Heroin:

Understanding Effects, Withdrawal, Addiction, and Detox

Heroin:

Understanding Effects, Withdrawal, Addiction, and Detox

What is Heroin?

Heroin is a natural derivative of opium from opium poppy seed pods, which causes feelings that may result in addiction. The side effects of heroin abuse are serious, harmful, and cannot be ignored. When combined with opioid receptors, heroin triggers brain regions responsible for pleasure and mood. These areas are responsible for controlling important body functions like blood pressure, breathing, and awakening. Most people who report using heroin started out using similar substances and eventually switched to heroin as the substance abuse progressed.

Background of Heroin

Heroin was synthesized by British chemists in 1874 from morphine, but was not manufactured commercially until 1898 by Bayer Pharmaceuticals. Comparable to many opioids developed later on, heroin originates from the poppy plant. ​​​1

Origins

Opium, from opium poppy seeds, comprises a number of different opioid combinations, containing morphine as well as codeine. The reaction of morphine with other acids forms heroin.

Historical Usage

The first clinical outcome was very promising, and heroin was considered a miracle drug. Initially, doctors were using heroin in cough medicine for pain relief during childbirth as well as placing the patient on anesthesia. It was also used for treatment of morphine addiction before the addictive nature of heroin was discovered. Bayer first used the term “heroin” as the product name of the drug in 1898. Individuals who were taking the drug commented on the heroic feeling they felt while taking it. In the past, Bayer sold heroin as a non-addictive painkiller nationwide. It was not until the 1920s that adults and children began taking it as cold medicines and for other pains.

How it Became Illegal

However, it has been proven that frequent use of heroin leads to the development of tolerance and addiction. International treaties regulate restrictions on the production, use and distribution of heroin. It has also been proposed to completely ban heroin production. 

Due to strict rules, the creation and use of heroin declined significantly after 1931. The black market has begun illegitimate production of heroin as well as drug trafficking. The US government made heroin illegal in 1924. Heroin remains a illegal schedule 1 drug, with high potential for abuse and no current accepted medical use. 

Other Names

In the culture surrounding illegal drugs, every imaginable drug has thousands of nicknames and street names. Heroin’s street names come from a variety of sources, including the appearance and type of heroin, where it comes from, its impact on users, and how it is packaged for sale.

Some street names for heroin include: 

  • Slap
  • Asphalt
  • Coating
  • Hell Dust
  • Tattered
  • Chiba
  • Brown Sugar
  • Chinese White
  • White Nurse/White Lady/White Boy

Usage

Heroin is a greatly addictive drug which is consumed in a variety of methods. How heroin is abused depends on the concentration of drug as well as the preferences of the user. Heroin is abused in the following ways:

Injection

Sniffing or snorted in powdered form

Smoked from a pipe or mixed with a cannabis joint or cigarette

Huffed via a straw, also known as “chasing dragons”

When heroin is injected, there is typically a feeling of the drugs effect within seven to eight seconds. When smoked, top effects are felt within 10 to 15 minutes.

People who inject heroin generally have a higher rate of addiction or dependence on the drug compared with those who snort or smoke it. People who inject heroin also tend to use more often and develop a tolerance to the drug more quickly. 2

Heroin Use Statistics

The use of heroin in the United States has been increasing. Latest statistics show that unintentional misuse can result in increasing medical costs and loss of life. 3

Abuse Statistics

In 2017, approximately 494,000 individuals in the United States indicated that they were currently abusing heroin. This is equivalent to 0.2% of the U.S. population.

About 886,000 people used heroin at least once in the last year.

About three-quarters of people who abused heroin first abuse prescription opioids.

Overdose Statistics

From 2002 to 2013, heroin overdose almost increased fourfold, with about 8,257 deaths associated with heroin in 2013.

In 2017, heroin-associated deaths increased to more than 15,000.

Proportion of non-lethal heroin overdose is also significant. In 2015, heroin overdose caused 81,326 trips to emergency rooms.

Health Effects of Heroin Use

Short-term Effects

People using heroin say they feel a kind of happiness and excitement. However, there are additional common effects, including:

  • Dehydrated mouth
  • Warm and red skin
  • Heavy feeling in the arms and legs
  • Nausea and queasiness
  • Severe irritation
  • Depression
  • Falling asleep at odd times, like while driving or during social gatherings

Long-Term Effects

Tolerance

Taking heroin for an extended period of time may result in tolerance as the drug produces a reduced effect after repeated use.

Dependence

If an individual is unable to function properly without medication, they will have a psychological and physical dependence on heroin.

Withdrawal

Heroin withdrawal is caused by opioid dependence and sudden discontinuation.

Reduced Control

Heroin has profound effects on the brain. It may result in reduced ability to make decisions and/or regulate behavior.

Slowed Breathing

An opiate like heroin calms the respiratory system. This means that people taking large amounts of heroin can breathe more slowly than usual.

Overdose and Death

After long-term use, there is an increased risk for overdose. As extended use tends to result in larger doses, each dose has an increased risk of stopping breathing.

Heroin Addiction

Heroin is an extremely addictive drug and is the most misused opiate. People with heroin use disorder describes a feeling of excitement, known as “hurry” or “high.” Long-term repeated large dosages of heroin can lead to physical dependence.

How Does Addiction Happen?

Heroin is an opioid that binds to the receptors in the mind and releases the chemical dopamine. Same as with most adverse drug effects, this feeling is temporary. It makes some individuals want extra “good” feelings. If an individual repeatedly takes opioids over a long period of time, then the brain does not naturally release dopamine like it did before. This results in patients taking greater or more recurrent doses of opioids to achieve same level of feeling.4

Signs of Heroin Abuse

The following are some of the more common symptoms and signs that may indicate abuse or dependence on heroin: 

Behavioral Symptoms

  • Often absent from work or school
  • Work or school performance is lower than normal
  • Presence of a syringe or other paraphernalia
  • Wearing long-sleeved shirts in warm weather (trying to hide traces of intravenous heroin)
  • Lie, keep secrets or otherwise hide activities and location
  • Loss of interest in important events or activities

Social Symptoms

  • Isolation from family and friends
  • Associated with a new peer group
  • Intense mood swings and unprovoked anger outbreaks
  • Unemployment or loss of job
  • Legal issues like arrest and imprisonment
  • Financial difficulties

Physical Signs

  • Significantly unconscious weight loss
  • Exhaustion and lethargy
  • Moist eyes and runny nose
  • Continuous flu-like symptoms
  • Constipation
  • Skin bruises or scars
  • Itching
  • Sleep problems
  • Kidney and liver damage
  • Hepatitis C and HIV/AIDS
  • Pneumonia and tuberculosis

Mental Symptoms

  • Shame, guilt, and depression
  • Despair
  • Poor judgment
  • Confusion and disorientation

Withdrawal Symptoms

One of the reasons why heroin addiction is so difficult to overcome without help is that stopping the use of heroin can quickly trigger a variety of painful withdrawal symptoms. Symptoms begin to appear 4 to 24 hours after the last dosage of heroin. The extent or the severity of withdrawal might depend on the time of heroin use and the amount as well as method of use. 

Depending on the nature and severity of heroin addiction, withdrawal may include the following symptoms:

Strong desire for heroin

Abdominal cramps

Anxiety and depression

Vomiting and diarrhea

Muscle and bone pain

Agitation

Other flu-like symptoms

Insomnia

Paranoia

Heroin Detox

Detoxification removes toxins from drugs or alcohol from the body. In the initial phase of heroin use disorder treatment, detoxification aims to decrease the effects of withdrawal as well as help start recovery.

For someone who is struggling with heroin dependence, detoxification may cause painful withdrawal symptoms, beginning as soon as a day after stopping use. Symptoms may be mild, moderate or severe, depending upon the extent of abuse. Although heroin withdrawal is rarely lethal, detoxification may worsen symptoms without therapeutic supervision.

During detoxification, trained medical professionals use drug-assisted treatment for the management of heroin addiction. Treatment drugs could relieve some of the withdrawal symptoms as well as decrease cravings. Detoxification from heroin may take several days.

The length of heroin detoxification depends on various factors, including:

  • The last time heroin was  used
  • Level of tolerance
  • The way heroin was taken or administered

Additional factors that influence heroin withdrawal:

  • Age
  • Weight
  • Medical history
  • Psychological health
  • Genetics
  • Presence of alcohol or any other drug use

The usage of drugs throughout detoxification can change the time needed to overcome heroin withdrawal. Even though it differs from patient to patient, heroin withdrawal usually takes approximately one week.5

Misconceptions About Heroin Use

The prevalence of heroin and prescription painkiller addiction was the major problem in the United States in 2016. The number of deaths caused by opioid overdose spiked in 2014, rising by 14%. Here are some of the dangerous myths surrounding heroin and how they cause harm:6

Heroin Use Begins with a Legal Pain Prescription

Consistent with the US Centers for Disease Control and Prevention, individuals who misuse prescription opioids are 40 times more likely to take heroin than those who do not. As per the National Drug Use and Health Survey, 75% of recreational opioid users in 2013-14 received medications from other sources, including friends and relatives. Even in this group, only 4% of people do this within five years.

Recovery from Heroin Addiction is Rare

Heroin addiction appears to be severe because of the high mortality rate and because rehabs usually report a recurrence rate of 60% or higher. However, the likelihood of recovery is better than they look.

Recovery rates increase with medication-assisted treatment which increases length and quality of life. Treatment centers may offer medication assisted treatment to assist with the recovery process. 

Heroin is Only a Problem for Intravenous Drug Users

The myth that heroin is used only by those who use syringes to inject drugs is not true. Although injection provides the most direct and intense delivery route, heroin can be used in a variety of forms. Other methods of ingestion include smoking and inhalation through the nose, known as “snoring.” According to NIDA, it doesn’t matter which method you use; all can lead to addiction.

Heroin is Too Expensive for Young People to Abuse

According to a study conducted by NIDA in the late 1990s, the prevalence of school-age children exposed to and using heroin almost doubled in just 10 years. Heroin is considered cheaper and easier for manufacturing compared to other opiates. This reduces costs and increases the usage of heroin from the intercity to rural areas of the United States.

Heroin Addiction Treatment

There are many effective treatments for heroin use disorders, including behavioral treatments and medications. Both of these methods help restore normal brain function and behavior, which increases employment and reduces the risk of AIDS and other infectious diseases. The type of treatment used will generally depend on the substance being used and coexisting medical conditions.

Although behavioral and medical treatments are very useful when used alone, studies have shown that for several people, incorporating the two management methods is the most effective technique.

Pharmacological Management (Medications)

Scientific study has determined that medication-assisted treatment for the use of opioids can:

Increase the rate of people following treatment
Reduce drug usage
Prevent the spread of contagious diseases
Prevent illegitimate activities

During the detoxification phase, medications can help alleviate cravings and other physical symptoms that can frequently prompt an individual to return to drug use. The FDA has approved the use of lofexidine, a non-opioid that aims to decrease the withdrawal symptoms of opioids.

Although not a treatment for the addiction itself, detoxification from heroin is a beneficial first step or evidence-based treatment. Inpatient detox involves 24-hour attention from medical professionals at an addiction treatment center, increasing the odds of recovery for moderate to severe heroin addiction.

Drugs developed to treat opioid use disorders work through the same opioid receptors as addictive drugs but are safer and less likely to produce the behaviors that show up in substance use disorders.

Three types of drugs to treat opioid use disorder include:

Agonistic opioid receptors

Factional agonists that also trigger opioid receptors to develop slighter responses

Antagonists that block the receptors as well as interfere with the effects of opioids

Behavioral Therapies

There are many effective behavioral therapies that can be used for opioid use disorders. Treatments can be performed in both outpatient as well as inpatient surroundings. Behavioral therapy can help a person:

Identify the causes of drug abuse

Establish coping skills in the face of cravings

Develop a method to deal with recurrence

Identify and respond to any problems that may cause emotional discomfort

For example, emergency management treatment plus cognitive behavior therapy is considered to be effective in treating heroin usage disorders, particularly when used along with medications. Emergency management is a practice where a voucher-based structure is in place. “Scores” are given to patients and centered on negative drug tests. Cognitive-behavioral therapy (CBT) is aimed at helping clients to change the beliefs and actions associated with drug use. CBT also helps to improve skills in responding to different life stresses.

Resources

  1. Hosztafi S. The History of Heroin. Acta Pharmaceutica Hungarica. 2001 Aug; 71(2):233-42.
  2. Tschacher W, Haemmig R, Jacobshagen N. Time series modeling of heroin and morphine drug action. Psychopharmacology. 2003 Jan 1; 165(2):188-93.
  3. Jiang R, Lee I, Lee TA, Pickard AS. The societal cost of heroin use disorder in the United States. PloS one. 2017 May 30; 12(5):e0177323.
  4. Hosztafi S. Heroin addiction. Acta pharmaceutica Hungarica. 2011; 81(4):173-83.
  5. DiPaula BA, Schwartz R, Montoya ID, Barrett D, Tang C. Heroin detoxification with buprenorphine on an inpatient psychiatric unit. Journal of substance abuse treatment. 2002 Oct 1; 23(3):163-9.
  6. Volkow ND, McLellan AT. Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine. 2016 Mar 31; 374(13):1253-63.
  7. Hser YI. Predicting long-term stable recovery from heroin addiction: findings from a 33-year follow-up study. Journal of addictive diseases. 2007 Mar 1; 26(1):51-60.