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Updated on September 29, 2021

Heroin Dependence, Risks, & Treatment

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.

Heroin comes in either white or brown powder. 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

Why Do People Use Heroin?

Taking heroin gives the user a rush of happiness and pleasurable feelings. For the next few hours after taking heroin, the user enters a dreamy state where everything is in slow motion. Heroin is very attractive to people with muscle and bone pain because they feel nothing but pleasure.

The growing misuse of prescription opioids has prompted users to switch to heroin. This is because prescription opioids produce the same effects as heroin.

People use heroin because it is a stronger, cheaper alternative to prescription painkillers such as hydrocodone and oxycodone. Heroin produces the same 'high' as these drugs, but stronger. Heroin also doesn't need a prescription, so it's more accessible. 

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Dangers and Risks Associated with Heroin Use

There are numerous risks linked to heroin abuse, with dangerous side effects. Heroin use may lead to:

Dependence

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. They will rely on continued use of the drug to prevent painful and uncomfortable withdrawal symptoms.

Addiction

Heroin is one of the most highly addictive substances in the world. In fact, 1 in 4 first-time users become addicted. Addiction latches on strongly to the parts of the brain responsible for decision-making and self-control.

A heroin user's 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 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

Toxicity

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.” This is when heroin is combined with the powerful opioid fentanyl, carfentanil, U-47700 (pink), or other powerful drugs. It 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

Withdrawal

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 on the drug is deep-rooted and can cause intense withdrawal symptoms.

Symptoms of withdrawal include:

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

Overdose

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 immediately, 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

Death

If left untreated, heroin users may overdose, which can lead to death. Large doses of heroin can affect the heart and lungs. It can cause significant respiratory depression and slowing of the heart rate to the point that a person wouldn't survive without medical help.

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 injections, can become infected, resulting in other serious complications.

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Short-Term and Long-Term Effects of Heroin Abuse

There are short-term and long-term effects to heroin addiction and abuse. According to the National Institute on Drug Abuse, the following are the associated short-term effects:

  • Anxiety
  • Depression
  • Decreased respiration
  • Hypotension (low blood pressure)
  • Heart arrhythmias
  • Inability to focus
  • Lapsing in and out of consciousness
  • Palpitations

Heroin is highly addictive. Many people who use heroin become long-term users. Therefore, they suffer from substantial consequences. The long-term effects of heroin abuse may include: 

  • 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

Treatment Options

Because withdrawal symptoms can be 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.

Heroin addiction treatment is a multi-faceted approach. 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, underlying issues 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

Sometimes, there may be co-occurring disorders such as substance abuse and mental health issues. When this happens, seeking professional treatment is highly recommended so that mental health services will be provided. Additionally, support from friends and family goes a long way in helping a person addicted to heroin stay on the right path.

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Resources

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Abuse, National. “What Is Heroin and How Is It Used?,” NIDA, 1 June 2018.

Lipari, Rachel and Hughes, Arthur. "Trends in Heroin Use in the United States: 2002 to 2013," Substance Abuse and Mental Health Services Administration.

Fact 1008,” Truth, 1 June 2018.

What Is Heroin? How Is Heroin Made? What Is Heroin Made of? - Drug-Free World,” Foundation for a Drug-Free World.

"Heroin Overdose Data," Drug Overdose | CDC Injury Center. 12 Aug. 2019.

"Trends in Opioid Use, Harms, and Treatment - Pain Management and the Opioid Epidemic," NCBI Bookshelf. 13 July 2017.

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