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Running Head: SHOOTING DOWN

Shooting Down the United States Heroin Epidemic

Bailey M. Nixon

Glen Allen High School

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Introduction

Within the last several decades, it is clear that America is experiencing an epidemic

unlike any other; the distribution and use of heroin in the United States has become an

increasingly difficult situation to combat. To put it in perspective, Jen Christensen and Sergio

Hernandez compare the heroin crisis to the HIV epidemic when the United States had no

treatment to turn to (2017). Contrary to popular belief, however, both researchers claim that the

increase in heroin use has spread so drastically due to the use in small towns and rural areas

compared to industrial and urban areas (Christensen & Sergio 2017). In fact, West Virginia, New

Hampshire, and Kentucky were the top three states with the most overdoses in the entire country

(Christensen & Sergio 2017). West Virginia alone holds six of the twenty counties in the country

that have the most heroin overdoses (Christensen & Sergio 2017). Additionally, updated research

has introduced that minority groups are no longer the group affected most by the epidemic; it is

white Americans that are using heroin the most. In a study done by the Department of Psychiatry

at the Washington University in St. Louis, it was found that heroin use has evolved from an

“inner-city, minority-centered problem” and developed into a issue involving “white men and

women...living outside of large urban areas” (Cicero et. al 2014). The impact of this epidemic is

enormous and it is reaching men and women across the country in every age, race, and

socioeconomic status. It has become increasingly clear that this issue must be reviewed and

resolved in order to prevent the overdoses of addicted Americans. But what happens to the

individuals who are not aware of the repercussions of their choice to use heroin? In this review,

the causes and effects of a heroin addiction on a person’s life are discussed in order to reveal

why individuals choose to alter their lives to get high.

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Mental Causes of Heroin Addiction

In an article designed for nurses treating patients with addiction, Georgina Casey

describes the biological causes and effects of substance abuse and addiction. Casey claims that

drug use causes “changes in the brain that lead from recreational use to addiction, and the

neurological mechanisms underlying relapse” (2017). She explains the debate between

“addiction” and “dependence” within the DSM-IV and discusses the two types of dependence

that occur within an addiction. Physical dependence occurs due to “repeated use of many

chemical substances” that cause tolerance to said substances (Casey 2017). As a result of

continuous use of a drug, individuals experience withdrawal symptoms. Similar to physical

dependence, psychological dependence refers to the actual cravings and individual experiences

as a result of the repeating use (Casey 2017). Throughout the article, Casey discusses the

dopamine theory on how individuals become easily addicted as a result of involuntary mental

reinforcement practices.

In this theory, dopamine release along this pathway triggers sensations of

reward and pleasure. Illicit drugs work by increasing firing of dopaminergic
neurons, or inhibiting the breakdown or reuptake of dopamine, once it is
released into the synapses. Stimulant drugs act directly on the mesolimbic
system to produce their effects, but other drugs of abuse, as well as activating
this pathway, have their primary actions in other regions of the brain.

While some studies show that opioids do not have a large effect on the dopamine release process,

it is clear that other brain regions are involved. In her article, Georgina Casey describes the

insula, which feeds into both the amygdala and prefrontal cortex (2017). The insula interprets

“stress, sleep [deprivation], and drug deprivation and cause impulsive behavior when these

sensations are not accurately maintained (Casey 2017). To compare to Casey’s research, a group

of researchers at the Ningbo Addiction Research and Treatment Center in China tested the effect
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of a drug addiction on the levels of the dopamine receptor D4 methylation. In general, higher

dopamine levels in a person’s brain causes the need for higher reinforcement from a substance,

causing dependence on drugs that give the brain an elated sensation. Within their study, there

were 60 individuals addicted to either heroin or methamphetamine and 52 individuals used as a

control (Ji 2017). As stated in their results, “DRD4...methylation levels were significantly higher

in all heroin and meth addicts compared with 52 controls” (Ji 2017). It was also stated that males

who were addicted to either drug were more likely to have increased methylation levels as well

(Ji 2017). Therefore, addicts typically have increased levels of dopamine and according to their

study, this is more prominent in male users. Compared to the 2017 article by Georgia Casey, it

can be inferred that dopamine levels do play a role in the causes of a heroin addiction. However,

this is not the only feasible theory on why and how individuals become addicted to quickly to a

drug such as heroin.

In an article analyzing the heroin epidemic from the lenses of three historic psychologists,

Nancy Dyer introduces the short and long term effects as well as the causes of addiction from

their perspective. Dyer questions how the symptoms can get as worse as “skin crawling”, but

people are still willing to put their lives through an addiction (2004). As she explains her ideas

on the concept of causes of addiction she states:

It is no wonder that this euphoria is found to be so compelling psychologically

and physically; after all, pain and pleasure are our most primal motivators.
Thus, the compulsion to use despite adverse consequences is fueled by very
basic brain functions, perhaps the most important elements to consider when
trying to understand why someone would use such a dangerous, addictive
substance.

Dyer also references Emile Durkheim who explains addiction in two ways: “collective

effervescence and amonie” (Dyer 2004). Emile Durkheim compares an addiction to a “religious
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ritual” where individuals use drugs like heroin to find peace just as many turn to their religion to

find peace (Dyer 2004). Dyer claims that Durkheim’s quote, “religion, or some substitute for it,

will always be with us”, is an omen for current substance abuse within society (Dyer 2004).

Prescription Causes of Heroin

As society continues to prescribe pain relieving opioids for medical purposes, the stigma

between prescription drugs and heroin use has increased. According to a study from the

Department of Psychiatry at Washington University, there is “growing evidence that some

prescription opioid abusers, particularly those who inhale or inject their drugs, graduate or shift

to heroin...because it has become more accessible and far less expensive than prescription

opioids” (Circeo et. al 2014). Researches in this study interviewed addicts through two different

programs: Survey of Key Informants’ Patients Program (SKIP) and Researchers and Participants

Interacting Directly (RAPID) program. Specifically within the RAPID interviews, “every

respondent”, which consisted of over 150, “who indicated heroin as their primary drug also

endorsed lifetime abuse of prescription drugs” (Cireco et. al 2014). Additionally, 94% of

participants said they chose heroin simply because it is cheaper and easier to find than

prescription drugs (Cicero et. al 2014). In their final discussion of the study, they noted the

heroin crisis has become a major issue due to three primary reasons: the misuse of prescription

opioids, the common use of individuals using other opioids after prescriptions, and the easy

availability of heroin compared to prescription pills (Circeo et. al 2014).

To counteract the prescription to heroin theory, Jacob Sullam writes to prove that the

opioid crisis has nothing to do with the use of prescription pills. In his article “Don’t Blame Pain

Pills for the Opioid Crisis”, he explains a viewpoint that is not so typical in this field. Sullum
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states that opioid addictions and deaths have little to do with prescriptions, but more to do with

“multi-drug users with histories of substance abuse and psychological problems” (2018). He

references a 2015 review between the prescription to opioid addiction pipeline. In the study,

former patients treated with narcotics were followed for thirteen years, yet only 1 in 550

individuals died from an overdose related to opioids (Sullum 2018). Throughout the article,

Sullum argues that overdose occur less from former treatment and more from past decisions to

experiment with illegal narcotics.

Effects of a Heroin Addiction

In a 2015 study completed in Bologna, Italy, Raimonda Pavarin researched the

standardized mortality ratios between public treatment center patients and non public treatment

center patients. The SMR is based on the deaths found in a study compared to the average

number of deaths that would be expected (Paravin 2015). The study was completely voluntary

and featured 959 subjects from age 15 to 64 (Paravin 2015). Paravin states, “448 subjects went to

a PTC...434 went to an emergency department… and 77 were admitted to the hospital” 2015).

Individuals treating in the PTC experienced 18 deaths compared to 29 deaths within the non-PTC

group (Paravin 2015). After following the PTC subjects, over 24% successfully completed the

treatment, 61% remained in therapy, and 14.7% ended their treatment entirely (Paravin 2015).

The study was concluded with the suggestion to treat addictions from a large population scale

compared to small and specific groups of individuals with heroin addictions (Paravin 2015).

Further research will provide information on the rehabilitation and overdose statistics of

individuals suffering from a heroin addiction.

Conclusion
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This review alludes to the conception that the heroin epidemic in the United States has

reached a point where change must be instituted. Using a variety of research methods including

research journals and surveys, it has been found that heroin majorly affects the lives of addicts.

This subject is extremely relevant to society today, as the epidemic has transitioned from a

lower-class urban issue to a middle-class rural issue. Given that more individuals are becoming

influenced by heroin, it is imperative that citizens nationwide should become informed on the

detrimental effects of a heroin addiction.

Research List

Casey, G. (2017, September). Dealing with addiction. ​Kai Tiaki: Nursing New Zealand​, ​23​(8),

20+. Retrieved from

http://link.galegroup.com/apps/doc/A507185361/GPS?u=henrico&sid=GPS&xid=ece33b

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Christensen, J. & Hernandez, S. (2017, June 23). This is america on drugs: A visual

guide. ​CNN​. Retrieved from

https://www.cnn.com/2016/09/23/health/heroin-opioid-drug-overdose-deaths-visual-guid

e/index.html

Cicero T. J., Ellis M.S., Surratt H.L., & Kurtz S.P. (2014). The changing face of heroin use in the

united states: A retrospective analysis of the past 50 years. ​JAMA Psychiatry​;

71(7)​:821–826. Retrieved from

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575?;resultClick=3

Dyer, N. O. A. K. (2003). Durkheim, mead, and heroin addiction. ​Human Architecture: Journal
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of the Sociology of Self-Knowledge​, ​2​(2), 99+. Retrieved from

http://link.galegroup.com/apps/doc/A227788678/GPS?u=henrico&sid=GPS&xid=77d9b

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Ji, H., et al. (2018). Dopamine receptor d4 promoter hypermethylation increases the risk of drug

addiction. ​Experimental and Therapeutic Medicine​, ​15​(2), 2128+. Retrieved from

http://link.galegroup.com/apps/doc/A525840893/GPS?u=henrico&sid=GPS&xid=320a2

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Sullum, J. (2018, February). Don’t blame pain pills for the opioid crisis. ​Reason, 49​(9), 15.

Retrieved from

http://link.galegroup.com/apps/doc/A522210607/GPS?u=henrico&sid=GPS&xid=9ed64a

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