Ashel Kruetzkamp, MSN, RN, SANE
Lynne M. Saddler, MD, MPHDistrict Director of Health
It is now harder to get these…
Pain Relief
You can easily get this…
Heroin• Is a drug made from morphine, a “natural substance” in the
seedpod of the Asian poppy plant
• Usually appears as a white or brown powder
• It can be injected, smoked or snorted
• Although purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin also can be cut with fentanyl or other poisons.
National Institute on Drug Abuse
Heroin Addiction – A Substance Use Disorder
Addiction: Definition
• compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful
Warning: Even a single dose of heroin can start a person on the road to addiction.
Another way of describing addiction is the presence of the 4 C’s:
1) Craving
2) Loss of Control of amount or frequency of use
3) Compulsion to use
4) Use despite Consequences.
Consider a person who finds alcohol so pleasurable that he regularly goes to the bar after work (Craving). His drinking escalates to overcome tolerance, and he experiences withdrawal when he abstains. He tries and repeatedly fails to cut down (loss of Control). He begins to reorganize his life in order to maximize drinking opportunities, neglecting his work and family (Compulsion). Eventually his spouse leaves and he loses his job (Consequences).
Behavioral signs of heroin abuse and addiction include:o Avoiding eye contact, or distant field of vision
o Substantial increases in time spent sleeping
o Increase in slurred, garbled or incoherent speech
o Sudden worsening of performance in school or work, including expulsion or loss of jobs
o Loss of motivation and apathy toward future goals
o Withdrawal from friends and family, instead spending time with new friends with no natural tie
o Repeatedly stealing or borrowing money from loved ones, or unexplained absence of valuables
o Hostile behaviors toward loved ones, including blaming them for withdrawal or broken commitments
Heroin affects your health
Affects on the Brain• Heroin enters the brain, where it is converted to morphine and
binds to receptors known as opioid receptors. Opioid receptors are located in various parts of the brain, especially the receptors with pain, reward and perception
• Frequent use of heroin can cause irreversible damage to brain cells over time.
• Heroin abuse the brain gets use to the morphine and surge of chemicals creating the powerful rush and sends intense messages throughout the brain and body for repeated use. This leads to tolerance and eventually addiction.
Retrieved from: http://www.heroin.org
Signs of Heroin Overdose: Airways and lungs
o No breathingo Shallow breathingo Slow and difficult breathing
Eyes, ears, nose, and throat o Dry moutho Extremely small pupils, sometimes as small as the head of a pin ("pinpoint
pupils")o Tongue discoloration
Heart and blood o Low blood pressureo Weak pulse
Skin o Bluish-colored nails and lips
Stomach and intestines o Constipationo Spasms of the stomach and intestinal tract
Nervous system o Comao Deliriumo Disorientationo Nodding off
Symptoms of Heroin Withdrawal:Heroin abusers and addicts feel compelled to continue using the drug both because of its pain relieving effects, and because of fear of symptoms they may experience if they stop. Heroin withdrawal symptoms can start a few hours to one day after sustained use of the drug stops. Withdrawal symptoms can include:
Early symptoms of withdrawal include:o Agitationo Anxietyo Muscle acheso Increased tearingo Insomniao Runny noseo Sweatingo Yawning
Late symptoms of withdrawal include:o Abdominal crampingo Diarrheao Dilated pupilso Goose bumpso Nauseao Vomiting
Data
Jan Feb M
April May Jun
e July Au Se
p Oct Nov Dec0
1020304050607080
16 10 31 20 24 20 29 16 20 24 16 2624 28 46 28 66 33 29 37 20 39 48 4944 34 50 56 51 50 48 52 33 41 37 4945 54 44 75 55 63
Heroin OverdosesEmergency Departments
(Covington, Ft. Thomas, Edgewood, Florence and Grant County)
2011 2012 2013 2014
2011=252, 2012=447, 2013=545, 2014=336 (YTD)
KY Countyof
residence
Number of deaths due to drug overdose Rate of drug overdosedeaths per 100,000
population 2011-2012
Year 2011 2012 All All
Boone 19 29 48 20
Campbell 25 54 79 43
Carroll * * 32 32
Gallatin * * 8 47
Grant 8 11 19 39
Kenton 55 54 109 34
Owen * * * 9
Pendleton 5 * 8 27
Snapshot of 200 patients who arrived in the ER as a heroin overdose:
Hepatitis C
•Nationally, acute Hepatitis C cases decreased this year by 7%.•Kentucky saw a 14% increase in cases reported.•Rates in Northern Kentucky are much higher than the state rate and are more than 24 times the national rate.•Public health officials attribute Northern Kentucky’s high infection rate to the region’s high levels of the intravenous (IV) use of heroin.
Hepatitis B
•Nationally the rate of acute Hepatitis B decreased in 2013. •In Kentucky, the rate increased slightly and is 5 times higher than the nation. •NKY’s rate of Hepatitis B is 11 times the national rate.
Is HIV next?
Healthcare Costs• It is estimated that local governments across the U.S. spend about 9% of
their local budgets on issues related to substance use and the disease of addiction. The estimated cost for Kentucky statewide related to substance use is $6 billion annually.
• Lifetime health care costs to treat infections, such as Hepatitis C, are estimated at $64,490 per person. A 2013 article described Hepatitis C as “a public health and health care expense time bomb.”
• The per-episode cost for treating endocarditis, an infection that can be related to intravenous drug use, is projected to exceed $120,000.
• The actual cost for treating babies born with drug withdrawal syndrome in Northern Kentucky is astounding. In 2012, the cost was $898,219.85 for 63 infants equating to approximately $14,257 per infant. (2013-$1,110,960=$13,887 per infant)
Northern Kentucky's Collective Response to the Heroin Epidemic (2013)
NKY’s Response Strategies
HealthcareBusinessesGovernment Faith Community
Northern Kentucky Heroin Impact Response Leadership Team
NKY Heroin Impact ResponseLeadership Team includes:
Community CoalitionsPublic HealthSocial ServicesMedia
Thank you
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