Despite its dangers and reputation for harm, use of heroin continues to climb higher in the US. According to the Centers for Disease Control and Prevention (CDC):
- Rates of heroin use have increased across gender, socioeconomic status, age group, location, and race/ethnicity over the past 10 years.
- Among 18-25 year olds, use has doubled during the last decade.
- Twice as many women use it now than in 2002.
- 90% of people that use it also use other substances.
- Heroin-related deaths have nearly tripled since 2002.
Heroin is an illegal substance that produces a strong high that is a key component of its highly addictive nature.
Addictive Properties of Heroin
Throughout the history of its use, heroin has been known for its highly addictive nature. All opioid addictions stem from the mechanism of action these drugs have in the brain. Heroin is a chemically modified version of its morphine precursor substance. When the drug is ingested, it rushes to the brain where enzymes convert it back into morphine before it attaches to sites on the surface of neural cells called opioid receptors. Opioid receptors are located throughout the body including the brain stem, spinal cord, and along the digestive track.
When docked with these receptors, morphine initiates a chain of events, eventually triggering the release of dopamine. Dopamine is a neurotransmitter that imparts many of the pleasurable feelings associated with heroin. In fact, dopamine is related to the addictive qualities of many drugs because it mediates the rewarding, pleasurable sensations that condition the user to engage in the behavior again and again.
As someone seeks to continually achieve and maintain their intense highs over time, they will find themselves requiring larger amounts or more potent or pure heroin to accomplish this. This is called tolerance. It develops over time as the brain acclimates to a persistently elevated opioid drug influence, resulting in a situation wherein certain brain cells will not respond as robustly to opioid receptor stimulation, releasing diminishing amount of dopamine with repeated use.
With a perceived physiologic need for more heroin, drug-seeking behavior and compulsive drug use often begin. More time, effort, and energy will be necessary to maintain this level of use. Largely, this is fueled by both:
- The desire to receive the high from heroin.
- The desire to avoid the discomfort of not having the substance in the body.
The body’s discomfort at not having the drug is called withdrawal and it is a main indicator of substance dependency having developed. Avoidance of withdrawal symptoms keeps many users running back to the drug even when they want to stop.The New Face of Heroin
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Methods of Use and Effects
Pure heroin can be smoked or snorted, but it is usually injected:
- Into a vein.
- Under the skin.
- Into a muscle.
The impact of heroin will vary depending on the quality, the quantity, and the method of delivery into the system.
- When smoked or injected, the substance enters the bloodstream quickly with more immediate results. The high will be intense but shorter in duration.
- Those that choose to snort the substance experience a more gradual-onset high that may be less intense, but relatively longer lasting.
The increased frequency and intensity of intravenous use also increases the risk of secondary problems including:
- Bruising, tissue damage and localized infection at the injection site.
- Systemic, blood-borne infection or diseases such as HIV and hepatitis.
- Cardiovascular issues, including inflammation and/or blockage of the peripheral blood vessels, endocarditis and widespread embolic events.
Effects of Mixing Substances
Per the CDC, the majority of people that use heroin reported using at least three other substances. Additionally, people that are addicted to alcohol, marijuana, cocaine, or opioid pain relieving medications are at increased risk of addiction. This means people addicted to pain medications are 40 times more likely to use heroin.
Heroin users will often mix the drug with other substance to heighten its pleasurable effects or to diminish the unwanted effects. For example, benzodiazepines may be used to limit the discomfort from the heroin high ending.
This and similar practices can add to the danger as combining substances can lead to increased depressant effects including:
- Slowed heart rate.
- Slowed breathing with lack of oxygen to the brain.
What Does It Mean to be Addicted to Heroin?
Addiction to heroin can be an all-consuming condition that wreaks havoc on a user’s physical health and livelihood. Someone struggling with an opiate use disorder, as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) may experience some or all of the following:
- Spending a majority of resources finding, securing, and using heroin.
- Using more heroin than intended or more frequently than intended.
- Failing to participate in once-enjoyed activities or fulfill personal or professional responsibilities.
- Struggling to end use even with repeated attempts.
- Experiencing withdrawal symptoms when not using.
- Using heroin in situations that are potentially hazardous (e.g., driving).
- Becoming tolerant to the drug (needing increasing doses to get the same effects.)
Telltale indicators of a heroin dependency are the withdrawal symptoms that present at some point after the last high fades and the substance leaves the body. This will initiate within 12 hours of last use and last for a period of time that will depend on frequency and intensity of use. Heroin withdrawal can be very uncomfortable. Its characteristic presentation includes symptoms such as:
- Nausea and vomiting.
- Muscle pain.
- Inability to sleep.
- Increased anxiety.
- Higher stress levels.
- Drug cravings.
Due to the intensity of symptoms and the duration of withdrawal, many people will seek out more of the substance to relieve symptoms. This only restarts the process and delays the withdrawal symptoms by a few more hours.
Heroin Treatment: How to Get Help for Addiction
Professional care for someone abusing heroin is extremely important to begin the process of quitting comfortably and safely, so that relapse can be avoided. Treatment frequently begins with detoxification. In many formal treatment programs, the detox process is completed throughout a period of medical supervision, during which the body is allowed to naturally process and clear itself of heroin’s influence.
During a medically managed detox, medications like clonidine – a mildly sedating antihypertensive medication – may be administered to aid comfort and reduce symptoms like:
- Runny nose.
Additionally, different medications can be used to manage the symptoms of nausea and vomiting, should they be present. In many programs, following completion of detox, further medical management will continue—specific medications designed to aid someone recovering from heroin dependence will be administered. Examples of these pharmaceutical agents include:
- Methadone – a less potent, longer-acting opioid. Since it is long-acting, the high produced will be much less intense than that of heroin when taken appropriately and not abused.
- Buprenorphine – available as Suboxone or Subutex. When used properly, this partial opioid agonist helps yield relief from cravings without producing a high.
- Naloxone – a substance that blocks heroin from producing a high. This drug can also be used to reverse opiate overdose
In tandem with medication-assisted treatment, behavioral therapies are shown to be helpful in ending use, establishing a period of abstinence, and avoiding future use through relapse prevention plans. Some behavioral therapies include:
- Cognitive-behavioral interventions.
- Motivational and communicative interviewing.
- Contingency management/conditioning.
- Family-based treatment.
Support programs and groups provide a level of informal treatment that permit someone in recovery to access new ideas and information from people with extended abstinence from heroin in order to learn effective coping skills and tools.