Tuesday, May 27, 2014

How heroin kills you and why, a huge downfall for our country and our children-scary drugs

The New York Police Department, the largest police force in the United States, announced Tuesday that it has received funding to equip close to 20,000 officers with naloxone, a heroin antidote that can instantly reverse the effects of an overdose.
State Attorney General Eric Schneiderman declared that his office would provide the funding of more than $1.1 million to equip and train the NYPD officers as part of the Community Overdose Prevention Program.
"By providing NYPD police officers with naloxone, we are making this stunningly effective overdose antidote available in every corner of the five boroughs. This program will literally save lives," Schneiderman said at a press conference.
Each naloxone kit consists of a zip bag or pouch containing two pre-filled syringes of naloxone, two atomizers for nasal administration, sterile gloves and a booklet on the use of the drug, according to a statement from Schneiderman's office.
The emergency treatment works like the well-known EpiPen -- an epinephrine auto-injector for serious allergic reactions -- as it is injected into the muscle and does not require training, making it more user-friendly. Once injected, the naloxone stops heroin and other opioids from slowing a person's breathing down to the point that it stops.
The FDA approved the prescription treatment after just 15 weeks under priority status.
Currently, most law enforcement agencies are using the nasal spray version of the antidote, which is slightly different than the auto-injector.




"A recent pilot project in Staten Island has already proven effective with several overdose victims," said NYPD Commissioner William Bratton, who did not have an exact time frame of when the officers would officially be equipped.
The training for each officer takes roughly 45 minutes, Bratton said.
Joining Schneiderman and Bratton at the announcement was Carol Christiansen, co-founder of Drug Crisis in Our Backyard.
Christiansen's son, a former NYPD detective, died of a heroin overdose in 2012. Erik, 28, injured his back at the gym and became addicted to oxycodone for the pain, which led to an eventual addiction to heroin.
"It's an epidemic I think everybody should be aware of," Christiansen said, who believes the real problem is the poor monitoring of prescription medication.



"A recent pilot project in Staten Island has already proven effective with several overdose victims," said NYPD Commissioner William Bratton, who did not have an exact time frame of when the officers would officially be equipped.
The training for each officer takes roughly 45 minutes, Bratton said.
Joining Schneiderman and Bratton at the announcement was Carol Christiansen, co-founder of Drug Crisis in Our Backyard.
Christiansen's son, a former NYPD detective, died of a heroin overdose in 2012. Erik, 28, injured his back at the gym and became addicted to oxycodone for the pain, which led to an eventual addiction to heroin.
"It's an epidemic I think everybody should be aware of," Christiansen said, who believes the real problem is the poor monitoring of prescription medication.
Schneiderman also led the effort to pass legislation to create I-STOP, a monitoring program that prevents individuals from going from doctor to doctor to accumulate multiple prescriptions.
"If the I-STOP law was in effect over two years ago possibly my son, Erik, would be alive today," Christiansen said.
The police department of Quincy, Massachusetts, was the first in the nation to require its officers to carry naloxone and has successfully reversed 211 overdoses with a success rate of over 95%. In New York's Suffolk County, 563 lives were saved last year alone, the statement said.
"Equipping the NYPD with naloxone is a tremendously important step in the fight against New York's growing opioid addiction epidemic," said Dr. Andrew Kolodny, chief medical officer of Phoenix House in Manhattan.



How heroin works
Heroin is most often mixed with water and injected. Injecting it minimizes the lag time between when the drug is taken and effects are felt -- with injection, the effects are almost immediate.
It can also be smoked, snorted or eaten, but smoking or eating destroys some of the drug and mutes its effects.
When someone takes heroin there is an immediate rush. Then the body feels an extreme form of relaxation and a decreased sense of pain.
What's happening inside the body is the heroin is turning into morphine. Morphine has a chemical structure similar to endorphins -- the chemicals your brain makes when you feel stressed out or are in pain. Endorphins inhibit your neurons from firing, so they halt pain and create a good feeling.
Morphine, acting like your endorphins, binds to molecules in your brain called opioid receptors. When those receptors are blocked, that creates a high.
Why you die
Most people die from heroin overdoses when their bodies forget to breathe.
"Heroin makes someone calm and a little bit sleepy, but if you take too much then you can fall asleep, and when you are asleep your respiratory drive shuts down," said Dr. Karen Drexler, director of the addiction psychiatry residency training program and an associate professor in Emory University's psychiatry and behavioral sciences department.
"Usually when you are sleeping, your body naturally remembers to breathe. In the case of a heroin overdose, you fall asleep and essentially your body forgets."
A heroin overdose can also cause your blood pressure to dip significantly and cause your heart to fail.
Studies show intravenous heroin users are 300 times more likely to die from infectious endocarditis, an infection of the surface of the heart.
Heroin use can also cause an arrhythmia -- a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart may not be able to pump enough blood to the body, and lack of blood flow affects your brain, heart and other organs.
Heroin use can also cause pulmonary edema. That's when the heart can't pump blood to the body well. The blood can back up into your veins, taking that blood through your lungs and to the left side of the heart.
As pressure in the blood vessels increases and fluid goes into the alveoli, the air spaces in the lungs, this reduces the normal flow of oxygen through your lungs, making it hard to breathe. This too can give you a heart attack or lead to kidney failure.
Heroin can also come with other toxic contaminants that can harm a user -- although deaths from such instances, while not unheard of, are thought to be rare.
Studies suggest instantaneous death -- like what may have happened in Hoffman's case -- is unusual. The actor was found dead on his bathroom floor with a needle sticking out of his left arm, authorities have said.
Such deaths, where a needle and syringe are still in place, would be considered instant by scientists. One study showed this accounts for only 14% of heroin-related deaths.
Heroin deaths increase when...
There are some common social characteristics in heroin deaths that would make Hoffman more of a typical case. Most fatalities involve men, particularly those who have struggled with other drugs or alcohol (he admitted to this in the past) and other drugs or alcohol are often present.
While many are single (Hoffman had a partner), most users die in their homes and/or in the company of another person.
An addict does have a much higher chance of dying if he or she leaves treatment. The risk of death is higher for newly clean heroin addicts. A number of fatalities appear to happen after periods of reduced use, one 2000 study showed.
In fact, long-term users who die from overdoses are likely to have heroin levels no higher than those who survive.
That may be in part because those who are newly clean don't know how much of the drug to give themselves any more, Drexler said. They won't need the same amount to get high as when they were using more regularly.
There are also some studies that show tolerance to the respiratory depressive effects of opiates increases at a slower rate than tolerance to the euphoric and analgesic effects. As your tolerance to the drug develops, you typically need more of it to produce the high you are used to getting. This may be why long-term users are potentially at greater risk of overdose than novices.
Statistics suggest that newer heroin users aren't the ones most likely to die. One study showed only 17% of the deaths studied were in new heroin users.
However, Drexler said newer users can overdose because they don't know how much drug to take, compared to experienced users. "I think it is misleading to say you would not die if you only use it once or twice," she said.
A person's chances of dying from heroin use increase dramatically after 20 years of use. Studies show that after 30 years of use, 16% of heroin users have died, compared with 6.5% of cocaine users and 1.5% of meth users.



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