cover letter and policy brief final

Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement

Act of 2015 Policy Brief

Brittany Weber

University of Illinois at Chicago

“Heroin and Prescription Opioid Abuse Act”

The Problem

The United States, and more specifically, the Chicago suburbs, are experiencing

one the worst heroin epidemics in history. The number of heroin users has skyrocketed

across the nation from about 373,000 in 2007 to 669,000 in 2012 (Kazan, 2015). Since

2012, heroin has taken a life every 3 days in Chicago's suburbs and the number keeps

increasing (Kazan, 2015) (Kirk, 2015). 4.2 million Americans aged 12 and older have

tried Heroin at least once and 23% of people who try Heroin become addicted to it (Kirk,

2015). This is because the human brain is able to quickly develop a tolerance to opioids

and heroin leading to a requirement for higher and higher doses to achieve the same

intense high, which frequently results with overdoses. Prescription drugs and

painkillers are a common gateway drug amongst heroin users due to the accessibility

and over prescription. Nearly one-third of people aged 12 and over who used drugs for

the first time began by using a prescription drug recreationally (Kirk, 2015). Given these

statistics, it is clear that the United States needs to take more drastic measures to reduce

fatality rates due to heroin overdoes and protect America’s youth.

Proposed Policy Solution

Fortunately there is an opportunity for America to be proactive in reducing the

fatality rate due to heroin and opioid overdoses. In April, the Heroin and Prescription

Opioid Abuse Prevention, Education, and Enforcement Act of 2015 was introduced in the

Senate and House of Representatives. Because of the recent knowledge of learning that

many heroin abusers began their use with prescription pills, this was deemed the area

that needs focus. The S.1134 bill requires the Department of Health and Human Services

(HHS), along with the Department of Veterans Affairs, the Department of Defense, and

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the Drug Enforcement Administration, to create an inter-agency task force to focus on

pain management best practices. The task force will develop and study the best and

safest practices for pain management and prescription of pain medication (S. 1134; H.R.

2805). It is essential to increase education and awareness of the risk of abusing

prescription opioids and the consequences. The overall goal is to reduce prescription

drug abuse and the increasing rates on heroin use and overdose deaths. Unfortunately,

despite strong support and co-sponsors, passage of this bill has stalled. It has been read

twice and referred to the Committee on the Judiciary. Therefore, the Heroin and

Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 needs to

be reintroduced at the beginning of the upcoming Congressional term in order for both

the House and Senate to see all that this act has to offer and how it can drastically impact

lives across America.

Who is Affected by the Problem?

As mentioned earlier, 4.2 million Americans aged 12 and older have tried Heroin

at least once, and many of these users began by recreationally taking prescription pills.

Heroin kills someone every three days and 390 people have died total from Heroin use

in Chicago’s collar counties since 2012. There have been 81 deaths in Lake County, 34

deaths in McHenry County, 59 deaths in Kane County, 3 deaths in Kendall County, 100

deaths in Will County, and 113 deaths in DuPage County (Kirk, 2015). And that is just

Chicago’s suburbs alone. Across the nation, the number of individuals who have

reported using heroin in the past year has almost doubled from 314,000 to 681,000.

Heroin overdoses took a total of 8,200 lives across the United States in 2013 (5 Shocking

Facts About the Illinois Heroin Epidemic, 2015). More and more people are turning to

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heroin as their drug of choice and at younger and younger ages. Heroin has become the

new drug of choice because it is considered cheaper than cigarettes and more accessible

than alcohol (Kirk, 2015). The National Survey on Drug Use and Health reports that in

2011, the average age at first use among heroin abusers between 12 and 49 years was

22.1 years as compared to 2009 where the average age was 25.5 years (S. 1134; H.R.

2805). Health officials are beginning to develop a clearer picture of who is becoming

addicted to this drug. A predominant increase is emerging among groups that,

historically, have lower rates of heroin abuse. This includes women and white (non-

Hispanic) Americans. Typically, they tend to be 18-25 years old on average with a

household income below $20,000. Men still outnumber women in heroin use, but the

gap is narrowing. Additionally, 96% of heroin users reported that they had used other

drugs within the past year (Harris, 2015). In order to target the main issue of heroin

abuse and overdose, it is essential to look at the roots of the addiction. Approximately

four out of five new heroin users report that they became addicted to prescription

opioids before they used heroin for the first time (S. 1134; H.R. 2805). Recent research

has discovered a confirmed shift in demography amongst heroin users. A typical recent

day heroin addict is more likely than before to be rich, white and suburban. Researchers

believe that shift can be attributed to an unanswerable demand for prescription opioids

(Kazan, 2015). Advocates for this issue hope that by raising awareness and limiting

access to these powerful prescription medications, a reduction will occur in the

likelihood that an individual will use heroin in the first place and an overdose can be

completely prevented. Senator Mark Kirk has demonstrated initiatives such as National

Prescription Opioid and Heroin Abuse Awareness month in hopes that awareness will be

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spread about this national epidemic, and we can win the war over heroin abuse.

How are Children and Families Affected?

It has been addressed by many spokespeople of this topic, that too many families

(as of recent, Illinois’ families in particular) have seen their child’s life cut short from

heroin addiction and overdose (Reports, 2015). It is important to remember that

addiction is a family disease that doesn’t only affect just the user, but it also makes a

huge emotional impact on all of the members of the family. It has been reported that one

of the toughest challenges in the recovery process is the idea that everything will be ok if

a family member could just 'fix' their loved one who is struggling with an addiction.

Unfortunately, no one but the individual can fix their addiction and their situation. It is

common for family members to blame themselves and their struggling loved ones for

the consequences of the addiction; however, the focus should be placed on taking care of

the recovering individual and giving as much support as possible (Kazan, 2015). Parents

need to be aware of the possibility of their children being involved with abusing

prescription pills, and take the initiative in their home to secure their medicine cabinets.

More than likely, parents already know to keep their liquor cabinet locked and

monitored when adolescents are in the home. However, now parents need to be

conscientious of the easily accessible, unlocked cabinet that could possibly be storing

addictive and dangerous medications. Not only parents, but also grandparents and any

other family member who possesses prescribed medications are prime targets of

curious teens who are experimenting with drugs. Surveyed research shows that this

scenario is a far more common source of abused medicines than the stereotypical "street

corner" drug dealer (Kazan, 2015). The impact of drug addiction and overdose has a

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clear impact on the individual, families, and their communities. Senator Kirk is an active

advocate for heroin awareness and has created anti-heroin task force teams, as well as,

demonstrated his support at the National Safety Council's Overdose Awareness Day. He

has provided families with necessary information to common questions that parents

may have. Some information he provided to families includes warning signs and

symptoms of heroin users, signs of a heroin overdose, how heroin is used, various

heroin paraphernalia, and the many street names for the drug. One of Senator Kirk’s

goals is to spread awareness of the seriousness of the issue as well as provide education

to affected individuals, especially concerned family members.

Long and Short-term Consequences

Research has shown that once heroin enters the brain, it converts to morphine

and binds rapidly to opioid receptors. Once this occurs, an overwhelming pleasurable

sensation takes over. This feeling is described as a “rush” or better known as “the high”.

The intensity of the rush is a result of how much drug is taken and how rapidly the drug

enters the brain and binds to the opioid receptors. When heroin is used, the high 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.

After those initial effects, the user will typically feel drowsy, their mental functioning

and thought process is clouded, heart functioning slows, and the user’s breathing is also

severely slowed. Sometimes breathing can be slowed down enough to be life

threatening, and it could also lead to coma and permanent brain damage

(Abuse, What are the immediate (short-term) effects of heroin use?). It is because of this

life threatening potentiality that Senator Mark Kirk stressed the importance and urgency

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of getting the nasal spray called Naloxone approved by the FDA and into the hands of all

Illinois first responders. Once Naloxone was approved, officials in DuPage County trained

non-EMT first responders to use the intranasal spray device. Between January 2014 and

October 2014, Naloxone was 100% successful and saved each of the 22 people the spray

was used on (Kirk, 2015).

When looking at the long-term effects of heroin use, research shows that

repeated heroin use eventually will change the physical structure and physiology of the

brain thereby creating long-term imbalances in neuronal and hormonal systems that are

not easily reversed. Studies have also shown deterioration of the white matter in the

brain because of heroin use. This deterioration may affect an individual’s decision-

making abilities, their ability to regulate their behavior, and their responses to stressful

situations. Heroin is also known to produce a profound degree of tolerance and physical

dependence in an individual. Tolerance is what develops when it requires someone to

take more and more of a drug to achieve the same effects as the time prior. When a

physical dependence is developed, the body will adapt to the presence of the drug over

time and then withdrawal symptoms will occur if the individual suddenly stops use. It is

possible for a withdrawal to occur as quickly as only a few hours after the drug is taken;

however, major withdrawal symptoms tend to peak between 24 to 48 hours after use

and decrease after about a week. Some of these symptoms include restlessness, muscle

and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and leg

spasms. More severely, repeated heroin use often results in addiction. Addiction is

known as a chronic relapsing disease that goes beyond physical dependence and is

characterized by uncontrollable drug seeking no matter the consequences. Heroin is one

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of the most addictive drugs, and once a person becomes addicted to heroin, seeking and

using the drug becomes their primary purpose in life (Abuse, What are the long-term

effects of heroin use?). Unfortunately, detoxifying the body from heroin is not enough.

Individuals also need to learn and develop tools to stay clean and sober. Studies show

that users of opioid drugs, like heroin, have an 80% or higher relapse rate as compared

to other addicts. Therefore, a focus has been shifted on measuring the effectiveness of

holistic treatment approaches where individuals learn and practice how to live a sober

balanced life; results have demonstrated dramatically improved success rates (Kazan,

2015). This is why chemical dependency programs are essential in the treatment and

recovery process of heroin addicts.

History of the Problem

Opium was a widely known drug in the mid to late 1800’s. Part of the popularity

of this drug was due to it being brought into the country via Chinese immigrants who

came here to work on the railroads. History shows that opium dens were scattered

through the once wild west and our stereotypical imagery of a cowboy sitting at the

saloon is only part of the story. In reality, the cowboys spent the majority of their time in

dim candle-lit rooms smoking opium in the company of an oriental prostitute. It was not

uncommon for these individuals to spend several days and nights at a time in these dens

in a constant dream-state, eventually becoming physically addicted to the drug (History

of Heroin). Morphine was then developed from opium as a painkiller in approximately

1810. People called it the wonder drug, because it eliminated severe pain associated

with medical operations or traumatic injuries by leaving the user in a completely numb

euphoric mood. By the mid 1850’s, morphine became available in the United States and

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more and more medical professionals utilized it despite its addictive properties. In just

ten years, the United States experienced a major morphine epidemic. No statistics were

recorded or measured on the addiction, but the problem was severe enough that the

medical profession had serious concerns. In 1874, the release of a new drug, advertised

as a safe, non-addictive substitute for morphine, was believed to be the answer to the

morphine epidemic. This new drug was called Heroin and trademarked in Germany

(History of Heroin). From the late 1800’s to the early 1900’s , drug companies

manufactured over-the-counter drug kits including a glass barreled hypodermic needle

and vials of opiates (morphine or heroin) and/or cocaine packaged neatly in attractive

engraved tin cases (History of Heroin). Marketing and advertising campaigns advertised

this product as the cure for all types of physical and mental ailments ranging from

alcohol withdrawal to cancer, depression, sluggishness, coughs, colds, tuberculosis and

even old age (History of Heroin). Unfortunately, because heroin, morphine and other

opiate derivatives were unregulated and sold legally in the United States, this allowed

enough time for a market for these drugs to fully develop. It wasn’t until 1920 that

Congress realized the dangerous effects of these drugs. They then enacted the

Dangerous Drug Act that made it illegal to purchase these drugs over-the-counter and

deemed that their distribution be federally regulated. By this time, it was already too

late and there were already an estimated 200,000 heroin addicts in the country (History

of Heroin).

Policy Solution

S. 1134’s specific objectives are to develop and study best practices for pain

management and the prescription of pain medication to address opioid abuse and

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heroin use. It acknowledges that advanced education and awareness of the risk of abuse

of prescription opioids is needed, as well as, a national drug awareness campaign that

emphasizes the similarities between heroin and prescription opioids and increases

awareness of the dangerous effects of mixing fentanyl (a prescription opioid painkiller)

with heroin. The bill allows the department of justice to make grants to state, local, or

tribal governments to create demonstration programs to allow first responders to

prevent opioid overdose death by administering an opioid overdose reversal drug (e.g.,

naloxone) (S. 1134; H.R. 2805). Enactment of this bill will involve the creation of a Pain

Management Best Practices Inter-Agency Task Force comprised of representatives from

the following: the Department of Health and Human Services, including the Centers for

Disease Control and Prevention, the Department of Veterans Affairs, the Department of

Defense, the Drug Enforcement Administration, the Office of National Drug Control

Policy, and the Institute of Medicine, the Director of the National Institutes of Health,

physicians, dentists, and non-physician prescribers, pharmacists, experts in the fields of

pain research and addiction research, representatives of pain management professional

organizations, the mental health treatment community, the addiction treatment

community, and pain advocacy groups, and finally other stakeholders, as the Secretary

determines appropriate (S. 1134). The task force’s goal will be develop best practices for

pain management and prescription pain medication prescribing practices. Additionally,

this bill will require the development of awareness campaigns, and Naloxone

demonstration grants. This bill also amends the Omnibus Crime Control and Safe Streets

Act of 1968 to extend the Edward Byrne Memorial Justice Assistance Grant Program

through FY2020, which plays a critical role in fighting the prescription opioid abuse and

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heroin use epidemics, and should be reauthorized and fully funded (S. 1134; H.R. 2805).

Benefits of Policy

The enactment of this bill and the resolution created by the task force will

positively affect individuals, because a solution will be developed that will hopefully

prevent prescription drug misuse and abuse. Additionally, awareness will be spread

about the life saving nasal spray and fatality rates of heroin overdose will hopefully

reduce even more. Better practices will be also developed on the prescription of pain

medication, with the hopes of individuals then not being attracted to finding other

means of obtaining the same effects such as heroin use. Doctors need to be better

educated about the potential for opioid abuse and addiction by understanding that their

prescribing practices are often a gateway to other addiction issues and health care

problems (Kazan, 2015), and this bill will assist in the understanding. The educational

component and awareness will help family members immensely. They will learn many

aspects such as warning signs if a loved one is using or overdosing. Moreover, they will

be able to identify the many reasons that could prompt a child to begin using heroin to

begin with. Additionally, initiatives will be implemented to prevent, educate, and treat

this serious issue. Overall, an urgent, all-society, response is needed to help terminate

this epidemic, and it can all begin with the reintroduction of bill S.1134- Heroin and

Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015.

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References

5 Shocking Facts About the Illinois Heroin Epidemic. (2015, August 16). Retrieved

November 25, 2015, from Huffington Post:

http://www.huffingtonpost.com/reboot-illinois/5-shocking-facts-about-

th_b_7989122.html

Abuse, N. I. (n.d.). What are the immediate (short-term) effects of heroin use? Retrieved

November 25, 2015, from National Institute on Drug Abuse The Science of Drug

Abuse and Addiction: http://www.drugabuse.gov/publications/research-

reports/heroin/what-are-immediate-short-term-effects-heroin-use

Abuse, N. I. (n.d.). What are the long-term effects of heroin use? Retrieved November 25,

2015, from National Institute on Drug Abuse The Science of Drug Abuse and

Addiction:

http://www.drugabuse.gov/publications/research-reports/heroin/what-are-

long-term-effects-heroin-use

Harris, R. (2015, July 8). Heroin Use Surges, Especially Among Women And Whites.

Retrieved November 25, 2015, from NPR: http://www.npr.org/sections/health-

shots/2015/07/07/420874860/heroin-use-surges-especially-among-women-

and-whites

History of Heroin. (n.d.). Retrieved November 25, 2015, from Narconon:

http://www.narconon.org/drug-information/heroin-history.html

H.R.2805 (2015). H.R. 2805: Heroin and Prescription Opioid Abuse Prevention, Education,

and Enforcement Act of 2015. Retrieved November 25, 2015, from

https://www.congress.gov/bill/114th-congress/house-bill/2805

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Kazan, C. (2015, July 21). From the community: A Heroin Epidemic is Invading Our

Suburbs . Retrieved November 25, 2015, from Chicago Tribune:

http://www.chicagotribune.com/suburbs/buffalo-grove/community/chi-ugc-

article-a-heroin-epidemic-is-invading-our-suburbs-2015-07-21-story.html

Kirk, M. (2015, September). Heroin: Killing in Our Suburbs. Retrieved November 25,

2015, from Mark Kirk U.S. Senator for Illinois:

http://www.kirk.senate.gov/heroin/

Reports, D. (2015, September 1). Sen. Kirk calls attention to International Overdose Day.

Retrieved November 25, 2015, from DuPage Policy Journal:

http://dupagepolicyjournal.com/stories/510636213-sen-kirk-calls-attention-to-

international-overdose-day

S. 1134 (2015). S. 1134: Heroin and Prescription Opioid Abuse Prevention, Education, and

Enforcement Act of 2015. Retrieved November 25, 2015, from

https://www.congress.gov/bill/114th-congress/senate-bill/1134

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November 25, 2015

Senator Mark Kirk524 Hart Senate Office Building Washington DC, 20510

Dear Senator Kirk,

I want to start off by congratulating you on receiving 10,000 petition signatures in one day for the Kirk For Senate 2016 campaign. I know that many families have expressed that they appreciate and value your thoughtful and independent leadership in the Senate. I want you to know that you have my vote, and I wish you the best of luck in the upcoming election. I also want to commend you on your efforts in pushing the Food and Drug Administration’s approval of a life-saving nasal spray that can prevent a heroin overdose from being fatal called Narcan/Naloxone. I am aware of the Suburban Anti-Heroin Task Force you created in 2014 to tackle the ongoing problem of heroin addiction and abuse in the Chicago suburbs and I wholeheartedly value your initiative. I am a resident of DuPage County, where 113 deaths have occurred since 2012 due to heroin overdoses and a life is taken every 3 days in Chicago’s suburbs.

Heroin is not often considered a common or serious concern for suburban parents; however, statistics show that the epidemic is rapidly growing. 4.2 million Americans aged 12 and older have tried Heroin at least once in their lifetime. Heroin users report the gateway to their drug addiction was due to consuming a friend or relative's prescription drugs. Opioids and Heroin are so highly addictive because the brain quickly develops a tolerance to the drug and requires higher and higher doses to achieve the same intensity. Because of this, recreational uses frequently lead to overdoses.

As a concerned voter and citizen in the state of Illinois, I believe this is an issue greatly affecting the youth of our nation and should be a platform focus during your next election. I also ask that you please co-sponsor this bill. I have attached a policy brief to this letter that outlines a major problem and the necessary solution: Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 (S.1134). Unfortunately, this bill has stalled since April and is waiting to be approved by the senate. I believe that you would be the perfect individual to reintroduce this bill and see that it passes in the upcoming Congressional term. I strongly encourage you to read the attached policy brief and take action in order to improve the lives of our children, families, and future generations. I thank you in advance for your time and consideration.

Sincerely,

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Brittany WeberMaster of Social Work Student

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cover letter and policy brief final

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