Heroin Addiction, Withdrawal and Treatment
- Heroin Addiction
- Signs & Symptoms of Abusing Herion
- Heroin Withdrawal & Detox
- Treatment for Heroin Dependency
Heroin is a highly-addictive, opioid drug made from morphine. The drug goes by the street names of smack, big H, horse, and hell dust. It is available as a powder, which is white or brown in color. There is also a black, sticky version of the substance known as black tar heroin. Heroin is typically injected intravenously, but it can also be smoked or snorted.
Compared to other illicit drugs, relatively few people use heroin. However, heroin use in the general population has been on the rise since 2007 among the general population. This may be due in part to the fact that heroin has become more readily available and less expensive than other opioids, namely prescription pain relievers like oxycodone and codeine. Some prescription opioid users may be turning to heroin due to an increased chemical tolerance. They are looking for something stronger.
Physiologically, all opioids function in the same way, attaching to receptors in the brain to block pain, slow breathing, and elicit a calming effect. At low doses, opioids can be comforting and do not cause intoxication or inebriation in the traditional sense. Rather, the user experiences positive feelings of joy, comfort, and even accomplishment similar to those caused by the presence of natural opioids (endorphins) in the body. With higher dosage amounts, however, opioids cause respiratory depression that can result in death.
Heroin abuse brings with it a high risk of addiction. In some cases, one-time use can result in dependency. Lack of control of the purity of the drug and potential contamination with other drugs make it difficult for users to know how much they are taking, a factor which increases the risk of a fatal overdose.
Secondary consequences of heroin usage include a higher risk of diseases like hepatitis, HIV/AIDS, and sexually-transmitted infections due to the common practices of needle sharing and sexual promiscuity. Furthermore, the abuse of heroin is commonly associated with crime and violence. Heroin abuse may also disrupt a person’s relationships at home, at school, and in the workplace.
Signs & Symptoms of Abusing Heroin
Heroin affects the body differently than drugs like alcohol or marijuana. Heroin users may not seem intoxicated, which may make it difficult to identify someone who is abusing the drug.
Heroin works quickly, and users experience an almost-immediate feeling of euphoria. While “high,” they may seem sleepy or like they are moving more slowly than usual. Pupils will noticeably contract, and users may experience short-term physiological effects such as dry mouth, severe itching, or flushed skin. Long-term users may experience more serious mental and physical effects ranging from insomnia and depression to abscesses and major organ diseases.
If the heroin is being injected, you may notice wounds (known as track marks) on the arms, between the fingers and toes, or anywhere else there is a vein. It is not uncommon for heroin addicts to inject three to five times per day, so excusing oneself frequently may also indicate use or abuse.
Someone who has taken too much heroin can overdose. During an overdose incident, the person’s breathing will slow or stop, decreasing the amount of oxygen reaching the brain. This condition is known as hypoxia and can lead to brain damage, nervous system damage, coma, or even death.
In the event of an overdose, emergency personnel will administer Naloxone. When given right away, it quickly binds to opioid receptors to block heroin’s effects and restarts breathing. In some states, Naloxone is available over the counter without a prescription to make it more accessible to people who use heroin and/or their friends and family members.
Heroin Withdrawal & Detox
Heroin wears off relatively quickly. People who are addicted to heroin and stop using without medical intervention may experience severe withdrawal symptoms as soon as hours after the last use. Short-term withdrawal symptoms can include:
- muscle and bone pain,
- vomiting and diarrhea,
- inability to sleep,
- cold flashes,
- uncontrollable leg movements, and/or
Opioid addiction may also have long-term effects on some users, most notably the loss of white brain matter. This part of the brain controls decision-making, behavior, and stress response, areas of the personality which may all be permanently altered due to drug use.
Detoxification from heroin can be painful, prompting some users to relapse. For this reason, many users choose to detox in a residential or outpatient facility under the supervision of medical professionals. Medication can help addicts in recovery by reducing the severity of withdrawal symptoms.
Treatment for Heroin Dependency
Treatment options for heroin addiction include medication, behavioral therapy or, more commonly, a combination of the two. The type of treatment is typically chosen on a case-by-case basis in order to ensure the needs of each individual patient are met. This approach also increases the likelihood of successful rehabilitation.
Medication-Assisted Treatment (MAT)
Medication options include methadone, buprenorphine, and naltrexone. All of these medications must be prescribed by a doctor or mental health professional and must be used in conjunction with counseling services.
Methadone binds to the opioid receptors in the brain, acting as a weaker version of heroin. As a result, the recovering addict experiences reduced cravings and lessened withdrawal symptoms. However, methadone use can have its own side effects:
- difficulty breathing,
- chest pain,
- increased heart rate,
- hallucinations, and/or
Methadone is available in pill, liquid, and wafer forms and must be administered under the supervision of a physician via a certified opioid treatment program (OTP). Patients typically visit a treatment clinic once daily to receive their dose.
Like methadone, buprenorphine mimics heroin, but on a lesser scale. After a moderate dosage is reached, the euphoric effects of the drug level off. This helps to lower the risk of misuse, dependency, and side effects when a recovering addict stops using. Side effects of buprenorphine are similar to those of opioids and include:
- muscle soreness,
- trouble sleeping,
- irritability, and/or
Unlike methadone, buprenorphine is long acting. This means that patients may not need to take the medication every day. Buprenorphine is also available to be prescribed and dispensed in doctor’s offices. Both of these factors can increase accessibility of treatment.
Naltrexone works differently than other medications by blocking opioid receptors and preventing the patient from feeling high. Because it does not mimic heroin, there is no abuse potential. However, patients must be completely withdrawn from heroin before they begin naltrexone treatment. Naltrexone increases sensitivity to opioids, making relapse more dangerous. If a patient relapses during or after treatment, using heroin at or below previous dosage rates may result in overdose. Furthermore, people using naltrexone should avoid other drugs and alcohol.
Naltrexone is available in pill or injection form and can be prescribed by any doctor or mental health professional. In some cases, patients may experience liver injury, injection site reactions, and/or allergic pneumonia, and should see a doctor right away if they have symptoms of any of these illnesses. Other side effects of this medication include:
- upset stomach,
- fatigue, and/or
- joint and muscle pain.
Behavioral therapy as a treatment for heroin dependency includes both cognitive-behavioral therapy and contingency management. In the case of opioid addiction, these types of therapies are typically used in conjunction with medication to improve effectiveness.
Cognitive-behavioral therapy (CBT) teaches recovering addicts to identify and correct behaviors that may lead to relapse. With the help of CBT, patients are able to anticipate triggers, develop coping mechanisms, and exert the self-control to implement them. Skills learned in CBT can also be used to help manage other mental health conditions that often co-occur with substance abuse.
Contingency management (CM) is a type of intervention that provides motivational incentives for continued sobriety. Voucher-based reinforcement (VBR) provides a voucher for each negative drug screen. Vouchers can be exchanged for goods and services and usually increase in value over time. Another type of CM awards cash for negative drug screens, program attendance, and completion of assigned activities. In both cases, a positive drug screen resets the incentives.
Heroin Research Report – National Institute on Drug Abuse
Opiates/Opioids – The National Alliance of Advocates for Buprenorphine Treatment
America’s Addiction to Opioids: Heroin and Prescription Drug Abuse – National Institute on Drug Abuse
Signs of Heroin Use and Addiction – National Institute on Drug Abuse
Drug Facts: Heroin – National Institute on Drug Abuse
Medication and Counseling Treatment – Substance Abuse and Mental Health Services Administration
Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – National Institute on Drug Abuse