heroin use such as intravenous diseases. Statistical
information was provided with grafts for the typical age of use and overdose.
Literature review
Heroin has increasingly become a national epidemic. Rates of heroin overdose has
increased from 1999-2010 by more than 50percent with ensuing rise in death rates (Rudd et al.,
2014). The Centers for Disease Control and Prevention (CDC) observed 28 states and found the
overdose death rates from 2010 to 2012 increased from 1.0 to 2.1 per 100,000; at the same time
death rates from opioid pain relievers decreased from 6.0 to 5.6 per 100,000 (Rudd et al., 2014).
Death rates from heroin overdoses has increased in all age ranges, male and female, in all census
regions regardless of racial or ethnic backgrounds (Rudd et al., 2014). The CDC report identified
needs for increased prevention to decrease opioid overdose deaths (Rudd et al., 2014). The CDC
determined that prescription users need preventive measures to decrease the amount expanding
to heroin due to availability (Rudd et al., 2014).
In the United States (U.S.) prescription drug abuse and heroin use are interconnected
(Traynor, 2014). The director of the Office of National Drug Control Policy, Michael Boticelli,
stated, It is impossible to understand our nations heroin challenge without also understanding

HEROIN

Page 5

our prescription drug abuse challenge (as cited in Traynor, 2014, p. 1242). During the year
2011, approximately 110 Americans died of an overdose each day; more than traffic accidents
(Traynor, 2014). Heroin overdoses accounted for 4,000 or more deaths in 2011; opioid overdoses
accounted for 17,000 deaths during the same year (Traynor, 2014). Research has found a link
between heroin addictions beginning with prescription opioid use (Traynor, 2014). Policy
changes to restrict illicit use of prescription opioids may have an influence in the increase of
heroin use (Traynor, 2014). The street price of heroin is cheaper than that of Oxycontin and other
prescription opioid medications (Traynor, 2014). A White House summit was held in 2014,
identified some of the states heroin combat strategies including; law enforcement and public
health initiatives, increased funding for substance abuse, needle exchange programs, Drug
Enforcement Administration (DEA) and Department of Justice pharmacists educational
programs for substance diversion, and take-back prescription return programs (Traynor, 2014).
Its estimated that between 600,000 and 1.5 million Americans use heroin (Heady &
Haverstick, 2014). Significant heroin overdoses spikes have been reported in individual states
(Heady & Haverstick, 2014). Two million Americans reported abusing prescription painkillers
non-medically in 2010 (Heady & Haverstick, 2014). It is believed that the increase in heroin use
is due to the increase in availability and comparably cheap cost to prescription opioids due to the
increase unavailability of prescription medications (Heady & Haverstick, 2014).
Heroin from Mexico is called black tar and from Colombia white heroin (Heady &
Haverstick, 2014). The street value of South American heroin decreased from $1.75 per
milligram in 2010 to $1.18 in 2011; from Mexico street value decreased from $2 to $1.35 per
milligram in the same time period (Heady & Haverstick, 2014). New heroin users are statistically
young adults between 18 and 25 years of age (Heady & Haverstick, 2014). Overdose risk factors

HEROIN

Page 6

include; unemployed, single, male, intravenous use, history of heroin dependence without
treatment, and alcohol or benzodiazepine concomitant use (Heady & Haverstick, 2014). Heroin
purity is unregulated and it is often cut with sugar, starch, powdered milk, quinine, cocaine,
amphetamine, methamphetamine, fentanyl, clenbuterol, diphenhydramine and acetaminophen;
all known as adulterants or bulking agents (Heady & Haverstick, 2014).
Heroin is an opioid synthesized from morphine found naturally from the extract of the
asioan opium poppy plant seed (Drug Facts, 2014). It is seen as white or brown powder or a
sticky substance, black tar heroin (Drug Facts, 2014). Approximately 23 percent users become
dependent on heroin. It is estimated that by 2011, 4.3 million Americans 12 years or older had
tried heroin at least once (Drug Facts, 2014). Heroin is snorted, smoked or injected (Drug Facts,
2014). Heroin binds to the opioid receptor in the central nervous system (CNS), reducing pain
causing a short lived state of euphoria (Heady & Haverstick, 2014). It is addicting due to its fast
action in the brain. The user needs to increase the amount of heroin used each time to feel the
same rushing sense each time, chasing the high (Heady & Haverstick, 2014). The purity of
heroin is improving and is resulting in increased overdoses; the most pure (31.1percent) coming
from South America (Heady & Haverstick, 2014). Drug screenings are generally only able to
detect the presence of opioids, only a few are able to detect heroin as a substrate (Heady &
Haverstick, 2014).
Naloxone (Narcan) is the reversal agent for opioid overdose (State initiatives, 2014). In
December 2013, many states have enacted 911 Good Samaritan Laws allowing witnesses and
overdose victims to call for medical attention without fear of prosecution (State initiatives,
2014). These laws allow victims possessing drug and drug paraphernalia to be treated without
risk of prosecution for possession (State initiatives, 2014). Naloxone is becoming more available

HEROIN

Page 7

to the public, including prescriptions made to friends or families of heroin or opioid medication
users, allowing them to carry and administer the medication (State initiatives, 2014). Many more
community-based organizations are carrying naloxone such as; Emergency Medical Services
(EMS), fire departments and police departments. Many states, policymakers and communities
are having difficulties with Good Samaritan Laws because of strong views of commitment to law
enforcement and the belief that allowing naloxone to be more available allows the heroin addict
to believe it is somehow safer to continue using and increases drug use overall (State initiatives,
2014).
Addicted individuals exhibit uncontrollable drug-seeking behavior, regardless of
consequences (Drug Facts, 2014). Intravenous (IV) users are at high risk of human
immunodeficiency virus (HIV) and hepatitis C (HCV) (Drug Facts, 2014). Besides fatal
overdoses, heroin can result in spontaneous abortions, low birth weights, collapsed veins,
endocarditis, abscesses, constipation, gastrointestinal cramping, liver and kidney disease (Drug
Facts, 2014).
Withdrawal symptoms can occur as early as a few hours after the last use (Drug Facts,
2014). Withdrawal symptoms include; restlessness, insomnia, muscle and bone pain, insomnia,
diarrhea, vomiting, goose bumping, kicking, as well as severe craving (Drug Facts, 2014).
Behavioral and pharmacological therapies are utilized together to offer the best results for
addiction treatment and recovery (Drug Facts, 2014). Pharmacological therapies include
buprenorphine and methadone; which binds to opioid receptors but more weakly assisting a
person to wean off heroin by reducing cravings (Drug Facts, 2014). Another pharmacological
treatment option is naltrexone (Vivitrol), which blocks opioid receptors, preventing heroin from

HEROIN

Page 8

having an effect. A newer, longer-acting intramuscular injection is available to increase

compliance (Drug Facts, 2014).
Heroin drug addiction is considered a complex illness. It can be characterized by intense,
uncontrollable drug craving with dangerous compulsive drug seeking, despite devastating
consequences to the individual (Treatment approaches, 2009). The individual, at first, willingly
takes heroin; they then become compulsive where seeking and consuming the drug is consuming
(Treatment approaches, 2009). Addiction affects the brain at multiple levels including reward and
motivation, inhibitory control over behavior and learning and memory (Treatment approaches,
2009). Treatment incorporates different components, each directed towards another dimension of
illness as well as health consequences (Treatment approaches, 2009). Treatment goals are to stop
using, maintain a drug-free lifestyle by achieving productive family, work and society
functioning (Treatment approaches, 2009).
Long-term therapy and episode treatment is required to sustain recovery of the illness
(Treatment approaches, 2009). Withdrawal medications can offer assistance with withdrawal
symptom suppression during detoxification. Outpatient behavioral treatment options include;
cognitive-behavioral therapy (recognize, avoid and cope), multidimensional family therapy
(address drug abuse patterns and family functioning), motivational interviewing (readiness for
treatment), and motivational incentives (contingency management) (Treatment approaches,
2009). Inpatient treatment facilities are generally known as residential treatment programs or
therapeutic communities (Treatment approaches, 2009). These are highly structured living
environments where a patient may remain for 6 to 12 months (Treatment approaches, 2009). The
focus of these facilities is group therapy and resocialization into a drug-free, crime-free lifestyle
(Treatment approaches, 2009). The Criminal Justice system can mandate a drug dependent

HEROIN

Page 9

person to rehabilitation (Treatment approaches, 2009). It has been shown that voluntary
admission into a rehab does not need to occur for a treatment approach to be effective (Treatment
approaches, 2009).
Teaching evaluation
There was a large turnout for the health fair. There were a great number of people that
stopped to see the poster and speak with my partner and me. There were two women who we had
in depth conversations about their person journeys. A few people had us list some of the
pharmacological treatment options for them. There were a few 15-18 year olds stop and ask
about the presentation and walked away with a piece or two of information. There were
organizations in the area that stopped and spoke with us about their mission and techniques for
treatment.
A four question, multiple choice survey (Appendix A) was provided health fair
participants who stopped and spoke to us. This method of survey was used to evaluate the
learners response and learning to the project because it was quick, easy to read and understand,
and most would stop to complete it when asked. The first question on the evaluation tool asked
about presentation appearance with responses; a) poor, b) fair, c) good, d) excellent. The second
question on the tool asked about the presenter knowledge with responses; a) poor, b) fair, c)
good, d) excellent. The third question on the tool asked how much was learned with responses; a)
none, b) some, c) fair amount and d) a lot. Question four asked how the presentation would be
rated overall, with responses; a) poor, b) fair, c) good, d) excellent. Thirty-two surveys were
completed in all; five people answered good and 27 answered excellent for question one,
two answered good and 30 answered excellent for question two, six answered some, 13

HEROIN

Page 10

answered a fair amount and 12 answered a lot for question number three, three answered
good and 29 answered excellent for question four. This evaluation tool demonstrated that the
teaching project was effective.
Future recommendation for a teaching project about heroin would include handout
information with bullet points from the poster. The project should focus more on treatment
facilities in the area. Although we did place a list of facilities in the area, it did not describe what
each of them offered.

HEROIN

Page 11

References:
Drug Facts: Heroin. (2014). National Institute on Drug Abuse. Retrieved
fromhttp://www.drugabuse.gov/publications/drugfacts/heroin
Drug Facts: Treatment approaches for drug addiction. (2009). National Institute on Drug Abuse.
Retrieved from http://www.drugabuse.gov/publications/drugfacts/treatment-approaches
drug addiction
Family health. (2014). Centers for disease control and prevention. Retrieved from
http://www.cdc.gov/family/college/
Heady, T. N., & Haverstick, D. (2014). Heroin: a worsening problem and a challenge for
testing. MLO: Medical Laboratory Observer, 46(7), 22.
Rudd, R. A., Paulozzi, L. J., Bauer, M. J., Burleson, R. W., Carlson, R. E., Dao, D., & ... Zehner,
A. M. (2014). Increases in heroin overdose deaths - 28 States, 2010 to 2012. MMWR:
Morbidity & Mortality Weekly Report, 63(39), 849-854.
State initiatives to prevent fatal ODs include naloxone and 911. (2014). Alcoholism & Drug
Abuse Weekly, 26(2), 4-5.
Traynor, K. (2014). White House summit tackles opioid abuse. American Journal Of Health
System Pharmacy, 71(15), 1242-1243. doi:10.2146/news140055
Utica (city), New York. (2015). U.S. Census Bureau: State and county quickfacts. Retrieved
from http://quickfacts.census.gov/qfd/states/36/3676540.html

HEROIN

Page 12
Appendix A

EVALUATION
1. Presentation appearance
a. Poor
b. Fair
c. Good
d. Excellent
2. Presenter knowledge
a. Poor
b. Fair
c. Good
d. Excellent
3. How much did you learn more about Heroin?
a. None
b. Some
c. Fair amount
d. Oodles
4. How would you rate overall?
a. Poor
b. Fair
c. Good
d. Excellent

HEROIN

Page 13

HEROIN

Page 14