Heroin Dependence, Risks, & Treatment

Heroin is one of the most addictive and dangerous drugs in the world. It is often mixed with dangerous chemicals such as fentanyl, that increase users' risks of overdose.
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What is Heroin?

Heroin is a highly addictive, illegal drug made from processed morphine. Opium poppy plants, grown in Columbia, Mexico, and Southern Asia, yield morphine.

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Pure heroin is a white powder and is usually "cut" with sugar, powdered milk, starch, or quinine to increase profitability. Other versions of heroin include brownish powder, hardened charcoal-like form, and a black sticky substance known as black tar heroin.

Heroin is related to legal opioid prescription drugs such as codeine, fentanyl, hydrocodone, and oxycodone. These drugs increasingly play their part in the opioid epidemic in America and are responsible for thousands of deaths each year.

A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers non-medically prior to using heroin

National Institute on Drug Abuse

Immediate effects of Heroin

Spoon and needle filled with drugs

The effects of heroin are fast-acting and powerful. Users get an immediate “rush” of pleasure and feeling of well-being that is intense and lasts for a few minutes. The high continues for another four to five hours as the drug works its way through the bloodstream. Other immediate effects include:

  • Euphoria
  • Dry mouth
  • Feeling of heaviness in the arms and legs
  • Warm flushing of the skin
  • Severe itching
  • Nausea or vomiting
  • Drowsiness — often nodding out

Dependence

Graphic of head filled with pills

Physical dependence occurs when the brain adapts to the effects of a drug and develops tolerance. The individual will require more and more of the drug to achieve the initial positive effect and will rely on continued use of the drug to prevent painful and uncomfortable withdrawal symptoms.

Once dependent, a person will experience symptoms of withdrawal if they abruptly stop taking the drug. The severity varies based on genetics, amount, and duration of heroin use. Heroin is a highly potent drug. Therefore, the dependence of the drug is deep-rooted and can cause dramatically intense withdrawal symptoms. Symptoms of withdrawal include:

  • A strong craving for the drug
  • Profuse sweating and clamminess
  • Runny nose
  • Chills and goosebumps
  • Restless leg-like symptoms
  • Stomach cramps
  • Nausea and vomiting
  • Insomnia
  • Depression
  • Psychosis
  • Agitation and irritability
  • Hallucinations
  • Homicidal or suicidal thoughts

Addiction

Pill bottle and skull

Heroin is one of the most highly addictive substances in the world. In fact, 1 in 4 of first-time users become addicted. Addiction latches on strongly to the parts of the brain responsible for decision-making and self-control. Heroin users’ constant chasing of the drug consumes many. While there are varying severities of addiction, some people have compared heroin use to be as essential as breathing air itself. The impact of heroin addiction has ruined families and even entire communities. Typical signs of addiction include:

  • Depression
  • Poor decision-making
  • Loss of control
  • Neglect of personal relationships and isolation
  • A decline in fulfilling responsibilities at work and home
  • Visible fatigue and drifting off
  • Seemingly distant or “out of it”
  • Mood swings
  • Apathy
  • Lapses in memory
  • Decreased appetite and weight loss
  • Financial or legal problems
  • Doing anything to obtain money for the drug, including theft

Long-term Use

Graphic of clipboard with checkboxes for timeline.

Heroin is highly addictive. Many people who use heroin become long-term users; therefore, they suffer many substantial consequences, including:

  • Insomnia
  • Constipation and stomach cramps
  • Sexual dysfunction
  • Irregular menstrual cycles
  • Depression
  • Psychosis
  • Collapsed veins from damage caused by frequent injections
  • Damaged nose tissue and nose bone erosion from those who snort it frequently
  • Infection of the heart lining and valves
  • Abscesses
  • Liver and kidney disease
  • Lung complications, including pneumonia
  • HIV, Hepatitis B & C from IV drug use

There is an extremely high risk of overdose associated with heroin use. The drug can be highly potent, and methods such as injection go directly to the bloodstream. Accordingly, it can be an overwhelming rush and unpredictable. Additionally, heroin is a street drug only and is therefore not regulated.

Often, heroin is cut or combined with other dangerous drugs, and users will take whatever they can get their hands on. One example is a combination called “gray death” in which heroin is combined with the powerful opioid fentanyl, carfentanil, U-47700 (pink), or other powerful drugs, and has been responsible for many overdoses. Toxic levels of the drug cause severe symptoms, including:

  • Vomiting and stomach cramps
  • Slurred speech and loss of essential motor functions
  • Low blood pressure
  • Slow or non-existent pulse
  • Pin-point-shaped pupils
  • Blue lips and fingertips
  • Cold to the touch
  • Clammy skin
  • Loss of consciousness
  • Seizure

Overdose

Icon of pill with warning sign

In the case of a heroin overdose, the drug Naloxone is used to save the individual. However, some opioids are so powerful, instant death is possible. The drug attaches to opioid receptors in the brain, stopping and reversing the effects of heroin. It is a fast-acting drug and can quickly restore and normalize breathing.

Vital life-sustaining neurons in the brain become suppressed to the extent where normal breathing becomes dangerously slow or stopped altogether. Immediate emergency medical attention is needed right away, as lack of oxygen to the brain and vital organs causes serious damage and can lead to death.

Intensive care is needed, and people who overdose may need the following to normalize breathing:

  • Life support
  • Intubation
  • Mechanical ventilation
  • Airway management, and observation

In 2017, 47,600 people died of opioid overdose in America.

Other Associated Risks

HIV and hepatitis are major risks for intravenous heroin users. People often share needles with reckless disregard and can contract those diseases. Additionally, the additives usually found in heroin of sugar, powdered milk, and starch, can clog veins and obstruct blood flow to the brain and major arteries. The damage caused can be significant and permanent.

The “track marks”, or visible scars from frequent injection, can become infected, resulting in other serious complications.

Treatment Options

Graphic of 3 different types of medication bottles and pills.

Because withdrawal symptoms can be so severe, a person usually needs to be taken to a detox facility. Certain Medication Assisted Treatment (MAT) drugs can also lessen the symptoms. However, they are not very effective without being combined with behavioral therapy.

Some common medications include:

  • Naltrexone — this medication is a non-addictive opioid antagonist that blocks the effects of other narcotics. It comes in either a daily pill form or a monthly injection.
  • Buprenorphine — this medication is an opioid partial agonist that blocks other narcotics. This particular drug has the added benefit of reducing withdrawal symptoms and cravings. It is either prescribed as a daily dissolving tablet, cheek film, or 6-month implant under the skin.
  • Methadone — this drug is an opioid agonist as well. However, it does not block other narcotics while preventing withdrawal. People take this medication as a daily liquid dispensed only in highly regulated clinics. Patients must visit to receive this medicine, so as to prevent abuse.

There are many tools readily available for people to end the vicious cycle of heroin addiction. The first and most crucial step is a desire to quit. While some people can quit on their own, the vast majority of success stories stem from help.

Behavioral therapy is important to an addicted person’s success. Usually there are underlying issues that lead to somebody falling into addiction, such as depression or PTSD. Some of these long-term support methods include:

  • Motivational Interviews — this method involves a one on one or small group setting, so as to ensure personalized care. The process of dealing with addiction is stressful in and of itself. Therefore, this helps people cope with the process and stay focused on the right path.
  • Contingency Management — this program uses positive reinforcement by giving people tangible rewards for their time spent sober. It uses a “point system” that gives people a sense of gratification for living a sober life. It is a great way to encourage healthy habits after people have received rehabilitative treatment.
  • Cognitive Behavioral Therapy — this therapy is used to get to the bottom of issues that may cause people to relapse. To be aware of what their triggers are, maintain realistic expectations, and the stress one goes through while staying sober. Also, it helps to identify certain behaviors that lead to a person acting on their addiction. This may include outside influence avoidance, as well as internal thought processes

Support from friends and family goes a long way in helping an addicted person stay on the right path.

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Resources

Abuse, National. “What Is Heroin and How Is It Used?” NIDA, 1 June 2018, https://www.drugabuse.gov/publications/research-reports/heroin/what-heroin

http://www.samhsa.gov/data/sites/default/files/report_1943/ShortReport-1943.pdf

“Fact 1008.” Truth, 1 June 2018, https://www.thetruth.com/o/the-facts/fact-1008

“What Is Heroin? How Is Heroin Made? What Is Heroin Made of? - Drug-Free World.” Foundation for a Drug-Free World, https://www.drugfreeworld.org/drugfacts/heroin.html

Heroin Overdose Data | Drug Overdose | CDC Injury Center. 12 Aug. 2019, https://www.cdc.gov/drugoverdose/data/heroin.html

Trends in Opioid Use, Harms, and Treatment - Pain Management and the Opioid Epidemic - NCBI Bookshelf. 13 July 2017, https://www.ncbi.nlm.nih.gov/books/NBK458661/

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Updated on: July 17, 2020
Author
Addiction Group Staff
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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