Helping a Loved One with Heroin Addiction


Heroin is an opioid drug that’s made from morphine, which is a natural substance taken from the seed pod of opium poppy plants.1,2 It can be a white or brown powder or a sticky black substance known as “black tar heroin.” It is commonly snorted, smoked, or injected when used.1,2

Opioids are central nervous system (CNS) depressant drugs that block pain receptors and slows down breathing and heart rate, while producing a euphoric rush, or “high.”1

Prescription opioid painkillers like OxyContin, Vicodin, and hydrocodone products have effects that are very similar to heroin.3 When the body’s opioid receptors are activated, it stimulates the reward center of the brain, which serves to reinforce the drug taking behavior and contributes to their abuse potential.3,4

Heroin is considered a Schedule I controlled substance in the United States by the Drug Enforcement Administration (DEA), as it has no accepted medicinal use in this country and is considered to have a high potential for abuse.2

Heroin use climbed steadily for nearly a decade, and in 2017 nearly 950,000 people reported use of heroin in the past year, up from 404,000 in 2002.5 The same year, prescription opioid misuse hit 11.4 million people and 47,600 people died from overdosing on opioids.6 This led the U.S. Department of Health and Human Services to declare a public health emergency.

The healthcare community, government, legislators and communities around the country have been working to curb prescription opioid abuse and progress is being made on that front, with use declining to 9.9 million people misusing prescription pain medications in 2018 (from 11.4 million the year before).6,7

Heroin use, however, remains high. In 2018, an estimated 808,000 people used heroin with nearly 15,000 people dying from heroin overdose.7,8 Many more—approximately 31,335 people—died from an overdose of synthetic opioids other than methadone. These synthetic drugs include fentanyl and fentanyl analogs.8

Heroin is a highly addictive drug. The body begins to develop a tolerance to the drug after regular use, and a person quickly finds they need higher—or more frequent—doses to get the desired effects.1 As tolerance builds, a person may find themselves neglecting other important parts of their life, such as their health, their job or going to school. This is indicative of a substance use disorder; a person with a substance use disorder may need professional help in order to quit using heroin.

Effects of Heroin

In addition to the “rush” of pleasure associated with using heroin, other common short-term effects include:

  • Flushed skin.
  • Nausea and vomiting.
  • Itching.
  • Heavy feeling in legs and arms.
  • Nodding off—going back and forth from being conscious and semiconscious.

Long-Term Health Impacts

There are many long-term effects that may result with regular heroin use, from health effects like constipation or stomach cramping or liver and kidney disease to the development or worsening of mental disorders.1

Those who snort heroin may permanently damage the tissue inside their noise. Smoking heroin is associated with an increase in asthma symptoms and a recent study demonstrates that smoking heroin is likely associated with a higher risk of chronic obstructive pulmonary disease.9,10

Injecting heroin has many medical consequences, including scarred veins, collapsed veins, bacterial infections of heart valves and blood vessels, boils (i.e., abscesses), and other soft-tissue infections.11 Additives used to “cut” street heroin often aren’t readily dissolved and may clog blood vessels leading to the lungs, liver, kidneys, or brain. This can cause infections in vital organs and even death.11

Intense Withdrawal

People who are addicted to heroin will experience an often-severe withdrawal syndrome upon abrupt discontinuation of the drug. Symptoms of heroin withdrawal begin anywhere from a couple hours to a day after last dose and can include flu-like symptoms along with intense cravings.1,12

The intensity of withdrawal often leads people to continue to use or to relapse, and current guidelines for opioid withdrawal recommend the use of FDA-approved medications over abrupt cessation.12

Overdose Dangers

Opioid overdose contributes significantly to overdose death numbers, which reached an all-time high in 2017, with 47,600 deaths due to opioid overdose out of a total of 67,367 drug overdose deaths.8

Heroin-related overdose is common among those who use heroin, and an overdose can occur after just one dose of the drug.12,13 Heroin users can never be certain of the actual strength of what they purchase on the street, which is increasingly being cut with fentanyl or other highly potent synthetic opioids.8,14 Fentanyl is involved in more deaths than any other illicit drug and is increasingly being included in illicit heroin supplies.8,14 The U.S. Drug Enforcement Administration reports that in some areas, fentanyl has supplanted traditional heroin supplies.14

A heroin overdose is potentially deadly, and is an emergency requiring immediately medical attention.13 It can be reversed by administering the drug naloxone. Overdose signs include:13

  • Unconsciousness of inability to awaken—or if semi-conscious a state of confusion.
  • Slow, shallow breathing or difficulty breathing (e.g., choking sounds or gurgling/snoring noises).
  • Lips or fingernails turning blue/purple.
  • Pinpoint pupils.

Addiction Takes Over

The American Society for Addiction Medicine (ASAM) defines addiction as a chronic, treatable medical disease.15 It is characterized by the loss of control over drug-seeking behaviors and drug abuse.15,16

Those addicted to heroin likely spend most of their time thinking about the drug, finding a way to get a hold of it, using heroin, and recovering from its use.16 School, work, or family responsibilities and obligations may take a backseat, and heroin may cause people to engage in risky or dangerous behaviors while using the drug.16 Those addicted to heroin are less likely to care about consequences related to their drug abuse and may get into legal trouble, or continue to use drugs even when understanding that in doing so they may be damaging personal relationships, their health, or emotional state.15,16

Heroin addiction is a treatable disease, and several different types of treatment programs are open to individuals and families to help foster recovery.

Treatment for Heroin Addiction

Individuals who are addicted to heroin can benefit from medical detox and treatment programs that offer continual medical supervision and use FDA-approved medications for opioid use disorder—such as methadone, buprenorphine, or naltrexone—to reduce cravings and withdrawal symptoms.12 These medications are proven to be effective in reducing the risk of relapse. Other medications, such as antidepressants or antianxiety drugs, may also be used to minimize specific symptoms or help manage cooccurring disorders.12

When treating a person with a heroin addiction, substance abuse treatment programs typically combine the use of medications with therapy sessions, counseling, educational opportunities, occupational and life skills training, and support services.12 Behavioral therapies like motivational interviewing and cognitive behavioral therapy are often helpful during heroin addiction treatment. They can assist a person in modifying the attitudes and behaviors they have which reinforce drug abuse, increasing a person’s life skills to handle stressful moments or the cues around them that may trigger intense cravings for drug—things that may cause a person to relapse and being another cycle of compulsive abuse.17

Addiction treatment programs can help you or your loved one to stop using heroin, maintain a lifestyle that’s drug-free, and contribute to all aspects of life, including work, family and community.

References

  1. National Institute on Drug Abuse. (2019). DrugFacts: Heroin.
  2. U.S. Drug Enforcement Administration. (2017). Drug Fact Sheet: Heroin.
  3. Comer, S., Sullivan, M., Whittington, R. et al. (2008). Abuse Liability of Prescription Opioids Compared to Heroin in Morphine-Maintained Heroin Abusers. Neuropsychopharmacology, 33, 1179–1191.
  4. National Institute on Drug Abuse. (2018). What effects does heroin have on the body?
  5. McCance-Katz, E. F. (2019). Key Results from the 2018 National Survey on Drug Use and Health: Webcast Slides. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  6. U.S. Department of Health and Human Services. (2019.) What is the U.S. Opioid Epidemic.
  7. Center for Behavioral Health Statistics and Quality. (2019). Key Substance Use and Mental Health Inidcators in the U.S. Results from the 2018 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  8. Hedegaard, H., Miniño, A. M., & Warner, M. (2020). Drug Overdose Deaths in the United States, 1999–2018.
  9. Self, T. H., Shah, S. P., March, K. L., & Sands, C. W. (2016). Asthma associated with the use of cocaine, heroin, and marijuana: A review of the evidence. Journal of Asthma, 54(7), 714–722.
  10. Tashkin, D. P. (2019). Heroin Smoking and COPD. Chest, 155(2), 247–248.
  11. National Institute on Drug Abuse. (2018.) What are the medical complications of chronic heroin use?
  12. American Society of Addiction Medicine. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
  13. Substance Abuse and Mental Health Services Administration. (2018). Opioid Overdose Prevention Toolkit.
  14. U.S. Drug Enforcement Administration. (2019). 2019 National Drug Threat Assessment.
  15. American Society of Addiction Medicine. (2019). Definition of Addiction.
  16. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  17. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Behavioral Therapies.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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