Derived from the opium poppy plant, heroin is an illegal opioid drug. It is generally found in a powder form that is snorted, smoked, or injected when abused. Opioids are central nervous system (CNS) depressant drugs that block pain receptors and slow down breathing, heart rate, and blood pressure, while inducing a relaxed and mellow state. Opioids also increase the levels of dopamine in the brain, which is one of the chemical messengers, or neurotransmitters, that induce feelings of pleasure.
When abused, heroin can produce a euphoric “high” that lasts only a few minutes. This is due to the drug’s short half-life, which can be as short as 2-6 minutes, the United States Department of Labor’s Occupational Safety & Health Administration (OSHA) reports. Opioid drugs also include prescription painkillers like OxyContin, Vicodin, and hydrocodone products. 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 diversion, abuse, and addiction.
Prescription opioid abuse has reached epidemic levels in America, as the Centers for Disease Control and Prevention (CDC) reports that every day in this country 44 people die of a prescription opioid overdose. As law enforcement, the government, and legislative efforts work to curb prescription opioid abuse, many may be turning to heroin as an alternative.
The CDC reports that heroin abuse is increasing across all demographics, socioeconomic circles, cultures, and genders, and in the 18-25 age group, twice as many people abused heroin in 2015 than had done so 10 years earlier. The National Institute on Drug Abuse (NIDA) estimates that in 2014, about 6 million Americans had tried heroin in their lifetime, and the American Society of Addiction Medicine (ASAM) published that 23 percent of heroin abusers will develop an opioid addiction. Heroin is a dangerous drug that can cause dependence both physically and emotionally, and individuals addicted to heroin can benefit greatly from a specialized heroin addiction treatment program.
Heroin Abuse Alters the Brain
When an person abuses an opioid drug like heroin, it binds to opioid receptors in the brain and creates a flood of dopamine in some of the regions responsible for mood regulation, making decisions, processing rewards, impulse control, and motivation. When people do something that makes them feel good, like eat a piece of candy, these same brain regions may be involved. When this happens, individuals are encouraged to eat another piece of candy to recreate the good feelings. A reward pathway is then built within the brain so that when people see a piece of candy, they will feel a desire to eat it and cause those happy feelings again. The same may be true of heroin, which circumvents the natural reward pathways and enhances the pleasurable sensations by over-stimulating opioid receptors and dopamine production. As this pathway is strengthened by repeated heroin abuse and artificial stimulation, other reward pathways may deteriorate, making heroin abuse the best way for individuals to now feel pleasure. This is called a loss of plasticity in the brain, and the Washington Post documents research that indicates that this may be part of the reason why heroin may be so addictive.
As dopamine and opioid receptors become used to the regular introduction of the artificial stimulant, or heroin, they may produce less dopamine without the drug’s interference. When the drug then leaves the brain, dopamine levels may drop, and it may be difficult for anything other than the drug to trigger the pleasure response.
Chronic heroin abuse can therefore make changes the neural pathways in the brain, and as time goes on, individuals may develop a tolerance to certain levels of the drug and may require bigger doses in order to keep getting the high they desire.
Dependence on heroin may not be far behind. Drug cravings may occur as individuals may feel depressed, anxious, restless, irritable, and have trouble sleeping when heroin leaves the bloodstream. These are some of the psychological withdrawal symptoms those addicted to heroin may experience.
Heroin withdrawal can be difficult to manage without professional help, and individuals may experience flu-like symptoms such as nausea, vomiting, fever, irregular heart rate, diarrhea, chills, runny nose, and muscle pain. Those addicted to heroin should not attempt to stop using the drug suddenly without medical support, as withdrawal from heroin can be intense and even dangerous as the brain attempts to regain its natural balance. In addition to changing the circuitry in the brain related to reward and motivation, continual heroin abuse over a length of time may actually decrease some of the white matter of the brain, which can negatively impact individuals’ ability to make sound decisions, control impulses, regulate emotions, or handle stress and difficult situations, NIDA reports. Fortunately, many of these negative changes in the brain may be reversed with abstinence.
Heroin Overdose Specifics
About 20 percent of the illicit drug-related emergency department (ED) visits in 2011 involved heroin, the Drug Abuse Warning Network (DAWN) published. In 2013, heroin overdose deaths had nearly quadrupled up to 8,200 people, compared to the number of fatalities in 2002 in America, according to The Atlantic.
Heroin overdose is one of the biggest concerns of heroin abuse and addiction, and an overdose can occur after just one dose of the drug. Heroin is commonly used in conjunction with another drug, at rates as high as 90 percent of the time, the CDC reports, which increases the risk for a negative drug interaction and potential overdose. An overdose from heroin is likely accidental, as individuals may take too much of the drug for the body to handle at once, and a toxic buildup is created. Most heroin overdoses cause an unsafe drop in respiration, and breathing may slow to very low levels or stop altogether.
Heroin overdose is a medical emergency. If any of the following signs are noted, emergency medical attention should be sought immediately:
- Trouble breathing
- Pinpoint pupils
- Dry mouth
- Low blood pressure
- Bluish color to the lips or fingernails
- Pulse or heart rate is erratic or weak
- Abdominal pain
- Muscle weakness
- Loss of consciousness
A heroin overdose can be deadly and may cause permanent brain damage, coma, or be fatal.
Physical Consequences of Heroin Abuse
Heroin abuse and addiction can be hard on the body, bringing a wide range of side effects and health concerns. When an individual abuses heroin, the drug slows down many bodily functions. Heart rate and blood pressure drop, body temperature may go down, and breathing slows down. A person may feel drowsy, nauseous, or itchy; be uncoordinated; have slower reaction times; and not feel pain. After abusing heroin regularly for a long period of time, other physical side effects may occur, such as:
- Lung infections
- Increased risk for pneumonia or tuberculosis
- Infections of the heart, heart muscles, blood vessels, and surrounding tissue
- Kidney disease
- Liver disease
- Clogged blood vessels in internal organs, lungs, or brain
The way a person abuses heroin may also increase specific risk factors. For example, those who snort heroin may damage nasal and sinus cavities, reduce their sense of smell, cause chronic nosebleeds or runny nose, and have further respiratory complications. Injection of heroin raises the risk for collapsed veins, skin abscesses, scarring around injection sites and contracting an infectious disease such as hepatitis B or C or HIV/AIDS from sharing dirty needles. Smoking heroin may lead to mouth sores and lung problems.
Addiction Signs and Symptoms
According to U.S. News, about one out of every 20 people in the United States above the age of 11 has abused a prescription pain reliever in the past year. Individuals addicted to prescription opioids are at least 40 times more likely to also be addicted to heroin. Heroin addiction is a disease that has both behavioral and physical signs and symptoms that loved ones can spot.
Addiction is characterized by the loss of control over drug-seeking behaviors and drug abuse. 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. Loved ones may notice withdrawal and a loss of interest in outside activities or social events. School, work, or family responsibilities and obligations may take a backseat, and those battling addiction may be irresponsible and unreliable. Heroin may cause people to engage in risky or dangerous behaviors while using the drug. 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.
Mood swings and erratic behavior may be commonly observed as well. Depression and anxiety are common side effects of heroin withdrawal. Family members and loved ones may notice suicidal or self-harming behaviors that may be otherwise out of character.
Physically, some of the outward signs of heroin addiction may include needle marks around the veins of IV heroin abusers, redness or white powder around the nose of those who snort the drug, or burns on the hands or mouth of individuals who may be smoking heroin. Sleep patterns may change, and individuals may be more tired than usual. Those addicted to heroin are also likely to disregard personal hygiene and may be dirty or malnourished; changes in weight or appetite may be recognizable. Physical withdrawal symptoms or recurrent apparent bouts of the flu may be signs of heroin addiction as well. 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
NIDA reports that heroin addiction is best treated by both pharmacological (the use of medications) and therapeutic, particularly behavioral therapy, methods. Individuals who are addicted to heroin benefit from medical detox programs that offer continual medical supervision and use medications, such as methadone, buprenorphine, or naltrexone, if appropriate, to reduce cravings and withdrawal symptoms as well as potential relapses. Heroin may be replaced with longer-acting opioids in order to wean off the drug slowly, giving the brain time to regain balance over a controlled period of time. Other medications may also be used to minimize specific symptoms, like antidepressants for depression, anti-anxiety medications for anxiety, and so on. Heroin withdrawal likely peaks in 48-72 hours and dissipates in about a week, the Hungarian medical journal Acta Pharmaceutica Hungarica reports.
Substance abuse treatment programs provide therapy sessions, counseling, educational opportunities, occupational and life skills training, and support services. Behavioral therapies, like Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT), are often helpful during heroin addiction treatment. Many times, an individual may not recognize that treatment is needed and may be pressured or mandated into a treatment program through an intervention or from legal pressures. MI can help individuals to find the necessary motivation to recognize the need to change, while cultivating a level of respect and acceptance between clients and therapists. Uncovering personal triggers and learning more effective coping mechanisms and healthy responses to stress can be taught during CBT sessions, which often involve homework and skills training sessions. Both therapy methods may be incorporated into a treatment program.
Treatment options for heroin addiction include medical detox, outpatient care, intensive outpatient treatment, partial hospitalization, transitional care, residential treatment programs, and recovery or aftercare programs.
Tips for Choosing an Addiction Treatment Program
There are many things to consider when deciding on which type of treatment program may be best suited for specific individuals. Here are some ways to simplify the choice:
- Educate oneself on the specifics of heroin addiction, treatment options, and what to expect during recovery.
- If an individual is not ready to seek treatment, consider enlisting a professional intervention specialist to facilitate an intervention, which can help the person to agree to treatment.
- Consider the flexibility of the program and its importance (e.g., outpatient options to work around school, work, and familial obligations, if needed).
- Think about geographic proximity to the treatment facility and transportation considerations.
- Look into payment options, including insurance; consider the family budget to determine what type of program may be most affordable. Treatment programs often employ trained professionals who can help clients with funding issues as well.
- Determine the level of support a person may have when deciding between outpatient and residential treatment, as a supportive environment is often essential to maintaining sobriety.
- When mental or medical illnesses co-occur with substance abuse and/or addiction, integrated treatment methods are considered optimal and should be considered as primary options.
- Consider the options, amenities, and types of holistic or alternative methods offered and their personal importance to the individual and family.
Treatment facilities will often perform a full evaluation and assessment, as well as a drug screening, prior to admission in order to ensure that the right level of treatment is being provided. These evaluations and assessments may be redone periodically to make sure that the level of care is still optimal, and individuals may move between levels of care when necessary. All drugs or substances should be accounted for as well to prevent any negative drug interactions that may interfere with treatment.
ASAM estimates that more than a half-million Americans are addicted to heroin. Addiction treatment programs can help families and individuals regain emotional, physical, and interpersonal balance, which is vital for a long and healthy recovery.