1. Ashel Kruetzkamp, MSN, RN, SANE

2. Lynne M. Saddler, MD, MPH
District Director of Health

3. It is now harder to get these…
Pain Relief
You can easily get this…

4. 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

5. Heroin Addiction – A Substance Use Disorder
NO One is Unaffected. This is an equal opportunity disease. Nobody is too smart, too rich, too religious or too cool to be immune. Addictions are in every neighborhood, every church, every profession and every family.

6. 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.

7. Another way of describing addiction is the presence of the 4 C’s:
1) Craving
Loss of Control of amount or frequency of use
3) Compulsion to use
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).

9. Behavioral signs of heroin abuse and addiction include:
Avoiding eye contact, or distant field of vision
Substantial increases in time spent sleeping
Increase in slurred, garbled or incoherent speech
Sudden worsening of performance in school or work, including expulsion or loss of jobs
Loss of motivation and apathy toward future goals
Withdrawal from friends and family, instead spending time with new friends with no natural tie
Repeatedly stealing or borrowing money from loved ones, or unexplained absence of valuables
Hostile behaviors toward loved ones, including blaming them for withdrawal or broken commitments

10. Heroin affects your health

11. Type:
PNG

12. 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:

13. Signs of Heroin Overdose:
Airways and lungs
No breathing
Shallow breathing
Slow and difficult breathing
Eyes, ears, nose, and throat
Dry mouth
Extremely small pupils, sometimes as small as the head of a pin ("pinpoint pupils")
Tongue discoloration
Heart and blood
Low blood pressure
Weak pulse
Skin
Bluish-colored nails and lips
Stomach and intestines
Constipation
Spasms of the stomach and intestinal tract
Nervous system
Coma
Delirium
Disorientation
Nodding off

14. 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:
Agitation
Anxiety
Muscle aches
Increased tearing
Insomnia
Runny nose
Sweating
Yawning
Late symptoms of withdrawal include:
Abdominal cramping
Diarrhea
Dilated pupils
Goose bumps
Nausea
Vomiting

15. Data

16. 2011=252, 2012=447, 2013=545, 2014=336 (YTD)

17. Number of deaths due to drug overdose
KY County of
residence
Number of deaths due to drug overdose
Rate of drug overdose
deaths per 100,000
population
 Year
2011
2012
All
Boone 19 29 48 20
Campbell 25 54 79 43
Carroll * 32
Gallatin 8 47
Grant 11 39
Kenton 55
109 34
Owen 9
Pendleton 5 27

18. Snapshot of 200 patients who arrived in the ER as a heroin overdose:

20. 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.

21. 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.

22. Is HIV next?

23. 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, 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)

24. NKY’s Response Strategies

26. NKY Heroin Impact Response Leadership Team includes:
Northern Kentucky Heroin Impact Response Leadership Team
Healthcare
Businesses
Government
Faith Community
Community Coalitions
Public Health
Social Services
Media

27. Thank you