Heroin is a highly addictive narcotic composed of the painkilling drug morphine and acetyl groups. Dependence on the drug hits quickly, accompanied by gruesome withdrawal symptoms that keep addicts in a constant cycle of pining for more.
A History of Heroin
By the latter half of the 19th century, doctors had taken to prescribing morphine and codeine, found in the opium poppy, to help patients deal with pain caused by respiratory illnesses like pneumonia and tuberculosis. Heroin was originally synthesized by English chemist C.R. Alder Wright as part of his quest to find a non-addictive alternative to these drugs. It was marketed by scientist Heinrich Dreser and his colleagues at Germany's Bayer Company in the late 1890s.
As heroin prescriptions became increasingly commonplace, physicians realized that it could be just as addictive as morphine, if not more so. In the United States, where heroin addiction first became a serious problem, it was not until 1924 that the federal legislation was established giving the government the power to regulate medications containing addictive substances such as heroin and cocaine.
Who Uses Heroin?
Heroin abuse can be found in virtually all socioeconomic and racial groups. A 2011 survey conducted by the National Institute for Drug Abuse revealed 4.2 million Americans 12 or older had used heroin at least once in their lives. Of those who tried heroin, 23% became addicted.
Heroin abuse is a growing problem in the US. As opium production worldwide has expanded, the purity level of heroin has risen. Heroin of a higher purity level can be snorted or smoked instead of injected, which makes the drug more attractive to people who may have avoided heroin if they had to inject it.
The prescription drug abuse epidemic has also played a role in the growing heroin problem. Like heroin, most of the prescription drugs that are abused are painkillers. Prescription drug abusers sometimes switch to heroin because the latter drug is more potent, cheaper, and easier to find.
Chemical Effects on the Brain
When heroin is ingested, it produces a “rush” that is almost instantaneous. This is one reason why the drug is so addictive. Once heroin enters the user’s bloodstream, the brain converts it to morphine and that chemical binds to opioid receptors in the brain.
Heroin can be smoked, snorted, or injected. For addicts, injection is the most popular method. If the user injects heroin intravenously, he or she can experience a feeling of euphoria within 6 to 8 seconds. If the user chooses to inject it intramuscularly, it takes 5 to 8 minutes to experience euphoria. The euphoric sensations peak within a window of 10 to 16 minutes.
The short-term physiological effects of heroin use can include dry mouth, a flushing of the skin, and heaviness in the limbs. Some of the other symptoms include acute itchiness, nausea and vomiting. For several hours after ingestion, the user experiences drowsiness. During this period of drowsiness, key bodily functions slow down. In the case of an overdose, breathing slows to the point of death.
John Cooper Clarke on heroin addiction.
Symptoms of Addiction
Heroin addiction is a disease that causes chemical changes in the brain. Abuse of the drug can lead to an increased tolerance, which in turn can create a physical dependence. Once an individual has become physically dependent on heroin, his or her life centers around seeking out the drug and using it. In some cases, the addict might engage in theft or other crimes in order to buy more heroin.
Heroin withdrawal is fatal only in rare instances, but the accompanying discomfort can be agonizing.
If a heroin addict cannot get their fix, they will begin to experience symptoms of withdrawal. The fact that withdrawal symptoms can manifest themselves just a few short hours after the last dose is another reason why heroin is so addictive. Symptoms include cold flashes, involuntary leg movements, restlessness, pain in the muscles and bones, insomnia, and diarrhea. Withdrawal is fatal only in rare instances, but the accompanying discomfort can be agonizing.
Left untreated, heroin addiction poses a number of long-term health risks: collapsed veins, bacterial infections, abscesses, arthritis, liver and kidney disease, lung illnesses (pneumonia, tuberculosis), and complications arising from HIV/AIDS or hepatitis infection. Addicts who inject heroin are particularly susceptible to HIV/AIDS or hepatitis infection because they sometimes share their hypodermic needles with other addicts or use needles that are unclean.
Detox, Treatment, and Recovery
A combination of detoxification and treatment is the best option for heroin addicts. The end goal of detox is to remove all traces of heroin from the addict’s body. There are a few ways to accomplish this.
The first method, rapid detox, is a medical procedure that involves flushing the drug from the body while the patient is under anesthesia. Because rapid detox speeds up the overall detox process, it also speeds up withdrawal. Doctors can give patients medications such as naltrexone to alleviate the withdrawal symptoms. At the completion of rapid detox, the addict’s physical, but not psychological, dependence on heroin has been eliminated.
An alternate method for detoxification is called tapering. With tapering, a physician prescribes to the patient an opiate alternative such as methadone or buprenorphine. Like heroin, the opiate alternative binds to the opioid receptors in the brain but does not produce the same euphoric “rush.” Opiate alternatives also diminish cravings. As the treatment progresses, the doctor will reduce the dosage of the opiate alternative. If the patient experiences withdrawal symptoms, the dosage level can be adjusted to help alleviate these symptoms.
Tapering allows patients to adjust to having lower levels of heroin in their bodies. Depending on the severity of the patient’s addiction and the initial dosage level, the tapering process can take anywhere from a few days to several months to years. Like rapid detox, the end goal of tapering is to eliminate the patient’s physical dependence on the drug.
Doctors can also recommend a detoxification process that does not involve opiate alternatives. However, due to the fact that heroin is so addictive and causes various changes in the user’s brain and body, a medication-free detox can be more taxing, both physically and psychologically.
Detoxification is only the first component of treatment for heroin addiction. The psychological aspects of addiction are often more complex than the physical ones. For this reason, patients must undergo therapeutic counseling with a drug treatment specialist. Counseling be can done one-on-one or in a group therapy setting. Programs will likely also involve the patient’s loved ones.
To overcome addiction, the patient must get to the root of why he or she started using in the first place. A therapist can help disentangle the issues in the addict’s life that contributed to substance abuse, and help the addict formulate a coherent plan for moving forward.
Choosing a Treatment Facility
Now that we’ve examined the basic components of a typical treatment process, it’s time for more logistical matters: Where should detox and therapy take place? When it comes to choosing a treatment facility, there are a plethora of options. Here are some questions for the heroin addict and his or her family to consider before making a decision:
- What program would be most appropriate for the patient’s needs? An inpatient residential facility? An outpatient program?
- What services does the facility offer? Detoxification? One-on-one counseling? Group therapy sessions? Family therapy?
- Is the facility accredited? Do the specialists have the right certifications?
- Where is the facility located? Close to home, making it convenient for outpatient treatment? Far away enough from people who would be a negative influence on the patient?
- How much does the program cost? Does the facility accept insurance? What about Medicaid? Heroin addiction treatment can be expensive, so families should inform themselves about scholarships for treatment.
At the end of treatment, the patient begins a lifelong journey in recovery. The addict must work with his or her family, friends, and therapist to make sure that relapse does not occur. Since heroin is among the most addictive illegal substances, relapse rates are high. Peer groups can be very helpful in keeping people who have completed treatment from going back down the dangerous path to heroin addiction. In peer groups, former drug addicts speak about their experiences and provide support for each other in their commitment to abstinence.