Heroin is a highly addictive, illegal drug with an analgesic effect, made from the resin of poppy plants. When harvested from poppy plants, it is a milky, sap-like substance. At this point, it is in the form of opium, refined initially as morphine, and then later into heroin.
Heroin was first discovered with no known use in a lab in Britain. It was first sold in 1898 by Bayer, a lab in Germany, as a treatment for tuberculosis, a children’s cough medicine, and as a remedy for morphine addiction.
When heroin is refined from morphine, it is typically a white powder with a bitter taste. When it is sold on the street, it is usually in the form of a powder, ranging in color from white to dark brown. The exact color is directly related to what additives have been introduced. When this occurs, the heroin has been “cut” or diluted, often with sugar, caffeine, or other substances, such as strychnine or other poisons.
Heroin from Mexico is called black tar heroin and looks like tar. Most of the heroin used in the US is from Mexico.
Until 1914, heroin was readily available. Then legislation called the Harrison Narcotics Tax Act was passed which controlled its sale and distribution. Then in 1924, the sale, import, and manufacture of heroin was made illegal.
Prevalence of Heroin Use
As an opioid, heroin belongs to the same drug class as prescription painkillers, such as OxyContin and Vicodin. Abuse of prescription painkillers is widespread in the US, with the National Institute on Drug Abuse (NIDA) calling it an “epidemic.” In many instances, use begins with a prescription for a legitimate medical problem, usually pain following an injury or surgery.
As users build up a tolerance to the medication, they may begin taking more than prescribed, or taking dosages more frequently than prescribed, in an effort to manage pain and enjoy the drug’s euphoric effects. Once abuse begins, addiction can quickly take hold.
People who are addicted to prescription painkillers often turn to heroin once they are no longer able to obtain more painkillers. Heroin is a cheaper, and often easier to access, alternative that brings about similar effects in users. According to NIDA, half of young people who have injected heroin report abusing prescription opiates prior to using heroin.
In 2011, 4.2 million Americans, aged 12 or older, reported that they had used heroin at least once in their lives. Approximately 23 percent of people who use heroin become dependent on it. According to the American Society of Addiction Medicine, 586,000 people suffered from a heroin use disorder in 2014.
Effects on the Brain and Body
The reason for opiate abuse relates to their primary route of action. Opiates work by stimulating the pleasure center of the brain, thus reducing the impact of pain. When entering the brain, heroin is turned back into morphine, which binds to opiate receptors in the brain and body. In addition to being located in areas of the brain related to pain perception, opiate receptors are found in the area of the brain, the brain stem, which is responsible for automatic life processes, such as respiration, blood pressure, and arousal.
Heroin produces its effects as it is carried to the brain and crosses the blood-brain barrier. After it enters the bloodstream, it is metastasized in the liver as morphine, releasing endorphins. Endorphins are the body’s natural pain medicine, and they are experienced as euphoria, a feeling of comfort and wellbeing. Users tend to feel extraverted and talkative.
The first effects of heroin include a surge of sensation, also known as a rush. Typically, this is accompanied by a warm feeling on the skin and a dry mouth. Sometimes, vomiting or severe itching also occurs. Once these effects fade, slowed mental functioning and drowsiness set in over several hours. Along with this are reduced breathing and heart rate, as well as a lowered body temperature.
Continued heroin use changes the physical structure and physiology of the brain. Long-term effects in the neuronal and hormonal systems can occur, which are often difficult to reverse. There may also be a deterioration of white matter in the brain that affects decision-making, behavior regulation, and responses to stress.
Tolerance and Withdrawal
Heroin use can quickly progress to addiction, largely due to intense cravings to repeat the euphoric feelings associated with use. As the body becomes accustomed to heroin, tolerance forms. This means it will take more heroin to achieve the same high that could be previously achieved with a smaller dose. With continued use, the body learns to operate with heroin and ultimately dependence forms.
Once physical dependence has developed, the user will begin to experience withdrawal symptoms when heroin levels drop. Opiate withdrawal symptoms can be intense and uncomfortable but they generally are not life-threatening. Symptoms include restlessness, aches and pains, vomiting, nausea, headache, and insomnia. Severe discomfort often leads to intense cravings for the drug, in an effort to make the discomfort stop, leading to a cycle of abuse.
Major symptoms occur quickly and peak at 24-48 hours after the last dose. These intense symptoms typically endure for about a week. Withdrawal symptoms decrease in severity as time passes, and the bulk of the symptoms generally pass within two weeks, though some symptoms may continue for months.
Methods of Use
There are several different methods of taking heroin. Intravenous injection gets the drug directly into the bloodstream, and effects are felt in less than a minute. Intramuscular injections, in which heroin is injected into a muscle, delay the reaction for 5-8 minutes. Heroin can also be snorted or smoked, which delays the reaction for 10-30 minutes.
While any use of heroin comes with significant health risks, injection drug use brings additional risks. Injection drug use is associated with a high risk for contracting HIV, hepatitis, and other blood-borne diseases. As heroin abuse continues and addiction takes hold, users often seek out methods that will produce a quicker high, leading them to injection use.
Other risks of heroin use include:
- Collapsed veins (from injection use)
- Gastrointestinal issues
- Heart valve infections
- Liver disease
- Kidney disease
- Respiratory issues
Oftentimes, heroin is “cut” with unknown agents. The nature of those additives, and the subsequent variable strength of the heroin bring high risk for overdose. For instance, if a user obtains a batch of heroin with a lower strength than usual, the person may take more and more of the batch in search of the high, and inadvertently overdose. On the other hand, if the strength is very powerful, it can easily result in an overdose with the first dose.
The risk of overdose is extremely high because of the unpredictability of the purity of the heroin. There is no way to verify the purity of a batch bought on the street. As a result, strength can vary greatly from batch to batch.
A heroin overdose is considered a medical emergency. Prompt medical attention could potentially reverse the overdose and save the user’s life. Signs of an overdose include:
- Slowed breathing
- Bluish tint to the lips and fingertips
- Dry mouth
- Tiny pupils
- Slow pulse
Overdose can result in brain damage due to a lack of oxygen, coma or, even death.
Those challenged by heroin abuse and addiction often want to stop using the drug. What may have started with an opioid prescription for a legitimate medical problem can quickly turn to illicit heroin use and abuse. Very soon, altered brain functioning leads users to constantly seek out the drug in an effort to avoid pain and withdrawal.
This is where caring family members can have a lifesaving impact on their loved one. Family members and friends can approach the person in need, express their concerns, and offer help.
With comprehensive care that addresses the physical and psychological components of addiction, true recovery is possible.
Pharmacological and behavioral approaches can help to restore brain function and behavior. The use of both options – both medication and psychological therapy – in combination is typically recommended. Pharmacological intervention for heroin addiction has been shown to increase retention in drug treatment programs and reduce relapse.
Sometimes, maintenance medications are used in heroin addiction treatment. Individuals may be switched from heroin to methadone or buprenorphine as a replacement medication. These medications tend to be successful since they activate the opioid receptors, activate these receptors with a smaller response, or block opioid receptors and interfere with opioids’ rewarding effects. As a result, individuals won’t experience cravings for heroin or intense withdrawal symptoms. This can allow them to be fully focused on therapy and actively involved in the process.
Additionally, Cognitive Behavioral Therapy can help to change expectations and behaviors, allowing individuals to also change their responses to stressful situations. With therapy, people can learn more healthy coping mechanisms rather than turning to substance abuse.
The effectiveness of a multidirectional treatment approach in dealing with heroin abuse has been clearly demonstrated. There are many options available to help a person overcome heroin addiction and begin to live a healthy, productive life once again.