Heroin is an illegal, highly addictive drug. It is both the most
abused and the most rapidly acting of the opiates. Heroin is processed
from morphine, a naturally occurring substance extracted from the
seed pod of certain varieties of poppy plants. It is typically sold
as a white or brownish powder or as the black, sticky substance
known on the streets as "black tar heroin."
Although purer heroin is becoming more common, most street heroin
is "cut" with other drugs or with substances such as sugar,
starch, powdered milk, or quinine. Street heroin can also be cut
with strychnine or other poisons. Because heroin abusers do not
know the actual strength of the drug or its true contents, they
are at risk of overdose or death. Heroin also poses special problems
because of the transmission of HIV and other diseases that can occur
from sharing needles or other injection equipment.
According to the 1996 National Household Survey on Drug Abuse,
an estimated 2.4 million people use heroin at some time in their
lives. The survey report estimates that there were 141,000 new heroin
users in 1995 and that there has been an increasing trend in new
heroin use since 1992. A large proportion of these new users were
smoking, snorting, or sniffing heroin, and most were under age 26.
Heroin is usually injected, sniffed/snorted, or smoked. Typically,
a heroin abuser may inject up to four times a day. Intravenous injection
provides the greatest intensity and most rapid onset of euphoria
(7 to 8 seconds), while intramuscular injection produces a relatively
slow onset of euphoria (5 to 8 minutes). When heroin is sniffed
or smoked, peak effects are usually felt within 10 to 15 minutes.
Although smoking and sniffing heroin do not produce a "rush"
as quickly or as intensely as intravenous injection, researchers
have confirmed that all three forms of heroin administration are
Injection continues to be the predominant method of heroin use
among addicted users seeking treatment; however, researchers have
observed a shift in heroin use patterns, from injection to sniffing
and smoking. In fact, sniffing/snorting heroin is now a widely reported
means of taking heroin among users admitted for drug treatment.
With the shift in heroin abuse patterns comes an even more diverse
group of users. Users over the age of 30 continue to be one of the
largest user groups in most national data. However, several sources
indicate an increase in new, young users across the country who
are being lured by inexpensive, high-purity heroin that can be sniffed
or smoked instead of injected. Heroin has also been appearing in
more affluent communities.
Abusers typically report feeling a surge of pleasurable sensation,
a "rush." The intensity of the rush is a function of how
much drug is taken and how rapidly the drug enters the brain and
binds to the natural opioid receptors. Heroin is particularly addictive
because it enters the brain so rapidly. With heroin, the rush is
usually accompanied by a warm flushing of the skin, dry mouth, and
a heavy feeling in the extremities, which may be accompanied by
nausea, vomiting, and severe itching. Heroin overdose is a particular
risk on the street, where the amount and purity of the drug cannot
be accurately known.
One of the most detrimental long-term effects of heroin is addiction
itself. Addiction is a chronic, relapsing disease, characterized
by compulsive drug seeking and use, as well as neurochemical and
molecular changes in the brain. Heroin also produces profound degrees
of tolerance and physical dependence, which are also powerful motivating
factors for compulsive use and abuse. As with abusers of any addictive
drug, heroin abusers gradually spend more and more time and energy
obtaining and using the drug. Once they are addicted, the heroin
abuser's primary purpose in life becomes seeking and using drugs.
The drugs literally change their brains.
Physical dependence rapidly develops with higher doses of the drug.
With physical dependence, the body adapts to the presence of the
drug, and withdrawal symptoms occur if use is reduced abruptly.
Withdrawal may occur within a few hours after the last time the
drug is taken. Symptoms of withdrawal include restlessness, muscle
and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose
bumps ("cold turkey"), and leg movements. Major withdrawal
symptoms peak between 24 and 48 hours after the last dose of heroin
and subside after about a week. However, some people have shown
persistent withdrawal signs for many months.
Medical consequences of chronic heroin abuse include scarred and/or
collapsed veins, bacterial infections of the blood vessels and heart
valves, abscesses (boils) and other soft-tissue infections, and
liver or kidney disease. Lung complications (including various types
of pneumonia and tuberculosis) may result from the poor health condition
of the abuser as well as from heroin's depressing effects on respiration.
Many of the additives in street heroin may include substances that
do not readily dissolve and result in clogging the blood vessels
that lead to the lungs, liver, kidneys, or brain.
Of course, sharing of injection equipment or fluids can lead to
some of the most severe consequences of heroin abuse - infections
with Hepatitis B and C, HIV, and a host of other bloodborne viruses,
which drug abusers can then pass on to their sexual partners and
children. For nearly one-third of Americans infected with HIV, injection
drug use is a risk factor. In fact, drug abuse is the fastest growing
vehicle for the spread of HIV in the nation. Heroin abuse can cause
serious complications during pregnancy, including miscarriage and
A variety of effective treatments are available for heroin addiction.
Treatment tends to be more effective when heroin abuse is identified
early. The treatments that follow vary depending on the individual,
but methadone, a synthetic opiate that blocks the effects of heroin
and eliminates withdrawal symptoms, has a proven record of success
for people addicted to heroin.
Methadone treatment has been used effectively and safely to
treat opioid addiction for more than 30 years. Properly prescribed,
methadone is not intoxicating or sedating, and its effects do
not interfere with ordinary activities such as driving a car.
The medication is taken orally and it suppresses narcotic withdrawal
for 24 to 36 hours. Patients are able to perceive pain and have
emotional reactions. Most important, methadone relieves the craving
associated with heroin addiction; craving is a major reason for
Naloxone and Naltrexone
Naloxone and naltrexone are medications that also block the effects
of morphine, heroin, and other opiates. As antagonists, they are
especially useful as antidotes. Naltrexone has long-lasting effects,
ranging from 1 to 3 days, depending on the dose. Naltrexone blocks
the pleasurable effects of heroin and is useful in treating some
highly motivated individuals. Naltrexone has also been found to
be successful in preventing relapse by former opiate addicts released
from prison on probation.
Although behavioral and pharmacologic treatments can be extremely
useful when employed alone, science has taught us that integrating
both types of treatments will ultimately be the most effective
approach. There are many effective behavioral treatments available
for heroin addiction. These can include residential and outpatient
approaches. An important task is to match the best treatment approach
to meet the particular needs of the patient.
Several new behavioral therapies show particular promise as treatments
for heroin addiction. Cognitive-behavioral therapies are designed
to help modify the patient's thinking, expectancies, and behaviors
and to increase skills in coping with various life stressors.
Both behavioral and pharmacological treatments help to restore
a degree of normalcy to brain function and behavior.
READ MORE ABOUT: Opiate
Withdrawal with Buprenorphine »
For further information on treatment of heroin addiction, Contact
Serenity Lane Treatment Center for Alcohol & Other Drug Dependencies
616 East 16th Avenue Eugene, OR 97401
Phone: (541) 687-1110 Or Toll-Free 1-800-543-9905