Heroin Addiction

What Is Heroin?

Heroin is a powerful opiate known by street names such as “Black Tar,” “China White,” and “Smack.” It is typically injected but can also be abused by smoking, swallowing, or snorting the drug.

Heroin works like any opiate: it binds to the opioid receptors of your brain. This part of the brain regulates your pain and emotions. When heroin binds to these opioid receptors, it can create feelings of euphoria, drowsiness, and pain relief. However, heroin can also create a strong physical dependence, leading to addiction.

Using heroin releases dopamine in the brain. This natural chemical is part of your brain’s reward center. Through heroin abuse, this release of dopamine can make drug users feel good, but over time they need higher doses of heroin to achieve the same effect.

Heroin VS Nonmedical Prescription Pain Relievers (NMPR)

According to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA), some heroin users start their habit after abusing prescription painkillers. Because a person develops tolerance after regular opioid use, eventually their body needs more of the drug to feel any effects.

“Both prescribed opioids and heroin act on the same receptors, and individuals who use prescription opioids nonmedically sometimes alter the route of administration (e.g., snorting or injecting) to intensify the effect… A recent study has shown that 77% of those reporting both NMPR and heroin use in the past year were found to have initiated NMPR use prior to initiating heroin.”

—SAMHSA

An additional concern to note is the risk of heroin addicts switching to fentanyl. In general, this is not a choice by the user, but rather because the vast majority of what’s currently available is filler plus fentanyl being sold as heroin.

Since fentanyl is a much more potent opioid, long-term users may also seek it out for its potency. However, this also drastically increases the user’s risk for overdose. Most individuals using illicit opioids aren’t aware that they’re getting fentanyl mixed with mannitol (a diuretic) rather than simply getting heroin or fentanyl-tainted heroin.

Effects of Heroin Abuse

There are many risk factors when it comes to the use of heroin. Not only is heroin an unregulated and illegal street drug, but it is also highly addictive with a high chance of overdose. Heroin also has many short- and long-term complications.

Short-Term Effects of Heroin Use

Heroin users often experience the following side-effects from abusing this drug in the short term:

• Dry mouth
• Nausea/vomiting
• Itchy or warm sensations of the skin
• Brain fog
• “Nodding off,” or the state of switching in and out of consciousness

In addition to the above list, heroin abuse can also lead to overdose and death. Heroin addicts are also likely to develop substance use disorder:

“​​Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”

—SAMHSA

Long-Term Effects of Heroin Use

Abusing heroin over a long period increases the risk of overdose and can cause additional adverse effects on the body. The long-term effects of this drug addiction include:

• Kidney disease
• Collapsed arteries or veins
• Insomnia
• Heart problems, including infection
• Liver disease
• Mental disorders

Long-term heroin use also decreases the user’s decision-making ability. Heroin addicts become more likely to take risks and make poor decisions, such as sharing needles, thus exposing them to Hepatitis B, Hepatitis C, and other bloodborne diseases like HIV/AIDS.

Heroin Overdose

A heroin overdose typically causes slowed breathing, confusion, and unconsciousness. Healthcare providers also point out that an overdose of heroin doesn’t always occur as a sudden event; sometimes, signs of overdose can be observed even hours beforehand.

Other symptoms of a heroin overdose will include:

• Confusion or agitation
• The person may not make sense when speaking
• Drowsiness
• A blueish tint to the skin, especially around eyes and mouth
• Vomiting or nausea
• Constricted pupils
• Stomach cramps
• Headaches

If you suspect a friend or loved one is experiencing a heroin overdose:

1. Immediately call 911 and report the overdose.
2. Administer naloxone (such as NARCAN®) to reverse the overdose
3. Turn the victim on their side to encourage normal breathing
4. Stay with the victim until emergency help arrives

Many states also have “Good Samaritan Laws,” which protect both the overdose victim and the person who reports the overdose from any kind of criminal charges. It is always best to report the overdose and stay with the victim until help arrives.

The FDA has approved two types of naloxone nasal sprays—NARCAN® and KLOXXADO®—which can be acquired for free thanks to a federal grant that passed with the support of the FDA.

Heroin Statistics

According to the CDC, more than 28% of opioid deaths in 2019 involved heroin. That number of heroin-related deaths is five times higher than in 2010. Despite this, the National Institute on Drug Abuse (NIDA) reports additional findings of heroin use in the United States:

“Although heroin use in the general population is rather low, the numbers of people starting to use heroin have been steadily rising since 2007. This may be due in part to a shift from misuse of prescription pain relievers to heroin as a readily available, cheaper alternative and the misperception that pure heroin is safer than less pure forms because it does not need to be injected.”

—NIDA, a division of the National Institutes of Health (NIH)

The shift in the use of heroin above may be related to the dramatic spike in illegal fentanyl use that began in 2013. But even with heroin abuse on the rise, there is treatment available to help addicts ready to quit.

Heroin Addiction Treatment

Treatment for heroin addiction is available and recovery is possible. If you or a loved one is struggling with heroin abuse or any addiction, the recovery process is similar to other types of drug use. With the help and support of medical professionals, a heroin addict can achieve a drug-free life.

Heroin Withdrawal Symptoms

Withdrawal from heroin is an unpleasant process to go through without medical support and intervention. Severe withdrawal can even be dangerous.

Withdrawal symptoms as reported by the National Institute on Drug Abuse include:

• Pain in the muscles or bones
• Trouble sleeping
• Diarrhea
• Vomiting
• Strong cravings for heroin
• Restless leg syndrome (sensations of uncontrollable leg movements)
• Cold flashes and goosebumps

Medication-Assisted Treatment (MAT)

Many heroin users rely on Medication-Assisted Treatment, or MAT, to help them safely detox from their heroin addiction. This treatment provides the user with a prescribed medication that will decrease the effects of withdrawals.=

The most commonly used MAT drugs include:

• Buprenorphine-naloxone
• Naltrexone
• Methadone

Of these listed medications, only methadone and buprenorphine-naloxone decrease withdrawals; however, all three have been shown in studies to reduce cravings. (The naltrexone does nothing for withdrawal symptoms but does reduce cravings.)

Inpatient Rehab Program

An inpatient rehab program is an on-site facility where the addict will live for 1-6 months and receive treatment 24/7. Inpatient rehabilitation includes detox support and behavioral therapy to assist them with getting sober and continuing on that path. Doctors often recommend residential inpatient drug rehab programs for addiction issues that require constant monitoring.

Partial Hospitalization Program (PHP)

A PHP allows the addict to visit a hospital or treatment center a few days a week (roughly 25-30 hours weekly). This treatment focuses on improving both the behavioral health of the addict as well as their physical health.

Intensive Outpatient Program (IOP)

An IOP is the least intensive program option, part of an outpatient rehab strategy, involving a 15-20 hour weekly commitment. The addict will receive support in the form of psychiatry alongside additional assessments and treatment to manage their addiction to remain sober.

Supporting a Loved One with a Heroin Addiction

Heroin addiction is difficult for everyone involved–from the addict themselves to their family and loved ones. If someone you care about is struggling with a drug addiction like heroin, there are also resources for you to receive support to help you through this process.

Programs such as AlAnon are available specifically for the family and friends of those who have been negatively impacted by a loved one’s addiction, whether the addict is in recovery or not.