In 2017, the opioid epidemic was officially declared a Public Health Emergency, but little has been done to effect change as the number of opioid-related overdose deaths continues to grow.
Even more troubling are the signs that more and more people already dependent on prescription opioids are switching to heroin, with at least 170,000 people trying heroin for the first time in 2016. In fact, according to the U.S. Centers for Disease Control and Prevention, the rate of fatal overdoses due to heroin increased by more than five times between 2010 and 2016.
This rise in heroin use is, ironically, due in part to attempts to combat prescription opioid abuse. New laws and restrictions that have made it more difficult and expensive to obtain prescription painkillers have had the unintended consequence of making heroin a cheaper and easier to access alternative.
In a 2014 survey of people in rehabilitation treatment for opioid dependence, 94 percent of them stated that they were first abusing prescription opioids but switched to heroin as prescription painkillers became more expensive and harder to get.
The price of heroin has been on the decline for the past 30 years. In 1982, a gram of pure heroin could cost more than 2,500 dollars, whereas now it’s less than 600 dollars, and a gram of heroin, depending on purity, can provide about 200 uses.
Speaking of purity, part of the reason heroin prices have dropped off so significantly is that it has become much cheaper to manufacture, because it is being cut with fentanyl with increasing frequency. Fentanyl is a synthetic opioid that is even cheaper to produce than heroin and significantly more potent.
This also makes heroin even more dangerous than it already was, as people buying heroin have no way of knowing how much of it has been cut with fentanyl and are at a much higher risk of accidentally overdosing due to taking the dosage they usually would for heroin.
While heroin addiction has, of course, always been a serious issue, this new dimension of danger associated with heroin use only heightens the importance of seeking out professional treatment for heroin addiction either for yourself or a loved one as soon as possible to avoid an overdose or worse.
Heroin is a drug of the opioid classification and is derived from morphine, which is in turn derived from opium. “Opioid” used to explicitly refer to substances that were completely synthetic but derived from naturally-extracted “opiates” like morphine, and has since become the term for any substance that acts as an opiate whether it is natural or synthetic.
Heroin was synthesized by a chemist at the pharmaceutical company Bayer in the late 1800s and soon after introduced as an over-the-counter cough suppressant. Heroin was originally hailed as the safer and less addictive alternative to morphine, but it wasn’t long before heroin surpassed morphine in terms of both addiction and overdose rates.
In 1924, the United States officially banned all manufacturing, imports, and sales of heroin, and today it is classified by the DEA as a Schedule I substance. This means that, in the United States, heroin is illegal to possess or make, has no recognized medical use, and has a potential for abuse and addiction.
Heroin can be snorted, smoked, or injected, and is commonly known by the street names dope, junk, and brown sugar, among others. In powdered form, it is either white or brown, with the exception of what is known as “black tar heroin,” a cheaper and less refined form of the drug.
Apart from being cut with fentanyl, heroin is also often combined with the following substances to either increase its potency or lower the cost of manufacturing:
These are only some of the wide variety of often poisonous substances frequently found in heroin, and there is no way of knowing just what or how much of something might be mixed in with the drug until it is too late.
Heroin, like the majority of opioid drugs, works by binding to the opioid receptors in the brain and activating them to increase opioid production. Opioid receptors are neurotransmitters, types of brain chemicals, that are in charge of regulating stress and how the body responds to pain, as well as transmitting pain signals throughout the brain and central nervous system.
Heroin rapidly enters the brain and mimics the composition of naturally-occurring neurotransmitters to create a massive spike in opioid receptor activity and production. This spike affects several key areas:
While heroin’s superior ability to mask pain is certainly a large part of why many people end up abusing it, it’s the way heroin overloads the brain with dopamine that creates what is perhaps the greatest potential for abuse and addiction by tying up heroin use with our motivation and reward system.
Heroin abuse creates pathways in the brain that link heroin abuse to activating the “pleasure button,” so to speak, and is what typically begins the cycle of addiction as the brain stops making its own dopamine and becomes reliant on the dopamine provided by heroin to continue functioning. This is why someone with a heroin addiction experiences withdrawal symptoms when they attempt to stop using.
Heroin’s effects on the human body and mind are severe and often permanent. In the short-term, through the drug’s manipulation of dopamine and opioid receptors in the brain, the effects of heroin use include:
Less common but still reported reactions that someone using heroin may experience include:
The long-term effects of heroin addiction are consistent with that of general chronic opioid abuse and include
If someone has been using heroin intravenously, then there are also an entirely separate set of serious health consequences, including
For someone suffering from heroin addiction, obtaining and using heroin becomes the top priority over essentially anything else in their life, including work, school, relationships, or any previous interests. When heroin is the objective behind someone’s choices and behavior, the signs and signals of addiction will begin to add up and become more apparent.
However, being able to spot some of the more subtle signs of heroin addiction while it is still building can make all the difference in ensuring that proper treatment is sought out in time. Some of the common signs of heroin addiction that serve as markers of someone needing help or treatment include:
Whether you have seen these signs of heroin addiction in yourself or someone you care about, it is vital, if nothing else, to seek out medical detoxification services to flush out the heroin and prevent as much permanent physical and psychological damage as possible.
The crucial first step in heroin addiction treatment, as well as addiction treatment in general, is to detox. This should ideally be done at a medical detox center as heroin withdrawal, while not deadly, can be extremely uncomfortable and even dangerous if not done properly.
Heroin works quickly and has a short half-life, which means that withdrawal symptoms can start just six hours after the last use. Heroin withdrawal symptoms can range from flu-like such as fever and nausea to more intense ones like panic attacks, convulsions, and severe depression.
When someone chooses to detox under the supervision of a medical professional, they can avoid the dangers of certain withdrawal symptoms as well as the risk of relapsing midway through the withdrawal process and potentially overdosing in an effort to find relief from the symptoms of heroin withdrawal.
A professional detox facility can also ensure a much safer heroin detox experience by establishing a tapering regimen to slowly wean people addicted to heroin down to smaller doses until it is safe to stop using completely.
They may also provide medications to decrease any unnecessary discomfort caused by the symptoms of heroin withdrawal, as well as for medical maintenance therapy to complement the tapering process.
The drugs used in medical maintenance therapy reduce cravings by providing similar effects as heroin, but at a much weaker level while simultaneously blocking the effects of heroin by taking up space in the opioid receptors, so there is no room for the heroin. These medications typically have a much lower risk of addiction, but some, such as methadone, still require strict monitoring as there is a potential for abuse.
Other common opioid maintenance therapy medications include buprenorphine, which is considered safer substitute than methadone, Suboxone, which is a combination of buprenorphine and a strong opioid antagonist called naloxone that completely blocks the effects of heroin, and finally, naltrexone, which has no opioid qualities, is non-addictive, and blocks the effects of a heroin high.
After detox, the next step in heroin addiction treatment, if it is to be successful, should be checking in to an addiction recovery treatment program. Detoxing is critical to the beginning of the recovery process, but it is just that: the beginning. If detox is not followed by aftercare, whether it is on an inpatient or outpatient basis, there is an extremely high risk of relapse.
How high? Studies have shown that a whopping 91 percent of people who detoxed from heroin but did not take part in any follow-up treatment relapsed, with 59 percent relapsing within the span of a week.
An addiction rehabilitation program will help someone address the root of their issues with addiction and gain the understanding and skills required to successfully manage their addiction and maintain long-term sobriety.
Treatment programs can be customized based on what is deemed to be most effective for a given individual and can including counseling, family therapy, addiction education classes, support groups, holistic therapies, and more.
At this point, the dangers involved in chronic heroin abuse and addiction should be clear. However, disregarding the actual effects of use, there are still many other dangers to using heroin that can have potentially fatal consequences not just for the user, but for those they care about as well.
While many people will try to rationalize not just a heroin addiction but also substance abuse in general with the claim that the only person they’re hurting by using is themselves, this is often not the case. Heroin addiction can cause inadvertent harm to the families and loved ones of users due to many of the negative behaviors associated with heroin abuse, but it can also cause much more direct harm in the case of the unborn children of pregnant women who are addicted to heroin.
Women who abuse heroin while pregnant have a high likelihood of giving birth to babies with congenital birth defects affecting their vision, spines, and hearts. There is also the significant chance that the baby will be born already dependent on heroin and exhibiting the symptoms of heroin withdrawal once they are no longer receiving it from their mother. This is known as neonatal abstinence syndrome (NAS).
According to the National Institute on Drug Abuse, in the United States, every 25 minutes a baby is born exhibiting the symptoms of NAS, which include:
And of course, one of the biggest dangers of heroin use is the threat of overdose, which, as we previously mentioned, is only becoming more commonplace due to the presence of fentanyl in heroin. It is still just as possible to overdose on heroin on its own if someone takes a large enough dose of it.
In the event of an overdose, a drug called Narcan can be used to reverse the overdose and flush the opioids out of someone’s system. Narcan is the name brand of the opioid agonist naloxone that we previously mentioned, and while it can save someone’s life, it’s still not a guaranteed solution, especially if there is fentanyl involved, which is strong enough to require several doses of Narcan to flush out. In any case, it needs to be administered as soon as possible. The common symptoms of a heroin overdose include:
Unknown Author (March, 2017).What is the U.S. Opioid Epidemic?. U.S. Department of Health and Human Services. from https://www.hhs.gov/opioids/about-the-epidemic/
CDC (August, 2017).Heroin. Centers for Disease Control and Prevention. from https://www.cdc.gov/drugoverdose/opioids/heroin.html
Wikipedia (May, 2018).Controlled Substances Act. Wikipedia. from https://en.wikipedia.org/wiki/Controlled_Substances_Act#Schedule_I_drugs
NIH (January, 2017).Heroin. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/heroin
NI, (September, 2017).Overdose Death Rates. National Institute on Drug Abuse. from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
ASAM (September, 2017).Opioid Addiction. American Society of Addiction Medicine. from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
Smyth, B, (September, 2017).Lapse and relapse following inpatient treatment of opiate dependence. Pub Med. from https://www.ncbi.nlm.nih.gov/pubmed/20669601