Heroin Addiction and Abuse

Heroin is a highly addictive painkiller synthesized from morphine extracted from the seeds of the poppy plant. Any drug derived from poppy plants is considered an opiate, as these plants are used to make opium. Heroin is also known by its street names Smack, Junk, or H. Street morphine is generally infused with dangerous additives, such as morphine or powerful pain killers like fentanyl.

It is reported that around four million Americans have tried heroin at least once in their lifetime. Depression, collapsed veins, and severe itchiness are some of the symptoms of prolonged heroin consumption.

Not all types of heroin are visually similar. Heroin is generally abused in several ways, such as smoking, injecting, and snorting.

Given below are three forms of heroin:

• Fine white powder
• Brown or black powder
• Black tar heroin

Heroin affects a lot of people from all walks of life. In 2015 alone, 21,000 adolescents aged 12 to 17 admitted to using heroin in the past year. It has been estimated that four out of five people only began abusing heroin after the abuse of prescription opioids.

Although heroin can affect anyone, it tends to greatly affect those between the ages of 18 and 25. Heroin abuse is more common among those who live in urban areas within this age group. Opioid dependence, however, generally affects women more than men. The ASAM states that an estimated 23 percent of individuals who abuse heroin will develop an addiction.

Individuals who abuse heroin have described euphoria generated by the drug as an intense sensation of well being. When an individual injects heroin, he/she generally experiences an instant rush from the drug as it reaches the brain.

The rush that is generated from intravenous heroin use lasts for around two minutes while its high generally lasts for four or five hours.

Mentioned below are the general effects of using heroin:

• Contentment
• Reduced anxiety
• Relieved tension
• Drowsiness
• Apathy

The effects of heroin may seem harmless to individuals who are experimenting with the substance. Unlike ecstasy or alcohol, there usually isn’t a period of a hangover or comedown effect from initial heroin use, making this drug highly tempting for new users.

Heroin alters the reward system in the brain by influencing the production of chemicals such as endorphins and dopamines that make one feel good. Generally, the brain releases these chemicals to affect behavior required for survival, such as eating and managing pain. Eventually, this would lead to the formation of dependence and addiction. The appearance of severe withdrawal symptoms makes it more difficult for users to quit heroin consumption on their own.

Mentioned below are some signs that indicate, the formation of an addiction:

• Continuous use despite heroin-related problems.
• Trying and failing to quit/cut down consumption.
• Having persistent cravings.
• Building a tolerance to heroin.
• Experiencing withdrawal or feeling junk sick.
• Requiring higher doses of heroin to reach the desired level of euphoria.
• Starting to inject the drug directly into one’s body.

The most noticeable side effects of heroin include its rush of pleasurable effects, during which you experience a feeling of euphoria and wellbeing. Nonetheless, some adverse side effects can occur.

Heroin’s short-term after-effects include:

• Clouded mental functioning
• Drowsiness
• Dry mouth
• Flushed skin
• Heaviness in the arms and legs
• Nausea or vomiting
• Extreme itching
• Alarming levels of slow breathing

After the initial rush, individuals may experience clouded mental functioning with distressing levels of slow breathing for several hours, resulting in low levels of oxygen in the brain. The National Institute on Drug Abuse (NIDA) states that excessively slow respiration can be life-threatening as it can lead to a coma or irreversible brain damage.

These side effects are most common during a heroin overdose. Decreased brain oxygen can cause short- and long-term effects on the brain and nervous system. Therefore, it is essential to identify the signs of overdose as soon as possible and seek treatment immediately.

Heroin overdose symptoms include:

• Reduced blood pressure
• Delirium or disorientation
• Tongue and nail discoloration
• Drowsiness
• Dry mouth
• Muscle spasms
• Reduced pupil size (pinpoint pupils)
• Stomach or intestinal spasms
• Rapid breathing or sluggish and painful breathing
• Slow pulse

The signs and symptoms of heroin addiction or abuse can differ in nature, length, and severity from person to person. General symptoms that suggest heroin addiction include:

Behavioral symptoms:

• Wearing long-sleeved shirts or long pants amidst warm weather conditions to conceal track marks.
• No longer getting involved in sports or hobbies.
• Consorting with unknown or unfamiliar individuals.
• Frequent absence at work and at home.
• Suddenly obtaining failing grades or being unable to perform professionally at work.
• Unable to cease itching.
• Showcasing irresponsible and Illegal behaviors.
• Experiencing sudden financial difficulties.

Physical Symptoms:

• Continuous flu-like symptoms (including fever, vomiting, and feeling achy)
• Constipation
• Changes in eating patterns
• Significant loss of weight
• Dry mouth
• Runny nose
• Bruising and scabbing on the skin
• Needle marks present on the arms and legs
• Bloodshot eyes
• Close-up pupils
• Discreet behavior and changes in appearance
• Lack of energy
• Severe drowsiness

Cognitive symptoms:

• Inability to focus
• Struggling to control impulses
• Difficulty in making decisions
• Hallucinations
• Paranoia
• Disorientation

Psychosocial symptoms:

• Frequent mood swings
• Anxiety
• Depression
• Hostility
• Excitability
• Losing interest in things that ones interested them

The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines 11 symptoms of heroin addiction. The more signs an individual shows, the more significant their dependence is considered to be.

The 11 symptoms of heroin addiction:

• Consuming heroin in larger quantities or for a longer period than expected.
• Continued failed attempts to prevent or regulate the use of heroin.
• Spending more time acquiring heroin, using heroin, or recovering from its effects.
• Experiencing a craving for heroin.
• Neglecting responsibilities and obligations at work and at home.
• Continuous consumption of heroin, despite chronic or recurring social or interpersonal issues.
• Neglect of social, occupational, or personal interactions and relationships
• The frequent use of heroin in cases where it is physically dangerous.
• Continuous consumption of heroin, despite chronic or recurring physical or psychological conditions
• Formation of tolerance, as described by one of the following factors:
  • The need for substantially high doses of heroin to achieve intoxication or the desired level of euphoria.
  • Decrease in effect with continued use of the same dose of heroin.
• The manifestation of withdrawal by one of the following:
  • The typical heroin withdrawal syndrome.
  • The same (or a closely related) drug used in helping ease or avoid symptoms of withdrawal.

Withdrawal from heroin is a nightmare for most heroin users. Nothing beats the fear of dope sickness, which is why users opt to continue the unhealthy habit rather than seek help.

Heroin withdrawal can crop up even after a few uses. While it is true that first-time heroin use cannot possibly develop a crippling addiction, it can, however, trigger a dangerous pattern of usage, which could easily and quite quickly lead to dependence.

As heroin functions similarly to the natural chemicals produced by the brain to control pleasure, motivation, and pain, our brain naturally limits the production of its chemical and starts to rely on heroin to function normally. Consequently, when an individual stops heroin consumption abruptly, the absence of opioids triggers the brain to overreact and cause withdrawal. This withdrawal phase will persist until the brain restores its natural chemical production.

Heroin withdrawal can begin as soon as six to twelve hours after the last dose, and the symptoms may greatly resemble that of prescription opioids withdrawal. Due to its fast-acting effects, heroin tends to clear out from a user’s system much faster than painkillers. Therefore, users may experience rapid withdrawal symptoms.

A few common withdrawal symptoms are:

• Nausea or vomiting
• Insomnia
• Agitation
• Diarrhea
• Dilated pupils
• Profuse sweating
• Anxiety
• Abdominal cramps
• Muscle aches

The duration of the heroin withdrawal depends on several factors, such as:

• Length of drug abuse
• Dosage regularly consumed
• Frequency of drug use
• Method of consumption
• Existence of any other medical or mental health issues

Depending on the factors mentioned above, users will most likely face post-acute withdrawal symptoms such as:

• Poor sleep
• Lack of concentration
• Anxiety
• Depression
• Panic attacks
• Fatigue
• Hypersensitivity
• Irritability
• Mood swings
• Restlessness
• Memory loss

Post-acute withdrawal symptoms last anywhere between 18 -24 months, and the behavioral changes and mood swings associated with it can linger on for months after other symptoms dissipate.

The type of heroin consumed also plays a significant role in the severity of withdrawal, as the purity of heroin tends to vary between one another. For instance, black tar heroin and white tar heroin may differ in the duration of withdrawal. Apart from that, speedballing, which is the process of mixing heroin with cocaine, or using heroin with other types of drugs, may also complicate and intensify the withdrawal symptoms and its duration.

Withdrawing from heroin on one‘s own could pave the way for complications or fatal injuries. Individuals can face severe dehydration and even asphyxiation by inhaling their own stomach content post vomiting. Even if the withdrawal does not lead to these complications, it can still be uncomfortable enough to force an individual to relapse. Therefore, supervised medical-detox is the most recommended technique to overcome heroin withdrawal.

During detox, doctors observe and monitor the psychological and physical withdrawal symptoms of patients as well as prevent possibilities of self-harm or relapses. Nurses will also keep monitoring the patient’s vital signs to ensure their safety.

It is not unusual for inpatient or outpatient rehabs to prescribe medications to ease withdrawal symptoms. These medications greatly assist in the recovery process by curtailing the withdrawal symptoms and cravings.

• Methadone is a slow-acting opioid that is strong enough to wean individuals off heroin and minimize withdrawal symptoms systematically.
• Buprenorphine – mostly prescribed to manage heroin withdrawal, this drug greatly abets with tapering down of cravings and withdrawal symptoms such as nausea and muscle cramps.

• Naltrexone – This drug works to reduce cravings and is best for patients who have completed detox.
• Suboxone – Suboxone is a blend of Buprenorphine and Naltrexone. This combination not only relieves pain during withdrawal but also inhibits the effect of heroin.

Treatment for heroin addiction generally includes therapy, support groups, medication, and changes to one‘s lifestyle. These treatment options are available at both inpatient and outpatient treatment centers. Anyone seeking treatment should first meet with a substance abuse professional for an evaluation to help determine the necessary level of care required.

Therapy is also an important aspect of addressing the underlying behaviors that led to a person‘s heroin consumption. Therapy may also be helpful in addressing any traces of co-occurring disorders that may be present. This is referred to as a dual diagnosis.

The duration spent at an inpatient recovery facility may vary from person to person. The 30–day program is a commonly offered treatment option, while some heroin rehab facilities also provide services lasting 60 to 90 days. In general, treatment is recommended for at least 90 days, since research has demonstrated that anything shorter is less effective. There are also heroin rehabilitation centers that provide inpatient treatment for as long as a year. Deciding which program is right for you is an important step in getting your recovery started.

Longer programs are also available and may provide additional assistance to individuals with co-occurring disorders and for those who have relapsed. This option is also ideal for those who lack any stable support system at home.

A majority of former heroin addicts have owed their recovery to inpatient rehabilitation. Inpatient rehabilitation eliminates external, environmental, and social factors, which may hinder one’s progress. The residents have a structured routine during rehab that includes daily therapy, support groups, and activities. Each rehab differs in forms of activities on offer.

Detox is a crucial component of inpatient rehabilitation. Patients are strongly advised to continue treatment after the completion of inpatient rehabilitation. Patients are usually recommended to undergo a Partial Hospitalization Program (PHP), followed by Intensive Outpatient Programs (IOP) and standard Outpatient Program (OP). Aftercare is also provided at outpatient treatment centers along with alumni support groups.

Some individuals who are addicted to heroin turn to outpatient rehabilitation for support. Outpatient rehab is generally recommended for users with mild addictions. Outpatient rehab allows individuals in treatment to receive counseling and medication while maintaining their personal and professional lives.

Ongoing treatment following inpatient or outpatient rehabilitation is key to remaining sober in the long run. Daily visits to a psychiatrist may help many patients remain focused on their sobriety. Therapists can help recovering addicts recognize and overcome weaknesses and triggers. They can also teach patients how to manage their cravings better.

Support groups such as Narcotics Anonymous (NA) and Heroin Anonymous (HA) are also effective ways for many individuals to prevent relapses.

• Adjust your life: Build a life that does not require heroin.
• Be honest: Be honest with yourself and those around you.
• Ask for help: Addiction is a life long journey. There is no weakness in asking for help.
• Practice self-care: Focus on your health and wellbeing.
• Don’t bend the rules: Follow the rules. They are there for a reason.