Heroin is a highly-addictive illegal opiate drug synthesize from morphine. It can be found as a white or brownish powder, or as a black sticky substance known as black tar heroin. The drug can be smoked, snorted, or dissolved in liquid and injected. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that heroin is one of the most addictive drugs of abuse, with 23 percent of users becoming dependent on the substance.
Heroin in the U.S.
According to SAMHSA, 4.8 million people in the U.S. have used heroin at least once, and about 435,000 of these people are regular users of the drug. On average, a heroin user first tries the drug at 28 years old.
Between 2007 and 2013, heroin-related deaths more than tripled in the U.S.; the number of heroin-related deaths in 2013 was 8,375. Young adults are at the highest risk of heroin overdose, largely due to high rates of use in this age group, and the likelihood to combine heroin use with other substances.
Path to Heroin
Sometimes individuals begin on the road to heroin use by abusing prescription painkillers like oxycodone or Vicodin. When they are no longer able to locate or afford prescription painkillers, they turn to heroin as a cheap, readily available alternative. In fact, people who first become addicted to prescription opioids are at a higher risk of subsequently becoming addicted to heroin.
Heroin & Co-Occurring Disorders
Research has shown that certain psychosocial characteristics may be associated with heroin addiction. Risk factors include:
- Mental health disorders (depression, anxiety, PTSD, etc.)
- Chronic or severe pain
- Early tobacco, alcohol, and drug use
- History of child abuse, sexual trauma
- Poor health, illness, or injury
- Family history of addiction (genetic predisposition)
- Delinquent behaviors, dropping out of school
Effects of Heroin Use
Dopamine & Pleasure
According to the National Institute on Drug Abuse (NIDA), heroin affects the brain and body by binding to opioid receptors within the central nervous system. The drug causes levels of a neurotransmitter called dopamine to rise, which is responsible for feelings of pleasure and reward. With frequent use of heroin, the body becomes desensitized to naturally occurring levels of dopamine, and high levels of the drug must be used in order for the individual to feel pleasure.
Short-term effects of heroin use include:
- Surge of pleasure, or “rush”
- Flushed skin
- Dry mouth
- Heavy feeling in extremities
- Severe itching
Heroin Use: Damage Over Time
Repeated heroin use damages most of the major organ systems of the body. Some of the changes heroin causes in the body and brain may be permanent. When heroin is used, the bloodstream carries it to every major organ, including the lungs, heart, liver and kidneys. Drug use may weaken the heart, leading to heart failure. The liver and kidneys process every substance that enters the body, and repeated exposure to heroin can do permanent damage to these organs, even leading to cirrhosis.
Dangers from Long-Term Use
Long-term effects of heroin use include:
- Brain damage, which may be permanent
- Lowered decision-making abilities
- Decreased impulse control
- Physical dependence, tolerance
- Damage to major organs
- Depression, other mental health disorders
- Sexual dysfunction
- Irregular menstrual cycles
Heroin addiction can easily lead to an overdose of the drug. Overdose can occur at any time – with first-time use or with those who have developed a high tolerance to heroin. Risk of overdose is especially high if a relapse occurs after a period of sobriety. Because tolerance can decrease quickly after a period of abstinence, the person may overdose on an amount of heroin that was once well tolerated. Oftentimes, overdose fatalities occur after a period of sobriety.
Overdose Warning Signs
Symptoms of heroin overdose include:
- Shallow or stopped breathing
- Dry mouth, bluish nails and lips
- Pinpoint pupils, tongue discoloration
- Low blood pressure, weak pulse
- muscle spasms, drowsiness
- Constipation, stomach cramps
- Delirium, disorientation
- Coma, death
The first step in recovery from heroin addiction is often detoxification, or detox. This is the process by which the body rids itself of all addictive substances. If the individual is physically dependent on heroin, the detox process will include withdrawal. Withdrawal is the collection of symptoms that occur when the body adapts to functioning without a drug present.
Heroin withdrawal, while extremely unpleasant, is not life-threatening. The National Library of Medicine lists the following symptoms of heroin withdrawal:
- Agitation, anxiety
- Muscle aches, sweating, goosebumps
- Runny eyes and nose
- Dilated pupils
- Insomnia, yawning
- Abdominal cramping, diarrhea, nausea
- Dilated pupils
Physical symptoms of heroin withdrawal may be unpleasant and typically begin within 12 hours of last use. Treatment for heroin withdrawal should include medical supervision, supportive care, and a safe environment.
Medication & Detox
In some instances, medications may be given to ease specific withdrawal symptoms. Clonidine is most commonly used for this purpose. This medication reduces anxiety, muscle aches, sweating and cramping. Sometimes, long-term replacement medications, like methadone or buprenorphine, which mimic the effects of opioid drugs, may be used during heroin detox and recovery.
Treating Heroin Addiction
Treatment for heroin addiction typically incorporates both behavioral therapy and medications. For many people, utilizing both therapy and medication is more effective than either approach alone.
Medication Assisted Treatment
According to NIDA, pharmacological treatment of heroin addiction helps increase treatment retention and decrease drug use. Medications can help lessen symptoms of withdrawal and prevent relapse, making it more likely that the individual will complete treatment with a firm foundation in recovery.
Opioid Treatment Programs
Some drugs are used on a long-term basis during heroin recovery. Certain drugs, called agonists or partial agonists, mimic the effects of opioid drugs. Methadone, the most commonly used medication in the treatment of opioid addiction, is an agonist. This medication is taken orally and affects the brain slowly, preventing the high associated with heroin. It lessens symptoms of withdrawal and prevents cravings, which can reduce the chances of relapse. This medication is only available through licensed methadone clinics, and patients must visit the clinic daily to get their prescribed dosages.
Medication for Cravings
Buprenorphine is a partial opioid agonist. It mimics some of the effects of heroin, but to a lesser degree, which lessens cravings and withdrawal symptoms. This drug is often combined with naloxone, which helps to prevent abuse of the medication. Buprenorphine is available via a doctor’s prescription and can be taken at home, unlike methadone.
Blocking Effects of Drug
Antagonists are drugs that block the effects of heroin and similar drugs. Naltrexone, an opioid antagonist, isn’t often used on its own to treat addiction. The drug is used to deter individuals from relapse. Naltrexone is not addictive and does not cause physical dependence, but compliance with this treatment is low.
Counseling & Behavioral Therapy
Many different methods of behavioral therapy have been shown to be effective in heroin addiction treatment. Besides group and individual counseling, Cognitive Behavioral Therapy (CBT) is one of the most commonly used types of behavioral therapy. CBT teaches clients to recognize damaging or harmful thought patterns that often result in substance abuse. In place of these thought patterns, the client learns coping techniques that can help prevent future drug use. Once a person can identify triggers that prompt heroin use, that person can learn how to avoid or manage those triggers, thereby reducing the likelihood of succumbing to the triggers.
Treatment customized to the individual following medical and psychological evaluation may bring about better treatment results and progress. Throughout the treatment stay, as the person progresses, this plan will likely be amended to accommodate new and changing treatment goals.