The research question raised is does the abuse of opioid prescription drugs lead to dependency of acquiring heroin which creates the opportunity to commit crimes? This question is important to the study because the main focus of the study is to figure out how some people start out abusing heroin and what effects it can do criminally to someone. Certain findings within the studies will contribute to my research question and help with a better understanding of people who are addicted to prescription opioids which leads to heroin. These findings could help create change in public policy by adding strategic ways of dealing with people who abuse heroin.
The effects of heroin can make the struggles of society and the struggles for individuals difficult. The study conducted in this article is the first to associate heroin and premature aging within cellular and brain system levels (Cheng et al., 2013). Telomerase which is created to elongate telomeres is an important part of this study as it impacts cellular aging and relates to heroin abuse (Cheng et al., 2013). The researchers wanted to investigate certain findings within this question, does heroin abuse have an impact on telomerase activity and MRI brain structures (Cheng et al., 2013)?
The prefrontal cortex (PFC) and the medial temporal lobe (MTL) which are the areas in the brain that impacts the aging process, have been discovered by older research to show deficits within heroin abuse (Cheng et al., 2013). This means that older research has found decision making, impulse control, and memory are likely affected in someone who uses heroin (Cheng et al., 2013). Also, these older studies show the effects that heroin has on the structural and functional integrity of the brains PFC and MTL (Cheng et al., 2013). The matter discussed in this present research within the premature and cellular brain system levels has been untested up to this point (Cheng et al., 2013).
To conduct this study, 33 participants who are heroin users and 30 who have never used heroin were chosen to be in this study (Cheng et al., 2013). Within this study, heroin users who weren’t on treatment like methadone maintenance therapy were allowed to be participants (Cheng et al., 2013). Heroin users were based on if they used heroin over 50% of their drug use and the control group were picked at random based on local advertisement within their community (Cheng et al., 2013). Participants were excluded if they had any history of neurological and psychiatric disorders that could disrupt the legitimacy of this study (Cheng et al., 2013). Each participant had to complete the Raven's Progressive Matrices so there was a relation of intelligence between the heroin abusers and the control group (Cheng et al., 2013). They conducted a telomerase activity essay by collecting peripheral blood in EDTA containment tubes (Cheng et al., 2013). This was to measure the telomerase within each participants blood and relate it to the MRI scans which was conducted later (Cheng et al., 2013). The participants were given an MRI scan which tested the gray matter, white matter, and cerebrospinal fluid of the participants (Cheng et al., 2013).
The tests revealed that the telomerase activity within heroin abusers was significantly lower than that of the control group (Cheng et al., 2013). Based on the clusters associated with the white and gray matter and the telomerase activity, this study found that the measurements of the heroin users and the control group were significantly different (Cheng et al., 2013).
Based on the researchers understanding of their study, evidence is present that heroin abuse is associated with an accelerated increase of cellular and brain system aging (Cheng et al., 2013). The researchers believe that heroin manipulates the brain and body and science should further research this relationship between heroin and biological aging (Cheng et al., 2013). This could eventually create a greater understanding of this topic which could potentially reverse the effects of drug addiction and help future addicts have a better life (Cheng et al., 2013).
The purpose of a study with incarcerated black males in the south is to examine their self reported prescription, heroin and intravenous drug abuse (Watkins et al., 2015).
Incarcerated males are usually not included within national surveys and their abuses of different prescription and heroin can lead to a dramatic shift of the assumption that incarcerated black males are the least likely to use injection as their use of drugs (Watkins et al., 2015).
Black males in Kentucky prisons who enrolled in abuse treatments from 2011-2014 were interviewed. Different tests were done and they were asked if they have ever used certain drugs such as prescription opioid drugs or heroin in the last six months. Their hypothesis was that there would be a significant increase in non prescription drugs and illegal drugs such as heroin (Watkins et al., 2015). The independent variable would be the availability of the drugs provided to the inmates that they use to get a high within the prison. The dependent variable would be the actual use of the drugs within the prison and the effect it has on their overall health and the safety of the prison.
Between the years 2012 and 2013, there was a significant increase in non prescription opiate abuse and an increase in the amount of heroin that is being used in the prison (Watkins et al., 2015). Between 2013 and 2014, the use of stimulants decreased within the prison system (Watkins et al., 2015).
The conclusions within this study state that the increase of heroin and illegal prescription opioids within the black male population within the prison system is a public health concern (Watkins et al., 2015). This has created an HIV abundance in the south because people who share needles within these prisons are contracting this deadly virus (Watkins et al., 2015). The understanding of increased patterns of heroin and opioid abuse help understand cultural needs regarding drug abuse treatment and the decrease of contracting the HIV virus (Watkins et al., 2015).
The purpose of the article explaining Kentucky’s opioid legislation studied the effects of HB1 on people who are addicted to opioids and heroin in a tertiary care facility (Faryar et al., 2017). This was known as the first study that have characterized ED patients before and after the passing of Kentucky’s opioid legislation (Faryar et al., 2017). Also, it can be seen that with the legislation there has been a decrease in opioid dependence and an increase in heroin dependence, thus stating that these people are transitioning into heroin from their own opioid prescription drug (Faryar et al., 2017).
According to an article about Kentucky’s opioid legislation states that, in the United States opioid abuse has made an increase since the year 2000 (Faryar et al., 2017). The increases of the opioid abuses which leads to heroin abuse can be factored by many interesting things. One of these things would be the pharmaceutical companies increasing the span of time in which someone uses an opioid based drug (Faryar et al., 2017). Kentucky has been severely impacted by the heroin epidemic, as the state in 2014 ranked fourth in opioid and heroin related deaths (Faryar et al., 2017).
The research team got approval from the University of Louisville School of Medicine and requested a list of every patient listed in the ED from 2009-2014 (Faryar et al., 2017). In total, 3,324 patients were included in the experiment based on their opioid and heroin habits (Faryar et al., 2017). They were categorized into two groups based on drugs reported from the ED which were prescription opioid abusers and heroin abusers (Faryar et al., 2017). If the patients abused both or abused some opioid that wasn’t covered in the experiment then they would be excluded from this experiment (Faryar et al., 2017). The researchers used statistical analysis and past data to determine their findings (Faryar et al., 2017). The independent variable was the use of opioid drugs or heroin and the dependent variable was the dependency or addiction of being on these said drugs.
They found no significant change based on gender as most of the participants from the database were males (Faryar et al., 2017). The greatest increase of people who became addicted to opioids and heroin were of the ages 18-24 (Faryar et al., 2017). Meanwhile abuse increased dramatically from ages 25-44 years of 286 % (Faryar et al., 2017). The ethnicity that mostly used heroin and opioids were seen as white from the data (Faryar et al., 2017).
The goal of HB1 was to decrease the dependency of opioid drugs by constantly regulating the prescriptions for people (Faryar et al., 2017). With fewer amounts of opioids available they would hope that the abuses would decrease and that this would lead to lesser people using heroin (Faryar et al., 2017).
Opioids have become a huge problem within school districts as seen within a study about high schoolers and opioid addiction (Vosburg et al., 2016). The goals of this study were to characterize the development of RXO abuse and the addictions caused with kids who attended a Massachusetts high school (Vosburg et al., 2016). These kids would be looked upon that have formerly abused prescription opioid drugs (Vosburg et al., 2016).
Surveys have revealed that 1 in 4 seniors use RXOs either medically or non medically and the increase for kids using RXOs have increased over the years (Vosburg et al., 2016). In the United States they have been seen to have a high rate of abuse and this drug has been seen as one of the highest used from adolescents other than marijuana in 2012 (Vosburg et al., 2016).
The principals provided the researchers with adolescents who had a lifetime of history with RXO abuse (Vosburg et al., 2016). A questionnaire was provided and was designed to create quantitative and qualitative data of different drug abuses such as opioid abuse and heroin abuse (Vosburg et al., 2016). Once the volunteers filled out the questionnaire they were given a demographic form to fill out (Vosburg et al., 2016). Statistical tests were provided to create the outcomes that they needed (Vosburg et al., 2016).The independent variable in this study would be the adolescents pain or suffering caused in their young lives and the dependent variable would be the use of the RXO drugs (Vosburg et al., 2016).
The results were more finding of the reasons why these children are using these drugs over statistical data (Vosburg et al., 2016). It found that most adolescents were curious as what these drugs felt like and wanted to experiment with different kinds of drugs (Vosburg et al., 2016). There is a good amount of participants who believed that the reason why they use heroin is because they started on the RXO drug as well (Vosburg et al., 2016).
The researchers felt that even though their sample size was relatively small it related in similar ways to bigger sample sizes of the same research (Vosburg et al., 2016). This means that their research was beneficial to understanding why adolescents use RXO drugs and how they become familiar with heroin after the fact (Vosburg et al., 2016).
Increased use of heroin can be seen as from an increased opioid use. The article recognizing this analyzed their data to find a spillover effect in which people who don’t have an experience with opioids might turn to heroin as their first way of using it (Cicero et al., 2017).
From recent studies explained in the article, it has been said that supply reduction efforts have been successful in reducing the supply of non medication opioids in the United States (Cicero et al., 2017). So people who are faced with addiction and can’t get these opioids from their local hospitals are vulnerable to turn to more extreme measures of getting a high like heroin (Cicero et al., 2017).
The research used a survey from (SKIP) which is from key informant’s patients to find their data of how they first used opioids as in prescription or heroin (Cicero et al., 2017). It also asked their age as well and another test was conducted to see the differences of them using some sort of opioid over a span of time (Cicero et al., 2017). The independent variable would consist of when and what age did the patients start using heroin and the dependent variable would be the initial act of them abusing the drug (Cicero et al., 2017).
Only 8.7% of people in 2005 started with heroin, but in 2015 the data shows that people who started with heroin was at its highest (Cicero et al., 2017). This had no evidence of stabilization which means that over time these numbers are going to continue to grow and not be at a specific place that could be controlled (Cicero et al., 2017).
This article believes that supply reduction can’t battle the heroin epidemic alone and that as a nation we have to look for alternative ways of fixing this problem (Cicero et al., 2017). They believe as supply reduction could be a temporary solution but battling the initial cause has to be more deeper than that (Cicero et al., 2017).
Survey research would probably be the best way of answering the research question provided. We would need to measure if opioids were used before they started using heroin, what are the reasons why they use these drugs, the reasons why they switched to heroin, can they go back to opioids and stop using heroin if they wanted too, etc.
Independent variables could be family life in the sense meaning was their family life a factor in them taking opioids. To operationalize this independent variable a question could be did family life cause your involvement with opioid drugs? Then the question would use nominal measures as a yes or no question. Another could be experimentation which if they felt that they wanted to try opioids based on their own curiosity. The question to go along with this independent variable would be did your own curiosity cause yourself to take certain opioid drugs which lead to your addiction with heroin? This would be another nominal measurement kind of question with yes or no answers. Another independent variable could be if they were prescribed opioid medication which lead them to abuse the medication. The question for this independent variable would be were you provided opioid drugs for a condition medically and abused these said drugs, which lead to you being addicted to them? This would be the same as before with nominal measurement and yes or no answers. Peer pressure could be an independent variable where people pressure someone in trying things that they normally wouldn’t do and like the outcome. The question raised for this independent variable would be did friends or acquaintances pressure you into doing opioid drugs and lead you down a path of being addicted to said drugs? The nominal measurement would be used with a yes or no answer. The last independent variable could be if other drugs they used in the past have lead them to use opioids which lead them to use heroin. The question would be did past involvement with drugs lead you to uss opioid drugs and potentially lead you to use heroin? Sme as before this would be a nominal measurement with a yes and no answer. Even though these questions would all have the same outcome these would be used as filler questions to filler out where they fit in the study specifically. They would answer yes or no on one of these independent variable questions as this is the cause of their addiction and branch of from that question as the next questions would be pertaining to them. The dependent variable would be the use of opioids which eventually leads them to using heroin.
Introduction
The survey would be a self administered mail survey and this type would be effective because it could be sent to people who have had on record drug addiction all across the country. So there could potentially be a big sampling size with more effective data. The disadvantages of using mail surveys is you might not get some of them back as they don’t have to do the survey. Another disadvantage would be that they don’t have to be honest on the survey they could put completely different answers far from the actual truth. I would allow the people who are given the surveys to be able to complete it within a week and sent it to an address.
Methods
I would select the respondents by the amount of surveys that are complete and correctly answered, not meaning by correct answers as in correctly formatted. Non probability sampling would be used because the specifics of the population needed creates this. The reason for this is that there can’t be an equal random sampling of the opioid and heroin abusers as we need that data to be specific. Quota sampling would be used as the known characteristics of opioid abuse and heroin abuse would factor to be this way. If we can acquire the most participants we can get would be helpful for this study with 65 % response rate from the surveys. Efforts to maximize response rates would be to give out compensation of 20 bucks or a gift card for sending in the survey could be helpful as it would give the people a motive to participate.
Ethics
Ethical concerns for this study that would be conducted may vary. Within the Belmont Report, there are three criteria that need to be met within the study. Because of the mailing of the surveys to different past or present opioid and heroin addicts, we are bringing back past memories that maybe someone who just became clean wouldn’t want to remember. This means that their privacy of their past drug issues might be in jeopardy because they might be uncomfortable with people exploiting that they are drug addicts.
Beneficence allows our study to minimize harms where there basically is none. The survey that comes through the mail is not going to physically hurt anyone it’s just a set of questions. This maximizes the benefits because it allows them to take their time getting it done and not have to worry about anything that could potentially harm them.
Justice allows ensures us that there are fail procedures that could be in place for subjects who don’t participate. We could add more people part of this study if not enough people do the survey so that we can maximize the amount of people who will help us with their data.
References
Cheng, G. L., Zeng, H., Leung, M., Zhang, H., Lau, B. W., Liu, Y., . . . Lee, T. M. (2013). Heroin
abuse accelerates biological aging: A novel insight from telomerase and brain imaging
interaction. Translational Psychiatry,3(5). doi:10.1038/tp.2013.36
Cicero, T. J., Kasper, Z. A., & Ellis, M. S. (2018). Increased use of heroin as an initiating opioid
of abuse: Further considerations and policy implications. Addictive Behaviors,87, 267-271. doi:10.1016/j.addbeh.2018.05.030
Faryar, K. A., Freeman, C. L., Persaud, A. K., Furmanek, S. P., Guinn, B. E., Mattingly, W. A., . .
. Huecker, M. R. (2017). The Effects of Kentucky's Comprehensive Opioid Legislation on Patients Presenting with Prescription Opioid or Heroin Abuse to One Urban Emergency Department. The Journal of Emergency Medicine,53(6), 805-814. doi:10.1016/j.jemermed.2017.08.066
Stevens-Watkins, D., Knighton, J. S., Stanton-Tindall, M., Winston, E., & Leukefeld, C. G.
(2015). Prescription drug abuse, heroin, & IV drug use among incarcerated black men. Drug and Alcohol Dependence,156. doi:10.1016/j.drugalcdep.2015.07.572
Vosburg, S. K., Eaton, T. A., Sokolowska, M., Osgood, E. D., Ashworth, J. B., Trudeau, J. J., . . .
Katz, N. P. (2015). Prescription Opioid Abuse, Prescription Opioid Addiction, and Heroin Abuse Among Adolescents in a Recovery High School: A Pilot Study. Journal of Child & Adolescent Substance Abuse,25(2), 105-112. doi:10.1080/1067828x.2014.918005