Mothers that are users in jail do not realize that it affects both of their life. For example, one of the young ladies in the video got a c-section and sugar was put on her scar. A method that was used a long time ago that was not needed because there is new technology. Inmates pregnant or not might receive little to no medical attention when in need .Cutting cost has made a terrible impact on so many inmates. Medical spending dropped thirty million in Arizona. Due to that fifty people died the first eight months of 2013, when in the last two years the total deaths were thirty-seven.

The New Jim Crow is about how the system of mass incarceration threatens to undermine everything that people have worked for. In the last twenty years Amerikka has incarcerated more people than they did in their entire history, due to drugs in low income areas. The prison is basically compared to slavery now a days. The New Jim Crow makes the argument that the war on drugs has become a new system that operates like the old system. There was a report written for the Nixon administration that demonized black people and made them seem as monsters so elections could be won. President Nixon hyped up the publicity and made them think that black people were the number one issue and called the “war on drugs”. Nixon made it seem as if black people were disposable; he made a war on children and women and everyone that was vulnerable in the lower class. The system is designed to break you, you can not rehabilitate yourself once out of prison. You can not get a job because you have a felony, you can not get housing because you are a felon, you can not vote and make a change because you are a felon. The system makes it much harder for convicts to do anything, but supposedly they want them to reintegrate into society even though it is near impossible.

Portugal decriminalized all types of drugs, yet you can still get it taken if you do not obey the amount you are supposed to have. Second offences are punishable by community work or rehab. Prison time and criminal records have been replaced with art classes. They believe that jail is not a realistic approach for a drug addict. Europe is the only country that changed its structures to show that drug use is a health problem rather than a criminal problem.

How do we move on? Obviously big steps need to be made. The first step is admitting the system is corrupt and trying to rebuild something sane from scratch. The next step is to give the low income people a voice and actually help them as well as the children. What makes someone want to sell drugs? Not enough jobs? Discrimination? Maybe Amerikkka can take a look at Portugal and take notes on what works with them and what does not and try to compromise with people.

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How can we overcome this problem of drug abuse and overdosing deaths? Drug addiction is like a chronic disease that need time to heal. People just cannot be cured by stop using drugs for a few days. They need a long-term rehabilitation in order to stop using drugs completely and recuperate their lives. Sometimes they need and repeat care. Prime intervention should be to decrease the number of people abusing drugs and to occupy the ones involved in abusing drugs in dedicated treatment plans. (Hawk, Vaca, D’Onofrio, 2015). People with substance abuse can recover easily but need dedication, strong will, and hard work.

They should first seek help from family and friends because they will provide social support. There are many other options available to help with depression and to control the addiction if a person willing to seek help. There are many recovery centers available to help the drug abusers recover from drug addictions. There should be control over what prescriptions to be given to patients by providers and for how long if those prescriptions are for chronic use. Education should be provided on a community level to all public about drug abuse and overdosing on a regular basis so people are more educated and aware of drug abuse and its negative effects, there should be set medicinal plans for the treatment of chronic pain. (Lloyd, 2016).

Drug abuse and overdosing is a grave issue that must be addressed. Community should be educated on the negative effects of narcotic drugs on the body and mind including intellectual, social, psychosocial, and physical impacts. Primary care providers should be careful when and how much of narcotics should be prescribed, what population should be given prescribed medications for example, cancer patients have the reason to get prescribed medications since they are in lot of pain all the time, or patients on hospice. To avert any unintentional overdoses of medications, in kids or infants’ medications should be kept at safe and secure place at home.

Primary care providers should also be very careful when prescribing medications to younger generation keeping in mind, they can misuse the drugs. People addicted to drugs should seek help from friends and family. They should seek help from treatment centers. Elderly should be educated on names of medications, what do they look like and how to take them since most of the times elderly do not know the names of medication and often mix them with other medications causing overdosing and death. Education and prevention are the key necessary to help the community on drug abuse awareness. If the community is educated people will not abuse drugs and or die of overdosing. There should also be strict laws and regulations and punishment for people abusing drugs because it is not only harmful and risky for them but for other people as well as they can drive under the influence of narcotics and have an accident killing themselves and other people.

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Drug abuse and overdosing in United States has increased drastically effecting the economical, psychological, social, and physiological welfare of community. When we talk about economic impact meaning the cost of buying drugs, ER visit cost, and cost of prison. People spend too much money on buying prescription opioid drugs that is easily available to them through their primary care providers and insurance coverage benefits which is impacting the economy of nation. Not only this, the ER visits due to overdoing on drugs is additional along with prison cost. There are at-least 2-5 patient’s come to the Emergency Room because of overdosing on drugs every single day, not only impacting the economy of the nation but also endangering their lives. The economy of United States lost $218.1 billion dollars due to substance misuse and mental sickness in 1985. (Birkenshaw, 2014). Drug abuse not only impact person economically but also psychologically. These people suffer from intellectual damage, psychological dependence, anxiety, nervousness, depression, delusion, and paranoia with depression being the major problem. Depression occurs when person does not get enough dosage of drug to get high and not able to attain state of euphoria. People abuse drugs to get rid of depression which helps until the user is in state of euphoria. As soon as that state of euphoria ends, user goes through withdrawal symptoms which make depression even worse.

Psychological Impact: Psychological dependence occurs when person is on long term use of drugs or opioids due to some physiological reason for example cancer patients to help with cancer pain or non-cancerous chronic pain due to MVA (Motor Vehicle Accident). Anxiety, nervousness, delusion, and paranoia are all the symptoms of withdrawal that user goes through due to a long-term use of opioids for example, cocaine, marijuana etc. Not only economically or psychologically, a drug abuser also suffers socially and physiologically.

Social Impact: As the drug impact a person’s mind and body, it also impacts their social life, especially their close relationships. Because the drug is an essential part of drug abuser’s life that everything else comes after. The person who abuses drugs acts violently with his/her family to get money to fulfill drug requirement, abuse the family verbally, or even physically. This is the reason there is a high percentage of divorce because drug abusers cannot take care of their family, act violently, and in frustration family quit dealing with such a person. Drug addiction can be very exclusive to the family as the person abuses drugs reach to the point where he starts selling household things to get the next dose. Not only that to get next dose a person can even do illegal activities like robbery and lying to people to get money. There is a high risk of losing a job as a drug abuser cannot concentrate or focus on work. Losing a job can cause further depression and make a person take more drugs. The drug abuser puts his and other people’s lives in danger as they drive under the impact of drugs and often get into an accident causing death. (Ramani, Kasinathan, 2017).

Physiological Impact: When, we talk about the physiological effect, meaning the impact on a person abusing drugs physically. People often gain weight or lose weight when start abusing drugs. They start to neglect their daily activities like grooming, cutting their nails, start ignoring their family and friends, and they go through sleep disturbances. Drug addiction causes reduced memory and a reduction in intellectual abilities by damaging the brain. Not only this person also goes through withdrawal by showing symptoms of withdrawal physically when missing the dose. Withdrawal symptoms could be abnormal vital signs like High Blood Pressure, High heart rate, increase in respiration, the shakiness of hands, irritability, sweating, mood swings, violent behavior, anxiety, pin-point pupil or bloodshot eyes, and possible seizures.

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Buprenorphine is an opioid agonist-antagonist, as it binds the opioid receptors very strongly and out-competes the pure opioids. This provides some safety if a person with opioid use disorder tries to use heroin, fentanyl, or prescription pain relievers while on buprenorphine (National Institute on Drug Abuse, 2018). Also, buprenorphine does not have the same risk of respiratory depression that come with other drugs. People don’t seem to stop breathing when they misuse the buprenorphine, which is what kills almost all people who overdose (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).

Suboxone is a formulation buprenorphine that contains a small amount of naloxone. Naloxone has no, or very little, activity when taken orally. However, if the patient tries to melt the suboxone and inject it to get high, the naloxone is active and prevents the user from feeling any rush, making it less likely to be used inappropriately. Buprenorphine has less abuse potential than methadone, but there have been cases of illicit use now that it is being used more frequently (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).

Narcotics Anonymous

Almost all addicts have done better when prescribed drugs are combined with psychological and social counseling. Narcotics Anonymous is one of the biggest support groups in the nation. It was inspired by the success of Alcoholics Anonymous. Anyone is able to join a group, meaning it is accessible to anyone who believes they need it (Addiction Center, 2018).

Narcotics Anonymous has two meeting styles, including discussion meetings or speaker meetings (National Institute on Drug Abuse, 2018). Discussion meetings model a group discussion, while speaker meetings typically only have one speaker sharing. While sharing is encouraged, it is not enforced. In addition, addicts are encouraged to rely on a higher power to go through recovery with. A higher power can be anything the addict wants it to be; many people say theirs is God (Addiction Center, 2018).

Types of Non-Traditional Treatments

Equine Assisted Psychotherapy

Equine Assisted Psychotherapy has proven effective in addicts, especially youth and adolescent addicts. Addiction affects more than just the body, and in adolescents especially, has major effects on emotional health (National Institute on Drug Abuse, n.d.).

Equine Assisted Psychotherapy focuses heavily on social development, as many adolescents who struggle with drug addiction also struggle with self confidence (Bennington-Castro, 2014). In addition to social development, Equine Assisted Psychotherapy teaches responsibility. Therapists often allow the client to take care of the basic needs of horses, including grooming and feeding. Taking care of something bigger than themself is often both calming and rewarding for clients (Filippides, 2016).

Because it is often difficult for adolescents to bond with a therapist, due to either distrust or defiance, the presence of the horse allows them to connect with the animal in the presence of the therapist (Filippides, 2016). According to the theories of Ivan Pavlov, a physiologist and psychologist widely known for his work in classical conditioning, when the good thoughts are associated with the horse, they will also be associated with the therapist (The Nobel Prize, n.d.). This allows for a connection with both the animal and the person.

While Equine Assisted Psychotherapy has been very successful in alleviating the social effects of opioid addiction, it does not address the physical needs of patients (Foundations Recovery Network, n.d.). Because of this, it is often paired with some type of medication (Filippides, 2016). According to an Eagala study in 2013, children/youth ages 10-18 benefited most among each age group from Equine Assisted Psychotherapy (Eagala, n.d.). This set of data implies that Equine Assisted Psychotherapy may not work well for younger children, but mostly middle and high school students.

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Neonatal abstinence syndrome is a huge problem of concern at a global level.

Life course perspective

NAS affects the infant in a long-term pattern. Starting with neurodevelopmental disorders. Very less has been discovered regarding the association between NAS and the neurodevelopmental delay but according to American psychiatric association NAS can cause intellectual disabilities, disorders related to communication and learning, ADHD, autism spectrum disorder and hyperactivity disorder. (Shearer et al., 2018). A study was done in Tennessee which suggests that NAS babies were comparatively more likely to have a subsequent educational disability. (Mary-Margaret et al., 2011). Another study done in south western border state suggests that NAS babies were more prone to having LBW, respiratory distress and feeding difficulties compared to other newborns (Hussaini & Garcia, 2018).

Assessment of NAS

Infants suffering from NAS are usually assessed using a scoring system called as Finnegan scoring system. It is the most widely accepted measurement for opioid withdrawal. (Timpson et al., 2018). The initial scoring is done during the first hour then it is repeated after every 3-4 hours. This is repeated until 72 hours and if the infant has a history of long-term exposure then it has to be continued for 120 hrs. This scoring system is also used to check the effectiveness of the treatment (Hussaini & Garcia, 2018).

Usually the mother reports herself about the opioid usage, but some physicians often use urine toxicology screening for the suspected drug abuse. The result is useful to know the exact drug that was consumed so to plan the treatment strategy accordingly. The validity of the toxicology test is still a debatable topic. Also, the maternal consent is extremely important before performing any toxicology screening.

Management

Management of infants having NAS depends on various factors like creating a proper physical environment for the infant, having well trained health care team, providing correct medication according to the schedule and using proper assessment tools to check for the improvement and the effectiveness of the treatment. The main treatment goal is to restore the normal activities of the infant like sleeping pattern, weight gain, feeding and swallowing and also protect the infant from the possible complications of NAS.

The management of NAS babies can be divided into two main categories- pharmacological interventions and non-pharmacological.

Non-pharmacological interventions

The first step is creating suitable physical environment for the babies. Recent researches support rooming in that is keeping opioid dependent mother and the infant in same room from birth itself. This kind of practice has various additional benefits like shorter hospital stay, more breastfeeding sessions and lesser NICU admissions. Rooming in is considered over NICU admissions in cases when the infant is born after full term or is completely stable and out of risk. Some of the interventions followed are skin to skin contact, very quiet environment and gentle swaddling. Breast feeding is considered extremely important as it helps to delay the onset of NAS and also helps to decrease the severity of complications (Noah et al., 2018). All the opioid dependent mothers should be encouraged to breastfeed their child, it helps in maternal infant attachment and to enhance normal growth.

Impaired feeding behavior is another remarkable problem in NAS babies. They often tend to reject the nipple, hiccough continuously, spit up or cough. Supplementation can be given to such babies to improve the caloric intake.

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What is a prison? A prison is a building in which people are held legally as punishment for a crime they commited. The purpose of prisons are broke down in four different ways, retribution, incapacitation, deterrence, and rehabilitation. Retribution is giving people punishment for their criminal act. Taking freedom away from criminals is a way for them to pay back to society for their offense. Incapacitation is taking criminals off the street away from society so they are no longer able to harm innocent people. Deterrence is when one discourages future crimes by instilling fear or doubt of consequences. And lastly, rehabilitation refers to restoring someone's mental or physical health through activities.

Over 2.2 million people in the United States are incarcerated, that is 25% of the world's prison population, while only home to 5% of the world's population. ? of released inmates are incarcerated within three years with an even worse crime. There are over 5,000 jails and prisons spread across the country. There is one main difference in jails and prison. Jails hold people who have a short sentence or are awaiting their trial, while prisons hold inmates that are incarcerated long term.

What is the purpose of prisons?

The current US prison system is not what it is supposed to be. The purpose of prison is to rehabilitate criminals so they can be reintroduced into society as a better person, but the US seems to put punishment before rehabilitation. Stripping criminals from their freedom is a way of making them pay their debts to society. Incapacitation ensures the safety of innocent people by removing criminals from the society. The hope for prison is that it provides a warning to those thinking of committing a crime, and could possibly discourage them from breaking the law. Prisons are supposed to provide their inmates rehabilitation activities, which are meant to change them into law abiding citizens. Some of these activities include, educational courses, teaching skills they need for a job, and counselling with a psychologist. Getting a college degree in prison is the only thing that has been 100% effective for decades in preventing reincarnation. But the offenders leaving prison now are more likely to have fairly long criminal records, lengthy histories of alcohol and drug abuse, significant periods of unemployment and homelessness, and a physical or mental disability. In California, less than $3,000 per inmate per year was spent on rehabilitation. 50% of prisoners released the year before had not participated in a single program.

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In the US, the controversy surrounding the use of e-cigarettes is more of a moral panic than any research-based fact. There is still so much that is not known about e-cigarettes, especially about long-term use, but the premise of the argument in the US seems to be based upon the notion that vaping is a gateway to smoking, and that young people are more likely to try regular tobacco cigarettes after trying e-cigarettes. As a matter of fact, research focused on smoking substitutes in the US has been largely narrowed down to the potential for children to become heavy users due to the fruity flavors that e-cigarette offers; the potential for kids to try and become hooked on smoking; and the effects that vaping may lead to cardiovascular diseases, a total contrast to the debate in the UK.

This argument is in total contrast to the UK, where statistics have shown a steady decline in smoking since 2014.

Stan Glantz, a tobacco control expert at the University of California San Francisco said:

“To say something is only two-thirds as bad as cigarettes – it’s like saying jumping out of the 20th story isn’t as bad as jumping out of the 30th story.”

He added: “The number of people left in the world who think e-cigs are harmless is getting to be a very short list, and it happens there’s a bunch of them in England. The number of people going around who say we don’t think e-cigs pose any risk is diminishing” [The Guardian]

It appears that vaping and smoking are lumped under the same umbrella and are not seen differently as in the UK. New York is the newest member of the 11 states to ban vaping. This ban came into law after Governor Andrew Cuomo accented to a bill that prohibits vaping at workplaces, bars, and restaurants – The Guardian

The ban on vaping has been welcomed by prominent voices of the anti-tobacco movement. One of such key voices is the executive director, Matt Myers, of the Tobacco-Free Kids campaign based in Washington DC, referred to the ban as “not only appropriate but important”.

“New York is not first to do this,” said Myers. “What we have found is when protecting people against any toxins indoors, you set a clear standard that both protects non-smokers and further de-normalizes any tobacco use.” [The Guardian]

The US National Institute on Drug Abuse has issued a warning concerning e-cigarettes stating that they may contain “potentially toxic metal nanoparticles”. The agency also stated that vaping “might be less harmful than cigarettes”. There is absolutely no doubt that more research will be required to ascertain what the long-term effects of vaping are.

Things are not likely to change much in the US concerning vaping, in fact, we are likely going to witness stiffer regulations to curb it, but with more open conversations and seeing vaping for what it really is, then it might become more acceptable. Also, as more countries like the UK record more successes with the reduction in smokers and a decline in smoking-related disease due to the use of e-cigarettes, there will definitely be a shift in the perception of e-cigarettes in countries like the US. 

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What is MDMA

Methylenedioxymethamphetamine (MDMA), is an illegal, synthetic drug referred to on the street as Molly, the powder or crystals often used in capsules or Ecstasy, the pill or tablet form (MDMA: Everything You Need to Know, 2018). According to the National Institute on Drug Abuse (NIDA), MDMA acts both as a stimulant and hallucinogen which produces energy; yet, it can alter both time and perception (Ecstasy, 2018). MDMA is mostly used as a recreational or party drug which is known to elevate feelings of euphoria, enhanced pleasure and allows users to be more empathetic with others. Although MDMA can be snorted or smoked, it is commonly taken orally, in pill form (NIDA, 2018). MDMA is thought to have the stimulation effects of methamphetamine, as well as the halogenic effects of mescaline (Ecstasy, 2018).

The Creation of MDMA

MDMA has been in existence since the beginning of WWI and patented in 1914, by Merck, a German pharmaceutical company hoping it could prevent blood clots but, since it was proven ineffective, it was overlooked until 1953, when an Army Chemical Center began testing its toxicity by giving it to animals. In 1976, MDMA was reported and published by Alexander Shulgin as a psychoactive drug to humans upon ingesting it himself. Before the publication, it was said that MDMA had surfaced underground and was quickly banned because of the threat of it becoming another street drug such as its predecessor, LSD (Eisner, 2013). After being considered to have no medical use and a high potential for misuse, the United States listed MDMA as a Schedule I drug in 1985, making it illegal for any type of use.

Uses of MDMA

An in-depth study of MDMA users in the United States revealed that the majority were employed college graduates living in large metro areas with an annual income under $40,000.00. In 2013, the National Survey on Drug Use and Health (NSDUH) reported over seventeen million Americans reported having used ecstasy with the highest use being those between 18-25 years old (MacLauren, 2017). Ecstasy became popular among partygoers early 1991 in the United States once English rave promoters and DJ’s began surfacing in California. Among the largest raves was in San Francisco by a group called Toontown (Eisner, 2013). The rave culture was notorious for using MDMA, as well as other psychedelics.

MDMA is used in raves and other party scenes as a means to enhance interpersonal skills and to better enable the user to relate to and communicate with others. It has also been said that MDMA can increase the user’s empathy and affection by releasing serotonin and norepinephrine while producing subjective prosocial feelings (Hysek, et al., 2014).

Effects of MDMA

Within about forty-five minutes of consumption, the user may begin feeling the effects of MDMA. Some of these effects can include but, are not limited to a sense of self-confidence, heightened sociability, emotional warmth, compassion towards others and a willingness to exchange emotional reminiscences (Bershad, Miller, Baggott, & de Witt, 2016). According to a study carried out to evaluate the changes of a person’s perception of others based on looks and behavior after using MDMA, it was noted that upon use of a single dose, the individuals experienced increased level of trustworthiness and increased empathy (Bershad, Miller, Baggott, & de Witt, 2016).

Although, these side effects may seem pleasurable and harmless, MDMA can also produce adverse effects. Based on research gathered from eighty-eight PubMed articles, it was noted that thirty-three articles concluded the following:

Preclinical and clinical molecular imaging studies on the effects of ecstasy/MDMA use administration on neurotransmitter systems show quite consistent alterations of the 5-HT system. Particularly, in human studies, loss of SERT binding was observed in heavy ecstasy users, which might reflect 5-HT neurotoxicity, although alternative explanations (e.g. down-regulation of the SERT) cannot be excluded (Vegting, Reneman, & Booij, 2016).

MDMA, in some cases have been known to increase the heartrate, cause profuse sweating (which could lead to dehydration), Excessive sweating and dehydration could cause the individual to overheat, convulse and/or seize. The increase in the body’s temperature could lead to organ failure and in some cases, death. It has also been reported that some users clench their teeth and have chills. Frequent users of MDMA have reported withdrawal symptoms including depression, fatigue, suppressed appetites and difficulty thinking. Since most MDMA users are polydrug users, it is difficult to estimate how many deaths are solely related to the use of MDMA. Although the United States does not track MDMA related deaths, it was reported that the first death was believed to have occurred in 1987, and in 2009, the United States reported that MDMA was responsible for about fifty years per year. However, since the use of MDMA has increased, the number of deaths may have also increased (Rigg & Sharp, 2018)

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Addiction is so complex, and opioid addiction, especially, is really hard to get rid of for good. Many people describe addicts as “once and addict, always an addict.” The initial use of opioids causes a rush, a euphoria, and feeling of wellbeing that is very stimulating the the reward and pleasure center in the brain, causing a physiological addiction. It is very powerful, and begins to change the brain’s neurochemistry from the first use. Over time, that rush and euphoria starts to fade. Users are always trying to recapture their first high, which is why they are constantly increasing their dosage (American Addiction Centers, 2018).

The danger comes when the brain realizes that its normal function is being blunted by the drug, because it increases a number of receptors to include those that sense pain and those that give you energy and motivation. The longer the drug is used, the more these receptors are increased. At this point, the addict is in a situation where they depend on the drug to feel healthy. When they don’t use opioids, those increased receptors are still active; the increased pain receptors make the addict feel pain; the increased energy and motivation receptors make the addict feel agitated, antsy, and shaky. Those biochemical changes take a long time to fully recover, if ever (National Institute on Drug Abuse, 2015).

There is also a psychological component, which can be just as harmful for some addicts. The things that led them to use opioids in the first place can be remain such strong triggers for relapse, such as friends, locations, romantic partners, other psychological diseases or disorders, past trauma, stress, homelessness, joblessness; the list goes on. These can be reminders of why they started in the first place, and make the addict feel the need to go back to the perceived safety or comfort that the drug provided them (Psychology Today, n.d.).

The United States needs to break the stigma that surrounds addiction, particularly opioid addiction. It affects all walks of life, no matter what race, religion, color, creed, sexual orientation, or age. Some start use on the street, but the majority start using from legitimate prescriptions, out of curiosity, or a desire to party. Suddenly, they are hooked and can’t stop. Nobody starts with the desire to completely destroy their lives. These people have a disease, and society needs to treat them the way society would treat somebody with cancer; people need to treat them with support and focused care.

As a country, the United States needs to try to eliminate the illicit drugs from entering the market. Similarly, hospitals and doctors need to be smarter and safer in their prescribing of these drugs. Small amounts of the least potent opioid should be used for the shortest time possible and only when absolutely needed. The United States needs to work on developing better pain medications that are not opioids and that have little to no risk of dependence. 

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Adventure and Wilderness Therapy

Adventure therapy is a method of combining healing exercises with outdoor activities. Each activity is guided by a therapist, and the activities can take place individually or with a group. One of the most popular methods of wilderness therapy is therapeutic camps. Therapeutic camps date back to the 1800s, and have been used ever since. The point is to get away from their everyday life and focus on the nature around them. This is important for addicts, as many of them lead very stressful lifestyles (Learn Through Experience, n.d.)

Much like therapeutic camps, adventure therapy is meant to take the patient out of their comfort zone and bring them somewhere outside of their normal life. Adventure therapy pushes the patient to learn more about both their environment and themself. Leadership is one of the main skills people take away from adventure therapy. There are many different kinds of adventure therapy because different patients have different fears or interests. Some of the most popular methods include rock climbing and ropes courses (Learn Through Experience, n.d.).

Art and Music Therapy

Art therapy has a heavy emphasis on self expression, and is popular throughout each age group. The therapy is guided by a therapist, and it usually takes place one on one. One of the main goals of art therapy is simply relaxation. There are three different types of art therapy, including self-expressive art, art studio, and legacy projects. Self-expressive art and art studio are the more popular types, as they predominantly focus on how the patient is feeling in the moment. Legacy projects, however, focus on memories. The style of art therapy that the patient chooses really just depends on their background and the details of their addiction (Hope Healthcare, n.d.).

Like art therapy, music therapy focuses on relaxation. Patients, accompanied by a therapist, listen to music, and oftentimes are encouraged to create their own. Many patients enjoy writing songs and performing them to the therapist. Music has many physical effects on the brain and releases endorphins when people hear music they enjoy. This is what causes the positive symptoms like relaxation and contentedness. While the meetings with the therapist are critically important to improving, patients are encouraged to listen and create music outside of therapy sessions as well (Hope Healthcare, n.d.).

Virginia Efforts

The state of Virginia has taken several approaches to address opioid addiction in the commonwealth. According to Tina Pullen, the Public Affairs Officer for the Norfolk Field Office of the Federal Bureau of Investigation, Virginia is a leader in addressing the opioid epidemic. From the Governor of Virginia, who is a pediatrician, to the Virginia Attorney General and the United States Attorney, there is a strong sense of urgency at every level of government to address the crisis T. Pullen, personal communication, November 2, 2018).

This is exemplified, for example, by Virginia’s initiative to spearhead statewide change in education curriculum both at the K-12 level and in higher education. More emphasis has been placed on education about opioids and the hazards associated with its use as opposed to focusing on the traditional DARE program. Additionally, there has been an improved response capability by the law enforcement and first responders community. Naloxone is more readily available and coordination in investigations and the responsibilities of the first person to respond to a scene involving opioids are being handled in an unprecedented way. Also, the medical community in Virginia has changed the way they treat pain and has led efforts to incorporate comprehensive opioid education and training for medical and nursing students. Furthermore, the outreach groups have engaged the faith-based community and initiated social media efforts to crowdsource awareness and information sharing (T. Pullen, personal communication, November 2, 2018).

In the Coastal Plain region of Virginia, the Virginia Attorney General and the United States Attorney for the Eastern District of Virginia teamed up in 2016 to form the Hampton Roads Opioid Working Group. The Hampton Roads Opioid Working Group is a community-based group of action oriented members who are dedicated to reducing the number of opioid related deaths by addressing the demand side of the threat through community awareness, medical community innovation and leadership, and through the support of service based organizations and treatment facilities. The group is made up of members of the law enforcement community, educators, medical professionals, peer recovery specialists, and outreach coordinators. Since September 2016, it has met regularly to address all angles of the epidemic (T. Pullen, personal communication, November 2, 2018).

Because of all of these changes, Virginia was able to report that opioid related deaths in Hampton Roads went down 17% in 2017 (T. Pullen, personal communication, November 2, 2018).

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Detoxification involves clearing the body of opioids, or any drug for that matter. The process is often extremely mentally taxing and physically painful. Because of this, some people pair detoxification with medicine to help cope with the pain (Goodman, n.d.). Detoxification should not be confused with treatment, as it only addresses the physical side of opioid addiction (National Institute on Drug Abuse, 2018).

Naloxone or Naltrexone Therapy

Naltrexone is a once monthly injection form of Naloxone. Naloxone and Naltrexone are opioid antagonists, meaning they bind to the receptors in the brain where opioids do damage and block the activity of the drug (The National Alliance of Advocates for Buprenorphine Treatment, n.d.). Naloxone and Naltrexone are very attractive, and they bind to the receptors so strongly that they remove the opioid and block it from re-binding (Bloom, 2018). This is why Naloxone works in an overdose (Harm Reduction Coalition, n.d.). If an addict tries to use heroin, fentanyl, or prescription pain relievers, they will not work if Naltrexone is in his or her system (Tate, 2018). Naloxone or Naltrexone Therapy are only successful in very motivated individuals who have a lot to lose if they continue to use or work in sectors where other Medically Assisted Treatment modalities are not acceptable, such as pilots or physicians (National Institute on Drug Abuse, 2018).

Methadone

Methadone, at its core, is really just a substitution of one opioid for another in a controlled, safe, and monitored environment. Methadone is a long-acting opioid agonist. Because of its long duration of action, it doesn’t produce the same high and euphoria as heroin, oxycodone, fentanyl, etc. The goal is to give it at a dose that keeps the patient from feeling withdrawal and craving, but still allows them to function, hold a job, etc (Ambardekar, 2017).

The danger of the drug is that Methadone can be abused. For example, it can be crushed and injected. It doesn’t relieve the patient of their addiction, but refocuses their addiction on something less destructive (National Institute on Drug Abuse, 2018). Methadone maintenance therapy can be quite effective. It decreases homelessness and joblessness among users, as well as decreases the spread of HIV and Hepatitis C (Ambardekar, 2017).

Buprenorphine

Buprenorphine is commonly known as Suboxone. It binds the same receptors as other opioid and has some opioid properties; however, it produces about half the effect of other opioids. Buprenorphine is an opioid agonist-antagonist, as it binds the opioid receptors very strongly and out-competes the pure opioids. This provides some safety if a person with opioid use disorder tries to use heroin, fentanyl, or prescription pain relievers while on buprenorphine (National Institute on Drug Abuse, 2018). Also, buprenorphine does not have the same risk of respiratory depression that come with other drugs. People don’t seem to stop breathing when they misuse the buprenorphine, which is what kills almost all people who overdose (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).

Suboxone is a formulation buprenorphine that contains a small amount of naloxone. Naloxone has no, or very little, activity when taken orally. However, if the patient tries to melt the suboxone and inject it to get high, the naloxone is active and prevents the user from feeling any rush, making it less likely to be used inappropriately. Buprenorphine has less abuse potential than methadone, but there have been cases of illicit use now that it is being used more frequently (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).

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The Opioid Crisis began in the 1990’s and has continued to ravage the United States ever since. Currently, more than 115 Americans die each day from overdosing on opioids (Kurland). That’s more than 12 deaths every minute. The first wave of the the opioid crisis caught the attention of Americans when opioid related deaths skyrocketed in the late 1990’s. Many of these deaths can be attributed to the major increase in prescription rates for opioid painkillers. Doctors and surgeons around the country began increasing prescription rates due reassurance received from pharmaceutical companies that the risk of addiction from opioids was very low. Throughout the 90’s, pharmaceutical companies also advocated that opioids should be used for non-cancer pain, despite the lack of data on the problems that this could create. “By 1999, 86% of patients using opioids were using them for non-cancer pain” (Liu, History of the Opioid Epidemic). In 2001, Purdue Pharma spent $200 million to market OxyCotin (an extended-release opioid), resulting in a massive prescribing increase from roughly 600,000 to over 6.2 million annual prescriptions (Weiner). Due to the marketing and acceptance of opioids for non-cancer use, pharmaceutical companies began greatly increasing the amount of opioids that they produce. According to Scott Weiner, “Distribution of opioids through the pharmaceutical supply chain increased from 96 morphine milligram equivalents per person in 1997 to 700 morphine milligram equivalents in 2007, an increase of more than 600%.”

This massive increase in opioid production is tearing apart many towns across the United States. One place this can be see is in the town of Williamson, West Virginia, a small coal mining town with a population of about 3,000. “According to an Investigation by the House Committee on Energy and Commerce, from the years 2008 to 2015 drug wholesalers provided two pharmacies, only four blocks apart, with more than 20.8 million prescription painkillers” (Gutierrez). That’s more than 6500 painkillers per person! The two pharmacies in Williamson were Tug Valley Pharmacy and the Hurley Drug Company, each taking in more than 10 million pills. How could these companies possibly receive this volume of pills? Did the drug wholesalers not feel as what they are doing is unethical? Did shipping this many pills to so little people raise ANY flags to the DEA? These are questions that we all want the answers to after learning the number of pills that were received in Williamson. In a town that had already struggled with addiction, it’s as if these wholesalers are putting salt on an open wound. These selfish acts by the drug wholesalers pushed West Virginia to have the “highest fatal drug overdose rate with 52 per 100,000 people in 2016, far outpacing Ohio, which had the next highest at 39.1 fatalities” (Gutierrez). There’s no doubt that these numbers are outrageous, and “If you’re trying to figure out how to get rid of the epidemic, trying to figure out how to resolve the problem, start with the prescription” (qtd, Gutierrez).

When opioid production is increasing at such an alarming rate, far more Americans that just the individuals who are prescribed are greatly affected. Many of the opioids prescribed by doctors seemingly find their way into the hands of others through drug diversion. Drug diversion is the concept involving the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. As more and more opioids are being produced and prescribed, the amount of drug diversion that occurs increases as well, resulting in an even wider scale of substance abuse. By 2015, an estimated 2 million people in the United States had a substance abuse disorder linked to prescription opioid painkillers (Kurland). Addiction to opioid painkillers poses a serious risk of overdosing. In 2016 alone, there were 19,354 overdose deaths involving opioid painkillers (National Institute on Drug Abuse). The graph below, provided from the National Institute on Drug Abuse, shows how opioid overdoses have increased drastically from 2002-2016 and how they will continue to harm our country if the crisis isn’t contained soon.

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However, if the drug was legalized and sold by public dealers, the government can have more control of the drug composition. Stores wouldn't likely add rat poison to the drug or any other dangerous substance since the consequences for lacing weed would be high. Wouldn’t it make more sense for smokers to get their drug in a safe legal form than from a dealer illegally with the risk of poison or other toxic chemicals? A lot of the people who are against the legalization of the drug worry about the health costs that come with the drug. First off, just because the drug isn’t legalized doesn’t mean there aren’t people who get sick from using drugs. You might think that even though that is true, there will be more users of the drug so there will be more health issues. However, as mentioned above, the use of the drug decreases when it is legalized, so theoretically there should be fewer issues.

Also, for people who do decide to use marijuana, their health insurance will cover them less, which means, in the end, the risks they take with the drug will mostly have to be covered by themselves, holding them accountable for their actions and likely making them more responsible. One last point to prove that the health costs won’t be a big issue with legalization is the statistics comparing the health costs of drugs versus alcohol. The difference in cost between health issues that are drug-related and those that are alcohol-related is about 50%. We legalized alcohol years ago knowing that drinking came with risks, so how come legalizing marijuana is such a big deal? The statistics show that marijuana actually causes fewer issues plus on top of that you have the health benefits that come with legalizing the drug, something alcohol doesn’t have. So yes of course with marijuana comes health costs, but the costs would not increase, it would likely decrease with legalization and the costs wouldn’t even be comparable to those of alcohol use. This chart shows the difference in health costs between drugs and alcohol. Another reason a lot of people are against legalizing marijuana is because they believe it will make their cities and neighborhoods less safe. This assumption is actually false. First off, when people don’t have to illegally buy the drug, it eliminates the issue of people having to sneak around with the drug. They can simply ring it into their house and keep it there without any issues.

Also with the market for marijuana being moved to public stores, it eliminates a lot of the dealers that could be in your city and neighborhoods. Another way it actually makes your communities safer is that it is shown with legalization there is a decrease in criminal activity. In Portugal where they legalized drugs, the “proportion of offenses committed under the influence of drugs and/or to fund drug consumption dropped by half” (Law Enforcement Against Prohibition). In Switzerland, a program was created to allow people to take drugs in special areas, including jails, so that they could be monitored and evaluated. The people participating in this program showed a decrease in felony crimes by 60% and a decrease of 80% for those who were in the program for over a year. If a safer community is something you are in favor of, then you should consider voicing your support for marijuana legalization. To recap, the advantages to legalizing cannabis is endless. Legalizing the drug is what the majority of the people want. Could this be because of the medical and economic advantages? Or could it be because use and overdose of the drug decreases while the amount of help for drug users increases? Or maybe it’s because of the added safety to the drug and neighborhood. Or maybe all of the above! So what can you do to help legalize the beneficial drug? You can write letters to your local governments or even the federal office. You could speak your mind in public about your opinion of legalizing the drug. You could get involved in an anti-prohibition group near you. You could vote for candidates who are fighting for the new laws allowing marijuana. It takes you, yes you, to help America get to legal marijuana. So get out there fellow marijuana supporters and help us all get to a better time- weed appreciate it!

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There are so many other success stories out there, just like the ones of Diaz and Graham. With all the positive benefits being seen by users and scientists, why wouldn’t states at least offer the drug as an option for medication? More and more states are legalizing marijuana, both medically and recreationally, but for those who haven’t, they’re only causing themselves more expenses that could be eliminated by legalization. The list of costs for keeping up with prohibiting the drug goes on and on. First off you have the court time and police time used up by keeping up with the drug laws. In addition to that, the prisons are fuller and the crime rates are higher.

When the state doesn’t have to spend as much tax money on arresting and imprisoning users, you have more available money to be used on a more important issue. One last lowered cost is the cost of health services and state provided welfare programs. Not only by legalizing the drug do you reduce or eliminate a lot of costs but you also get the income made by stores who sell the drug. So why do states keep wasting all their money on a lost cause? This image shows that the price to keep marijuana legal is much higher than the cost of legalizing it medically or recreationally. If marijuana is legalized, it is proven that addiction and drug use decreases, especially in teens. An example of this is in Portugal, where they legalized all drugs for adults. Since the legalization, there has been a decrease in drug use and addiction in the youth. They also found that people, in general, tend to be less likely to be addicted to drugs when the government isn’t forcing them to avoid drugs. Clare Wilson talks similarly about how legalizing the drug decreases the number of youth users.

With legalization often comes a minimum age limit making it harder for teens to get their hands on the drug. For all of those who are worried about legalization because they don’t think more people should be taking and abusing the drug, they have no reason to worry because legalization has proved to do just the opposite. For those who are going through addiction and need help, legalizing the drug increases the chances that they’ll get the help they need or have the help available. From 1998 to 2008, the number of drug users getting treatment jumped 62% even though the number of people using drugs didn’t change at all. So why were more people finally getting help? It’s because the people getting the help were in places where the drug was legalized.

When you eliminate the fear of getting arrested for using the drug, people are more likely to seek help. Also in places where the drug is legalized, states make more places to get help available. Legalizing marijuana can lead to those who desperately need help with addiction to have less fear when they get the help that might save them from worse consequences later. One last advantage to legalizing marijuana is when it is sold publicly, the drug contents can be more controlled. Recently, it has been more common for drug dealers to sell laced marijuana, meaning they combine other drugs with the weed without informing their customers. One of the most common chemicals mixed in is rat poison, which is deadly and very dangerous. An article by Time in 2018 writes that in Illinois, laced marijuana has killed three people already. In addition to the deaths, there have been more than 100 cases of severe bleeding in five states including Illinois. These patients often face symptoms including “coughing up blood, blood in the urine, severe bloody noses, bleeding gums and internal bleeding” (Tanner).

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Thirty-three states currently have medical marijuana legalized and ten of those states have also legalized the drug for recreational purposes. Imagine your state legalized marijuana both medically and recreationally. The gas stations start stocking the drug. Your best friend’s anxiety improves. Your wife starts to sleep all night. Your brother becomes financially stable with no more smoking tickets. Your cousin finally isn’t scared to get the much-needed drug abuse help. Should marijuana be legalized? Of course, it should be legal. Marijuana can help improve the health care pathway, benefit the US economy and help solve other issues. These benefits from legalizing marijuana give justification for the legalization of the drug for those who are at least eighteen or need it medically. On July 4, 1776, America and its people earned their freedom. Part of being a free citizen in America is being part of democracy.

So if people are the voice of the country, why isn’t medical and recreational marijuana legal with the majority agreeing that it should be? According to a video by the New York Times in 2018, about 85% of adults believe medical marijuana should be legalized. Not only do most adults agree with legalization, but about 67% of adults also believe the risks of the drug don’t outweigh the benefits of the medicine. The majority of people also think recreational marijuana should be legalized. According to the Gallup Organization, about 61% of people think the drug should be legal. This number isn't biased to a specific gender or ethnicity though. About 64% of men and 57% of women agree with pleasurable pot. The percentages for Whites, Blacks, and Hispanics are also all over half. So with a clear majority advocating for putting the pot into play in a place known for giving the people say in politics, why is it still illegal in the majority of states?

Medical marijuana, which is only currently legal in 66% of the states, has been proven to have many positive health advantages. Cannabidiol (CBD), a cannabinoid in weed, which doesn’t get the user high has been proven to have many concrete benefits. First off, CBD has been proven to be good for its anti-inflammatory and pain relieving properties. CBD is also able to reduce anxiety, insomnia, and symptoms due to multiple sclerosis. The drug has also been known to help with childhood epilepsy. Nate Diaz, a professional mixed martial artist, used CBD to treat some of his symptoms of concussion and chronic traumatic encephalopathy (CTE). Another chemical in marijuana that is known to have healing powers is Tetrahydrocannabinol (THC). THC is a drug approved by the Food and Drug Administration and used to help people with nausea and decreased appetite. Mike Graham, a patient with a bad case of degenerative spine disease began to take medical marijuana when doctors offered him 14 different medications that came with the risk of paralyzation or weed. After he began to take three to four puffs of the drug twice a day, he was able to get off all but one of his medications. The six-foot-tall man went from 135 pounds to 250 pounds and is still continuing to gain appetite.

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It is impossible to determine the contents of heroin on the streets because they are cut with other substances. Films like Pulp Fiction, Trainspotting, and deaths of popular celebrities like Kurt Cobain and Mac Miller. One of the dangers of heroin cause individuals to become physically and psychologically dependent and interfere with the normal functions of life. Very rarely, people use heroin and don't develop an addiction but usually get hooked after their first time using. A quarter of the people develop a dependency on it. There are many treatments available to help battle heroin addiction. What you experience during heroin addiction treatment varies on the individual. Factors like the length of use, amount of use, and the environment. Recovery will depend on the ability to understand and cope with challenges and any other issues, like mental disorders, that may contribute to the dependency.

Residential treatment centers, rehabilitation services, therapy, and 12 step programs like NA are available. The first step is admitting that one has a problem and then it's withdrawal. This withdrawal time allows for chemical withdrawal from the drug. To free the body of the mind and mood altering substance. Prescriptions for methadone or suboxone can be obtained medically to help with the symptoms of withdrawals. However, the MAT medications need to be monitored so there is no abuse to them. As the withdrawal symptoms come to an end, therapy should be started. Programs and therapy are essential to the recovery process. It allows a place of security and non-judgment. Families of heroin addicts tend to go to therapy also, to cope with the family changes and challenges. Staying connected to an outpatient program is important in recovery. Medically Assisted Heroin Detox, cognitive behavior therapy, 12 step programs.

Education lectures, counseling and family therapy are all sources available. Heroin/opioid addiction is serious and treatable but not curable. There is so much help available to anyone who has a problem. Education is key to treating opioid addiction. Harm reduction programs help minimize the worldwide effects of heroin use. Many people argue the federal government should battle the public health crisis. As of January 2018, there is no head of the DEA as overdoses are on the rise. The federal government needs to rethink their mission to battle this epidemic. The Food and Drug Administration keeps approving and marketing new highly addictive opioids to the marketplace. More availability of opioids gives greater risk for abuse. AS the DEER tries to limit manufacturers of pills and crack down on doctors and illegal drug dealers, other forms become available. There needs to be more authority to impose change.

Funding is also under control of multiple departments in the government. The task should be to educate health professionals and take begin new testing approaches to this epidemic and manage better treatment plans. In times of crisis, a major change needs to happen and leadership needs to be announced. The DEA, FDA, law enforcement and National Institute of Drug Abuse and Substance Abuse Mental Health Administration along with the Center for disease control should work together. We need to change how this country views addiction and how to prevent addictions worldwide epidemic. The programs for treatment and prevention will cost billions of dollars. Without centralizing responsibility and finding the right leadership, we will lose much more than money, we will continue to lose lives and society will continue to break down.

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Withdrawals symptoms of heroin are harsh and can make some fear stopping. Drugs like methadone and Suboxone and Buprenorphine are used to help battle and overcome addiction. These medicines are to help block the receptors in the brain so no physical symptoms are prevented and reduce the cravings. If these medicines are taking correctly, it can help addicts function normally. These treatments need to be maintained and supervised. Although for use of these medicines, you need to be withdrawing off heroin, it will help the ease of the rest the existing withdrawal symptoms. Withdrawing of heroin is painful and intense. Users begin to experience withdrawal symptoms within 12 hours of their last use. Heroin leaves the body faster than most other drugs and that is why withdrawals are more intense.

Symptoms include, nausea and vomiting, insomnia, agitation, diarrhea, dilated pupils, sweating, anxiety, abdominal cramping, and muscle aches. While the symptoms are intense, then the length of withdrawals depends on many factors. Depending on how much you use and how often affects the withdrawal symptoms. The effects of moods and behaviors can last for months even when withdrawal symptoms pass. Some long-lasting symptoms might include anxiety, depression, fatigue, insomnia, and irritability. It usually takes about a week to go through withdrawals physically because of the effects of heroin withdrawal, it leads to a relapse at times. With the increasing epidemic, the public and government began to become concerned. Naloxone has been made to help with the survival of overdoses on heroin. Today, a number of people have accessibility to Naloxone. Naloxone is a medication that reverses an opioid overdose. It's an antagonist, that blocks receptors and reverse the effects of opioids. It can quickly restore a person back to response. There are three forms that Naloxone is available in. They are injectable, auto-injectable and a nasal spray. Depending on the state you live in, depends on who can dispense Naloxone. Here in NYS, Naloxone is extremely safe and people should be observed for at least 2 hours after its dispensed. Heroin for decades has been the most commonly used opioid illegally. The supply in the US has soared and death rates have increased. Drug overdoses are now today's leading cause of accidental death. Reducing heroin addiction and overdoses, public awareness and support, emergency medical departments, and medical doctors to work together. There should be more access to MAT treatment and counseling with behavioral therapy to help in the battle of addiction. Heroin seems to get popular every few decades. Starting in the 1970s then taking a backseat to crack. Now, the heroin epidemic is on the rise.

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