A young man makes heroin in, preparing to take heroin, pours heroin into a spoon.

Much attention has been given to societal effects of the ongoing opioid epidemic in the United States. More than 1 million people could fall victim to it by 2020, warns USA Today. But what often gets forgotten are the real effects of heroin, the drug that has exploded in use and trafficking as the result of prescription painkiller diversion. While many victims get sucked in through abusing legitimate opioid medications, the long-term effects of heroin speak to the dangerous power of opioids and the harm they can wreak on the body and mind.

The Need for More Heroin

One of the most significant long-term effects of heroin is that as a person uses the drug more and more, increasing amounts of it are required to achieve the same feelings. WebMD explains that the immediate sensation following a hit of heroin is “a rush of good feelings and happiness” followed by several hours’ worth of tranquility and bliss. Being on a heroin high has been compared to being enveloped by a warm blanket, where all physical and emotional pain is dispelled.

Heroin has this effect because when it enters the body, its molecules quickly bind to the opioid receptors in the brain and central nervous system. The opioid receptors are part of the body’s opioid system, which produces natural endorphins to relieve stress and pain and are also responsible for feelings of pleasure and anticipation. However, while endorphins are natural and healthy products, heroin is a highly concentrated and extremely powerful artificial substance that overwhelms the opioid receptors. If endorphins help to reduce stress and pain, and are responsible for biochemical feelings of pleasure, then heroin completely buries any negative feelings under waves of euphoria, making every distress seem distant and unimportant. And in the same way that the activation of the opioid receptors creates a feeling of anticipation for more (which is what motivates humans to seek out more pleasurable experiences), heroin creates such a deep anticipation that it becomes an addiction.

A side effect of this is that the brain has to produce new opioid receptors to facilitate the ongoing blitzkrieg of incoming heroin, further deepening the need for and expectation of more heroin.

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Reliving the First Experience

In a piece on “Former Users Describe the First Time They Tried Heroin,” Vice magazine quotes a reformed heroin user as saying that her first experience with the drug at the age of 18 was “amazing,” that life became instantly better, and that she decided “almost immediately that [heroin] was going to be [her] life.” Another man said that when he did heroin for the first time, he was 19 years old and did not know that it was possible for the human body to experience as much sensation and enjoyment as he did in that moment. It took 20 minutes for the initial rush to wear off, followed by “six to eight hours where [he] was very relaxed, calm, and had a heightened sense of wellbeing.”

With such instantaneous effects, it comes as little surprise that someone trying heroin would want to experience those sensations repeatedly, especially if they are struggling with stress or behavioral disorders like depression, anxiety, or post-traumatic stress disorder.

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Heroin Tolerance

But among the many problems this causes is drug tolerance, one of the long-term effects of heroin use. With every shot of heroin, the brain is overwhelmed, but the constant activation of the opioid receptors becomes the new normal. The central nervous system responds less and less to the same amount of heroin, compelling users to take more of the drug or to try mixing it with other substances because they are afraid they’ll never feel the warmth and happiness again (words used by another former heroin user in the Vice article). As the consumption of heroin increases, so does the dependence on the drug. While tolerance is not addiction, it is a big step toward a full-fledged psychological dependence on heroin and long-term development of continual heroin use.

Drug tolerance is not merely wanting more heroin or any drug. It refers to specific changes in the brain chemistry caused by constant heroin intake rewriting the physical structure of the brain. These changes can remain for a lifetime even if the heroin use is permanently discontinued. Inside the brain is white matter, nerve fibers, and nerve cells that act as a “subway,” connecting different regions of the brain and allowing for the instantaneous transmission of chemical and electrical signals. Heroin use, as well as the use of other drugs, “has been associated with disrupted brain white matter,” according to Brain Research.

Also inside the brain is gray matter, located in the areas of the brain responsible for muscle movement, behavior, speech, sight, hearing, emotions, and decision-making. The Drug and Alcohol Dependence journal noted that the brains of heroin users showed reduced density of gray matter in the frontal cortex, which is where information is stored for comprehension, memory, and critical thinking and evaluation.

The Nature Reviews Neuroscience journal explains that heroin is so potent that it doesn’t just overwhelm the opioid receptors in the brain; it destroys the gray and white matter in the brain. In the long-term, the structure, functioning, and physiology of the brain is gradually eroded, causing long-lasting damage to multiple physical and psychological systems. Of course, users are not aware of this. All they know is that the second and third hits of heroin don’t make them feel as warm and good as the first did, so they inject themselves again and again. But the opioid receptors cannot respond the way they initially did, and the brain continues to buckle under the flood of more heroin.

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The Dopamine Effect

Render illustration of Dopamine title on head silhouette with cloudy sky as a background

The constant tide of heroin also pushes the brain to release more and more dopamine, the neurotransmitter that is released as a response to pleasurable experiences. Like endorphins, dopamine plays a significant biochemical role in what makes humans happy and what makes them want to seek out more happy experiences. At its most basic level, it is simply a drive for survival.

However, the dopamine system can be overtaken by addictive drugs, especially powerful ones like heroin because no natural experiences can stack up against what heroin does to the brain’s production of dopamine. While dopamine is meant to be broken down and reabsorbed by the brain after a short period, heroin prevents this process from happening, making the brain pump out dopamine for dangerously long periods of time. This explains why, for example, heroin users feel preternaturally calm and tranquil for hours on end; a normal dopamine-producing activity, like enjoying sex or exercise, becomes less enjoyable after a short period of time. The high from heroin lasts for hours, and it drives users to seek it out again and again, notwithstanding the diminishing returns and the need for greater amounts.

The result of this is that heroin slowly pushes out the brain’s ability to produce dopamine as a response to any other stimuli. In short order, the drug becomes the only way users can experience any happiness or even comfort, so much so that being on heroin becomes a new sense of normalcy.

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Heroin Withdrawal

If one of the long-term effects of heroin is a sense that being on the drug is the only way to live, what happens when the heroin is taken away? For someone who has been using heroin for a considerable period of time, to go without the drug can be devastating. In interviews with doctors and people who overcame their addiction to heroin, the Minnesota Post listed some of the experiences a user can go through:

  • Depression and hopelessness
  • Sleep disruptions
  • Anxiety and panic
  • Fatigue
  • An intense craving for more heroin

These are withdrawal effects, the result of the central nervous system being thrown into disarray without the heroin upon which it has become so dependent. Starved of the heroin molecules, the opioid receptors in the CNS and brain send out frenzied signals in a desperate attempt to compensate for the void, which causes painful and distressing emotional, psychological, and physical upheavals. These can also include nausea, vomiting, and diarrhea, among other flu-like symptoms.

As a long-term effect of heroin use, users are often frantic for more heroin as they experience withdrawal, convinced that getting high again will alleviate the flood of symptoms. They may be willing to renege on promises to never use again or to trade in their jobs, relationships, and general wellbeing because heroin is such a potent drug that longtime exposure to it changes the way users think. Withdrawal can be a crippling process, insidiously making users think that being off heroin is no way to live. This is, of course, the heroin talking, and it is one of the main reasons why attempting to discontinue heroin should not be done without medical supervision. The temptation to go back to heroin or any other kind of drug can be overwhelming for most users, and getting high again after the experience of withdrawal can make the psychological dependence much deeper than it was before. Due to how drug tolerance works, people relapsing on heroin under these circumstances will increase their heroin intake to deadly levels, endlessly searching for the comfort of the first hit, to the point where their body cannot survive the levels of heroin and they overdose.

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Damage to the Brain

The long-term psychological effects of heroin use can last for years. Speaking to the Minnesota Post, a counselor explains that some recovering users report never feeling fully “normal,” even after therapy and rehabilitation because of how the experience of heroin use changed them. Disruptions to the brain resulted in behavioral changes for up to three years of non-use, according to the results of a study published in the Journal of Neuroscience Research. The study used MRI analyses on people in recovery compared with a control population of people who had never taken heroin. The study showed that even as users completed a full course of treatment and therapy and abstained from heroin use for three years, they still experienced “an intense desire for heroin.” The authors of the study concluded that the risk of a heroin relapse can last for a very long time, and it is in all likelihood impossible to entirely eliminate.

Other research has corroborated the idea that one of the long-term effects of heroin use is actual damage to the brain, to the point where people in recovery have to be very careful about the situations, environments, lifestyles, and choices they make. A confluence of factors out of their control could result in a relapse.

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Comprehensive Treatment

Nurse/Doctor writing notes

For all these reasons and many more, the need for comprehensive treatment to address long-term heroin use is critical. The most immediate need is to scale down the heroin consumption itself. This is usually done through the application of medication-assisted therapy, which usually involves the administration of drugs like methadone and Suboxone. Both are opioids themselves, but with different and significantly weaker mechanisms of action than heroin. This allows users to gradually wean off heroin without inducing the full onslaught of withdrawal.

The idea of giving opioid users more opioids has been controversial, but the Expert Opinion on Pharmacotherapy journal noted in 2009 that “methadone maintenance is currently the gold standard of treatments” because of how it has been associated with a reduction in intravenous drug use as with heroin and also a reduction in crime and behaviors likely to lead to HIV infection and death. Community-based treatment programs around the world use methadone to help addicts get off heroin, and even new and experimental opioid treatments are compared to medication-assisted therapies.

There is the potential for abuse of either Suboxone or methadone, so those products are not commercially available. Individuals looking to wean off heroin using “replacement opioids” will have to go through a drug detoxification program in order to navigate withdrawal in the safest manner possible.

Another advantage of going through a formal treatment program are the resources to begin treatment to address the mental health damage of a long-term heroin addiction. Spending time working on the psychological causes and effects behind heroin addiction is key to future success in keeping cravings and urges under control. Without this step, there is a prohibitively high chance of relapse.

A combination of one-on-one therapy, group therapy, and family therapy helps individuals develop a comprehensive approach to positive and healthy mental wellbeing, which can make all the difference when faced with the temptation to use again. Methods like Cognitive Behavioral Therapy teach clients how they can recognize the thought patterns and processes that lead to the desire to get high and how anticipating negative thoughts can be channeled into something more productive and positive, even if simply waiting until the moment passes.

In Psychiatric Clinics of North America, researchers write that Cognitive Behavioral Therapy for the treatment of addiction and substance use disorders has proven effective in clinical trials because of how it “captures a broad range of treatments” that target how people think and how they motivate themselves to improvement. For those struggling with the long-term effects of heroin use, such precise focus on their thoughts and behavior offers the best chances for a new life of recovery and health.

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