Heroin-related overdose nearly quadrupled between 2002 and 2013 with more than 8,200 people dying in 2013.

Heroin addiction has increased across the US in most age groups, and all income levels. But, the greatest increase in Heroin addiction is the least suspect for Heroin use; White males, 18 – 44. Today, Heroin use has undergone a demographic shift; the new Heroin addict is more apt to be white male, younger, privately insured and  with a much higher income than the image one usually associates with Heroin use.

In 2000, the highest heroin death rate was among black men ages 45 to 64.

By 2013, the highest Heroin overdose rate is among white males, ages 18 to 44. 

Actor Phillip Seymour Hoffman, shocked the world when found he was found dead February 2, 2014 on the bathroom floor of his New York apartment with a syringe in his left arm.  According to the New York Medical Examiners Office, the poor soul stopped breathing due to an acute mixed drug intoxication of heroin, cocaine, benzodiazepines and amphetamine.



Phillip Seymour Hoffman: Heroin Addict

Heroin and Multiple Prescription Drug Use On the Rise

Alarmingly, Hoffman is typical of many dear souls using heroin while also abusing multiple other substances, especially cocaine and prescription painkillers. A study looking at the most common drugs involved in motor vehicle fatalities between 1993 and 2010 found the number of drivers who had three or more drugs in their body increased from 11.5 percent to 21.5 percent during that period. In 1993, about 1 in 8 drivers were using multiple drugs concurrently, by 2010, it was closer to 1 in 5, as reported by HealthDay News.

A compassionate shift towards pain relief in the 80’s saw an explosion in pain medicine practices and the subsequent demand for better drugs and pain management technologies.

Naturally, big pharmaceutical Corporations responded and by 1995, Purdue Pharma released the new wonder drug, OxyContin, a pure concentration of oxycodone, in a timed released formulation providing 12 hours of pain relief.

However, the tablets can be crushed and snorted, chewed, or mixed with water and injected, eliminating the time-release factor while providing a quick and intense rush to the brain. This practice can lead to overdosing on OxyContin’s active ingredient, oxycodone, by releasing too much of the medication into the bloodstream too quickly. OxyContin is also highly addictive, so higher doses of the drug must be taken when a tolerance develops.

In the first year on the market OxyContin made up only 1.3 percent of Purdue Pharma’s gross sales. By 2003 OxyContin sales skyrocketed to 1.6 Billion dollars and accounted for 94% percent of the company’s revenue. Sales have remained strong for Purdue Pharma while OxyContin has become the most widely popular and abused opioid drug today.

Doctors were prescribing pain medications in record numbers and it wasn’t just OxyContin prescriptions. During 2001, pain medication prescriptions jumped 150 percent from the previous year. Between 1997 and 2005, prescriptions for Oxycodone, the active ingredient in Oxycontin and many other pain killers under other brand names, jumped up by 600 percent.

Rush Limbaugh’s shocking radio show confession and subsequent arrest for doctor shopping and multiple prescription drug abuse had the mainstream media talking about his addiction and profound hearing loss from opioid use. ABC  Television’s Good Morning America did feature stories about Rush, bringing the new image of the white male junkie into every home in America.

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Heroin Demographics

The Cost of Addiction

Hearing loss is just one of many possible side effects from high dose opioid use. Luckily for Rush and his radio career, he was a good candidate for Cochlear Implant surgery. Common side effects of opioid use include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression and itching. Less common side effects may include delayed stomach emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and spasmodic jerky muscle group contractions. And of course, tolerance, addiction and the loss of self.

People addicted to painkillers have pushed demand for heroin, according to CDC director Dr. Thomas Frieden, who stated what he thought are the two main reasons for the epidemic increase in Heroin addiction :

“More and more people are susceptible to heroin because they have been prescribed prescription opiates, like OxyContin; and Heroin itself is cheaper and more widely available.”

Exactly. Addicts indeed turn to Heroin because it is less expensive, with the average street cost of a single dose of heroin at approximately $10 – $25 per dose depending on one’s tolerance. Compared to OxyContin at an average street cost of $1.15 per mg, 80 mg to 400 mg habits can range from $46 – $92 per day.

Compassion Turns to Greed

The age of compassionate pain treatment turned into a profitable landscape for entrepreneurs who seized the opportunity to create Pill Mills, clinics where doctors could sell narcotics directly to people for cash. When the Federal Drug Enforcement Agency, DEA, got wind of the high volumes of prescription opioids sold from these businesses they were shut down.

Since that time, physicians and pharmacies have faced increased DEA scrutiny on opioid prescriptive practices, making it often extremely difficult for non abusing patients to get pain medications due to Doctor’s fear of the DEA.

According to the Mayo Clinic, one in four patients end up in chronic pain, so, in reality, the need for pain relief is high. Yet the DEA has Doctors under such scrutiny patients are at risk for being under treated for pain. The negative long term impact of chronic pain on MindBodySpirit is well documented with depression, job loss and increased risk for obesity at the top of the list.

The Rise of Heroin Chic


Calvin Klein using Heroin chic to sell underwear.

Heroin overdose rates greatest among White Males 18 – 44.

Far easier and less costly (we already did the math) than prescription drugs, Heroin lost its reputation as a drug to be feared and became more fashionable with the rise of “drug addicted chic” in mid 90s fashion.

A reaction against the “healthy” and vibrant look of models such as Cindy Crawford and Claudia Schiffer, some designers began glamorizing the look of wealthy emaciated androgynous waifs emulating “a nihilistic vision of beauty” closely resembling the ravages of drug abuse.

At the U.S. Conference of Mayors on 21 May 1997, President Bill Clinton set the media on fire with comments about the dangers of  heroin chic in contemporary fashion imagery. “You do not need to glamorize addiction to sell clothes,” he asserted. “The glorification of heroin is not creative, it’s destructive. It’s not beautiful, it’s ugly”.

Ultimately, the death of a prominent fashion photographer from a Heroin overdose, set the industry in motion rallying against the glamorization of Heroin addiction with influential fashion designers speaking out against addiction promoted through fashion.

A collective statement from the designers expressed their concern at “the waste of human potential caused by substance addiction” and objected to the industry’s use of the strung-out “heroin look” to promote fashion. Objection to the trend was so strong, the U.K. periodical, The Independent, printed a searing article speaking on  “the ugly side “ of glamorizing this tragic chic back in 1997.

First-time heroin users often believe they can smoke the drug rather than resorting to a needle. When tolerance develops and they become addicted, smoking quickly gives way to injection and risk of overdose and death dramatically increases. It’s difficult to imagine Phillip Seymour Hoffman didn’t know the risk of injecting Heroin, snorting Cocaine and popping prescription pills. Every conscious person knows there is risk to injecting street drugs into one’s veins, yet the power of addiction is so strong people are risking their  life to find relief. In the end, many are finding the ultimate healing…death.

Where Do We Go From Here?

There are practical ways to deal with the epidemic of Heroin addiction, but first we must acknowledge it exists as problem in white communities. Each time popular media reports on the Heroin epidemic, they need to emphasize White males, 18 – 44  are at greatest risk. We can no longer afford to mask this epidemic as a problem among people of color because of shame. Overdose is the leading cause of death in this demographic and pain is the driving force. We have many young lives at risk from opioid abuse and unfortunately, early death due to chronic physical and Spiritual pain.

Rescheduling Cannabis from Federal Schedule I would allow Doctors to recommend Cannabinoid therapeutics in chronic pain, Anxiety and PTSD without fear of reprisal or sanction. Currently, chronic back and neck pain are most often listed as the leading response for seeking a Cannabis recommendation while demographic studies report the largest population of dispensary patients are White males 21 to 40 something.

A recent study published in the Journal of the American Medical Association demonstrated States with Medical Cannabis have lower rates of opioid overdose with a 24.8% decline in overdose deaths since legalization. The striking implication is this real life data supports the science validating Medical Cannabis as a viable solution for reducing opioid dependance for pain relief.

“The potency and efficacy of cannabinoids in producing pain relief rivals that of morphine” British Journal of Sports Medicine, 2004.

Cannabis is NOT a gateway to Heroin!

Heroin is NOT a gateway drug! Chronic cannabis smokers only 3x more likely to abuse harsher drugs vs. 40x for prescription pain killers!



What Can You Do to Stem the Rising Tide of Heroin and Prescription Painkiller Deaths?

Individuals can:

• Talk to your family, friends and Community about the Heroin and prescription painkiller epidemic.

• Listen to the concerns of young, White males. Indications of chronic pain, stress, depression and social isolation can increase risk for Heroin and opioid use. These are often early warning signs

• Support Cannabis legislation at the State and Federal level. The Compassionate Access, Research Expansion, and Respect States Act (CARERS) Act of 2015 is the most comprehensive piece of federal medical marijuana legislation ever introduced in the U.S. Congress. The bipartisan act is sponsored by:

Writing, emailing or calling your representative to tell them you support the CARERS Act of 2015 is just a start to the action individuals can take at the local and federal level to lobby for passage of the CARERS Act.

Senator Chuck Grassley, Iowa(R), the Chairman of the Senate Committee on the Judiciary is probably the largest obstacle to passage of the CARERS Act with his “tough on drugs” position.

“I oppose moving marijuana from a Schedule I to a Schedule II drug, based on the current science on the risks and benefits,” in a statement released by Grassley’s staff, “Recent studies suggest marijuana use by young people can cause long-term and possibly permanent damage to brain development.” However, he said, “for children suffering from severe epileptic seizures, the anecdotal evidence says components of the marijuana plant might help. I want to help those children. The key is aggressive medical research.”


Opinion pieces directly targeting Senator Grassley may be one effective way of taking action. All of the legislatures have social media presence on Facebook and Twitter where they tend to update constituents. One often sees angry citizens on and remember, if you have family in Iowa or know anyone in Iowa, tell them to take action.

This important bill would remedy the state-federal conflict over medical marijuana law, with far-reaching impacts, including:

  1. The ability of State programs to operate without Federal interference
  2. Moving Marijuana out of the Schedule I list and hopeful official adoption of the proper name Cannabis.
  3. Removing CBD from the scheduling.
  4. Access to banking services for legal Cannabis businesses which is estimated to be a multi billion dollar industry.
  5. Ending the DEA-Imposed National Institutes of Drug Abuse monopoly blocking research.
  6. Allowing Veterans Affairs doctors to write recommendations in states that have a medical Cannabis programs.
  7. Rescheduling of Hemp, opening the door to Hemp farming and International and National Industrial Hemp markets.

States can:

  1. Increase access to substance abuse treatment services, while including Cannabis as a treatment option.
  2. Expand access to and training for administering naloxone to reduce opioid overdose deaths.
  3. Ensure that people have access to integrated prevention services, including access to sterile injection equipment from a reliable source, as allowed by local policy.
  4. Help local jurisdictions to put these effective practices to work in communities where drug addiction is common.

Heroin and prescription painkiller overdose have become a Public Health epidemic costing the nation billions of dollars in lost productivity and health care costs. It’s time to recognize we have a new face of Heroin addiction and they look more like White middle class America’s sons and daughters.

Nursing theory as a guiding framework for practice


In my 20 years of experience as a professional nurse, I have found that nursing theory provides a cognitive and Spiritual framework for my practice. Using a theoretical framework, gives meaning to my practice by aligning my Spiritual beliefs as an individual with my actions and interventions as a nurse.



All theories are grounded in the Metaparadigm of Nursing, the most global perspective of the discipline of nursing with central concepts of person, environment, health and nursing.



My own foundational guiding theory is Orlando’s Nursing Process Theory: finding and meeting the patients immediate verbal and nonverbal needs for help.


“Nursing….is responsive to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing or curing the individuals sense of helplessness.” – ~Orlando





Utilizing nursing theory as an intuitive guide to practice



As someone trained to set up field Army hospitals and deliver care under stressful circumstances, this model never fails to guide my priorities. For example, a patient in respiratory distress cannot verbalize the need for air, but as an experienced nurse I know the nonverbal signs of acute respiratory distress and can respond to their immediate needs for oxygen without them having to utter a word. This nursing action preserves lifesaving energy and answers the nonverbal signal of distress.



This also evidences the extreme importance of meeting the patients verbal and nonverbal needs for help while prioritizing the most immediate need for air. Nurses triage every circumstance guided by the nursing process and that process is guided by a personal honor code most people refer to as Nursing Theory.


As an instrument of healing…my actions are always guided by theory first!


What are the guiding principles or theory of  your own nursing code of honor?


Love you all so much!

Nurse Courtney