Heroin is an illegal, highly addictive drug. It is both the
most abused and the most rapidly acting of the opiates. Heroin is processed from morphine,
a naturally occurring substance extracted from the seed pod of certain varieties of poppy
plants. It is typically sold as a white or brownish powder or as the black sticky
substance known on the streets as "black tar heroin." Although purer heroin is
becoming more common, most street heroin is "cut" with other drugs or with
substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut
with strychnine or other poisons. Because heroin abusers do not know the actual strength
of the drug or its true contents, they are at risk of overdose or death. Heroin also poses
special problems because of the transmission of HIV and other diseases that can occur from
sharing needles or other injection equipment.
According to the
1998 National Household Survey on Drug Abuse, which may actually underestimate illicit
opiate (heroin) use, an estimated 2.4 million people had used heroin at some time in their
lives, and nearly 130,000 of them reported using it within the month preceding the survey.
The survey report estimates that there were 81,000 new heroin users in 1997. A large
proportion of these recent new users were smoking, snorting, or sniffing heroin, and most
(87 percent) were under age 26. In 1992, only 61 percent were younger than 26.
The 1998 Drug Abuse
Warning Network (DAWN), which collects data on drug-related hospital emergency department
(ED) episodes from 21 metropolitan areas, estimates that 14 percent of all drug-related ED
episodes involved heroin. Even more alarming is the fact that between 1991 and 1996,
heroin-related ED episodes more than doubled (from 35,898 to 73,846). Among youths aged 12
to 17, heroin-related episodes nearly quadrupled.
NIDA's Community Epidemiology Work Group (CEWG),
which provides information about the nature and patterns of drug use in 21 cities,
reported in its December 1999 publication that heroin was mentioned most often as the
primary drug of abuse in drug abuse treatment admissions in Baltimore, Boston, Los
Angeles, Newark, New York, and San Francisco.
usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to
four times a day. Intravenous injection provides the greatest intensity and most rapid
onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively
slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects
are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not
produce a "rush" as quickly or as intensely as intravenous injection, NIDA
researchers have confirmed that all three forms of heroin administration are addictive.
Injection continues to
be the predominant method of heroin use among addicted users seeking treatment; however,
researchers have observed a shift in heroin use patterns, from injection to sniffing and
smoking. In fact, sniffing/snorting heroin is now the most widely reported means of taking
heroin among users admitted for drug treatment in Newark, Chicago, and New York.
With the shift in
heroin abuse patterns comes an even more diverse group of users. Older users (over 30)
continue to be one of the largest user groups in most national data. However, the increase
continues in new, young users across the country who are being lured by inexpensive,
high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been
appearing in more affluent communities.
injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is
converted to morphine and binds rapidly to opioid receptors. Abusers typically report
feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is
a function of how much drug is taken and how rapidly the drug enters the brain and binds
to the natural opioid receptors. Heroin is particularly addictive because it enters the
brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the
skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by
nausea, vomiting, and severe itching.
After the initial
effects, abusers usually will be drowsy for several hours. Mental function is clouded by
heroin's effect on the central nervous system. Cardiac function slows. Breathing is also
severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on
the street, where the amount and purity of the drug cannot be accurately known.
One of the most
detrimental long-term effects of heroin is addiction itself.
Addiction is a
chronic, relapsing disease, characterized by compulsive drug seeking and use, and by
neurochemical and molecular changes in the brain. Heroin also produces profound degrees of
tolerance and physical dependence, which are also powerful motivating factors for
compulsive use and abuse. As with abusers of any addictive drug, heroin abusers gradually
spend more and more time and energy obtaining and using the drug. Once they are addicted,
the heroin abusers' primary purpose in life becomes seeking and using drugs. The drugs
literally change their brains.
develops with higher doses of the drug. With physical dependence, the body adapts to the
presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal
may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal
include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes
with goose bumps ("cold turkey"), and leg movements. Major withdrawal symptoms
peak between 24 and 48 hours after the last dose of heroin and subside after about a week.
However, some people have shown persistent withdrawal signs for many months. Heroin
withdrawal is never fatal to otherwise healthy adults, but it can cause death to the fetus
of a pregnant addict.
At some point during
continuous heroin use, a person can become addicted to the drug. Sometimes addicted
individuals will endure many of the withdrawal symptoms to reduce their tolerance for the
drug so that they can again experience the rush.
and the emergence of withdrawal symptoms were once believed to be the key features of
heroin addiction. We now know this may not be the case entirely, since craving and relapse
can occur weeks and months after withdrawal symptoms are long gone. We also know that
patients with chronic pain who need opiates to function (sometimes over extended periods)
have few if any problems leaving opiates after their pain is resolved by other means. This
may be because the patient in pain is simply seeking relief of pain and not the rush
sought by the addict.
Short- and Long-Term Effects of Heroin Use
- Depressed respiration
- Clouded mental functioning
- Nausea and vomiting
- Suppression of pain
- Spontaneous abortion
- Infectious diseases, for
example, HIV/AIDS and hepatitis B and C
- Collapsed veins
- Bacterial infections
- Infection of heart lining and
- Arthritis and other
consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial
infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue
infections, and liver or kidney disease. Lung complications (including various types of
pneumonia and tuberculosis) may result from the poor health condition of the abuser as
well as from heroin's depressing effects on respiration. Many of the additives in street
heroin may include substances that do not readily dissolve and result in clogging the
blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection
or even death of small patches of cells in vital organs. Immune reactions to these or
other contaminants can cause arthritis or other rheumatologic problems.
Of course, sharing of
injection equipment or fluids can lead to some of the most severe consequences of heroin
abuse-infections with hepatitis B and C, HIV, and a host of other blood-borne viruses,
which drug abusers can then pass on to their sexual partners and children.
Heroin abuse can
cause serious complications during pregnancy, including miscarriage and premature
delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant
death syndrome), as well. Pregnant women should not be detoxified from opiates because of
the increased risk of spontaneous abortion or premature delivery; rather, treatment with
methadone is strongly advised. Although infants born to mothers taking prescribed
methadone may show signs of physical dependence, they can be treated easily and safely in
the nursery. Research has demonstrated also that the effects of in utero exposure to
methadone are relatively benign.
are at risk for contracting HIV, hepatitis C, and other infectious diseases. Drug abusers
may become infected with HIV, hepatitis C, and other blood-borne pathogens through sharing
and reuse of syringes and injection paraphernalia that have been used by infected
individuals. They may also become infected with HIV and, although less often, to hepatitis
C through unprotected sexual contact with an infected person. Injection drug use has been
a factor in an estimated one-third of all HIV and more than half of all hepatitis C cases
in the Nation.
has found that drug abusers can change the behaviors that put them at risk for contracting
HIV, through drug abuse treatment, prevention, and community-based outreach programs. They
can eliminate drug use, drug-related risk behaviors such as needle sharing, unsafe sexual
practices, and, in turn, the risk of exposure to HIV/AIDS and other infectious diseases.
Drug abuse prevention and treatment are highly effective in preventing the spread of HIV.
A variety of effective treatments are available for heroin
addiction. Treatment tends to be more effective when heroin abuse is identified early. The
treatments that follow vary depending on the individual, but methadone, a synthetic opiate
that blocks the effects of heroin and eliminates withdrawal symptoms, has a proven record
of success for people addicted to heroin. Other pharmaceutical approaches, like LAAM
(levo-alpha-acetyl-methadol) and buprenorphine, and many behavioral therapies also are
used for treating heroin addiction.
The primary objective
of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free
state. Not in itself a treatment for addiction, detoxification is a useful step only when
it leads into long-term treatment that is either drug-free (residential or outpatient) or
uses medications as part of the treatment. The best documented drug-free treatments are
the therapeutic community residential programs lasting at least 3 to 6 months.
has been used effectively and safely to treat opioid addiction for more than 30 years.
Properly prescribed methadone is not intoxicating or sedating, and its effects do not
interfere with ordinary activities such as driving a car. The medication is taken orally
and it suppresses narcotic withdrawal for 24 to 36 hours. Patients are able to perceive
pain and have emotional reactions. Most important, methadone relieves the craving
associated with heroin addiction; craving is a major reason for relapse. Among methadone
patients, it has been found that normal street doses of heroin are ineffective at
producing euphoria, thus making the use of heroin more easily extinguishable.
last for about 24 hours - four to six times as long as those of heroin - so people in
treatment need to take it only once a day. Also, methadone is medically safe even when
used continuously for 10 years or more. Combined with behavioral therapies or counseling
and other supportive services, methadone enables patients to stop using heroin (and other
opiates) and return to more stable and productive lives.
Methadone dosages must
be carefully monitored in patients who are receiving antiviral therapy for HIV infection,
to avoid potential medication interactions.
LAAM, like methadone,
is a synthetic opiate that can be used to treat heroin addiction. LAAM can block the
effects of heroin for up to 72 hours with minimal side effects when taken orally. In 1993
the Food and Drug Administration approved the use of LAAM for treating patients addicted
to heroin. Its long duration of action permits dosing just three times per week, thereby
eliminating the need for daily dosing and take-home doses for weekends. LAAM will be
increasingly available in clinics that already dispense methadone. Naloxone and naltrexone
are medications that also block the effects of morphine, heroin, and other opiates. As
antagonists, they are especially useful as antidotes. Naltrexone has long-lasting effects,
ranging from 1 to 3 days, depending on the dose. Naltrexone blocks the pleasurable effects
of heroin and is useful in treating some highly motivated individuals. Naltrexone has also
been found to be successful in preventing relapse by former opiate addicts released from
prison on probation.
Another medication to
treat heroin addiction, buprenorphine, may already be available by the time this Research
Report appears. Buprenorphine is a particularly attractive treatment because, compared to
other medications, such as methadone, it causes weaker opiate effects and is less likely
to cause overdose problems. Buprenorphine also produces a lower level of physical
dependence, so patients who discontinue the medication generally have fewer withdrawal
symptoms than do those who stop taking methadone. Because of these advantages,
buprenorphine may be appropriate for use in a wider variety of treatment settings than the
currently available medications. Several other medications with potential for treating
heroin overdose or addiction are currently under investigation by NIDA.
and pharmacologic treatments can be extremely useful when employed alone, science has
taught us that integrating both types of treatments will ultimately be the most effective
approach. There are many effective behavioral treatments available for heroin addiction.
These can include residential and outpatient approaches. An important task is to match the
best treatment approach to meet the particular needs of the patient. Moreover, several new
behavioral therapies, such as contingency management therapy and cognitive-behavioral
interventions, show particular promise as treatments for heroin addiction. Contingency
management therapy uses a voucher-based system, where patients earn “points” based on
negative drug tests, which they can exchange for items that encourage healthy living.
Cognitive-behavioral interventions are designed to help modify the patient's thinking,
expectancies, and behaviors and to increase skills in coping with various life stressors.
Both behavioral and pharmacological treatments help to restore a degree of normalcy to
brain function and behavior, with increased employment rates and lower risk of HIV and
other diseases and criminal behavior.
Drug analogs are
chemical compounds that are similar to other drugs in their effects but differ slightly in
their chemical structure. Some analogs are produced by pharmaceutical companies for
legitimate medical reasons. Other analogs, sometimes referred to as "designer"
drugs, can be produced in illegal laboratories and are often more dangerous and potent
than the original drug. Two of the most commonly known opioid analogs are fentanyl and
meperidine (marketed under the brand name Demerol, for example).
introduced in 1968 by a Belgian pharmaceutical company as a synthetic narcotic to be used
as an analgesic in surgical procedures because of its minimal effects on the heart.
Fentanyl is particularly dangerous because it is 50 times more potent than heroin and can
rapidly stop respiration. This is not a problem during surgical procedures because
machines are used to help patients breathe. On the street, however, users have been found
dead with the needle used to inject the drug still in their arms.
chemical dependency and its toxic impact on family members. Raise your
children to choose to be alcohol and other drugs
free. Learn how
to in Dr. Frischs, Psy.D. Recovery book series.