Heroin is an opioid drug with highly addictive properties. The use or abuse of this drug can result in unwanted and wide-ranging repercussions, including the need for treatment at a rehab facility. The semi-synthetic opiate is derived from morphine, which in turn is produced from opium poppy plants. Use of the drug has a number of consequences that extend beyond the individual, including family and society in general. Heroin is among the leading narcotics that are smuggled all over the world.
Medically speaking, heroin use can lead to health conditions that range from hepatitis to HIV or AIDS. The social consequences are also huge as it causes a massive negative social impact by acting as a catalyst for the growth of crime and violence. This drug has been known to cause disruptions within families, at the workplace, and on academic campuses, notching up huge expenses on individuals and society as a whole.
Most of the world’s heroin supplies are produced in South America, with some countries in Southeast Asia making up the rest. In its purest form, the drug is white and powdery. It is bitter to the taste. However, the heroin that is generally available on the market for sale is not pure as it is frequently mixed or ‘cut’ with additives such as sugars, powdered milk, starch or quinine. Heroin is identified by its white or brown powder form. The money raised from illegal sales are known to finance terrorist organizations and warlords in underdeveloped countries.
Use or abuse of this drug is indicated in two ways. Firstly, the physiological signs that the body displays when exposed to heroin. The second type is related to behavior and appearance.
Initially, it is quite possible that no outward symptoms are visible. This is partly because many people take a lot of care to hide drug abuse. But with prolonged use, it becomes more and more difficult to hide the signs. The signs of heroin usage are revealed through a combination of physiological symptoms and physical signs.
The physiological symptoms include:
The visible symptoms include:
In 2017, nearly 494,000 people in the United States (12-years old or older) reported using heroin in the past year, which is an estimated rate of 0.2 per 100 persons.
In 2015, 81,326 emergency department visits occurred for unintentional, heroin-related poisonings in America, which is an estimated rate of almost 26 per 100,000 people.
Heroin-related overdose deaths increased five-fold from 2010 to 2017.
During 2017, over 15,000 people died from drug overdoses involving heroin in the United States, a rate of almost 5 deaths for every 100,000 Americans.
In 2013, more than nine in 10 people who used heroin also used at least one other drug.
Among new heroin users during 2000 to 2013, approximately three out of four report having misused prescription opioids previously.
When heroin enters the blood stream, it binds itself to receptors of the brain. This results in the release of dopamine into the blood, leading to a sense of high or good feeling. Since the effect is temporary, craving will take effect, resulting in increased use and tolerance, which can lead to dependence.
The fallout of using opioids (especially heroin) is that as time passes, the brain’s ability to produce dopamine gets negatively affected. In turn, there is an increased likelihood of substance abuse to maintain the levels of dopamine in the bloodstream.
Many times, people who have been prescribed legal medications such as painkillers and sedatives for other health problems end up with a dependence to the drug. For too many people, once access to prescription drugs ended, they turned to heroin.
Heroin is sold by many names such as Mexican brown, smack, junk, china white, chiva, black tar, and skag.
This drug is injected, sniffed, snorted or smoked. Some people use heroin mixed with crack cocaine in what is known as speed-balling.
Highly purified heroin is snorted through the nose and can be smoked as well. Pure heroin is produced in sophisticated laboratories where purification processes are perfect. Impure heroin is the result of crude processing methods. Most heroin is impure heroin. Such heroin is generally diluted and then injected directly into the muscles or veins or even under the skin.
When heroin is ingested into the body (either by syringe or smoked), it causes two types of effects. The first sense of the drugs effect is immediate and lasts for a short span of a couple of minutes at most. This feeling is also called a ‘rush’ and envelops the entire body in a sensation. The peak of the rush is felt most in the abdominal region. The second effect felt -a ‘high’- usually lasts between four to six hours. Here, a warm and pleasant feeling is experienced, however, the person remains indifferent to all kinds of stimuli, external as well as internal.
Depending upon the mode of ingestion, effects can set in as early as seven to eight seconds or as late as ten to fifteen minutes.
Many people believe that a heroin use disorder can be effectively removed only after undergoing the worst possible experiences. However, it has been shown that people respond best to substance abuse recovery programs where they are treated with respect, dignity and love.
According to studies conducted by the Centers for Disease Control and Prevention, those who misuse prescription pain relievers are forty times more likely to end up with abusing heroin than people who don’t. However, the vast majority of people who misuse prescription drugs are in fact, not pain patients at all, according to the National Survey on Drug Use and Health. Actually, the number of pain treatment patients becoming addicted to opioid medications has been found to be very low.
Heroin use and abuse comes with a number of health side effects and complications. Typical side effects are insomnia and constipation. Apart from this, ongoing use frequently results in various types of lung complications, such as tuberculosis and pneumonia due to the negative impact on respiration. Some suffer mental disorders ranging from depression to antisocial personal disorders. Sexual dysfunction in men and irregular menstrual cycles among women are the other common health side effects.
It has also been observed that mucosal tissues in the nose get damaged in people who regularly snort heroin. Even the nasal septum has been known to get perforated in some cases.
In case of people who routinely inject heroin, the collateral damage takes place in the form of collapsed veins, scarred veins, and soft tissue infections. Many times, the blood vessels supplying blood to organs such as the liver, kidneys, lungs and brain get clogged by the additives. As a result, cell damage can occur in the affected organs.
Other health side effects include hepatitis B and C infections caused by sharing infected syringes for injecting the drug into the veins or muscle.
Apart from the actual physical symptoms associated with withdrawal, many people find it difficult to end heroin use because they are scared of the withdrawal symptoms they’ll encounter.
Withdrawal symptoms can set in as early as a few hours after stopping use in the case of long-term heroin abuse. Since withdrawal can cause serious medical complications (including death), it is advisable to attempt detox only under the supervision of qualified medical professionals.
The effects of withdrawal include symptoms such as:
The timeline for heroin detox can vary from person to person. However, withdrawal symptoms in most cases begin around 6 to 12 hours from the last dose. The symptoms are likely to peak anywhere between 1 and 3 days thereafter.
Symptoms will then begin to subside gradually over the next 5 to 7 days. The detox timeline can sometimes stretch over weeks and even months in cases classified as post-acute withdrawal syndrome or PAWS.
Heroin use disorder is treatable in different ways, most of which use a combination of medications and behavioral therapies. Pharmacological or medicinal treatment helps wean away the body and brain from cravings and improve the body’s physical abilities to cope with withdrawal symptoms. Behavioral treatment provides the skills needed to return to life after completing treatment.
Both systems are useful in restoring the brain’s function as well as behavior. However, the most success has been seen in cases where both approaches are used together.
Pharmacological treatment involves the use of medications under medical supervision to help withdrawal safely from the effects of prolonged heroin abuse. Medical treatment improves the likelihood of staying in treatment programs while reducing drug use and transmission of infections.
Pharmacological treatment is useful in combating withdrawal symptoms such as severe pain, nausea, vomiting and diarrhea. During detox, the medications used in treatment effectively address cravings and related symptoms that if left unresolved can end in relapse. Usually, FDA-approved non-opioid medications are used to counter heroin withdrawal symptoms during the detox program.
During medical treatment, the medications work on the same brain receptors that are affected by this opiate. The only difference is that the non-opioid medications are relatively safer than the opioid drug, and thus pose a far lesser risk of creating the negative behaviors associated with heroin abuse.
There are three types of medications typically used in this type of detox:
Agonists or Opioid Receptor Activators
Methadone is a slow-acting opioid agonist that has been used in heroin detox with success from the 1960s onward. It is ingested orally and slowly reaches the brain to dampen the effects of heroin use. It is available in approved outpatient detox programs and given on a daily basis to patients.
Partial Agonists that Activate Opioid Receptors but Produce less Response
Buprenorphine, approved by FDA in 2002, is the first medication that certified physicians are allowed to prescribe through the Drug Addiction Treatment Act. Patients can obtain this medication in outpatient facilities. It is a partial opioid agonist and is effective in relieving drug cravings without dangerous side effects.
Antagonists that are Receptor Blockers and Hinder the Positive Effects of Opioids
Naltrexone is an opioid antagonist that blocks the opioid action without the associated sedative effect nor creating physical dependence.
Depending upon the specific conditions and factors involved, the detox consultant will prescribe the appropriate medications for recovery.
Behavioral therapies for heroin abuse treatment are available in outpatient as well as residential settings. When used in combination with medical treatments, behavioral treatments like cognitive behavioral therapy and contingency management have proved beneficial in treating heroin dependence.
Cognitive behavioral therapy helps to increase the skills needed to cope with different life stressors. Contingency management is a points-based system designed to encourage a healthy lifestyle.
Even while undergoing detox under the guidance of a trained medical specialist, there are times when one can feel lost or overwhelmed.
Have a Personal Support System in Place: At such moments, it is best to rely upon a support system of people you care about and trust. Talking to them can help overcome the sudden cravings that may pop up from time to time. Never shy away from asking for help.
Stay Hydrated: Drink plenty of water and fluids as the withdrawal symptoms include vomiting and diarrhea.
Keep Yourself Busy: Make sure you have something to keep yourself busy or occupied so that you don’t have to pay attention to the withdrawal symptoms.
Cicero TJ, Ellis MS, Surratt, HL. The Changing Face of Heroin Use in the United States. A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry 2014; 71(7):821-826.