Heroin addiction treatment
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Heroin Treatment in Hawaii
Distribution, availability, and abuse of heroin continue to present a major threat to Hawaii. Heroin is definitely widely available, and abuse of the drug continues to increase. The most common type of heroin available in the state of Hawaii is Mexican black tar. The availability of Southeast Asian heroin, which dominated the Hawaii heroin market in the 1970s and 1980s, is very limited.
Admissions fluctuated to publicly funded treatment facilities for heroin abuse between 1994 and 2000.Admissions for treatment of heroin abuse rose from 209 in 1994 to a high of 434 admissions in 1998, according to TEDS data. Admissions then decreased to 313 in 2000.
During the transport of Mexican black tar heroin from Los Angeles to Hawaii, a Mexican organized crime group was responsible for the murder of two individuals in a dispute over control of heroin distribution territory on Oahu. Both victims were shot in the head.
At some point during continuous heroin use, an individual can become addicted to the substance. Sometimes addicted people will endure many of the withdrawal symptoms to diminish their tolerance for heroin so that they can experience the rush again.
Physical dependence and the emergence of 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 even a few months after withdrawal symptoms are long disappeared. We also know that persons with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is gone by other means. This reason may be the patient in pain is simply seeking relief of pain and not the rush or high sought by the addict.
Black tar heroin withdrawal
The withdrawal from heroin may begin from within 6 to 24 hours of discontinuation of sustained use of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms might include: sweating, malaise, anxiety, depression, persistent and intense penile erection in males (priapism), extra sensitivity of the genitals in females, general sense of heaviness, cramp-like pains in the limbs, yawning and lacrimation, sleep difficulties, cold sweats, chills, severe muscle and bone aches not precipitated by any physical trauma, nausea and vomiting, diarrhea, goose bumps, cramps, and fever. With an addict with a high tolerance, heroin withdrawal may even lead to fatality.
Numerous addicts also complain of a painful condition, the so-called “itchy blood”, which frequently results in compulsive scratching that causes bruises and sometimes ruptures the skin, leaving scabs. Abrupt stop of heroin use causes muscle spasms in the legs of the user (restless leg syndrome). Users taking the “cold turkey” approach (withdrawal without using symptom-reducing or counteractive substances) are more likely to experience the negative effects of withdrawal in a more pronounced way.
Two general approaches are used to ease the physical part of opioid withdrawal. The first is to replace a longer-acting opioid like methadone or buprenorphine for heroin or another short-acting opioid and then slowly taper the dose.
In the second approach, benzodiazepines like diazepam (Valium) can temporarily ease the frequently extreme anxiety of opioid withdrawal. The most usual benzodiazepine employed as part of the detox protocol in these situations is oxazepam (Serax). Benzodiazepine use must be prescribed with care because benzodiazepines have a wide addiction potential, and numerous opioid addicts also use other central nervous system depressants including barbiturates. Also, though unpleasant, opioid withdrawal rarely has the potential to be deadly, whereas complications related to withdrawal from benzodiazepines, barbiturates and alcohol (such as epileptic seizures, cardiac arrest, and delirium tremens) can prove dangerous and are potentially fatal. Numerous symptoms of opioid withdrawal are due to rebound hyperactivity of the sympathetic nervous system, which can be eliminated with clonidine (Catapres), a centrally-acting alpha-2 agonist primarily used to treat hypertension.
Buprenorphine is one of the drugs most recently licensed for the substitution of illicit opioids. Being a partial opioid agonist/antagonist, it develops a lower grade of tolerance than heroin or methadone because of the so-called ceiling effect. It also has less important withdrawal symptoms than heroin when discontinued suddenly, which should never be done without proper medical supervision. It is generally given every 24-48 hrs. Buprenorphine is a kappa-opioid receptor antagonist. This gives the substance an anti-depressant effect, raising physical and intellectual activity. Buprenorphine also acts as a partial agonist at the same μ-receptor where illegal opioids such as heroin exhibit their action. Due to its effects on this receptor, all patients whose tolerance is above a certain level are not able to get any “high” from other opioids during buprenorphine treatment except for very high doses.