What Is Being Done to Combat the Heroin Epidemic?
Heroin, derived from morphine and retrieved from the opium poppy, is a very addictive drug. It goes by various nicknames, which include Big H. Dog, Black Tar, Puppy Chow and Horse. It can be smoked in a water pipe, injected, snorted through the nose in a powder form or inhaled as smoke through a straw.
Heroin works much the same as prescription opioid drugs like hydrocodone and oxycodone. It binds to the opioid receptors found on your brain’s nerve cells and periphery along with other organs in your body and reduces the perception of pain. When these drugs bind to opioid receptors, it produces a sense of well-being as it reaches the reward regions of your brain. The drug stimulates deeper regions of your brain, which leads to respiratory depression, drowsiness and sometimes, sadly, overdose death.
According to Penn State’s assistant professor of demography, rural sociology, and sociology, Shannon Monnat, in order to not become addicted to heroin, you must not start using it. Heroin creates almost 100 times the “feel-good” hormone endorphins than what your body naturally produces, which is why it’s so addictive.
When your body stops making its own endorphins naturally and you try to stop using heroin, you end up having to go through withdrawal symptoms that may include diarrhea, pain, nausea and vomiting. To avoid the withdrawal symptoms and compensate for the lost endorphins, you have to take more of the opiate. This starts the savage cycle of heroin addiction, Monnat says.
Many young people who first began to abuse prescription drugs are now turning to heroin since it is easier and cheaper to buy. It’s pretty straightforward as to why: Prescription painkillers that are obtained illegally are harder to get and more expensive.
On the other hand, heroin is not as difficult or expensive to obtain. In fact, just one OxyContin (80 mg) pill can cost up to $100 on the streets, while one dose of heroin will run you only about $9. Even if you are heavily hooked on heroin, it still costs much less to get a day’s worth of heroin than it does to get only a couple hits of OxyContin.
What Is Being Done About the Heroin Epidemic — Big Picture View
The main cause of accidental death for Americans continues to be opioid overdose deaths from drugs like hydrocodone, oxycodone and heroin. This figure has risen 14 percent from 2013 to 2014. Plus, someone dies from an overdose of an opioid drug every 19 minutes.
The use of heroin has increased in America among men and women of all income levels and most age groups. In fact, some of the highest increases happened in low-heroin rate demographic groups, like the privately insured, women and people with high incomes. Not only are people using heroin, but they are also abusing other substances like prescription opioid painkillers and cocaine.
As the use of heroin increases, so do the overdose deaths related to it. In fact, between the years 2002 and 2013, the rate of overdose deaths from heroin almost quadrupled, with over 8,200 people dying in 2013 alone. This is the reason why educators, physicians, teachers, legislators, addiction recovery specialists, parents and people addicted to heroin want to know what is being done to fight the heroin epidemic.
Because of how many heroin overdoses there have been, the federal government has decided to call opioid abuse an epidemic. Not to mention, because of the increase in the problem, President Barack Obama has allotted $1.1 billion of his proposed 2017 budget to address the opioid and heroin epidemic. The intention is to follow the White House’s 2011 plan for addressing the problem through expanded enforcement, education and drug tracking.
The White House Office of National Drug Control Policy’s director, Michael Botticelli, said in a call to reporters that increasing access to these types of treatments for opioid-use disorders has and continues to be the administration’s top priority. This approach has been shown through research to be more effective when combined with behavioral therapy at preventing overdoses and sustaining recovery.
There have been huge efforts taken towards reducing misuse and diversion of opioids all over America and reducing overdoses and deaths from opioids. The National Institute on Drug Abuse (NIDA) supports research to determine how these policy changes impact the rates of use disorders, opioid misuse and other related health outcomes of the public.
This research has exhibited the productiveness of different forms of interventions, including:
- Community and school educational initiatives, or primary prevention.
- The support of constant use of monitoring programs for prescription drugs.
- Implementing education on overdose and naloxone distribution programs for issuing naloxone directly to opioid users as well as potential bystanders.
- Harsh and aggressive law enforcement efforts for addressing pill mills and doctor shipping.
- Redirecting people who have a substance use disorder to Drug Courts.
- Expanding Medication-Assisted Treatment (MAT) access.
- Opioid analgesics abuse-deterrent formulations.
One way we are fighting heroin overdoses and the opioid epidemic is by implementing medication-assisted treatments through the use of drugs like buprenorphine and methadone. Using these drugs along with behavioral treatment is a key element in managing the recovery of an addict and easing the withdrawal symptoms of opioid drugs.
How Are We Fighting Heroin Abuse, Addiction and Overdoses?
There are several targeted strategies in place to fight heroin use, abuse, addiction and overdoses, including the following:
Presently, methadone is the most commonly used drug in the U.S. for opiate addiction therapy. It is a Schedule II synthetic opiate. It reduces both symptoms of withdrawal and opiate cravings, which help you to stop abusing opiates. Methadone is believed to cut the mortality rates of people addicted to opiates in half.
There are a few downsides to this type of therapy. First, you can only obtain this treatment in a licensed methadone treatment clinic. If you live in a rural area, you have to make a long trip to get the drug since it is typically located in urban centers. Also, abusing methadone has become common in places where opiate and heroin abuse are common.
This drug is designed to reverse the overdose of heroin or opioid prescription drugs. When you take heroin, it locks onto your brain’s receptors, which disrupts your breathing and slows your body down. When you are given naloxone, it quickly frees up these receptors and restores your normal breathing and consciousness, which essentially brings you back to life from your overdose. This drug is intended to be administered to a person who overdosed only after 911 was called and their breathing is checked. It can be administered as a nasal spray or with a needle to counter the effects of a heroin overdose.
There is a push to make naloxone more easily available here in the U.S. Recent evidence of this was the over-the-counter expansion of naloxone to Walgreens in Pennsylvania. In addition to Pennsylvania, New York, Rhode Island, Ohio, Indiana and Massachusetts have naloxone available over the counter.
In addition, Rite Aid has trained more than 8,000 pharmacists on naloxone and is dispensing it in 10 states without needing a prescription. The pharmacy is expected to expand the number of states where naloxone can be dispensed without a prescription.
In 23 states, with projects to expand to 35 states by the end of 2016, CVS Pharmacies is dispensing naloxone to patients without a prescription.
This is one of the first treatment models that has been researched and refined and is referred to as Alcohol and Substance Abuse Services, Education and Referral to Treatment. Multiple healthcare systems have adopted this treatment model throughout the U.S., including Delaware’s Wilmington Hospital, Baltimore’s Bon Secours Hospital, Colorado’s Denver Health Medical Center and Connecticut’s Yale-New Haven Hospital.
In the mid-1990s, Boston Medical Center’s veteran emergency medicine physician, Ed Bernstein, pioneered a program that screened patients who showed substance abuse signs who were clearly at risk of harming others and themselves and who visited emergency rooms frequently. The goal of this program was to catch individuals in the small window of time they were at the ER and motivate them to seek treatment. Before a patient would leave the hospital, they would be interviewed by a team of recovering addicts known as “health promotion advocates.”
The Law Enforcement Assisted Diversion (LEAD) began in Seattle in 2011 and was designed to arrest fewer addicts and divert them to social services, counseling or treatment instead. LEAD is focused on rethinking incarceration to respond to drug addiction because of the thousands of heroin and prescription opioid overdoses deaths every year.
Good Samaritan Bill
The 911 drug immunity law, or Good Samaritan Bill, was formed by the District of Columbia and 34 other states to encourage individuals to get medical attention and follow-up care following an overdose or after naloxone has been administered. The Good Samaritan Bill is designed to provide immunity from offenses for low-level drug possession and supervision violations if you call 911 for assistance in the event of an opiate-related overdose or for medical attention.
In order to apply immunity, the caller is required by law to have a reasonable belief that you are experiencing an emergency overdose and you are in good faith reporting that belief. This “good faith” usually omits the seeking of help while you are being arrested or a search warrant is being executed. You are also required, by law, to remain on the scene for the arrival of help and cooperate with emergency assistance after they show up. Other laws state that immunity for covered offenses will not suppress other crimes’ evidence.
Buprenorphine is a Schedule III drug and is another form of treatment as part of an opiate addiction therapy. Like Methadone, buprenorphine is believed to cut the mortality rate in half.
In therapy, there are commonly two forms of the drug used.
- There is pure buprenorphine, known as Subutex, which is used in the beginning addiction treatment stages.
- Then there is suboxone, which is a drug that has an anti-abuse component in it that is used in the stages of maintenance treatment.
Both drugs block the opiate’s effects and reduce opiate cravings while they ease the symptoms of withdrawal. You can obtain buprenorphine in a physician’s office as well as a clinic. Because this therapy is less stigmatizing and more convenient than methadone and other clinic-based therapy, it is typically more advantageous.
A new formulation of buprenorphine is currently being developed. It is a new extended-release formula in an injectable solution containing small biodegradable capsules. These capsules slowly release the medication over several weeks as the capsule disintegrates. This new formulation is intended for administration only in a physician’s office once per month or once every six weeks. The goal is to eliminate the patient’s need to acquire buprenorphine in tablet form.
New White House Initiatives
The White House is not only upping the patient limit, but it has also announced providing an extra $11 million to go towards the expansion of medication-assisted treatment program efforts and an additional $94 million to fund 271 community health center treatment services around the country.
Other White House-announced initiatives include:
- Allotting another $11 million for increasing the opioid overdose reversal drug, naloxone.
- Founding the Mental Health and Substance Use Disorder Parity Task Force.
- Providing substance use and mental health benefits as surgical and medical benefits for individuals who currently are in the Children’s Health Insurance Program or have Medicaid.
- Providing $7 million for investigating and policing heroin distribution by the Department of Justice.
- Receiving Department of Health and Human Services guidance for needle-exchange programs that are federally funded.
- Developing Screening, Brief Intervention and Referral to Treatment (SBIRT) programs.
- Offering more access to substance abuse treatment programs through the Affordable Care Act.
- Increasing MAT use.
- Supporting the development and distribution of naloxone.
In a recent address, President Obama made it clear that addressing the opioid epidemic is a priority for his administration.
Cracking Down on Painkiller Prescriptions
The Centers for Disease Control and Prevention has issued new opioid prescribing guidelines that clearly state that opioids are not first-line therapies. Other new requirements were issued by the Food and Drug Administration that fast-acting or immediate-release opioids must have “black box” warning labels on them.
At present, physicians are limited by law in how much buprenorphine they are allowed to prescribe. It is currently at only 100 patients per physician. However, this cap is being increased by the White House to 200 patients per physician. Around the country, though, there is a limit to only 30,000 doctors that are able to prescribe the drug.
In light of the March 2016 federal announcements to address the heroin epidemic and prescription opioid abuse, more than 60 medical schools say they will mandate that their students take education requirements in light of the new opioid prescription guidelines.
What Could Be Done in the Future?
While all of these programs, decisions and actions are a step in the right direction to fight the heroin epidemic, the work is far from done. These are several other steps that can be taken to team up on the fight.
Legislative Solutions and New Policies
Recently, various new legislative solutions and policies have been developed to fight heroin and other drug abuse specifically. In states like Ohio, state agency assistance and drug courts, through legislation, are clambering a powerful fight against the addiction of heroin.
Many people who are addicted to drugs claim experiencing a glimpse of clarity while in the emergency room that makes them receptive to help. However, with health care systems offering little incentive to change, most of the potential for seeking help is often lost. Many people simply leave the hospital with a few options for treatment listed on their discharge papers, according to health care workers and researchers.
Sober Living Houses
As a heroin addict, drug treatments should offer you the chance of escaping active addiction so you have the ability to live a quality drug-free life. Sober living environments, sober houses and additional resources need to be increased. A necessary step in your continued care during the recovery stage of your addiction is structured, safe sober living. But there is an astonishing lack of quality sober living available. You might find some decent sober living homes and halfway houses, but there still need to be more options.
In order to recover from addiction, you need addiction treatment. To recover successfully from addiction, sober homes and an abstinence-based type of treatment are needed. There also needs to be some type of community support where people who are recovering can speak out and break the stigma of addiction if we are going to overcome this heroin epidemic.
Education and Awareness (NOPE)
In addition to law enforcement for reducing drug-related crime, education and awareness are also important. Teachers, community leaders and parents all play a vital role in educating the dangers of drugs, both prescription and illegal, to our youths.
This is how the Narcotics Overdose Prevention & Education (NOPE) program was formed. The NOPE program, which is funded by Delaware County Council, has climbed to more than 15,000 middle and high school students as well as around 1,000 community members. The goal of the program is to educate the community and bring awareness to the forefront regarding this drug epidemic. Teachers, parents, police officers and community members who volunteer in this program are invaluable resources in this effort, and they make a huge impact with their stories.
The message through the NOPE program is delivered from a few perspectives, both emotionally and graphically.
- It is delivered from the professional who educates on how drugs interact on a developing brain.
- It is delivered from the police officer who has the horrid job of notifying families of drug-related deaths.
- It is delivered from the families who have lost a child due to a drug overdose.
Through this program, it’s the hope that these true stories will grab the attention of students and evoke emotion.
The Public Health Crisis It Is
According to Ohio Democratic Senator Sherrod Brown, it is time that this situation is taken seriously and called what it really is — a public health crisis that requires genuine and immediate attention, not empty gestures.
“Without the government, without us as a society making this commitment, what we will repeatedly end up with is being penny wise and pound foolish,” President Obama said.
Rather than allowing people who are addicted to drugs to leave jails and hospitals without help and having their families keep suffering, it’s just smarter for the community to do what is right on the front end, Obama says. Medication-assisted treatment is clearly seen as valuable to the White House. Therefore, increasing access to it in order to conquer a huge public health crisis that has haunted this country for decades is seriously important.
Get Treated for Heroin Addiction
Although medications and behavioral counseling are important in your recovery of heroin addiction, the most important thing is that you stay engaged in treatment for the long haul. Recovering from heroin addiction is not a three-day or seven-day fix, nor is it a 30-day fix. It is a continued commitment to engage in treatment through self-help groups, counseling and ongoing medication which will give you the best chances of staying clean and living a better life.
Help for your heroin or other opioid addiction is just a phone call away. Contact us today.