Why is heroin abused?


Derived from the opium poppy plant, heroin is an illegal drug classified as a Schedule I controlled substance by the Drug Enforcement Administration (DEA). It has a high potential for abuse and is considered to be extremely addictive with no accepted medical properties in the United States. When the powdered or “black tar” version is smoked, snorted, or injected as a recreational drug of abuse, heroin causes a rapid-onset and euphoric high.

Heroin is a central nervous system depressant drug that binds to opioid receptors in the brain, causing relaxation, sedation, and a mellow feeling. When abusing heroin, individuals are often said to be “on the nod” as the drug can cause a person to fluctuate between a state of consciousness and semi-consciousness in an extremely relaxed state. The high can be intense, and the burst of euphoria highly desirable.

How common is heroin abuse?


Heroin availability and abuse rates are rising rapidly in the United States, as the DEA reports that the demand for and use of the drug have increased significantly in the past decade. This demand may stem, at least in part, from the prescription opioid abuse epidemic sweeping America. As controlled prescription painkillers are being more tightly regulated and harder to obtain, the demand for heroin seems to be increasing. It is often cheaper and easier to get than the narcotics that many Americans are abusing.

The Centers for Disease Control and Prevention (CDC) reports that three out of every four people who have recently started abusing heroin abused prescription opioid drugs first. Nearly 4 million Americans report having used heroin at some point in their lifetime, per The Guardian.

According to the CDC, abuse of heroin has increased among almost all demographics in the United States, including both men and women, people who have private health insurance, and those of all income levels. Among young adults between the ages of 18 and 25, heroin use has doubled in the past 10 years. The National Survey on Drug Use and Health (NSDUH) publishes that close to 1 million Americans reported past-year abuse of heroin in 2016.

What are some street names for heroin?


Heroin is harvested and imported into the United States from South America, Southwest and Southeast Asia, and Mexico in a white powder form and also from Mexico as “black tar” or a brown powder, per the DEA.

Common street names for heroin include:

  • Chiva
  • Big H
  • Horse
  • Hell dust
  • Thunder
  • Smack
  • Negra
  • China white
  • Skag
  • White girl/boy
  • Snow
  • Dragon

Since heroin is an illicit drug, it is only sold on the black market and not obtainable through legal means in the United States. Any use of heroin is considered drug abuse.

What are the side effects of heroin use?


Heroin typically causes a “rush” pretty quickly after ingestion, which is then followed by the ebb and flow of consciousness and a feeling of “heavy limbs.” A lack of motor control and coordination as well as an unsteady gait, dry mouth, a warm flushed feeling in the skin, and impaired reflexes are side effects of heroin use. Heroin also slows down heart rate and blood pressure as well as respiration (breathing) rates. Body temperature is lowered, and pain receptors are dulled. Heroin may also cause itching, nausea, and vomiting.

Heroin has a mellowing effect, increasing pleasure and lowering anxiety and stress levels. A person may struggle to remain awake and conscious while under the influence of heroin. Inhibitions are lowered, and memory, concentration, and thinking abilities are all impaired by heroin use. Heroin can make it difficult to think clearly and make rational decisions, increasing the risk for participating in potentially dangerous and out-of-character behaviors.

How high is the risk for a heroin overdose?


Heroin is an extremely potent opiate that may even be cut with other toxic substances or more potent drugs, such as the synthetic opioid fentanyl to stretch the product for sale. Someone taking heroin may not even be aware of how pure the dosage is and what is even in the drug they are taking. This can make the drug very dangerous and highly unpredictable. The CDC reports that over 15,000 people died from a heroin overdose in 2016, over five times the number of heroin overdose fatalities in 2010.

Heroin can quickly overload a person’s system and cause them to lose consciousness, fall into a coma, suffer brain damage as a result of oxygen deprivation to the brain, stop breathing, and possibly even die.

A heroin overdose is a medical emergency that requires immediate professional treatment. Many first responders carry the opioid antagonist drug naloxone (Narcan) that can help to reverse a heroin overdose. Many states also have Good Samaritan laws in place that protect individuals from drug-related charges when reporting an overdose and grant immunity to those who attempt to administer aid or the overdose-reversal drug in an attempt to save a life.

What are the risks of mixing heroin with alcohol and other drugs?


Heroin is commonly mixed with other drugs with potentially disastrous consequences. The CDC reports that 90 percent of people abusing heroin also use other drugs. Heroin may be laced with or cut with fentanyl or other drugs without a user’s knowledge or even on purpose to amplify the effects of the drug.

Heroin may also be mixed with drugs like cocaine (called a “speedball”) in an attempt to counteract the negative effects of the stimulant drug. Cocaine and heroin work in nearly opposite manners. While cocaine is an “upper, ” heroin is a “downer.” Cocaine will increase energy, focus, and concentration, while heroin induces relaxation and sedation. The combination of the two drugs may serve to blunt the effects of each drug. Mixing them can be very unpredictable, however, and drastically raises the odds for a potentially life-threatening overdose.

Mixing heroin with other central nervous system depressants, such as prescription opioids, alcohol, or benzodiazepine drugs, also heightens the risk for a negative reaction and possible overdose. Combining multiple drugs that depress the central nervous system can make it even more likely that a person will struggle to breath or stop breathing altogether, The Guardian warns, as most opioid overdoses involve at least one other drug.

Are there long-term health consequences of heroin use?


One of the most considerable long-term side effects of heroin use is addiction. Regular heroin use can cause a person to get used to certain levels of the drug and to develop a tolerance, which will mean that they will have to take more each time for it to keep working the same way. Taking more each time can increase the rate and risk for physical dependence, which often gives way to compulsive drug use and addiction.

The American Society of Addiction Medicine (ASAM) reports that nearly one-quarter of all people who abuse heroin will struggle with addiction to it. The NSDUH publishes that nearly 650,000 people struggled with addiction involving heroin in 2016.

Heroin binds to opioid receptors in the brain, changing brain chemistry and causing a flood of the pleasure-inducing neurotransmitter dopamine. Dopamine is one of the brain’s chemical messengers that is involved in the reward center and processes of the central nervous system as well as movement, thinking, and memory functions. Excess dopamine makes a person feel good, but also impacts normal cognitive and movement abilities. When heroin wears off, in about an hour or so, dopamine levels can drop, leaving a person feeling depressed, anxious, and irritable. With repeated use of heroin, the brain can become accustomed to its interaction with dopamine levels, and it may then struggle to keep up with dopamine production and transmission without heroin’s influence.

Withdrawal symptoms and cravings can be significant, and a person may wish to continue taking heroin in order to feel good. The brain may no longer be able to maintain a chemical balance without heroin as a physical dependence forms.

Aside from addiction, heroin also has a wide range of health consequences with perpetuated abuse, which can include:

  • Liver and kidney disease
  • Cardiovascular complications
  • Infections to the lining of heart and valves
  • Respiratory infections and complications, including pneumonia
  • Depression, anxiety, and an increased rate of mental distress and issues
  • Stomach cramps and constipation
  • Sexual dysfunction in men
  • Irregular and disrupted menstruation in women
  • Insomnia

Other issues can come from the way that heroin is abused as well. For instance, if the drug is injected, complications can include collapsed veins, scarring creating “track marks,” and heart problems. Snorting the drug can lead to a lost sense of smell, a chronic runny nose and/or nosebleeds, and damage to the sinus cavity and nasal passages. Smoking heroin can increase the rate of respiratory complications and cause a person to suffer from a persistent cough as well as endure potential burns on the lips and hands.

What are the signs of heroin addiction?


Addiction is defined as a brain disease by the American Society of Addiction Medicine (ASAM). Chronic heroin abuse makes changes to the way the brain processes pleasure and reward, creating a kind of shortcut to happiness and then making it more difficult to find it without the interaction of the drug. Drug tolerance, physical dependence, withdrawal symptoms, and cravings are all physical consequences of continued heroin abuse and often signs of addiction as well.

Addiction is also a behavioral disease. A person who is struggling with heroin addiction may experience a shift in personality, suffer from significant mood swings, and act in ways that are not normal for them.

Further signs of addiction include:

  • An inability to stop taking the drug despite multiple attempts
  • Using the drug for longer or taking more of it at a time than initially intended
  • Giving up social, recreational, or other activities that were important before to use the drug instead
  • Increased secrecy, isolation, difficulties with relationships, and changes in social circle
  • Fluctuations in appetite and irregular sleep patterns
  • Continued use of the drug even though it is known to cause physical, emotional, and/or social issues
  • Taking the drug in situations that are potentially hazardous or an increase in risk-taking behaviors
  • Lack of consistency in fulfilling regular obligations, such as those related to family, school, and/or work
  • Spending a lot of time figuring out how to get the drug, using it, and recovering from the high

How is heroin addiction treated?


Heroin addiction is optimally treated through a complete treatment program that will often include:

  • Medical detox: Withdrawal symptoms can be safely managed with medications, supportive care, around-the-clock supervision, and medical and mental health support in a controlled environment.
  • Counseling and behavioral therapies (group and individual): Therapies such as Cognitive Behavioral Therapy (CBT) can help individuals to develop stress coping techniques and tools for managing difficult emotions for a more balanced emotional state.
  • Medication management: Heroin is not a drug that is recommended to stop “cold turkey” as withdrawal symptoms can be intense. Instead longer-acting opioids like buprenorphine or methadone are often substituted during detox and treatment in order to slowly taper the opioids out of the brain and body in a safe and controlled manner. These medications can help to manage cravings and withdrawal symptoms.
  • Treatment for co-occurring disorders: Depression, anxiety, and other mood and mental health disorders are common in those struggling with addiction, and a fully integrated treatment program can help to manage both disorders simultaneously.
  • Life skills training and relapse prevention programs: People can learn how to recognize potential triggers, control cravings, and learn new healthy habits for a sustained recovery through educational and behavioral programs.
  • Aftercare and recovery support programs: Peer-support groups can help to bolster sobriety and serve as a healthy social outlet that offers continued encouragement and support into recovery.

What support groups exist for heroin addiction?


Support groups can be a great way for individuals to connect with others with a shared background and story. Addiction is an individual disease, and it can feel isolating. As a result, a support group of others who can empathize and offer suggestions for maintaining sobriety, controlling cravings, and combating possible stressors to minimize relapse can be very helpful.

Most support groups are peer-based, and there are often specialized groups catering to specific demographics if desired as well. Support groups often follow a 12-Step format, and Heroin Anonymous and Narcotics Anonymous are potential options. These groups are faith-based, but they are all-inclusive in nature with the only membership requirement being that a person desires to remain sober and abstinent from drugs. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a Behavioral Health Treatment Services Locator that can connect individuals with a support group as well as other options.

What techniques can help with relapse prevention?


Support groups and spending enough time in a treatment program to instill healthy habits can help to minimize relapse, which is often a component of addiction. NIDA reports that relapse rates are as high as 40-60 percent for drug addiction.

There are many tools that a person can use to minimize episodes of relapse though. Getting enough sleep and eating balanced and healthy meals is a great way to start. A strong physical foundation helps a person to have a clearer mind and feel more balanced emotionally. Physical fitness and exercise can help with this as well.

Emotional strength is important for combatting cravings and sustaining recovery; things that help build up self-esteem, self-reliance, and confidence are all beneficial for this. Finding new hobbies that can occupy the mind are beneficial in this arena as well. Creative expressions, such as painting, writing, sculpting, dancing, music, drawing, and more, can be great outlets for stress and provide emotional release. Holistic methods like chiropractic care, massage therapy, yoga, and mindfulness meditation can all help to align the body and relieve tension and stress. Mindfulness techniques can also promote a healthy connection between mind, soul, and body, helping a person to find inner strength and become more in tune with the way the physical self relates to the emotional one.

Aftercare programs and recovery support groups often host sober events and social gatherings, which can be a good way to connect with others in recovery.