What is a Heroin Addiction?

What is Heroin?

Heroin is a highly addictive opiate drug. 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.

Who Abuses Heroin?

According to SAMHSA, 4.8 million people in the US 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 US; 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.

Sometimes, individuals being 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 cheaper and often easier to obtain alternative. In fact, people who first become addicted to prescription opioids are at a higher risk of subsequently becoming addicted to heroin.

Research has shown that certain characteristics are associated with heroin addiction. If a person presents with these risk factors, addiction to heroin may be more likely:

• Mental health disorders, such as depression, anxiety, and suicidal ideation
• High levels of pain or chronic pain
• A history of alcohol or other drug abuse
• Poor health, illness, or injury
• A genetic predisposition toward addiction
• Associating with individuals who use illicit substances during childhood, particularly between the ages of 12 and 17
• Experiencing discrimination
• Cynicism and high levels of anger
• Early use of tobacco, heroin, or other opiates
• A history of polydrug use, particularly combined inhalant and marijuana use
• Having been in jail or a detention center
• Multiple delinquent behaviors, such as fighting, carrying guns, selling illicit substances, or stealing
• Access to heroin through friends or acquaintances
• A history of child abuse
• Dropping out of school

Effects of Heroin Use

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

Short-term effects of heroin use include:

• A surge of pleasure, called a rush
• Flushed skin
• Dry mouth
• A heavy feeling in the extremities
• A surge of pleasure, called a rush
• Flushed skin
• Dry mouth
• A heavy feeling in the extremities

Over time, repeated heroin use damages 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.

Long-term Effects of Heroin Abuse

Long-term effects of heroin use include:

• Brain damage, which may be permanent
• Lowered decision-making abilities and impulse control
• Tolerance
• Physical dependence
• Nausea
• Vomiting
• Severe itching

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.

Symptoms of heroin overdose include:

• Shallow or stopped breathing
• Dry mouth
• Pinpoint pupils
• Tongue discoloration
• Low blood pressure
• Weak pulse
• Bluish nails and lips
• Constipation
• Stomach cramps
• Coma
• Delirium
• Disorientation
• Drowsiness
• Muscle spasms

Heroin Withdrawal

The first step in recovery from heroin addiction is often 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
• Runny eyes and nose
• Insomnia
• Sweating
• Yawning
• Abdominal cramping
• Diarrhea
• Dilated pupils
• Goosebumps
• Nausea
• Vomiting

Symptoms of heroin withdrawal typically begin within 12 hours of last use of heroin. Treatment for withdrawal typically involves medical supervision and supportive care. As with all opiates, medical detox is always needed for heroin withdrawal.

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.

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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

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.

As mentioned, 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.

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.

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.

Therapy

Many different methods of behavioral therapy have been shown to be effective in heroin addiction treatment. 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.

Most often, therapists utilize a variety of techniques in addiction treatment, depending on their specialties and the specific client in question. Upon admission, the treatment team will work to develop a tailored treatment plan for the individual. Throughout treatment, as the person progresses, this plan will likely be amended to accommodate new and changing treatment goals.

Heroin addiction is a pervasive, debilitating disease that affects every area of an individual’s life. While recovery can be difficult, it is very possible with comprehensive treatment.

How Long Does Heroin Withdrawal Last?

Heroin withdrawal includes the set of symptoms that appear after a person builds up a dependence on the drug with regular use. Withdrawal symptoms from heroin can be significant, and the drug should not be stopped “cold turkey,” or suddenly, for this reason.

The severity of the emotional and physical withdrawal symptoms and cravings make it difficult to stop using the drug without professional help. The National Highway Traffic Safety Association (NHTSA) states that heroin withdrawal begins within 6-12 hours after the last dose of the drug, generally peaks within the first 2-3 days, and lasts about 5-10 days on average.

Heroin Withdrawal

Heroin is a central nervous system depressant drug that slows heart rate, respiration levels, and blood pressure, and lowers body temperature. It also increases levels of dopamine in the brain, which is what is responsible for the intense, euphoric, and rapid “high” the drug can produce.

When heroin is taken on a regular basis, the brain can become dependent on the drug and stop producing normal levels of dopamine on its own. This can cause extreme emotional lows, depression, suicidal thoughts, and anxiety during withdrawal, or when the drug wears off. Physically, blood pressure, respiration and heart rate, and body temperature may spike without the drug’s suppression of these autonomic functions. Other symptoms of heroin withdrawal include:

• Insomnia
• Restlessness
• Agitation
• Irritability
• Loss of appetite
• Difficulties concentrating
• Watery eyes
• Runny nose
• Tremors

Replacement Medications and Impact on Withdrawal

Medical detox programs, which often use substitute medications during withdrawal, impact the withdrawal timeline and decrease the intensity of the negative side effects. During medical detox, heroin may be replaced with a different, longer-acting opioid drug, such as methadone or buprenorphine, to control the severity of the withdrawal symptoms.

Buprenorphine is considered to be safe and effective as a replacement for heroin during treatment for dependency, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) when it is combined with therapeutic and supportive methods. Buprenorphine is a partial opioid agonist, meaning that it fills opioid receptors, like heroin does but to a lesser extent. This can keep cravings and intense withdrawal symptoms at bay without producing a euphoric high.‍

When a replacement medication is used during detox, it will be slowly tapered off over a set period of time until it is no longer taken at all. This method of detox ultimately lengthens the withdrawal timeline since a person isn’t technically fully detoxed until they are no longer taking the replacement medication, which can take months or even years. That being said, replacement medications can greatly alleviate the intensity of heroin withdrawal and promote long-term abstinence.

Some withdrawal symptoms, such as executive functions, anxiety, sleep disturbances, and depressed moods, may extend for a few months after stopping a drug like heroin, and SAMHSA refers to this extended form of withdrawal as protracted withdrawal. Medications for specific symptoms, therapy, and ongoing supportive care can help to control and manage these withdrawal symptoms.

In general, heroin withdrawal is optimally managed through medical detox and continued therapeutic, supportive, and pharmacological methods.