July 2015
Swank Health: Your monthly news from Swank HealthCare

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Did You Know?

Heroin Alert

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What's Going On?

Navigating the Road to Accreditation
Top Challenges Faced by Nursing Executives

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Test your knowledge of heroin use by answering these quiz questions.

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  • 64915 An Interdisciplinary Approach to Substance Abuse in the Elderly
  • 611814 Improving Medication Adherence and Decreasing Risk of Polypharmacy
  • 71114 Medication Use Evaluation: YOU Can Shift the Paradigm

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Did You Know?

Heroin Alert

According to a July 2015 report by the U.S. Centers for Disease Control and Prevention (CDC), heroin use increased by 63% between 2002 and 2013. During the same time period, heroin-related overdose deaths increased by nearly 300%. In 2013, 517,000 persons reported past-year heroin abuse or dependence. Officials say the skyrocketing trend is partly fueled by increased numbers of persons addicted to prescription pain medications. Those addicted to prescription opioid pain medications are 40 times more likely to become addicted to heroin. People addicted to prescription pain medications often switch to heroin because it offers a similar high, doesn’t require a prescription, and is cheaper to buy.

Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. It usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.” It can be injected, inhaled by snorting, sniffing, or smoked. All routes of administration deliver the drug to the brain very rapidly, which contributes to the high risk for addiction and health risks. Opiate abusers develop a tolerance, or the need to use larger amounts to achieve the same effects. Addiction occurs when a person requires regular and increasing doses in order to function normally in daily life. Changes in the brain from use of the drug are known to cause uncontrollable drug-seeking behaviors, no matter the consequences.

Users of heroin report feeling a rapid surge of euphoria followed by a pleasant drowsiness. This is accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Initial highs last from 4 to 6 hours, but once tolerance is developed, highs are reduced to 2 to 4 hours.

When heroin enters the brain, it is converted back into morphine, which binds to molecules on cells known as opioid receptors that control perception of pain and reward. These receptors also control processes critical for life, such as blood pressure, arousal, and respiration. Heroin overdoses frequently involve a suppression of breathing, which reduces the amount of oxygen that reaches the brain. This can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, and death.

Naloxone (trade name: Narcan) is a medication used to reverse the effects of heroin. When given intravenously, Naloxone works within 2 minutes, and when injected into muscle, works within 5 minutes. Multiple doses may be required as the duration of action of most opioids is greater than that of naloxone. When given to opioid dependent persons, it may cause symptoms of opioid withdrawal. Small doses administered every few minutes until the desired effect is reached may prevent withdrawal symptoms.

The signs and symptoms of heroin addiction vary among users, but the most common include:

  • Depression
  • Euphoria
  • Dry mouth
  • Warm, flushed skin
  • Constricted pupils
  • “Nodding off” during conversations
  • Shortness of breath
  • Extreme itching
  • Anxiety, hostility, agitation, and irritability
  • Disorientation
  • Hallucinations
  • Paranoia and delusions
  • Track marks on arms and legs
  • Scabs or bruises as a result of picking at the skin
  • Weight loss
  • Decreased attention to personal hygiene
  • Possession of burned spoons, needles or syringes, missing shoelaces, glass pipes
  • Periods of hyperactivity followed by periods of exhaustion and sleeping
  • Apathy, lack of motivation, decline in occupational or academic performance

The effects of heroin abuse differ depending on the length of abuse, amount of heroin used, presence of other substances, and individual health factors. The severity of symptoms tend to worsen the longer the drug is used. The most common effects of heroin addiction include:

  • Liver disease
  • Skin disease and abscesses around injection sites
  • Infections of the valves and lining of the heart
  • HIV, Hepatitis B and C
  • Chronic pneumonia
  • Collapsed, scarred veins
  • Blood clots, leading to stroke, pulmonary embolism, and heart attack
  • Kidney disease
  • Septicemia
  • Respiratory depression
  • Seizures
  • Overdose
  • Death

What's Going On?

Navigating the Road to Accreditation:

With the state of Georgia implementing new regulations on continuing education requirements for nurses, Swank HealthCare has everything you need to meet these requirements by 2016!

More Information »

Top Challenges Faced by Nursing Executives:

Swank HealthCare recently took a poll, asking nurse executives what challenges they face in their daily work routine.

More Information »

Recommended Readings

Top List

Withdrawal symptoms from heroin can develop as soon as a few hours after sustained use. Those with long-term abuse and dependence are at risk of serious medical complications during withdrawal. The most common symptoms include:

  1. Intense craving for heroin
  2. Extreme sweating
  3. Nausea, vomiting, diarrhea
  4. Severe muscle aches and pains, cramping, bone pain
  5. Feelings of heaviness
  6. Crying
  7. Insomnia
  8. Cold sweats
  9. Runny nose
  10. Fever

Now Trending

Test your knowledge of heroin use by answering these quiz questions.

Which of the following groups are at increased risk for heroin abuse or dependence?

A. Men
B. Persons age 18-25 years
C. Non-Hispanic whites
D. An annual household income less than $20,000
E. Medicaid recipients
F. The uninsured
G. All of the above

What percentage of U.S. heroin users report using at least 1 other drug within the past year?

A. 20%
B. 30%
C. 75%
D. 96%

People who abuse or are dependent on opioid pain medications are 40 times more likely to abuse or use heroin. Other drugs also carry an increased risk. Which of the following is NOT one of them?

A. Cocaine
B. Methamphetamines
C. Marijuana
D. Alcohol

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Answer: G – All of the above


Answer: D – 96%. Those that reported using at least 3 other drugs was 61%.


Answer: B – Methamphetamines are NOT known to significantly increase the risk of heroin abuse. Those with cocaine dependence are 15 times more likely to abuse heroin, marijuana - 3 times more likely, and alcohol -2 times.