Detailed Outline

Bailey Nixon

Purpose: The purpose of my capstone is to inform and bring awareness to the impacts of the
United States heroin epidemic.
Thesis: Since the 1960’s, the use of heroin has evolved into a nationwide epidemic focused
less on race and socioeconomic status, and more on opioid prescriptions and biological
dependence.

● Background on heroin epidemic

○ Source: “The Changing Face of Heroin Use…”
■ Study done to show how heroin use has changed over the past 50 years
■ Found that it has changed from an inner city problem to outer city
problem
Includes stats on who, when, and how they started using
■ Used self administered surveys
■ “Respondents who began using heroin in the 1960’s were predominantly
young men (82.8% mean age, 16.5 years) whose first opioid use was
heroin. However, more recent users were older (mean age, 22.9 years)
men and women living in less urban areas (75.2%) who were introduced
to opiods through prescription drugs (75%). White and nonwhites were
equally represented in those initiating use prior to the 1980’s, but nearly
90% of respondents who began use in the last decade were white”
■ “Changed from an inner-city, minority-centered problem to one that has a
more widespread geographical distribution, involving primarily white men
and women in their late 20’s living outside of large urban areas”
● This article perfectly demonstrates the shift in the heroin epidemic
that I discuss in my thesis. It shows how the epidemic is no longer
an issue focused on race and in large cities, rather it occurs to all
ages, races, sexes, and in less urban areas.
○ Source: “Increasing Prescription and Opioid…”
■ Study done with individuals between 1947-1964 and 1979-1992
■ Found that both age groups were exposed to potential opioid deaths
Discusses need for intervention at the end
● Includes information on the ages, races, and sexes of users; can
help deriving the low income city stigma of heroin addictions
○ Source: CNN’s “This is America On Drugs”
■ Includes a lot of graphs/visuals on where the epidemic is and who it is
affecting
■ Good outlook on WHY this is an epidemic
● Very effectively targets places this epidemic is located, shows it is
not a city issue, rather a nationwide one
● Biological causes of a heroin addiction
○ Source: “Immune Function Genes, Genetics…”
 ■ “The neuroimmune system of the nervous system that help regulate
immune responses, and in particular the innate immune system, play a
role in the development of addictions, including alcoholism, particularly in
the context of stressful situations”
■ “A regulatory protein called nuclear factor-kB, activates many innate
immune genes. Innate immune gene induction in certain brain regions, in
turn, can disrupt decision making, which is a characteristic of addiction to
alcohol and other drugs”
■ “Postmortem analyses of human alcoholic brain als have demonstrated
increased expression of innate immune genes, which can disrupt
cognition, mood, and drug consumption and is consistent with addiction-
like behavior”
● This article helps when aiding my argument about the biological
causes of a heroin addiction. This can be used to discuss genes
that influence addictions.
○ Source: “Dealing with Addiction”
■ “In this theory, dopamine release along this pathway triggers sensations
of reward and pleasure. Illicit drugs work by increasing firing of
dopaminergic neurons, or inhibiting the breakdown or reuptake of
dopamine”
■ “Feeding into both centres is the insula, which interprets incoming
sensations as subjective emotions or feelings, that are then projected to
the higher brain centers. This stress, sleep deficits, or drug deprivations
may be interpreted as an urge or a craving”
● This article explains the dopamine theory, a biological cause of
drug and alcohol addiction. It will be very effective when
explaining how addictions can be biologically caused, not through
previous drug users.
○ Source: “Dopamine Receptor D4…”
■ “Significantly higher levels of DRD4 and CpGl and CpG4 methylation
were detected in Meth and heroin addicts compared with controls”
■ “A positive correlation between DRD4 CpG5 methylation level and
depression-dejection was observed in male heroin addicts”
● This article aids my thesis by addressing the biological
components to an addiction. It describes the effect of dopamine
receptors on the uses of meth and/or heroin.
● Prescription causes of a heroin addiction
○ Source: “Don’t Blame Pain Pills…” (REFUTATION)
■ “Opioid addiction and opioid-related deaths typically involve multi-drug
users with histories of substance abuse and psychological problems”
■ “Addiction occurs in only a small percentage of persons who are exposed
to opioids-even among those with preexisting vulnerabilities”
■ Studies in North Carolina and Massachusetts
 ● While this article acts as a rebuttal from my prescription causes, it
still highlights the larger issue of this epidemic and shows that this
is a current problem including all races and socioeconomic
statuses.
○ Source: “The Epidemic as Stigma…”
■ “An increase in opioid prescribing beginning in the 1990s was a major
driver of the status of opioid-related harms, particularly with the
aggressive marketing of long-acting oxycodone”
■ “It is the stigma of opioid use, addiction, and historically stigmatizing and
criminalizing attitudes toward people who use drugs that has led to
societal inaction on opioid-related overdoses for decades”
● This article provides an interesting perspective on the stigma of
heroin addiction. The researcher also includes information on
prescription to addiction pipeline. I can use this for my thesis
where I explain how the epidemic has evolved.
○ “The Changing Face of Heroin Use…”
■ “There is growing evidence that some prescription opioid abusers,
particularly those who inhale or inject their drugs, gradually shift to heroin,
at least in part because it has become more accessible and far less
expensive”
○ Source: “Durkheim… And Heroin Addiction”
■ Include information on the immediate and long lasting side effects
■ Include information on religious piece on page 101
● This article includes information on the effects of a heroin
addiction and explains the addiction through the lenses of two
different psychologists.
○ NEED MORE SOURCES
● Rehabilitation of a heroin addiction
○ “Mortality risk among heroin abusers”
■ “In spite of the constant rise in the number of treated patients, many of
them do not turn to a public treatment center for their drug addiction”
■ “The study also shows the existence of a large groups of problematic
consumer with a high death risk directly correlated to the use of drugs
who do not turn to public health facilities for help with their addictions, not
even after suffering from major health problems”
● This article features a study done in Europe about addicts who did
or did not admit themselves into public treatment centers. I can
use this information to support my thesis because it features both
men and women from different ages suffering from rehabilitation
of their addiction.
○ “Heroin abuse: nurses confronting”
○ “Prefrontal cortex AMPA”
■ “Rats developed a stable preference for the active, heroin-paired hole.
The number of nose-pokes in the actve hole increased substantially when
 the fixed ration was doubled from FR1 to FR2 and from FR2 to FR4,
confirming the motivational drive to self-administer heroin.”
■ “Rats that were not exposed to the cues served as controls. These
conditions induced robust relapse to heroin-seeking in both the
abstinence and extinction groups”
● This article will help prove my thesis because of its reference to
the biological aspects of addiction. Through this study with rats, it
was concluded that relapse occurs frequently with exposure.
○ NEED MORE SOURCES
● Overdoses from a heroin addiction
○ “Frequency of non-fatal heroin overdose”
■ “23% of heroin users reported at least one overdose (98/432)”
■ Include more statistics on overdoses
● This article helps to establish that overdoses are nationwide and
occur with all demographics.
○ NEED MORE SOURCES
● Conclusion