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According to the 2008 National Survey on Drug Use and Health, the number of heroin users aged 12 or older in the United States increased from 153,000 in 2007 to 213,000 in 2008. There were 114,000 first-time users of heroin aged 12 or older in 2008.

In 2007, there were just over 1,600 adolescent substance abuse treatment admissions for heroin abuse. The average age at first use was 14.8 years and 16.3 years at admission to treatment. This indicates approximately 18 months of heroin use prior to treatment.

87 percent of adolescents reporting heroin abuse also reported abuse of other substances. Marijuana led with more than half (56 percent) of heroin admissions also reporting marijuana abuse. Cocaine was third with nearly one-third (32 percent) reporting cocaine abuse and almost one-fifth (19 percent) of adolescents reporting heroin abuse also reported abusing alcohol.

Almost one-third of adolescents with heroin abuse also suffer from a co-occurring psychiatric disorder

 

DEATHS MISSOURI JEFFERSON COUNTY
2005 46 na
2006 60 7
2007 69 7
2008 119 15
2009 167 17
2010 na 20

 

MISSOURI

  • Average age at death – 34 for Caucasians; 42 for African-Americans

  • Caucasian males – 67%; African-American males – 16%; Caucasian females – 14%; African- American females – 2%

  • Highest areas of use (estimated):

    • St. Louis City

    • Jefferson County

    • St. Francois County

    • Lincoln County

  •  Source of heroin: Mexico to Chicago to St. Louis to points south

 

COST: In 2007, a kilogram of heroin no. 3 (20-30% pure only for smoking/snorting) typically sold for an average wholesale price of $2,520 in Pakistan; the average 2005 per-kilogram wholesale price of heroin no. 4 (80-90% pure for injection/cutting) in that country equaled approximately $4,159. The 2007 wholesale price for a kilogram of heroin in Afghanistan ranged around $2,405. In Colombia, a kilogram of heroin no. 4 typically sold for $9,992 wholesale in 2006. In the United States in 2007, a kilogram of heroin no. 4 cost an average of $71,200 wholesale. One gram in Chicago costs $150+/- and makes 30-40 pills.

In Jefferson County a pill costs $10.00.

Comtrea Information: Heroin Fact Sheet 

  • Heroin (diamorphine) was the trade name of a drug launched by Bayer in 1898.

  • Heroin is an addictive drug that is processed from morphine and usually appears as a white or brown powder, or a black, sticky substance known as “black tar.”

  • Street names include smack, ska, H, and junk.

  • Heroin can be injected, inhaled, smoked or taken orally. Injected heroin accounts for the highest percentage of male and female users, with 43 percent of male and 56 percent of female users choosing this route of administration. Inhalation ranks next, with 36 percent of males and 27 percent of females. Smoking, oral, and other routes of administration account for 11 percent, 5 percent and 1 percent (female) and 12 percent, 8 percent, and 1 percent (male), respectively. 

EFFECTS

  • Acute intoxication is characterized by euphoria and drowsiness.   
  • Mast cell effects (e.g., flushing, itching) are common, particularly with morphine.
  • GI [gastro-intestinal] effects include nausea, vomiting, and constipation.
  • Users who inject the drug face increased risk of scarred and/or collapsed veins, abscesses (boils) and other soft-tissue infections, liver or kidney disease, and bacterial infections of the blood vessels and heart valves.
  • Sharing of injection equipment or fluids can also lead to infections with hepatitis B and C, HIV/AIDS, and many other bloodborne viruses; they may also be passed along to sexual partners and children.
  • Long-term effects of the opioids themselves are minimal.

Note: The principal harm comes from the risk of overdose, problems with injecting, drug impurities and adverse legal or financial consequences. 

WITHDRAWAL

Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, they may experience severe symptoms of withdrawal.

  • These symptoms, which can begin as early as a few hours after the last drug administration, include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ('cold turkey'), kicking movements ('kicking the habit'), and others. Users also experience severe craving for the drug during withdrawal, precipitating continued abuse and/or relapse. Opioid withdrawal does not cause fever, seizures, or altered mental status. Onset and duration of the syndrome depends on the specific drug and its half-life. Symptoms may appear as early as 4 h after the last dose of heroin, peak within 48 to 72 h, and subside after about a week. Some individuals may show withdrawal symptoms for months.
  • Heroin withdrawal is less dangerous than alcohol or barbiturate withdrawal, and it may be distressingly symptomatic. However, opioid withdrawal is not fatal unless there are other physical complications such as very poor general health.
  • The disadvantage of continuing to describe heroin-related fatalities as 'overdoses' is that it attributes the cause of death solely to heroin and detracts attention from the contribution of other drugs to the cause of death. Some studies have indicated that up to 70% of those deaths attributed to “overdoses” are a result of poly-drug use.

TREATMENT

Most people cannot fight heroin addiction without professional help. Drug treatment centers focus on the psychological and physical aspects of drug dependency and work to help users recover. Addiction treatment focuses heavily on counseling and relapse prevention. 

  • IMMEDIATE TREATMENT

    • The withdrawal syndrome usually includes symptoms and signs of CNS [Central Nervous System] hyperactivity. Withdrawal is typically managed in outpatient settings, unless patients require hospitalization for concurrent medical or mental health problems.
    • Narcan is a short-acting opiate antagonist that, when administered after an overdose, blocks heroin’s action on the brain and restores breathing. That is Narcan’s only use. Narcan can be administered by way of: injection or nasal. Its potential for abuse is nil as it has no addiction potential or street value. It simply and effectively provides for an immediate withdrawal from a heroin overdose. Administering Narcan has been proven to be a simple, inexpensive and safe way to reduce mortality.
    • Options for management of withdrawal include: Allowing the process to run its course ('cold turkey') after the patient's last opioid dose and administering another opioid (substitution) that can be tapered on a controlled schedule. Clonidine can provide some symptom relief during withdrawal.
    • In addition to cognitive behavioral therapy the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), cite experts in the field that say buprenorphine should be the treatment of choice for adolescents with short-term heroin addiction.
    • Age-appropriate relapse and recovery services should potentially also be required both to promote and sustain recovery for adolescent heroin abusers.
  • AFTER DETOXIFICATION

    • A range of treatments exist for heroin addiction, including medications and behavioral therapies. When medication treatment is integrated with other supportive services, patients are often able to stop using heroin (or other opiates) and return to stable and productive lives.
    • Inpatient - Typically a 28-day rehab program in a residential community with group sessions and counseling, and where one goes after detoxification.  Frequently, with drugs such as heroin, long-term treatment may be necessary.  Long-term inpatient/residential programs usually provide residential treatment for a period of 8-18 months.
    • Outpatient - A medically supervised treatment option that does not involve overnight stay in a hospital or medical facility.  It typically involves group sessions and counseling.
    • Opioid Treatment Services - an Opioid Treatment Program assists clients addicted to heroin and other opiates through the use of methadone or other approved medications (buprenorphine, suboxone) to treat opioid dependency.

    • Residential Services - provide an array of services for persons suffering from chemical dependence either directly or through cooperative relationships with other community service providers.  There are three levels of service that can be offered in a residential setting:  intensive residential rehabilitation services, community residential services, and supportive living services. Community residential services provide supervised services to persons making the transition to abstinent living, providing a drug and alcohol-free environment for persons who are completing or have completed a course of treatment, but who are not yet ready for independent living. 

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