Heroin: Addiction and Treatment Options
Heroin, what is it?
Heroin is a derivative of morphine, which is found in opium. It is highly addictive and more powerful than morphine. Some common street names include "H," dope, horse, black tar, brown sugar, and smack. The drug produces a euphoric, anxiolytic, analgesic effect. It is classified as a schedule I drug under the Controlled Substances Act of 1970.
Heroin has no accepted medical use in the United States. Pure heroin is white with a bitter taste. It is sold as a white or brown powder and is generally "cut" with other substances including sugar, starch, or quinine.
Heroin abusers are at high risk for overdose due to the fact that they are unsure of the strength of the drug and whether it is "cut" with any other additives. The term "black tar" heroin is so called due to the black, sticky tar-like form of the drug, which is generally imported from Mexico.
How is Heroin used?
Heroin is most often used intravenously, smoked, or snorted. It is less commonly used as a suppository or orally ingested. When the drug is taken intravenously, it gives an instant, euphoric "rush." When snorted or sniffed it takes longer to experience the rush feeling and euphoric effect. Taken orally, it does not produce a rush feeling. As a suppository, the drug gives the user an intense euphoric effect. Heroin is highly addictive, regardless of the way it is ingested.
Side effects of Heroin
When metabolized, heroin turns into morphine and other metabolites, which bind to opioid receptors that are located in the brain. After injecting heroin, the user reports the "rush" of euphoria that includes warming of skin, heaviness in extremities, and a dry mouth. After the "rush," the user then experiences a drowsy state where mental functioning becomes clouded and the central nervous system (CNS) becomes depressed. Other effects of this CNS depression includes respiratory depression, constricted "pin-point" pupils, and nausea. Effects of an overdose include slow and shallow breathing, hypotension, muscle spasms, convulsions, coma, and possible death.
Other complications from IV heroin use and sharing of needles and paraphernalia include HIV/AIDS, hepatitis, staph infections, and toxic reactions to heroin impurities. IV use may also result in venous collapse, abscesses, spontaneous abortions, and endocarditis. The continuous poor health and poor hygiene can result in the user getting pneumonia. All of these things can result in severe disability or death of a user.
With regular use of heroin the abuser develops a tolerance, which means more heroin is needed for the abuser to obtain the same desired euphoric effects. Over time, the abuser becomes physically dependent and addiction develops. With physical dependence the body has adapted to the presence of heroin in the body and withdrawal symptoms occur when the use is reduced or stopped. Withdrawal symptoms may include cravings, sweats, chills/goose bumps, restlessness, body aches, tremors, anxiety, abdominal cramping, diarrhea, nausea, vomiting, runny/stuffy nose, watery eyes, sneezing, insomnia, hypertension, tachycardia, and low grade fever. These symptoms may start within a few hours after last use and peak within 48-72 hours and subside after a week. This is also known as "dope sickness." Death related to withdrawal is rare but can happen in heavily dependent users.
PAWS, or Post-Acute Withdrawal Symptoms, may occur weeks or months later. Symptoms are similar and are generally more tolerable than initial withdrawal.
What is heroin overdose?
Heroin overdose may occur in the following ways:
- when there is a time gap between use
- when it is more potent form
- when the abuser uses large amounts
- no breathing, shallow breathing, slow/labored breathing
- dry mouth, small pupils, discolored tongue
- low blood pressure, weak pulse, slow heart rate
- bluish colored nails/lips
- coma, delirium, disorientation, drowsiness, uncontrolled muscle movements
Treatment options for heroin overdose:
Treatment options for heroin overdose include:
- Call 911
- if available, narcan or naloxone works by reversing the effects of heroin by instantly blocking the opioid receptors to prevent further damage of the heroin.
- monitor vitals and initiate CPR/rescue breathing if needed
- apply oxygen if available
What is naloxone (Narcan)?
Naloxone blocks and reverses the effects of opiates/heroin. It is often used to treat heroin/opioid overdose. It may be given into a large muscle, IV, or absorbed into the mucus membranes of the nasal passages. After administration it can put someone into immediate withdrawal.
Treatment for heroin addiction
Heroin addiction is a complex, treatable disease that affects brain function and behavior. Staying in treatment long enough is critical for successful recovery. Abstinence is first and foremost. The abuser then must go through detoxification from heroin. There are medications that may be used to assist with this detox which generally is over a 3-7 day span. Medications may include using methadone, subutex, or suboxone. Clients may be detoxed successfully without the use of these commonly used detox medications. Medications to help treat various signs and symptoms of withdrawal may be used. Detox is generally focused on getting the client to feel better physically.
Once the client is feeling better physically and the majority of the withdrawal symptoms have subsided then the client can focus on other aspects of treatment. Other forms of treatment include individual and group behavioral counseling. Cognitive/behavioral therapies are used to assist the client in modifying the attitudes and behaviors related to their use, to increase their healthy life skills, and to recognize, cope, and avoid situations in which they are most likely "triggered" to use drugs.
Treatment is generally intensive at first where a client will attend multiple sessions which may be at an inpatient or outpatient level of care. After attending and completing successfully intensive sessions the clients treatment will be less intensive but will be maintained to assist the client in maintaining sobriety.
Clients should be evaluated for the possibility of any co-occurring mental health disorders.
Relapse prevention should also be provided to assist the client to recognize and manage relapse warning signs. This should be a primary focus for clients unable to maintain sobriety.
There are also medication-assisted treatment programs, for example like methadone or suboxone maintenance. The success rate for sobriety increases with regular attendance in behavioral/cognitive treatment.