The Transition from Prescription Opioid Drug Abuse to Heroin Use An Integrative Literature Review Maria G. Varela │ DePaul University │ MENP 2017 Conclusion Background & Significance Methods Purpose Statement The decision for opioid drug users to turn to heroin is clearly a multifactorial one with biological, psychological, and social reasons and implications. The results of this review indicate that addiction cannot be attributed to a single reason and has to be treated on several levels. Furthermore, it highlights the need for us to investigate and understand the reasons for the initiation of illicit drug use of any kind in order to come up with ideas to prevent addiction. An integrative review guided by Whittemore and Knafl was conducted using literature found through the Cumulative Index to Nursing and Health Literature (CINAHL), PubMed, and ProQuest. The search was conducted using multiple keywords in a single search that included: “prescription opioid”, “drug abuse”, and “heroin” with dates between January 2012 and February 2017. The United States is currently facing alarmingly high and increasing rates of prescription opioid abuse as well as heroin use. Research has indicated that the abuse of prescription opioids such as hydrocodone and oxycodone may lead users to illicit drug use, specifically heroin. The purpose of this integrative review is to identify biological, social, and psychological factors that aid in the transition from prescription drug abuse to heroin use. The purpose of this literature review is to identify the factors that contribute to the transition from prescription opioid drug abuse to heroin use. In doing so, this review can shed light on ways that this transition can be prevented. Theoretical Framework The biopsychosocial model sees diseases such as drug addiction as a complex integration of biological, psychological, and social aspects. In this framework, drug misuse and addiction results from biological factors such as genetic predisposition, social factors such as socioeconomic status and accessibility to drugs, and psychological factors such as poor coping skills and depression amongst others Findings Nursing Implications Common factors in the transition from prescription opioid drug abuse to heroin use are summarized below in terms of their biological, psychological, or social relationships. Biological Tolerance Dependence Addiction Route of administration (PO vs snorting/injecting) Psychological Emotional dependence Addiction as a mental illness Initiating opioid use for nonmedical reasons (i.e. the high, escaping reality) Social Cost of heroin is lower than opioids Ease of access Tamper-proof opioids (OxyContin) Nurses are at the frontline of patients care and with this growing number of opioid and heroin use, overdoses, and deaths, it is important to be fully educated on the topic. Knowing the factors that play a role in drug use can aid in providing holistic and effective care to these patients. Furthermore, nurses can use this knowledge to implement preventative measures. Biological Psychological Social In 2013, the number of prescriptions written for opioids in the United States increased to an alarming 207 million. In 2015, more than 15,000 people died from overdoses involving prescription opioids. In 2012, 669,000 U.S. Americans reported using heroin in the past year. •From 2014 to 2015, heroin overdose death rates increased by 20.6%, with nearly 13,000 people dying in 2015. Ideas for Prevention Greater focus on alternative pain relief Treatment of addiction as a disease Continue making opioids less accessible/ less prescribed Explore emotional dependence and how this can be helped Investigate why heroin is easily accessible and cheap and explore solutions Early interventions/treatment for drug misuse Drug Addiction Figure 1. Diagram Illustrating the Concepts of the Biopsychosocial Model Related to Drug Addiction Acknowledgements: Dr. Barbara Harris, RN, PhD