Ashel Kruetzkamp, MSN, RN, SANE

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

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. Heroinaffects your health

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: http://www.heroin.org

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. Symptomsof 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)

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 $898,219.85 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 • Community Coalitions • Public Health • Social Services • Media Healthcare Businesses Government Faith Community

27. Thank you