REED HRUBY HEROIN PREVENTION PROJECT

ROBERT CROWN CENTER HISTORY• 1958- Opened our doors as Hinsdale Health Museum• Currently have offices in Hinsdale, North

Lawndale, Aurora• Serve more than 80,000 students annually• Mission: Keep kids happy, healthy, safe• Major topic areas: puberty and sex education,

drug use prevention, obesity prevention• New audiences

TODAY’S OBJECTIVES• Increase knowledge of heroin use

trends in the Chicago suburbs• Share key findings from Robert Crown

sponsored primary research conducted by Illinois Consortium on Drug Policy

• Provide suggestions for actions to reverse trend

REED HRUBY HEROIN PREVENTION PROJECT

• Background of our drug program renovations• Hruby proposal• Partnership with Reed Hruby Memorial

Foundation, Robert Crown Center, IL Consortium on Drug Policy

• Timeline• Accomplishments so far• Research included literature review,

interviews, focus groups, life-mapping

NATIONAL INDICATORS OF GROWING HEROIN USE

• Initiations to heroin have increased 80% since 2002, from around 100,000 in 2002 to over 180,000 in 2009.

• 34,000 youths initiate to heroin in a given year (ages 12-17).

• On any given day 3,753 youth (12 to 17year olds) use heroin.

TREATMENT AND HOSPITAL DISCHARGES DEMONSTRATE GROWTH

AMONG YOUNG USERS• Across the United States, treatment admissions for heroin from

1996 to 2006 increased 56 percent among teens and 58 percent among young adults.

• The majority of youth aged 12 to 17 entering public treatment for heroin across the nation was White (76%), followed by Latinos (16 %), and African Americans (2%).

• In Illinois, nearly 70% of youth under age 18 admitted to public treatment were White and 85% of those aged 15 to 19 discharged from the hospital were White.

WHERE DOES IT COME FROM?• Majority comes from Mexico (high

purity, low price)• Teens purchase it in open-air markets

on Chicago’s West Side (Austin blvd. off the Eisenhower)

• Cheap, 10 dollars per bag• Highly pure…kids don’t have to inject

it to get high

SUBURBAN HEROIN NOT CONFINED TO CHICAGO AREA

Atlanta, St. Louis, Cincinnati, New York City, Kansas City, Wichita, Boston, Philadelphia, Milwaukee, Denver, Los Angeles, Salt Lake City, Charlotte, Baltimore, Seattle, San Jose, Detroit, and Chicago have all reported increasing and alarming use among younger people in the suburbs.

WHAT IS HEROIN?• Heroin is in a class of drugs known as

depressants. Alcohol and Xanax are examples of other types of depressants.

 • Depressants are drugs that temporarily slow

down your central nervous system.

• Heroin is an opioid. All opioids are depressants. Other opioids include things like prescription pain medications (Vicodin or OxyContin).

UNDERSTANDING HEROIN USE, ADDICTION, AND DEPENDENCY

•Only nicotine ranks higher in dependency profile. • Of those who are offered heroin, about 20% will try it• Of those who try it, 25% will proceed to dependency.

• Physical dependency, withdrawal symptoms develop rapidly

• Tolerance develops rapidly (leading to increased use)

• Causes more harm to users than other “hard drugs”

HOW DOES HEROIN CAUSE ADDICTION?• Heroin molecules rapidly cross the blood-brain

barrier• Heroin causes neurons in the brain to release a

flood of dopamine• Dopamine makes the user feel good• The user’s brain creates links between feeling

good and heroin use• Repeated use reinforces these links• When drug is gone, chemical imbalance in brain

causes physical withdrawal symptoms

HEROIN INTERVIEWS

F I ND I N

G S FR O M I N

T E R V I EW S

HEROIN RESPONDENTS: CHARACTERISTICS

• All from the suburbs including Cook, DuPage and Will Counties.

• Half were male, half female.

• Youngest was 22, oldest was 31.

• Wide range of socio-economic backgrounds, peer group participation and experiences.

CO-OCCURRING DISORDERS AND SELF MEDICATION

The majority of the sample self reported co-occurring disorders or symptoms:• Depression• Anxiety Disorders• ADHD• Bipolar Disorder (this was the least common)

The majority of the interviewees indicated that heroin use was a form of self-medication for depression or other problems:

I was in my own world, in my own area, doing my own thing….And it [heroin] would make me not be sad.

SENSATION SEEKING

More than two-thirds of the sample exhibited sensation seeking behaviors, which include risk-taking (e.g. skydiving); disinhibition; boredom susceptibility; and adventurousness:

I found going to the west side exciting. It was a thrill. The chance was that you could get caught, but the reward was that you got your dope. I am a thrill-seeker. I bungee-jumped when I was 12. I used to steal small things just to do it. My parents would describe me that way – as a thrill seeker.

LOW DRUG KNOWLEDGE AMONG PARTICIPANTS

We had a D.A.R.E. program, but they spoke to us mostly about violence and gangs. And that was all in elementary school. And in high school it was just sex education. No drug education then. I didn’t know it [heroin] was a downer like it was. I thought it was like marijuana. I thought that the people that got addicted – that it was all in their head. I just saw heroin as another drug. I thought maybe it wasn’t true that it was so bad. I thought maybe people did more than they could handle.

NO UNDERSTANDING OF DEPENDENCY

Being around people that were doing it, if you don’t see anything bad happening, then it seems OK. But that was in the beginning. I expected it all to be like in the beginning when I was not getting sick. All those things that were supposed to happen were not happening then, so I thought it was fine. And I kept using.

If I knew about withdrawal, I would not have done it. If I knew, I would never have used. If they could show people this, what it is like— I think people might not use.

PEER GROUPTwo patterns emerged1. Individual leaves peer group or seeks out people

using drugs.2. Heroin comes to the group and spreads.

When I turned 20, a lot of my close friends from that group were starting to do heroin. And then my other friends in the group started using. And then I was around all them and thought it was OK to try.

After dependence, peer group changed to include other heroin users.

INITIATION: MODE OF ADMINISTRATION

All interviewees sniffed or snorted heroin:

When I was at [college] then I heard about it. And this person snorted it. And he said “you don’t get addicted this way” since you are snorting it and not injecting it.

I didn’t think it would be bad sniffing it. I thought, oh, when you sniff it, then it’s ok.

If you are at a party and someone opens a pack and dips a key into the powder and then puts it under your nose and says sniff, that’s not so scary. That’s how we did it.

PILL USE → HEROINAbout one third of interviewees were misusing or dependent on opioid pills before transitioning to heroin.

I didn’t use heroin first – I broke my foot and I was out of pain in like 2 weeks, but he [the doctor] kept me on Vicodin for 8 months. I kept calling for refills and he kept giving them to me. I didn’t know it was addicting. I figured it was safe because it was from a doctor and he kept giving it to me.

Pill use softened perception of heroin useI remember thinking that I was scared to try it because it was heroin, but then I remember thinking that it was the same as Oxys, so it was OK.

DISCOVERING DEPENDENCY

Dependency was generally pointed out by another person I really thought I had the flu. I said “lately I’ve been feeling weird like I am sick” and my friend V flat out told me “that’s withdrawal.” I don’t remember what I felt. I know it wasn’t good. I was surprised. I didn’t know what addicted meant. I didn’t understand why people would get sick or how or why they would have to use all day.

FOCUS GROUPS

F I ND I N

G S FR O M F

O C U S GR O U P S

FOCUS GROUP METHODSTo participate:

Had to have used at least one illicit substance in high school AND had to attend a suburban high school.

Recruited through a variety of means including:• Posted in Triblocal, Craigslist• Posted on Facebook college and high school networks• Posted fliers throughout the suburbs at public locations• Handed out fliers over the summer at public beaches, malls and

other areas where young people congregate.Participants names were not recorded, used disposable phone and

gmail address to ensure confidentiality.

DRUG EDUCATION• Participants believed drug education was not comprehensive

• Focused primarily on tobacco, alcohol and marijuana• Did not provide information or discussion on heroin or other “hard drugs”

• Programs “lumped drugs together,” making it difficult to understand the effects of specific drugs on the person

• Programs did not clearly explain addiction, dependency or withdrawal

• Programs did not help students understand the path from experimenting to addiction

• “Just don’t do it” is not a reason

PARTICIPANT KNOWLEDGE

• High disapproval of heroin, low disapproval of opioid pills • Did not understand the link between the two (heroin and pills)

• Did not understand differences between “dependency” and "addiction”

• Understood that there was a link between mental health and drug use, but not how the two were linked

ADDRESSING KNOWLEDGE GAPS

• Participants believed parents did not have the knowledge or communication skills to talk to them about drugs

• Did not know where to go to find a source of accurate, quality information about drugs

MAJOR TRENDS• Heroin use is a growing problem in

Chicago suburbs• Because it is highly addictive, this

trend won’t fix itself!• What can we do?

PARENTS• Talk to your kids!!!• Monitor for behavior changes (dropping out of

activities, change of friends, grades drop, etc.)• Link between mental health disorders and

heroin use• Look for signs (watery eyes, runny nose,

appears sleepy and distant, frequent excuses, valuables missing, high mileage on car)

• Push school board to support drug prevention

SCHOOLS• Research-proven effective education at every

grade level• Authentic messages from authentic

messengers• Parent resources• Staff development training• School wide system for early intervention

MEDICAL COMMUNITY• Educate patients about potential danger of

pain medication• Closely monitor pain medication, and

prescribe the minimum amount necessary

TODAY’S OBJECTIVES• Increase knowledge of heroin use

trends in the Chicago suburbs• Share key findings from Robert Crown

sponsored primary research conducted by Illinois Consortium on Drug Policy

• Provide suggestions for actions to reverse trend