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Jeanne Keen, RN, CADC
Program Administrator
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Opium
Heroin
Morphine
Codeine
Oxycodone
Hydrocodone
Hydromorphone
Oxymorphone
Methadone
Aunti, Big O
H, Horse, Smack
Dreamer, Morf, God’s Drug
School Boy
Hillbilly Heroin, OC, Oxycotin
Hydro, Tabs, Vikes , Lortab
D, Dillies, Dust, Juice, Dilaudid
Opana, OPs
Fizzies, Wafer
History of Opiate Use
and Abuse
The problem of cough
has been solved by
using Heroin syrup!
Mrs. Winslow's Soothing Syrup
Mrs. Winslow's Soothing
Syrup was an indispensable
aid to mothers and child-care
workers. Containing one grain
(65 mg) of morphine per fluid
ounce, it effectively quieted
restless infants and small
children. It probably also
helped mothers relax after a
hard day's work. The company
used various media to promote
their product, including recipe
books, calendars, and trade
cards such as the one shown
here from 1887 (A calendar is
on the reverse side.).
Heroin (opiate) addiction is a disease – a
“metabolic disease” of the brain with resultant
behaviors of “drug hunger” and drug selfadministration, despite negative consequences to
self and others.
Heroin addiction is not simply a criminal behavior
or due alone to antisocial personality or some
other personality disorder.
1963
DRUG ADDICTION IS A COMPLEX ILLNESS
www.drugabuse.gov
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Mild: social, recreational, occasional
Moderate: negative consequences but
continue to use
Severe: negative consequences PLUS:
◦ Tolerance
◦ Withdrawal
◦ Compulsive use
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Initial decision to drink or use is voluntary
Over time, changes in the brain caused by
repeated use can impact
◦ self-control
◦ ability to make sound decisions
◦ PLUS, causes intense cravings
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People who abuse drugs can stop more
easily, but they may not think they have a
problem!
People with addiction can choose to stop, but
it is hard work, and some are not successful
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Chronic
Often relapsing
Progressive
Causes compulsive drug seeking
Causes use despite harmful consequences
Changes the structure and function of the brain
Can be fatal is left untreated.
Addiction is a brain disease, not a weak will. The
disease of addiction causes changes in brain
chemistry. These brain changes directly affect
thinking, judgment, planning, sequencing, memory...
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Opiates affect the way your brain
functions
◦ Imitating your brain chemistry
◦ “fools” your brain to send
abnormal messages
◦ Over-stimulating the
“reward circuit”
www.drugabuse.gov
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The limbic system has to do with survival
(eating, spending time with loved ones)
Drugs flood the brain with DOPAMINE in the
LIMBIC system - part of the brain that
controls
◦ Movement
◦ Emotion
◦ Motivation
◦ Feelings of pleasure
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Drugs cause euphoria or a “high”
This brain response “teaches” people to
repeat the behavior of using/abusing drugs
Then the brain stops making its own dopamine
and the receptors get damaged, so you need
more drug to get high
Now you need the drug to feel normal
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“They just need to stop
partying and fly right”
becomes
“They have the disease of
addiction. How can we reach
them through this disease and
support them to overcome it??”
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Detoxification
Counseling – inpatient and outpatient
◦ Individual
◦ Family
◦ Group
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Self-Help
Pharmacological
◦ Prevent withdrawal symptoms
◦ Reduce drug craving
◦ Normalize any physiological functions disrupted
by drug use
◦ Target treatment agent to specific site of action,
receptor, or physiological system affected or
deranged drug of abuse.
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Generic Name:
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Marketed As:
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Purpose:
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Class: agonist
methadone hydrochloride
Methadose and Dolophine
(among others)
To discourage illicit opioid use due to cravings or the desire to
alleviate opioid withdrawal symptoms.
 Amount: maintenance dose of 80 to 120mg
 Method: mouth
 Frequency: once a day
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IV
Immediate effect
Lasts 3-6 hours
Euphoria first 1-2 hours
Withdrawal after 3-4 hrs
Heroin
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Oral
30 minutes for effect
24-36 hours
No euphoria
Withdrawal after 24 hrs
Methadone
Methadone Maintenance is approved by
the US FDA for treatment of heroin
addiction because an efficient oral dose
of methadone given once daily to a
heroin addicted person effectively
prevents opiate withdrawal and
associated cognitive and behavioral
problems
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In 1991 there were 40 million prescriptions for pain killers world
wide. In 2001 there were 180 million prescriptions written. The
vast majority of these prescriptions are used in the U.S.
Painkillers are now the most commonly abused prescription
drugs.
Young adults, ages 18-25 show the most opiate abuse and
increase in abuse.
From 1985 and 2001 the number of people abusing opiates rose
from ½ million to 2.5 million.
Deaths from opiate use rose from 160 percent from 1999 to
2004.
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Abuse of opiates causes more deaths than heroin and cocaine
combined.
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Emergency Room visits rose 153 percent from 1995 to 2002.
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About 1 in 5 teens use opiates to get high.
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2,500 teens abuses prescription drugs for the first time each
day.
Experts predict that abuse of prescription drugs will increase
by 190 percent by 2020.
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Misconceptions about their safety
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Increasing environmental availability
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Varied motivations for their abuse
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KASPER Reports
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Increased Regulations for Pain Clinics
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Heroin arrests have increased 2,334 percent
from 32 in 2008 to 779 in 2012 in
Louisville – LMPD
Seizures of heroin are up 6,688 percent
LMPD blames 80 percent of burglaries and
thefts on heroin addicts
JADAC - 90 percent of
calls are heroin related
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There were 22 heroin related deaths in
Lexington in 2012
Year to date in Lexington there have been 38
heroin related deaths.
50 people died from heroin overdose in
Louisville last year (2012).
Krocodil is coming…..