According to the Centers for Disease Control and Prevention (CDC), heroin abuse is on the rise in the United States and adding fuel to the opioid abuse epidemic. White males between the ages of 18 and 25, who live in large urban areas and have no insurance or are on Medicaid, are at the greatest risk for heroin abuse, the CDC further reports. Heroin abuse is rising across all demographics, however, including those who in the past have seen relatively low rates of heroin abuse, such as women, those with insurance, and individuals who make substantial annual wages.
Heroin: The Basics
Heroin is an illegal opiate drug that is processed from the opium poppy plant that grows in Southeast Asia, Southwest Asia, Mexico, and Columbia, the Drug Enforcement Administration (DEA) reports. As a Schedule I controlled substance, heroin has no accepted medicinal uses in the United States, although it does have a similar method of action to prescription opioid pain relievers like OxyContin (oxycodone) and Vicodin (hydrocodone). White powder heroin typically comes from Columbia while “black tar” heroin comes from Mexico. Heroin is abused by snorting, smoking, or injecting the drug. Heroin is known by many names, including chiva, thunder, hell dust, negra, horse, black tar, big H, and smack.
Heroin is a fast-acting opioid that acts on opioid receptors in the brain, dulling pain sensations, causing relaxation, and leading to a flood of euphoria, or a “high.” By slowing down some of the workings of the central nervous system like heart rate, respiration rates, body temperature, and blood pressure, heroin also lowers anxiety and the stress response.
Heroin abuse may be rising due to the sheer volume of individuals who have become addicted to narcotic painkillers, as heroin may offer a cheaper and more readily available opioid source. As prescription painkillers are more regulated and often structured to prevent abuse, they become harder to obtain for recreational, or nonmedical use.
The National Institute on Drug Abuse (NIDA) reports that over 50 million people in the United States (aged 12 and older) have abused a prescription medication at least once, with prescription opioid painkillers being the most commonly abused class of prescription drugs. Someone who abuses and suffers from an addiction to a prescription opioid is around 40 times more likely to also be addicted to heroin. In addition, nearly half of all individuals battling heroin addiction are also suffering from prescription opioid addiction, per the CDC. Without a doubt, heroin is a potent, powerful, and highly addictive drug.
Heroin overdoses in the past several years have skyrocketed, with rising abuse numbers. The CDC reports that between 2002 and 2013, heroin overdose fatalities quadrupled, and 8,200 people died from a heroin overdose in the United States in 2013.
Heroin is considered a short-acting drug that takes effect within seconds, peaks in an hour or two, and wears off in 3-5 hours, the National Highway Traffic Safety Association (NHTSA) reports. Heroin can make individuals feel euphoric, drowsy, have a heavy feeling in their arms and legs, and experience constricted pupils, dry mouth, and nausea. Due to heroin’s rapid onset of its effects, individuals may want to take more and more in order to extend or continue the “high.” As higher doses are perpetuated, a tolerance may develop to lower levels of the drug, meaning that more will need to be taken each time to keep feeling heroin’s effects. Increasing the dosage can also raise the risk for a life-threatening overdose.
Heroin overdose usually occurs because individuals stop breathing when respiration levels drop too low in response to the drug. Overdose victims may also have clammy skin, be drowsy or lose consciousness, have a blue tinge to lips or fingernails, struggle to breathe, and experience convulsions, slip into a coma, or die. A heroin overdose may also lower blood pressure too far and cause heart failure.
Heroin is commonly combined with other drugs or alcohol, which exacerbates all potential side effects and the risk for a fatal overdose. The CDC reports that nine out of every 10 people who abuse heroin use at least one other drug as well, and many used at least three others. Polydrug abuse can be extremely unpredictable and have disastrous consequences.
Additional Dangers of Heroin Abuse
Heroin can also create many other health concerns. CNN reports that people who inject heroin, or intravenous (IV) heroin users, are over 300 times more likely to suffer from fatal infectious endocarditis, which is an infection affecting the surface of the heart. IV drug use can also cause scarring at the injection site, known as track marks; infections of the skin and injection sites; collapsed veins; and an increased risk for developing an infectious disease, such as viral hepatitis and HIV/AIDS. NIDA publishes that injection drug users accounted for more than half of all individuals who newly contracted hepatitis C (HCV) in 2010. The Morbidity and Mortality Weekly Report (MMWR) published by the CDC reports that in 2009, injection drug abuse accounted for 9 percent of new HIV infections in the United States that year.
Individuals who snort or smoke heroin may still be at risk for developing infectious diseases, as they can be transmitted through sexual contact as well as through sharing dirty needles. Heroin can impair a person’s judgment and therefore lead to risky sexual behaviors and other questionable decisions with long-reaching consequences. Snorting heroin can damage nasal passages, the nasal septum, and sinus cavities, and cause a perpetual runny nose or regular nosebleeds. Both snorting and smoking heroin can cause respiratory issues, and smoking the drug may cause a chronic cough to develop.
Further potential physical side effects of heroin abuse that may be fatal include:
- Arrhythmia: irregular heart rate disrupting blood flow
- Heart attack
- Kidney failure
- Pulmonary edema: inability for the heart to pump blood effectively, causing blood to back up into the lungs
- Bacterial infections of the heart, skin, or bloodstream
- Organ damage from clogged blood vessels that heroin additives may cause
Over a quarter-million Americans sought medical treatment in an emergency department (ED) for heroin abuse in 2011, the Drug Abuse Warning Network (DAWN) publishes.
Heroin Dependence, Withdrawal, and Addiction Signs
The American Society of Addiction Medicine (ASAM) estimates that almost a quarter of the individuals who abuse heroin will become addicted to an opioid drug. In 2014, approximately 586,000 American adults who were at least 12 years old battled a heroin use disorder.
Heroin may be so addictive because of the way it so rapidly takes effect in the brain and body. Individuals may develop a tolerance rather quickly and need to up the dosage, which when done regularly, may lead to drug dependence. When a person becomes dependent on heroin, their brain may not work quite the same way as it did before the drug was introduced.
For example, dopamine is one of the brain’s neurotransmitters that helps to make a person feel happy. Heroin causes a flood of this chemical messenger in the brain, which is what makes people feel “high.” It is not absorbed back into the brain as it should be, so the brain stops making it. When heroin then wears off, dopamine levels drop, and it takes time for the brain to realize that it needs to make more. Low levels of dopamine can cause depression, fatigue, anxiety, and general malaise. Individuals may experience drug cravings and a desire to recreate the good feelings heroin produces; often, dependence on the drug comes with an inability to feel pleasure without it. NIDA reports that chronic heroin abuse may damage some of the parts of the brain that are related to making decisions, reacting to stress, and regulating emotions.
One of the side effects of heroin dependence is opioid withdrawal syndrome. NIDA publishes that heroin withdrawal can start in as little as a few hours after the last dose of heroin, and symptoms usually peak in intensity at around 24-48 hours, generally tapering off after a week or so. Opioid withdrawal can be both physically and emotionally intense, with side effects that may include:
- Muscle aches
- Sweating and chills
- Irregular heart rate and blood pressure
- Nausea and vomiting
- Abdominal cramps
- Bone pain
- Mood swings
- Drug cravings
Drug dependence is one of the signs of addiction; however, not all people who suffer from dependence are addicted. Addiction is a disease that influences a person’s ability to control their drug use. Someone who battles addiction may try to stop taking heroin several times and be unable to do so.
Addiction affects behaviors and relationships as well. Individuals may become secretive or withdrawn, and exhibit changes in personality. They may engage in behaviors that seem out-of-character and particularly risky, getting into accidents or legal entanglements. Activities that were priorities before may not be anymore, and regular obligations may be left unfulfilled. Work production or grades in school may suffer, finances may be drained, and physically, a person battling heroin may pay less attention to their personal appearance. Sleep schedules may be erratic and weight fluctuations are common.
Medical Detox for Heroin Addiction
Since one of the side effects of heroin addiction is a significant withdrawal syndrome, opioid addiction should be initially treated with medical detox. The main goal of detox is to help a person reach a physically safe and stable level, so they can enter into a treatment program and begin to recover from the effects of drugs.
Medical detox provides the highest level of care, as it is usually provided on a residential basis, requiring individuals to stay onsite for a period of 5-10 days on average. During this time, vital signs can be monitored, and necessary medications can be administered by highly trained medical professionals. Withdrawal symptoms can be managed and controlled.
There are several medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid dependence, as published by the White House, which include:
- Methadone (Dolophine, Methadose, Diskets): Methadone is a long-lasting and slow-acting opioid agonist that activates opioid receptors at lower levels than fast- and short-acting opioids like heroin, thus staying in the system longer and allowing for lower and fewer doses.
- Buprenorphine (Subutex, Buprenex): Buprenorphine is a partial opioid agonist medication that also activates opioid receptors at a lesser level than full agonists and with a ceiling effect, meaning that after a certain amount, it will not produce any additional or euphoric effects.
- Naltrexone (Vivitrol, ReVia): Naltrexone is an opioid antagonist used to block opioid receptors. It prevents opioids from working in the body.
- Combination buprenorphine/naloxone medications (Suboxone, Zubsolv, Bunavail): The agonist part of the medication is active while the antagonist naloxone remains dormant unless other opioids are introduced. It then it blocks them and their effects, and precipitates withdrawal.
During detox, it is likely that a long-acting opioid agonist may be used to slowly wean opioids out of a person’s system and to minimize the withdrawal syndrome. Medications may need to be modified when polydrug abuse is present, so a drug screening is likely done upon entering detox. Other medications may be helpful to address specific symptoms, such as depression, anxiety, and/or the flulike physical side effects of withdrawal.
Treatment beyond Detox: Sustaining Recovery
After detox, individuals should continue with a substance abuse treatment program. These programs may be outpatient if the person requires scheduling flexibility and has a lot of family and social support, or residential for a more comprehensive treatment program. Residential programs generally provide the greatest variety of options and amenities, and give individuals time for new habits to become fixed and for their brain to heal.
The longer a person remains in a treatment program, the more time they have to practice new strategies learned in rehab. NIDA recommends that treatment last no less than 90 days.
Beyond a residential program, individuals may enter into a transitional living situation. In sober living homes, individuals in recovery work together to run a household while following some simple rules, generally attending therapy sessions or meetings regularly, and remaining abstinent from drugs and alcohol.
Within an addiction treatment program, individuals will engage in both group and individual therapy and counseling sessions. Behavioral therapies teach stress management, communication skills, and healthy coping mechanisms. Self-destructive behaviors are addressed, and negative thought and emotional patterns are modified. The root causes of substance abuse and addiction are determined and worked through cooperatively. Individuals learn new life skills and how to apply them, and also may participate in complementary techniques that enhance healing.
Eating balanced meals and regular exercise can be very helpful in sustaining long-term recovery and maintaining overall wellbeing. Yoga and mindfulness meditation can be performed virtually anywhere and may help to reduce stress and provide internal insight and self-awareness.