Stark County’s opiate epidemic

Facts & Figures

What is heroin?

  • Heroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.
    • It is typically sold as a white or brownish powder that is “cut” with sugars, starch, powdered milk or quinine.
      • Pure heroin is a white powder with a bitter taste that predominantly originates in South America and, to a lesser extent, from Southeast Asia, and dominates U.S. markets east of the Mississippi River.
      • Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use.
    • “Black tar” heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River.
    • The dark color associated with black tar heroin results from crude processing methods that leave behind impurities. Impure heroin is usually dissolved, diluted and injected into veins, muscles or under the skin.
Source: U.S. Department of Health and Human Services, National Institute on Drug Abuse, Research Report Series-Heroin, April 2014

 

Effects heroin has on the body

    • Once heroin enters the brain, it is converted to morphine and binds rapidly to opioid receptors.
    • Abusers typically report feeling a surge of pleasurable sensation – a “rush.”
    • With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting and severe itching.
    • The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the opioid receptors.
  • After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life threatening.
Source: U.S. Department of Health and Human Services, National Institute on Drug Abuse, Research Report Series-Heroin, April 2014

05-25-16_Short_and_Long_term_effects_table

Source: U.S. Department of Health and Human Services, National Institute on Drug Abuse, Research Report Series-Heroin, April 2014
    • Skipping use of heroin for an addicted person can lead to significant withdrawal symptoms such as chills, sweating, runny nose and eyes, abdominal cramps, muscle pains, insomnia, nausea and diarrhea.
    • Heroin use during pregnancy may result in miscarriage, stillbirth, premature delivery or drug-dependent babies.
    • Injecting heroin introduces substances into a user’s bloodstream with the potential to cause severe damage to the heart, lungs and brain.
    • When heroin users share needles it has the potential to spread diseases. Needle sharing is the leading cause of all new HIV and hepatitis cases.
  • Opiate abuse can cause significant and long-lasting chemical changes in the brain such as experiencing intense cravings and negative emotions when users try to stop.
Source: Let’s Talk Facts About: Substance Abuse and Addiction, American Psychiatric Association, 2007

 

Heroin use is on the rise

Since 2006, opiate clients who have sought treatment from StarkMHAR funded providers in Stark County have increased across the county.

Source: Stark County Mental Health & Addiction Recovery, “Opiate percentage of change map CY06-16 full,” accessed June 13, 2017

Source: Stark County Mental Health & Addiction Recovery, “Opiate Use – change over time CY 2006 to CY2016 compiled 6.9.17,” accessed June 29, 2017

There was a 603% increase from 2004 to 2016 of Stark County opiate use disorder clients in treatment (adults only).

Source: Stark County Mental Health & Addiction Recovery, “Stark County Opiate Use Disorder Adult Client Counts – Calendar Year 2004-2016,” accessed June 27, 2017

Clients who sought treatment are likely to be white and male; however, in 2014 female users who sought treatment were nearly equal to male users who sought treatment from StarkMHAR funded contract service providers.

  • In 2011, more than 1 in 5 (21%) of Ohio high school students reported using a prescription drug without a doctor’s prescription one or more times during their life.
    Source: Ohio Department of Health, Ohio Youth Risk Behavior Survey, 2011
  • Of these teens, nearly half (49%) used narcotic pain relievers, 8% used multiple drugs and another 19% were unsure what they took.
    Source: Ohio Department of Health, Ohio Youth Risk Behavior Survey, 2011
  • Drug overdoses are also at an all-time high, averaging four deaths a day in Ohio with nearly 45 percent of them attributable to prescription drugs.
    Source: http://governor.ohio.gov/PrioritiesandInitiatives/OpiateActionTeam.aspx#sthash.6xtvOnD6.dpuf
  • Ohio has witnessed a 300% increase in overdose deaths from 1999-2007.
    Source: Ohio Department of Health
  • According to Substance Abuse and Mental Health Services Administration (SAMHSA), 26.5% of Ohio’s high school students are using illegal prescription drugs.
    Source: Ohio Department of Health, 2007

 

Costly medical complications of chronic heroin use

Drug use, viral hepatitis and other infectious diseases, mental illnesses, social dysfunctions and stigma are often co-occurring conditions that affect one another, creating more complex health challenges that require comprehensive treatment plans tailored to meet all of an opiate client’s needs.

Chronic heroin users experience a variety of medical complications, depending on overall health and specific consequences associated with different routes of heroin administration. Medical consequences of chronic heroin users include:

  • Insomnia and constipation
  • Lung complications including various types of pneumonia and tuberculosis, likely from user’s poor health and heroin’s effect of depressing respiration
  • Mental disorders such as depression and antisocial personality disorder
  • Men often experience sexual dysfunction.
  • Women’s menstrual cycles often become irregular.
  • Those who snort heroin can damage nasal mucosal tissues and perforate the nasal septum.
  • Users who chronically inject heroin can experience scarred and/or collapse veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft tissue infections.
  • Additives in street heroin may include substances that do not readily dissolve that can clog blood vessels leading to the lungs, liver, kidneys or brain causing infection or even death of patches of cells in vital organs.
  • Immune reactions to these contaminants can cause arthritis or other rheumatologic problems.
  • Sharing injection equipment of fluids can lead to infections with hepatitis B and C, HIV and other blood-borne viruses which heroin users can pass on their sexual partners and children.
    • Injection drug users (IDUs) are the highest-risk group for acquiring hepatitis C (HCV) infection and continue to drive the escalating HCV epidemic. Each IDU infected with HCV is likely to infect 20 other people. Of the 17,000 new HCV infections occurring in the United States in 2010, over half (53%) were among IDUs.
      • Hepatitis B (HBV) infection in IDUs was reported to be as high as 20 percent in the United States in 2010.
    • Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent along with the mother.
    • Symptoms of a dependent baby include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting and possibly death.
      • NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms.
    • Medication is gradually tapered off until the baby adjusts to being opioid-free.
      Source: U.S. Department of Health and Human Services, National Institute on Drug Abuse, Research Report Series-Heroin, April 2014

 

Research indicates abuse of prescription pain relievers can lead to use of heroin

  • Nearly half of young people who inject heroin reported abusing prescription opioids before starting to use heroin. Many of these young people also report that crushing prescription opioid pills to snort or inject the powder provided their initiation into these methods of drug administration.
    Source: www.drugabuse.gov/publications/drugfacts/heroin
  • While prescription drugs are not the commonly substance of abuse among 12-13 year olds, one in four teens has misused or abused a prescription drug at least once in their lifetime.
    Source: medicineabuseproject.org
  • Young people report using heroin because it is cheaper and easier to obtain than prescription drugs.
    Source: http://www.drugabuse.gov/publications/drugfacts/heroin
  • 39% of all opioids are prescribed from emergency departments. According to the federal Center for Disease Control (CDC), there were enough prescription painkillers prescribed in 2010 to medicate every American adult around the clock for a month.
  • Between 1997 -2012, Ohio’s per capita dosage of opioids increased from 7 pills per person to 67 pills per person, which is a 1000% increase.
    Source: Ohio Automated Rx Reporting System(OARRS)ohiopmp.gov
  • Fatal and non-fatal poisonings from drug overdoses cost Ohioans $3.6 billion annually.
    Source: Ohio Department of Health, http://governor.ohio.gov/Portals/0/pdf/budget/Press%20Kit%20Doc_Stats.pdf

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