Heroin

Overview

Heroin is a highly addictive recreational opiate. Heroin abuse is common in the U.S, with an estimated
620,000 Americans being considered daily users as of 2010.1 Heroin is so addictive due to its close
interaction with dopamine production in the brain. Heroin remains one of the most deadly recreational
drugs found today due to its potency, frequency of being cut with dangerous and toxic additives,
negative physiological effects, and how easy it is to build a tolerance to it. Overdoses on heroin are
common, with heroin accounting for 14,000 deaths due to overdose in 2015.2 Heroin exhibits short-term
effects similar to other narcotics including drowsiness, euphoria, pain reduction, and lethargy. Long
term abuse of heroin can lead to a variety of physiological and mental ailments including infections,
body deterioration, cardiovascular problems, and neurological decay. Recovery from heroin can be
effective through the use of various medications and therapeutic treatments, and rehabilitation facilities
offer extensive resources for recovering from heroin addiction in a safe, stable, and comfortable manner.

What is Heroin?

Heroin is one of the most common and recognizable opiates abused recreationally today. Heroin often
carries an infamous reputation for its extremely potent addictiveness, common overdoses, and difficult
withdrawals. Opiates are a class of drugs that include opium, morphine, and codeine. Opiates are
differentiated from opioids by the manner in which they are created. Opiates are created from naturally
occurring organic compounds called alkaloids that are found in poppies. Poppies are a type of flower
common all over the world, but are grown in particular abundance throughout the Middle East and
particularly in Afghanistan where they are grown, harvested, and sold in the opium trade. This differs
from opioids, which are synthetically created in a lab and include common prescription painkillers such
as Oxycodone, Hydrocodone, and Methadone. Heroin comes from a long line of related opiates that
have held historical significance in their prevalence and addictiveness. This lineage includes opium,
which remained popular throughout the 19th century, followed by morphine, and finally heroin during
the mid-20th century. Both opiates and opioids are responsible for a deadly epidemic both in the United
States and abroad. The National Institute of Drug Abuse estimates nearly 35,000 overdose deaths due to
opioids and opiates in 2015, and nearly 14,000 deaths can be attributed to heroin alone, with numbers
growing drastically every year. Overdosing heroin is a frequent risk factor and leads to death if not
treated immediately. Those who survive heroin overdose are at risk of brain and neurological damage
from cerebral hypoxia. Heroin is classified as a Schedule I drug by the FDA, meaning that heroin has no
accepted medical usage and is not considered safe for use either in clinical or personal settings due to its
high potential for abuse.

How Does Heroin Addiction Work?

Heroin’s deadly addictiveness can be attributed primarily to its effectiveness at mimicking the brain’s
natural opiates, which work to allow dopamine to be released. Dopamine is a neurotransmitter that is
colloquially known as the ‘happiness drug’ due to its purpose in producing feelings of well-being and
pleasure when released into the brain. When the body is hurt, the brain produces natural opiates that
allow dopamine to be released in the areas of the brain commonly responsible for feelings of pain and
stress, which works to reduce overall feelings of pain. Heroin mimics this process in the brain, allowing
dopamine to constantly be produced and released, over-stimulating the brain and associating heroin
with the pleasure and happiness that comes from dopamine release. Because the brain isn’t capable of
handling such intense rushes of dopamine, dopamine receptors become damaged and make it more
difficult to feel pleasure, leading users to use more and more heroin to chase the fleeting euphoria it
once offered them. These numerous issues compound to create a strong addiction potential for heroin,
which becomes more and more difficult to feed the more it is abused. This deadly self-feeding cycle of
addiction is at the root of heroin’s effectiveness at becoming addictive.

Short and Long Term Effects

Heroin can be taken orally, smoked, snorted, or injected. Onset of effects varies with the
method used to take it, ranging from five seconds when injected to close to an hour when taken
orally.
The short term effects of heroin are similar to the effects of dopamine in general – only
amplified. Users report short-term mental effects such as feelings of:

• • • • Pain reduction
    • • Intense pleasure
    • • Relaxation
    • • Contentment

And physical effects such as:

• • • • Heaviness of limbs
    • • Drowsiness
    • • Lethargy
    • • Elevated body temperature

Repeated long-term use of heroin leads to physical side effects such as:

• • Diminished cardiovascular health – Particularly in the case of intravenous heroin use,
    heroin has shown to put a large amount of strain on the circulatory system and the
    heart in particular. Frequent injections can lead to infections and the deterioration of
    veins until they collapse

• • Neurological damage – Frequent abuse of opioid receptors through heroin can lead to
    both physical and chemical damage, and has shown to diminish the presence of white
    matter in the brain, which reduces important neural activity such as decision making
    and judgment skills.

• Diminished digestive health – Digestive health is severely diminished in the body of a
  frequent heroin user due to a reduction in digestive activity. This can lead to weakened
  gut fauna, cramping, nausea, constipation, and diarrhea.
• Decay in health of skin, teeth, and hair – Heroin abuse can lead to open sores and
  abscesses on the skin, in the lining of the gum, and even inside the body. This makes the
  user susceptible to infection and may lead to further complications such as blood
  poisoning.
•  
• Liver and kidney damage – Frequent use of heroin has shown a correlation with an
  increased risk of both kidney and liver disease as the body is not capable of healthily
  processing heroin. The use of additives in heroin also poses a particular threat to the
  liver and kidneys, as many additives are not meant to be ingested.
• Increased risk of bacterial infection – Heroin has shown to significantly increase the risk
  of bacterial infections both externally and internally due to a diminished immune
  response and, in the case of intravenous injections, wounds that can allow bacteria to
  infect. Infections of the heart valves as well as the appearance of abscesses on the skin
  are signs of frequent heroin abuse.
•  
• Insomnia – Due to a general decay in personal health as well as frequent interruptions
  in ordinary circadian activity, heroin users often experience worsening sleeping
  problems that can develop into insomnia.

Long-term use of heroin also carries several mental side effects including:

• • Severe addiction – Because of heroin’s addictiveness, both mental and physical
    addiction are developed very quickly, leading to a complete dependency on the drug.

• • Depression – Due to overstimulation of dopamine receptors, heroin frequently leads to
    depression due to the brain’s inability to utilize dopamine effectively.

• Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in
  heroin abuse due to external factors such as family or friends finding out, and internal
  factors from the drug itself. This can compound and develop into chronic paranoia.

Other risks posed by heroin abuse include:

• • Increased risk of HIV – The use of heroin intravenously poses a significantly greater risk
    of HIV and Hepatitis infection. Reusing and sharing needles are some of the most
    common methods of transmitting infections.

• • Risk of overdose – Heroin holds a reputation for how easy it is to overdose on for a
    good reason. Because heroin and heroin tolerance are so volatile, and potency can differ
    between different batches, it is very easy to misjudge the amount you can handle and
    overdose. Death by respiratory failure is common, and survivors are at risk of
    permanent neurological damage.

• • Additives – Heroin purchased on the street is often cut with additives to maximize
    profits, including many dangerous and toxic additives. In 2006 large amounts of heroin
    around the United States were cut with Fentanyl, an opioid painkiller, which led to
    hundreds of deaths around the country due to overdoses.

• • Pregnancy – Heroin can lead to a wide variety of difficulties with pregnancy. This
    includes both fatal and nonfatal birth defects, premature birth, stillbirth, Sudden Infant
    Death Syndrome, Neonatal Abstinence Syndrome, and various other dangerous
    abnormalities.

• Heroin withdrawal is a notoriously difficult process to go through, and includes withdrawal

• symptoms such as:

• • • Cold sweats

• • • Uncontrollable shaking and shivering

• • • Diarrhea

• • • Nausea and vomiting

• • • Elevated heart rate

• • • Muscle aches and cramps

• • Insomnia

Methods of Treatment

Pharmacological:
Treatment for heroin addiction via medication is one of the most common and effective forms of
treatment available. Due to the strength of heroin’s addictive potential and the severity of withdrawal
symptoms, treatment through medication aims at minimizing as many adverse reactions to withdrawal
as possible. Treatment through medication begins with a detoxification process in which the body is
given time to expel heroin from the body, which is often accompanied by common withdrawal
symptoms such as diarrhea and vomiting. Once the user has gone through detox, they begin treatment
with certain opioid substitutes. These drugs function similarly to heroin in their reaction with dopamine,
but to a lesser degree, and through significantly safer and less addictive chemicals. This allows a gradual
transition from addiction to sobriety while minimalizing unpleasant side effects of withdrawal that are
likely to lead to relapse. Buprenorphine is a common medication used in heroin treatment.
Buprenorphine is particularly effective due to its ability to satiate opiate cravings without producing any
high, which is due to it being a partial opioid agonist. This means that when Buprenorphine is ingested, it

will only activate opioid receptors in the brain to the point where cravings are satiated, but without
producing a high. Other medications include Methadone, one of the earliest medications used in heroin
treatment that works as a full opioid agonist, and Naltrexone, an opioid antagonist which completely
blocks the functioning of opioids when ingested. Each of these medications functions differently and is
prescribed on a case-to-case basis to best fit the needs of the individual undergoing treatment.
Therapeutic:
Other forms of treatment for heroin addiction come in the form of psychological and behavioral
therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in
an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral
Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical
communities all the time. Cognitive Behavioral Therapy sees substance abuse such as heroin addict as a
symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and
analytic techniques, an addict is better able to understand what led them to addiction in the first place,
change bad habits, and avoid behaviors that may trigger cravings.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to
programs that require patients to check themselves into a facility where they will undergo all
rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the
facilities, environment, and support offered by these facilities are conducive to a stable and effective
recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and
all of the living facilities necessary for a comfortable stay. The extensive support offered by these
facilities, combined with an environment that is focused on self-improvement and wellness is a great
combination for providing the motivation to push through the difficulties of withdrawal and to establish
good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those
who would benefit from a stricter more scheduled recovery in which the outside distractions and
temptations of life won’t get in the way of focusing on recovery.
Outpatient rehabilitation is based on the principle of spending only part of your time in recovery
programs while offering you the freedom to continue daily living on your own. Generally these programs
will require ten to twelve hours of commitment per week spent in a treatment facility participating in
similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox.
While this does offer easier access to drugs, some may find being able to maintain their normal daily
schedule more beneficial. This form of rehabilitation is effective for those who require more freedom
and contact with friends and family.
Both forms of rehabilitation are effective solutions at combatting heroin addiction, and there is a variety
of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each
individual.

References

1. “Overdose Death Rates.” NIDA, National Institute on Drug Abuse, 6 Jan. 2017,
www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
2. Center for Behavioral Health Statistics and Quality (CBHSQ), et al. “Results from the 2011
National Survey on Drug Use and Health: Detailed Tables.” SAMSHA Web Archives, SAMSHA,

Sept. 2011, http://archive.samhsa.gov/data/NSDUH/2011SummNatFindDetTables/NSDUH-
DetTabsPDFWHTML2011/2k11DetailedTabs/Web/HTML/NSDUH-DetTabsTOC2011.htm.