University of Cincinnati 2016

Conversations about Life

HEROIN PROBLEMS IN
COMMUNITIES

AN ANALYSIS OF CURRENT HEROIN PROBLEMS

AND SOLUTIONS FOR SMALL CITIES

Tobin Anderson 1

Heroin Problems in Communities

There is a common problem among many states and communities inside of
America that has been steadily growing: drugs. The problem can be considered a
problem of addiction, enforcement, or general health depending on moral viewpoints,
and is a much contested issue in current political climates. The impact of policies and
changing times can be seen nationwide, but the changes that are most apparent are
differences that come in ones small community. In Washington Court House, Ohio,
much like other small towns in Ohio, heroin has caused many differences in the lives of
those who reside there. The city has expressed needs for improvement, but the
methods of improving are forever under scrutiny and debate. In order to understand the
best ways to fix the broken system, large scale solutions need to be understood and
applied in ways in which small communities could effect change.
History of the War on Drugs
For a background to the current American sentiment of drugs, the beginning of
the war must be analyzed. Richard Nixon, former President of the United States,
professed in 1971 his opinion on drugs in America. Nixon is quoted saying Americas
Public enemy number one in the United States is drug abuse. In order to fight this
enemy, it is necessary to wage a new, all-out offensive. This idea was conceived
around 60 years after Americas very first law against narcotics, which focused heavily
on punishing only sale and therefore pharmacists and doctors which prescribed
narcotics (The United States War on Drugs). Despite Nixons own admittance only
months later of futility in completely eradicating drugs, he pressed on to create the Drug
Enforcement Agency in order to drive drugs out and stop Mexican supplies of illegal
substances. This view of Nixons on hard drugs has largely been maintained for the

Tobin Anderson 2

past forty years on a national scale as is shown by the amount incarcerated for drugs in
past years with 1,561,231 arrests in 2014 for drug violations, which is higher than in
2013 where the number of arrests was 1,501,043 (Crime, Arrests, and US Law
Enforcement). Still, the DEA is a very well-funded and active part of our executive
branch, proving that the war which Nixon declared is still ongoing and affecting our
justice system.
It is plainly obvious that not only is the rate of incarceration problematic, but also
the rate of use and death from opiates is astonishingly high in America. In 2011, 11
Americans died every day from heroin overdose, (What Can We Do About the Heroin
Epidemic, 2016) and that is the equivalent of a person dying from overdose every two
hours. This value has been on an increase for a long time, increasing by 119% since
2006. It has been suggested that this change has come from a shift from more
accessible opioids to heroin as it became cheaper and easier to find.
National Examples of Policies
The War on Drugs, as it is commonly known, has caused much political
controversy since its declaration not only in America, but elsewhere in the world.
Countries around Europe show a huge variety of policies and opinions about the
problem of drugs. In order to group types of policies, three groupings can be used to
classify policies: repressive, preventative, and free-use. Repressive policies are what
are most common in America and places like Sweden, where attempts to assist drug
users are seen as acceptance of the use and therefore immoral. Preventative polices
would not allow drugs to be legal, but provide assistance to users despite illegality.
Free-use policies allow the legal use of drugs. A mix of all three types of policies can be
seen and analyzed from a few places: Sweden, Portugal, and a places in America.

Tobin Anderson 3

Starting with one extreme, Sweden, much like America, has taken a hard push to
end the prevalence of drugs in its borders. In Sweden The ultimate aim is a society in
which drug abuse remains socially unacceptable, (Costa 15, 2007) meaning that the
goal is to have drugs illegal and citizens not want to abuse them anyways. In the
1980s, drug use increased in drastically along with the need to find a solution. A more
preventative solution which was used, and actually created in Sweden was a
methadone treatment center for abusers. Although this program seems very open to
use, penalties for any possession at all were increasing every year, with new laws which
steepened jail time for even minor offences were being placed by the government
(Costa 5-18, 2007). The approach was deemed successful by the United Nations report
on drugs in Sweden, as use began decreasing and is at a much lower rate for every
drug other than cannabis than the average for the EU (Costa 40-55, 2007). The biggest
problem found with the Swedish model of drug policy is the likelihood of drug users to
become problematic users. Between 1 out of 5 and 1 out of 6 drug users in Sweden
(annual prevalence) is a problem drug user, (Costa 49, 2007) but it then compares this
figure to the UK which is around 1 in 12 users being problematic. This can be
interpreted as either Sweden failing to stop the most dangerous users or the Swedish
taking the use of drugs much more seriously than other countries of Europe. There had
been almost no policies in place at the time of the report that could even slightly
resemble enabling the use of drugs in Sweden other than the methadone treatment:
there were no needle exchanges or safe shooting areas. The overall outlook of how to
beat the drug problem seems much like America: almost a war against the public
perception and use of illegal drugs, but it worked in Sweden.

Tobin Anderson 4

An example from closer to the free-use side of the discussion is Portugal. In

2001, all drugs were decriminalized, meaning those who deal or attempt to smuggle
drugs are still hunted and punished, but those who are just carrying less than a 10 day
supply are usually allowed to go unpunished or pay a very small fine. The number of
deaths from HIV or overdose have dropped dramatically since the decriminalization and
the total usage has not grown, and maybe even dropped on average (Peerson and
Aleem, 2015). Obviously, incarcerations due to drugs has decreased significantly
because it is no longer illegal to possess, but there is another effect that results from
this decrease in incarcerating drug users; the police force has been able to focus on
protecting people in a way that does not target the possibly harmless drug users, and
instead on possible threats to the livelihood of people in the area. The decriminalization
alone may not have succeeded in doing any good, but no empirical evidence is
available of the effects that that could have had because Portugal also put social
programs in place alongside the decriminalization. There was a large shift in how drugs
were controlled: no longer was the justice system responsible for drug users, but the
Ministry of Health came to the aid of the user with public health at the forefront of their
policies (Peerson and Aleem, 2105). So, decriminalization was a part of a larger shift
that resulted in the ne positive change.
Current American Policies
In America, there are multiple examples of each type of policy. Alcohol was once
dominated by a regressive policy, but has since been given mostly free-use and there
have been problems with how society views alcohol. Preventative measures have been
taken in multiple states with needle exchange programs. In Ohio, the laws were
changed just over a year ago to allow local health departments to conduct needle

Tobin Anderson 5

exchange programs without declaring a public health emergency (Tucker, 2016).

These programs are helping to curb the HIV spread that could possibly be happening
without the 54 thousand needles given to heroin and prescription drug abusers every
month. Along with needle exchanges, the health departments also add services like
test[s] for HIV and Hepatitis C, overdose prevention, and drug treatment referral
(Tucker 2016). Cleveland, Cincinnati, Columbus, Dayton and Portsmouth all have these
needle exchange programs in place, but smaller cities have very little access to this
type of funding, so the preventative measure is not a comprehensive policy. The
regressive policy is the category by which most laws in America could be characterized.
Almost every drug that is not prescribed by a doctor is illegal and holds jail time, and
many states still allow no prescription of drugs considered to be too dangerous, like
Ohio with marijuana. Specifically with heroin, minimum sentencing for any amount of
heroin is 5 years in prison by federal law. America has a very mixed set of policy types,
just like many other countries, but the mix has not been working (What Can We Do
about the Heroin Epidemic).
Effects of Heroin and Medicine
Heroin is labeled as an opioid, which means that it is a compound which
connects to the opioid receptors in the users body: it ultimately relieves pain or all
normal feeling depending on the strength and dosage of the opioid. Many drugs given
by doctors or first responders for intense pain are opioids, but this may be the start of
the heroin problem. The drugs that keep the feeling of pain at bay can become addictive
to the user and be craved and used past the time for which the doctor intended it
(Ratini, 2106). Another effect of opioid use, though, is slowed breathing. The only
problem with the slowed breathing is that if you take too much of [an opioid], your

Tobin Anderson 6

breathing may stop and you could die (Ratini, 2016). It is very dangerous to become
accustomed to large doses of heroin, because of this effect of slowed breathing and
death, which has been on the rise in America since the early 2000s. In fact, heroin
deaths since 2002 were multiplied by four by 2013 (Ratini, 2016). Despite the fear of
death, people have still been using heroin more and more, and it is likely due to the
cheap prices and ease of access to those most susceptible to the abuse of heroin.
Opioids taken in excess, even heroin, do not have to be deadly, though. There is
actually a very effective drug which has been created that nullifies the effects of opioids
and can save lives. Currently, there is a drug called Naloxone that reverse[s] the effects
of an overdose of heroin or some types of painkillers (Ratini, 2016). Naloxone has been
used by medical professionals to save those who overdose and are brought to the
hospital for years, but public availability is still very limited. Due to regressive measures,
the allowing of free purchase of the cure to heroin is seen as possible acceptance of the
choices of those who abuse the drugs. But, some more preventative policies are in
place in some states that allow the family of an addict to carry an injectable version of
Naloxone. This allows them to save the lives of the family member if a hospital is not in
easy reach during a possible crisis of overdose.
Common Abusers
To end the problem of drug abuse, just as with any business plan, the main target
for a project must be found and focused on. Heroin is a very inexpensive and widely
available drug to people looking for alternatives to other opioids. In a small town in
central Ohio called Washington Court House, the city which this essay is focused on
and inspired by, a young man by the name Taylor passed away in 2014 from overdose
of heroin. In just the three weeks predating his death, six people had died from heroin

Tobin Anderson 7

overdose in a city of 13,000 people ("Community Takes Action to Fight Heroin

Epidemic"). Taylors mother spoke out about heroin, and spoke of the fact that her son
began abusing heroin at the age of 18. This is not an anomaly according to CDC
statistics. Taylors mother also made a terrifying statement that Heroin is easier to get
in this town than beer. ("Community Takes Action To Fight Heroin Epidemic"). From
first-hand experience, this is very true for this small town: heroin is available to anyone
prepared to purchase it for the prices set.
Heroin is a growing trend, but the most surprising part about its growth is the
demographics over which it is growing most. It is quite often assumed to be abused
most by lower class minority men, but this is not a factual observation. A study by the
US News based on CDC statements has shown that the most common age of use has
dropped from the range of age from 35-49 to the range of age from 20-34 as time has
gone on from 2004 to 2011. This is not the most common age group for abuse of heroin.
When looking at race, non-Hispanic blacks were the most prevalent users in 2000, but
this has shifted to non-Hispanic Whites being a very large majority of heroin users in
2013. In fact, the total amount of non-Whites who claim to use heroin has decreased
significantly while whites have nearly tripled in the amount of users. By geography, the
Midwest and northeast dominate in use of heroin as of 2013. Each of these figures is
from the US News report on heroin. The CDC says males, non-Hispanic Whites 18-25year-olds and people living in large metropolitan areas are at the most risk for heroin
addiction, which covers most of the U.S. (Cook, 2013). The problem of heroin is more
widespread in the U.S. than ever, because it is striking at the average person in
America.
The Call for Cities without Drugs

Tobin Anderson 8

The Office of National Drug Control policy released a journal in 2005 which
attempted to answer the question of how major cities should handle the drug problem
that had been growing, but had not yet reached the levels of use found today. Looking
at the stance now provides some context for possible solutions and government
positions, but combing the information with the knowledge gained in the 10 years since
the publication can create a full picture of a possible solution for communities to take to
solve the growing problem of heroin abuse and move forward as a city without the
continuous fight against growing drug abuse.
To begin to understand the paper, one must first analyze the preface for the
purpose behind the publication. In the forward, Walters, the director of the Office of
National Drug Control Policy, states that working together and uniting as a community
can allow that community to make any objective happen. Directly following this
statement, though, is a statement of less happiness. He says Among the biggest
threats facing our cities, towns, and neighborhoods today is illegal drug abuse. Drugs
destroy lives and spoil the quality of life for entire communities (Walters 1, 2015). This
preface leaves the true intent slightly mysterious but that reflects the office which
Walters is directing.
The paper also admits that the policies of governments cannot fully effect
change, and that it takes communities actively supporting the measures for success to
become a reality. This creates a problem, though, if the community does not align with
the governments opinion on drug policy. If a community wants to fully rid itself of the
problem of illegal drugs, though (assuming the drugs are illegal), compliance with the
government regulations will be the only method of doing so, because the government
agencies decide what is and isnt an illegal drug.

Tobin Anderson 9

For the purpose of this section, the compliance with government laws will be
assumed for the communities which are acting towards ridding the problem of drugs
from the cities.
Walters agency calls communities to fill what is lacking in the attempts to work
together and create a cohesive program: the paper says that what is needed is
effective collaboration and coordination among the various entities involved in the antidrug effort (Walters 4, 2015). What is often missing in community efforts is not the
passion or willingness to work, but the communication between people to work together
and not as separate forces. It is important to find a common ground to work with when
bringing together a group of people of any size behind an effort.
In Washington Court House, this exact push was used to try to gain support and
cohesive pressure against the spread of heroin when over 100 people gathered at the
city schools gym for a rally against the epidemic led by Police, medical personnel, and
influential city members (Community Takes Action to Fight Heroin Epidemic, 2014). This
attempt was met with difficulty when so few turned up to join the movement, but that is
the largest challenge to finding collaboration: finding people willing to sacrifice for the
common work.
In order to beat this lack of motivation, the leaders of the community need to find
a more effective way of gaining the support of the patrons of the community: this can be
done through many effective means of encouragement. Unfortunately, the most
effective is likely a crisis coming to a head that affects the patrons needed to create the
change.
The Cities without Drugs papers also try to help leaders lay the foundation for the
change that they want to make by first deciding exactly what the substance abuse in the
area is like: for Washington Court House, heroin is growing and overdose is also. More

Tobin Anderson 10

importantly, though, the exact target of the efforts must be established in order to pull
together the collaborative effort necessary to bring change. An important realization,
though, is the necessity to not assume that the entire problem can be faced at once:
drug abuse is much too complex for one sweeping program to fix, so realistic goals
need to be used to fight specific issues with logical methods.
On a community wide scale, a small group of people leading will be necessary to
create a structured system of operation so that everyone can be focused on the goal,
much like a company or government agency. The guide to reducing substance abuse
logically calls for a system made of people that are representative of the population of
the community, because the target audience of the program will not be as likely to
respond if the people interacting are not from the same environment as them (Walter
10, 2007).
The full structure, though, likely needs to have a committee that steers the rest
of the program. This should be a group of 10 to 12 key individuals who have contacts
and skills needed to assess the local drug situation (Walters 10, 2007). For smaller
locales, though, this number should be lower as 10 people would be too much for a
town of 13,000 people. The steering committee will advise all other groups to reach
better cohesion. A working group should be recruited that have people who are
knowledgeable about substance abuse to work more closely with those who will be
doing the laborious jobs. Those jobs should be done by task forces; task forces should
be created for each effort and dedicate all available time to that specific task. These
forces could be made up of law enforcement, medical workers for treatment, and
possibly people to work on housing and teaching (Walters 10-11, 200).
Once a group is assembled, a strategy must be found which can assist the
community in a way that reaches the goals set by the group. There are many possible

Tobin Anderson 11

ways to effect the change necessary to solve the problem of drugs in small cities. The
main options available to American cities today to face heroin fall under regressive or
preventative policies. The three possible options are providing treatment resources,
hurting the economy of the drug market, or providing education. (Walters 19, 2007)
Disrupting the drug market is the most difficult of these for small towns, as the
economy doesnt fluctuate near enough in small communities because other
communities near can likely provide cheaper options. Markets are much too
complicated for a small group to handle.
Providing treatment for heroin abusers is the next option, and this has been done
in multiple cities. Needle-exchange programs have been the most effective, legal
method of providing heroin users with ways to be less likely to die due to the drugs. This
was already looked at for Ohio, and it has been successful, but this is difficult for small
towns due to funding problems with very little money to work with.
Education is more likely than not the best solution available to small cities to
begin a shift away from the harmful abuse of drugs which has been plaguing many
towns in Ohio. Education programs have been put in place nationally before, and the
effectiveness has been shown lacking more than effecting change. Previously, the
D.A.R.E. program has been used to attempt to educate students about the dangers of
drug use, but the program was ineffective overall (West, 2004). There was almost no
real change in abuse whether or not students were taught through the program, but the
total use in the nation continued to rise, so a new approach to teaching may be
necessary.
D.A.R.E. tended to focus on showing the possible destruction of oneself that can
happen if drugs are abused, but a new focus on teaching actual effects of the drug and
cases in that town of abuse going wrong could be the most beneficial to educate the

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public well. A group of people dedicated to this education which comes directly from the
community is necessary to bring about change for the small locales.
In order to make changes on a small scale like towns, one must comply with the
national laws in place, but fight for change there, also. If no change can be brought
about on larger scales, the small scales can do best to either treat abusers or educate
people before they can begin to abuse he harmful drugs.

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Tobin Anderson 13

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