Heroin Addiction Treatment

What is Heroin?

Although purer heroin addict is becoming more common, most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the heroin or its true contents, they are at risk of heroin overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other heroin injection equipment.

What are some other names for heroin?

“smack”, “junk”, “horse”, “skag”, “H”, “China white”

How is heroin used?

Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject heroin up to four times a day. Heroin intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while heroin intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a “rush” as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

Heroin i njection continues to be the predominant method of heroin use among addicted users seeking treatment; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now the most widely reported means of taking heroin among users admitted for heroin treatment in Newark, Chicago, and New York.

Heroin addiction user’s age

With the shift in heroin abuse patterns comes an even more diverse group of users. Older users (over 30) continue to be one of the largest user groups in most national data. However, the increase continues in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been appearing in more affluent communities.

What are the immediate (short-term)
effects of heroin use?

Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Heroin Abusers typically report feeling a surge of pleasurable sensation, a “rush.” The intensity of the rush is a function of how much heroin is taken and how rapidly the heroin enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching.

After the initial heroin effects, abusers usually will be drowsy for several hours. Mental function is clouded by heroin’s effect on the central nervous system. Cardiac function slows. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the heroin cannot be accurately known.

What are the long-term
effects of heroin use?

One of the most detrimental long-term effects of heroin is addiction itself.

Heroin addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence fro the heroin, which are also powerful motivating factors for compulsive heroin use and abuse. As with abusers of any addictive drug, heroin abusers gradually spend more and more time and energy obtaining and using the heroin. Once they are addicted, the heroin abusers’ primary purpose in life becomes seeking and using heroin. The heroin literally change their brains.

Heroin addiction physical dependence

Heroin addiction physical dependence develops with higher doses of the heroin. With heroin physical dependence, the body adapts to the presence of the heroin and withdrawal symptoms occur if use is reduced the heroin abruptly. Heroin withdrawal may occur within a few hours after the last time the heroin is taken. Symptoms of heroin withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements. Major heroin withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent heroin withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the fetus of a pregnant heroin addict.

At some point during continuous heroin use, a person can become addicted to the heroin. Sometimes heroin addicts will endure many of the withdrawal symptoms to reduce their tolerance for the heroin so that they can again experience the rush.

Heroin physical dependence and the emergence of heroin withdrawal symptoms were once believed to be the key features of heroin addiction. We now know this may not be the case entirely, since craving and relapse can occur weeks and months after heroin withdrawal symptoms are long gone. We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the heroin addict.

What are the medical complications
of chronic heroin use?

Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the heroin abuser as well as from heroin’s depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

Of course, sharing of heroin injection equipment or fluids can lead to some of the most severe consequences of heroin abuse-infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which heroin drug abusers can then pass on to their sexual partners and children.

What are the current trends for heroin addiction abuse?

A generation ago, the heroin (colloquially known as “smack”) available in the U.S. was barely five percent pure and used by a relatively small percentage of young people because it had to be injected heroin with a needle. Now, it appears smack is back with a vengeance and it’s addicting large groups of new heroin users.

The Office of National Drug Control Policy issued a report (April 1992, No. 5, pp. 1-6) claiming “a massive increase in heroin use and addiction is not likely.” One reason for this was, “…the apparent absence of new initiates (i.e., heroin users with little or no prior drug-using experience).” However, based upon recent news reports and other sources (see the A.T. Forum Web site for News Updates), the ONDCP report appears to have been premature, to say the least.

Just this past February, Attorney General Janet Reno admitted heroin is more plentiful, purer, and less expensive than it was just a few years ago. “If we do not counteract the heroin threat now,” she said, “we risk repeating the terrible consequences of the 1980s’ cocaine and crack epidemic.” Authorities estimate that heroin addiction has increased 20 percent and worldwide production has grown sharply, even as other illegal substance abuse is declining.

Reports of problems have sprung-up countrywide. In California, heroin sold in the San Joaquin Valley is cheap, potent, and plentiful – business is booming in area emergency rooms as two or three overdose cases appear each day. In Colorado, Boulder County officials may establish a methadone clinic for the first time in 16 years to deal with increasing heroin addiction. On the East Coast, heroin is reported to be 40 to 70 percent pure and around $10 for a small packet. The number of heroin-related hospital emergencies has more than doubled in New York City and surrounding areas.

Many heroin drug abusers mistakenly believe inhaling heroin, rather than injecting it, reduces the risks of heroin addiction or overdose. In some areas, “shabanging” – picking up cooked heroin with a syringe and squirting it up the nose – has increased in popularity. Street heroin carries prophetic names: “DOA,” “Body Bag,” “Instant Death,” and “Silence of the Lamb.” Rather than scaring off young initiates, the implied danger seems to actually increase the heroin’s allure.

How does heroin addiction abuse affect pregnant women?

Heroin addiction abuse can cause serious complications during pregnancy, including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome), as well.

Are heroin users at special risk for contracting HIV/AIDS and hepatitis B and C?

Because many heroin addicts often share needles and other heroin injection equipment, they are at special risk of contracting HIV and other infectious diseases. Infection of injection drug users with HIV is spread primarily through reuse of contaminated syringes and needles or other paraphernalia by more than one person, as well as through unprotected sexual intercourse with HIV-infected individuals. For nearly one-third of Americans infected with HIV, injection drug use is a risk factor. In fact, drug abuse is the fastest growing vector for the spread of HIV in the Nation.

Research has found that heroin abusers can change the behaviors that put them at risk for contracting HIV, through drug abuse treatment, prevention, and community-based outreach programs. They can eliminate drug use, drug-related risk behaviors such as needle sharing, unsafe sexual practices, and, in turn, the risk of exposure to HIV/AIDS and other infectious diseases. Drug abuse prevention and treatment are highly effective in preventing the spread of HIV.

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