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Relief, without Remedy:
The Return of Heroin
Terrence D. Walton, MSW, CSAC
Director of Treatment
Pretrial Services Agency for the
District of Columbia
Any substance that alters
mood, level of perception,
and/or brain functioning
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Bottle to Blood to Brain
Route of Administration:
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Smoke
Sniff
Snort
Shoot
Swallow
The Blood Brain Barrier
Neuro-compatibility
1. Power (receptor affinity)
2. Popularity (acceptability)
3. Presence (accessibility)
4. Pay off (onset & intensity)
5. Persistence (length of high)
6. Patterns (of use)
7. Penalty (onset & intensity)
1.
2.
3.
4.
5.
Legal & Illicit
Street Drugs and
Prescribed Drugs
Hard Drugs & Soft
Drugs
Very Addictive &
Less-Addictive
Natural and
Synthetic
1.
2.
3.
4.
5.
6.
Stimulants
Depressants
Opioids
Cannabinols
Hallucinogens/
Dissociatives
Inhalants/
Deliriants/Other
 Number of those 12 and over using heroin rose from
373,000 in 2007 to 669,000 in 2012
 Number of those 15 to 24 dying of heroin overdose rose
from 198 in 1999 to 510 in 2009.
 Drug overdose was the leading cause of injury death in
2010. Among people 25 to 64 years old, drug overdose
caused more deaths than motor vehicle traffic crashes.
 ER visits for opiate misuse doubled from 2004 to 2008
(CDCP 2010)
 Prescription drugs (mostly opiates) are the 2nd most
commonly abused drugs—behind only marijuana (ONDCP
2007)
 Those under 18 are among
the fastest growing group
misusing
 Opiates (Vicodin) number
one abused prescription
drug among adolescent
12th graders—9.7%
 Prescription opiate abuse
up 345% between 19982010
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Heroin is a narcotic that is highly addictive; It is processed from
morphine, a naturally occurring substance extracted from the
seedpod of the Asian poppy plant.
The most abused and most rapidly acting of the opiates.
Usually seen as a white or brown powder or as a black sticky
substance. The differences in color are due to impurities left from
the manufacturing process or the presence of additives.
Pure heroin, which is a white powder with a bitter taste, is rarely
sold on the streets.
Sometimes cut with other substances such as sugar, powdered
milk, cornstarch, or even poisons like strychnine.
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H
Smack
Junk
Horse
China white
Black tar
Brown
Skag
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Injection, smoking, snorting
The user feels the effect of heroin
within seconds of taking it. Heroin is
converted into morphine when it
enters the brain, which disrupts
normal brain activity and creates
intense feelings of pleasure.
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Euphoria
Warm flushing of the skin
Dry mouth
Heavy extremities
Decreased mental ability
Insensitivity to pain
Vomiting
Lowered breathing
Lowered heart rate
Death By
Overdose
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Addiction
High degree of tolerance
Brain damage
Arthritis
Liver disease
Infection of the heart lining
HIV/AIDS or hepatitis
Abscesses of the skin (at injection sites)
Death By
Overdose,
Disease, Suicide,
Injury, Violence
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Heroin can cause severe physical and
psychological symptoms 6 to 8 hours after the
last dosage. Painful withdrawal gets worse as
time passes.
Symptoms Include:
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Runny nose muscle and bone pain
Emotional distress and restlessness
Diarrhea
Vomiting
Hot flashes and heavy sweating
Cold flashes with goose bumps
Insomnia
An overwhelming need for more heroin
Any use causes acute
and temporary
changes and
prolong use
changes the brain in
fundamental,
destructive
and long lasting ways
A brain based disorder
associated with impairment
within the brain’s reward
center that impacts brain
executive functions and
results in compulsive,
repetitive, self-destructive
behaviors
Interact with neurochemistry
 Results:
Opiates
Provide
Both
 Feel Good –
Relief & Reward
euphoria/reward
 Feel Better – reduce
negative feelings/relief
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Dopamine – excitement &
reward
 Serotonin – feel – “normal”
 GABA – lowers anxiety
 Endorphin/Enkephalin –
pain relief, reward, craving
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Desomorphine
(Krokodil)
Zohydro
(hydrocodone-based)
Manuals
Science
EBT
Outcomes
Best
Practice
Cognitive
Behavioral
Treatment
Relapse
Prevention
12 Step
CoOccurring
Disorders
Preparation
Medication
Assisted
Treatment
1) To provide relief from withdrawal
symptoms
2) To reduce craving
3) To prevent drugs from working ~
occupies receptor (antagonist)
4) To provide replacement ~ activates
receptor (agonist)
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Naltrexone – Interrupts actions
of opiates (partially blogs
alcohol); reduces cravings
(antagonist)
Methadone – Opiate addiction –
reduces craving, mediates
withdrawal symptoms, helps
restore normal functioning
(agonist)
Buprenorphine (Subuxone) –
similar to methadone, may be
prescribed by an MD with
special training (partial
agonist)
National Registry of Evidencedbased Programs and Practices:
www.nrepp.samhsa.gov
Relief, without Remedy:
Prescription and Illicit Opiate Abuse
Terrence D. Walton, MSW, CSAC
Director of Treatment
Pretrial Services Agency for the
District of Columbia
[email protected]