Heroin Addiction Guide: Symptoms, Treatment, and More
Heroin addiction is a severe problem in the United States, affecting thousands yearly. More people are falling into opioid abuse and dying of drug overdoses. Heroin alone was responsible for 15,500 drug overdose deaths in 2016, which seems to be rising.
Heroin use can increase your risk of developing an opioid use disorder. It may also increase your chances of experiencing heroin overdose symptoms. Opioid overdose is a significant health concern all over the United States, and it has a lot to do with heroin and the other opioids that are often mixed into it.
Learn more about the signs and symptoms of heroin addiction and how it can be treated.
What Is Heroin?
Heroin is a semi-synthetic opioid once used to treat pain. It has been replaced with other opioid options in the United States. The term semi-synthetic refers to heroin’s nature as a derivative of a naturally occurring opiate. In this case, heroin is derived from morphine, which is found in the opium poppy plant. Heroin is a potent opioid that can comprehensively treat moderate-to-severe pain and facilitate euphoria, extreme comfort, a sense of bodily warmth, and general well-being.
The drug works by binding to opioid receptors in the brain and body. These receptors are designed to bind with natural neurotransmitters called endorphins. Endorphins are chemically similar to morphine and heroin, which can attach directly to the body’s nerve cells. When opioid receptors are activated, they stop the nerve cells from sending and receiving pain signals, which is how it blocks pain.
Heroin can also manipulate the brain’s dopamine levels. Dopamine is a neurotransmitter that’s related to reward and pleasure. It’s intended to encourage you to repeat healthy activities. However, dopamine can also cause heroin’s positive feelings and euphoric effects. Dopamine is often tied to substance use disorders and addiction. Because of the drug’s effect on dopamine, repeated heroin use can cause your brain to treat heroin as an essential task that should be repeated.
Why is Heroin Addiction a Disease?
With the growing addiction epidemic, it’s essential to recognize heroin addiction as a disease. For a long time, addiction to narcotics and alcoholism was seen and treated as purely a moral failing. If you were rich, you’d “dry out” in comfortable medical facilities; if you were poor, you would be sent to prison or asylums. Today, the National Institute for Drug Abuse (NIDA) recognizes that addiction is a disease as a pillar of effective treatment.
The idea that addiction is a disease rather than a bad habit and a moral failing isn’t a novel concept. It was first theorized decades ago by doctors who had treated addicted patients who couldn’t stop using independently. Dr. William Silkworth, a physician who specialized in the treatment of alcoholics in the 1930s, wrote a paper titled “Alcoholism as a Manifestation of Allergy,” which criticized the poor treatment of alcoholism.
Today, we have learned more about addiction and how it operates in the brain. First, chemical dependence is a clear physical consequence of drug use and how it affects your brain chemistry. Heroin binds to opioid receptors in the brain and body, which you come to rely on over time. When you stop taking the drug, your brain chemistry is equipped to deal with the whiplash of chemical imbalance, causing you to feel unpleasant withdrawal symptoms.
However, we know that addiction doesn’t stop after your brain chemistry balances out in detox. Addiction can take a long time to correct, and it is a lifelong process for most people who achieve abstinence. This is because addiction affects the limbic system, the part of your brain responsible for reward and motivation. Through drug use, you teach your brain that heroin makes you feel good. The limbic system is designed to recognize healthy activities that should be repeated. It’s why we have an instinctual desire to find food and seek comfortable shelter. But heroin sends signals to the limbic system that mimic the signs food and comfort send, only much more powerful.
Your limbic system goes into overdrive. It sends you impulses that make finding more heroin a top priority, even after your last drug hit leaves your system and withdrawal symptoms fade away. Those impulses will still fire because your limbic system has been hijacked, which takes time and treatment to correct.
However, NIDA also points out, “The initial decision to take drugs is voluntary for most people….” If taking drugs leads to addiction and the initial act is voluntary, how can addiction be a disease and not a decision? To understand this, it helps to compare addiction to another condition: type 2 diabetes. Addiction and diabetes can begin in people after adulthood, with similar relapse rates between 40 and 60 percent.
Type 2 diabetes is caused by several factors, including genetics, just like addiction, but lifestyle is a significant contributing factor. Lack of exercise, unhealthy eating, and obesity come from unhealthy choices and can lead to diabetes. Is it not a disease because choices lead to it? Of course not. A plethora of diseases are caused by unhealthy life choices, but we still treat them as diseases. NIDA says, “repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs.”
Heroin addiction can affect anyone. It’s not relegated to specific parts of society.
The growing opioid epidemic has shown that heroin use has spread like other diseases, across vast populations, from the inner city to rural areas. But what caused this epidemic?
Why is Heroin Addiction on the Rise?
The opioid epidemic has spread across the country like wildfire. Despite the use of standard and new methods, the epidemic shows no signs of stopping. It’s growing faster. Drug overdose has always been a problem, but 20 years ago, the number of people dying in the U.S. from an overdose was less than 20,000. Today, we’ve exceeded 64,000. In the last few years, the rate of overdose death increase has gotten to the point where the line graph is almost entirely vertical. But why? Why are more people using heroin and other opioids, and why are more people dying?
The fight against opioids is a battle waged on two fronts: a flood of prescription opioids and a scourge of illicit heroin and synthetic drugs.
According to the U.S. Centers for Disease Control and Prevention, sales of prescription opioids have increased nearly four times between 1999 and 2014. They also point out that there hasn’t been a significant change in the amount of pain Americans report that would warrant such an increase. While the regular use of prescription opioids can lead to addiction in a small percentage of highly susceptible people, hundreds of millions of opioid prescriptions are written each year. Still, only a tiny percentage of that number leads to addiction. So, is there a link between prescriptions and the epidemic?
The increase in opioid prescriptions may not likely lead a legitimate user into addiction. However, it does cause a large number of unused pills to sit on shelves after the pain subsides. Opioids are prescribed for everything from chronic pain to recover from having your wisdom teeth pulled. Some people have been prescribed things like oxycodone and Percocet for recovery from surgeries and injuries. But they are given enough to last well beyond their pain has subsided.
The excess pills can take one of the multiple paths:
They can be disposed of when no longer needed, but this is highly unlikely. They are expensive and still effective, so why would anyone throw them out, not knowing their potential danger?
They can be found by children, teens, or other people living in your house that are curious as to their potential recreational effects.
They can be given to a friend or family member that doesn’t have a prescription.
The last scenario is the most common form of prescription drug abuse. People who abuse prescription opioids don’t usually get drugs from illegal street sales or their prescriptions. They get them from friends and family members.
Users dependent on prescription opioids often switch to heroin when prescriptions become too expensive or difficult to get. The low price and high availability of illicit heroin are caused by an influx of the drug from black markets involving transnational criminal organizations. According to the National Institute on Drug Abuse, combining these two factors has contributed to the overall increase in heroin overdose cases. In their 2016 National Heroin Threat Assessment Summary, they wrote, “Increased demand for, and use of, heroin is being driven by both increasing availability of heroin in the U.S. market and by some controlled prescription drug (CPD) abusers using heroin.”
Heroin Addiction Signs and Symptoms
Heroin abuse and subsequent addiction come with several signs and symptoms, including both physical and behavioral signs. Directly after using heroin, intoxication may involve shortness of breath, dry mouth, dilated pupils, disorientation or confusion, limp and lethargic appearance, and fatigue. However, other drugs and even medical disorders can cause similar symptoms. Other symptoms, like behavioral signs, can point more definitively to heroin abuse. Signs include:
Heroin Addiction Symptoms
Lying about drug use
Struggling with work or school performance
Withdrawal from normal activities
Loss of motivation
Sudden change in friends
Changes in weight
Lack of attention to personal hygiene
Lack of self-esteem
Hiding needle marks with long sleeves and pants
Drug paraphernalia
How Long Does Heroin Stay in One’s System?
Recent heroin users who have recently stopped using the drug may wonder how long it takes for it to leave their systems. It depends on several factors, which are all unique to the person who used it.
Although the drug’s effects last for several hours, heroin is a quick-acting drug that reportedly has a short half-life of 30 minutes. This is the amount of time it takes for half the dose to be reduced in the bloodstream. However, not all drugs affect everyone the same, so other factors must be taken into consideration, too. They are:
Factors Affecting Length of Time in the Body
Age
Height and weight
Genetics
Body fat content
Metabolism
Diet
Vital organ health (liver, kidney functioning)
The amount of heroin used
Duration of heroin use
Tolerance to heroin
Purity, quality of the heroin used
How heroin was used
If other drugs were used in addition to heroin
Hydration
Heavy or frequent heroin users can expect the substance to remain in their systems longer than someone who uses it infrequently or occasionally. The purity of heroin use is also an important factor because the more potent it is, the stronger it is. Additives to mixtures containing the opiate may affect how long the substance lingers. Metabolism also matters. People with faster metabolism rates will process the drug more quickly.
How Heroin Overdose Occurs
Pure heroin, in appropriate doses, only has mild effects and doesn’t produce deadly, adverse reactions. However, illicit heroin is rarely pure, and it can come contaminated by inert substances, other psychoactive drugs, dangerous chemicals, and other more powerful opioids. A shipment of heroin may arrive in the U.S. with few adulterants, but as it travels down the supply chain, dealers will cut it with other substances to increase profits. Once it gets to the street level, it’s difficult to know how pure it is or what else is mixed into it, so the appropriate dose is difficult to determine. Because of heroin’s unpredictable nature, overdose can happen in three ways:
A person who has developed an addiction to heroin achieves sobriety because of a medical procedure, prison, or because they were in recovery and then relapses. Over time a heroin user builds up a tolerance and uses more and more of the drug at a time. After they go through detox and stay clean for a while, their tolerance will drop, and if they relapse using the same doses they used to be tolerant to, they’ll experience an overdose.
A person starts by using heroin they don’t realize is very diluted. Once they get used to a week batch, they may assume that their normal dose is appropriate for any heroin. Once they get a purer batch the amount they are used to can lead to an overdose.
A batch of heroin has fentanyl or another powerful opioid mixed in. Fentanyl can be deadly to the average person in amounts as small as a snowflake.
What Is a Speedball Drug?
Speedball is a term often used alongside heroin abuse. It refers to a mixture of heroin and a stimulant, which is usually cocaine. Some drug users combine these drugs to create a unique high that includes the benefits of both substances. They may also be combined to counteract some of their respective side effects. Since heroin can cause drowsiness, a stimulant can keep you awake. Since cocaine can cause restlessness or anxiety, heroin can relax you. However, speedballs are often associated with overdose. The counteracting effects of each drug mask what the substances are actually doing in your body, which can encourage you to take heavy, more dangerous doses.
Ingredients Often Mixed Into Heroin
Most illegal street heroin is only 50 percent pure. It can contain unknown ingredients that consist of fillers and other substances. These can cause additional unexpected side effects.A January 2019 article published by the Tennessean mentioned that fentanyl had been found in many batches of heroin. Sellers usually add fentanyl to heroin supplies to maximize its strength and stretch their batches. This addition can quickly lead to a fatal overdose in users.
There are many ingredients you can encounter regardless of what type of heroin you purchase. Non-toxic substances used to cut heroin include:
Non-Toxic Substances Used To Cut Heroin
Sugar
Cornstarch
Powdered milk
Flour
These substances will dilute the strength of heroin, and they are commonly found in heroin supplies. Water-soluble substances are preferable because heroin users will dissolve the product to inject the substance.
Even though these substances are non-toxic, they can cause problems if injected. If they do not dissolve, they can block veins and arteries. This can cause heart failure, stroke, collapsed veins, and other complications.
Non-Narcotic Substances
Some non-narcotic substances used to cut heroin include:
Non-Narcotic Substances Used To Cut Heroin
Paracetamol: This substance is an analgesic pain reliever, which can be added to heroin to reduce side effects and give the user the impression that the supply is of higher quality.
Caffeine: This stimulant may be used to cut heroin to facilitate vaporization at a lower temperature. The mixture of stimulation and sedative effects of this mixture can cause a strain on your heart.
Laundry detergent This may be used to increase the volume of supply so that dealers can profit more from the batch.
Other Narcotics
Heroin may also be mixed with other illicit drugs to create a different high for the user. Heroin cut with fentanyl is one example. Black tar-cutting agents might also be added.
Cocaine
Heroin has been cut with cocaine for decades into a cocktail known as a “speedball.” This combination has been a popular mixture with a reputation as a party drug because of the stimulating effects of cocaine and the euphoric effects of heroin.
Fentanyl
The recent emergence of fentanyl into illicit drug markets during the past several years has been a devastating contribution to the overdose crisis. A study from the journal eNeuro found that heroin that has been cut with fentanyl causes oxygen in the brain to drop rapidly and remain low for an extended period. Brain temperature also lowers. These combined effects also make it more difficult for the anti-overdose drug naloxone to be effective.
Fentanyl is a substance that is at least 50 times more powerful than morphine, and it can be deadly when used to cut heroin. It is used to treat pain conditions or to help with pain after surgery. As a cutting agent, fentanyl has been convenient for dealers to use because it can be made at the street level or imported from overseas markets. It is cheaper than heroin, so it works well to increase profits.
Fentanyl increases the potency of heroin rather than dilutes it, so the supply remains strong enough for regular users with a tolerance for opiates to get still high.
It is also highly addictive, so people who use the substance will continue to use the drug. This can increase market share for dealers and keep their customers coming back for more.
The National Institute on Drug Abuse reports that just 2 milligrams of fentanyl can be deadly, and even people who touch or breathe the substance can be affected. With the opioid overdose crisis claiming more than 130 people every day in the United States, awareness about the dangers of fentanyl-laced heroin is more important than ever.
Is Heroin Withdrawal Dangerous?
It is often said that heroin addiction is very uncomfortable, but it can’t kill you. And there is very little evidence to suggest that there is any significant risk of fatality. For instance, naloxone is a drug that reverses an opioid overdose by kicking heroin off of opioid receptors and blocking any further binding until it wears off. However, naloxone often sends people who are addicted to opioids into immediate withdrawal symptoms, yet the medication saves lives every day.
Heroin dependence can cause uncomfortable withdrawal symptoms when you try to quit. These withdrawal symptoms can include flu-like nausea, vomiting, diarrhea, and sweating. You may also experience body aches, restlessness, general discomfort, and other uncomfortable symptoms. In most circumstances, heroin withdrawal isn’t deadly, but it can be extremely challenging to get through it on your own. Trying to detox from heroin by yourself may result in a relapse, which can be dangerous. Withdrawal symptoms can last for five to 10 days. During that time, you will start to lose your tolerance. If you relapse with your typical dose, it could result in an overdose, which can be life-threatening.
But, researchers like Shane Darke from the National Drug and Alcohol Research Centre have pointed out that people can and have died from an opioid overdose. When you go into an opioid withdrawal, you can experience a variety of symptoms that are often described as flu-like, including insomnia, yawning, muscle aches, runny nose, nausea, sweating, vomiting, and diarrhea. The last three symptoms pose a potential threat of dehydration without proper care or medical attention. Sweating, vomiting, and diarrhea can cause you to lose water quickly, which can lead to serious medical complications like dehydration, elevated blood sodium levels, and heart failure. If you can’t replace those fluids, you may experience medical complications related to dehydration.
These symptoms can usually be avoided easily with medical or clinical supervision and care. However, the idea that opioid withdrawal is uncomfortable but ultimately harmless could lead to inadequate care. Going through heroin detox with the help of medical professionals may be safer. Medical detox can help you get through the withdrawal phase more comfortably.
How can Heroin Addiction be Treated?
Heroin addiction is a complex disease that requires complex treatment to effectively recover from. The disease is chronic, and relapse is a significant threat, but there are a variety of treatment options that can help you achieve lifelong recovery from active addiction. Though heroin withdrawal is not typically deadly, the safest option is to go through withdrawal in some kind of medical professional setting. In medical detox, you will have 24 hours of medically managed supervision that last for about a week. During that time, your symptoms will be mitigated as much as possible, and your safety will be a top priority. In medical detox, you will also have the accountability to help you avoid relapse.
Levels of Care
After a week of detox, clinicians will help you find a treatment program that is right for you. Typically, treatment will involve the continuum of care, which describes different levels of care that you’re placed in based on your needs. As you progress, you will move to lower levels of care until you complete treatment. After detox, the levels of care include:
Inpatient Treatment
Inpatient treatment is the most intensive level of care after detox. It involves 24-hour clinically monitored care and offers extra supervision for clients that might have significant health and psychological needs that need attention. This is often useful for clients with ongoing medical concerns that need 24-hour care and for people with serious post-acute withdrawal symptoms that last for a few weeks after detox.
Intensive Outpatient (IOP)
In intensive outpatient treatment, you will no longer need constant medical or clinical supervision, but you will still need highly intensive treatment. In IOP, you will have access to more than nine hours of clinical services every week.
Outpatient
Outpatient treatment involves fewer than nine hours of clinical services and represents the lowest official level of care in addiction treatment. This is an ideal step to help clients back into normal life, in which they continue to learn coping strategies for real issues they are encountering in day-to-day life.
After treatment is completed, you should continue your commitment to recovery by connecting to your treatment center’s aftercare program or by seeking out support groups. People who become complacent after treatment often fall back into old habits and are more likely to relapse. Connecting to a support community like a 12-step program can help you gain accountability to avoid relapse.
What is Involved in Treatment?
Addiction treatment can involve a variety of treatment options and therapies but one of the most important aspects of an effective treatment plan is that it’s highly individualized. When you enter a treatment program, you should have an opportunity to sit down with your therapist so that you can give them as much information and input as to make your plan.
Addiction can be caused by a variety of underlying factors, and people will respond to different types of treatment. A personalized treatment plan will help ensure that you are getting the best treatment for your needs.
It’s also important for a treatment program to answer multiple needs besides a heroin addiction. Addiction can cause multiple problems like infectious diseases, vocational issues, and financial problems.
Effective treatment will address medical, psychological, social, vocational, and legal problems.
Though treatment is individualized and can include a variety of different therapies, one of the most commonly recommended treatment options is behavioral therapy. Behavioral therapies focus on motivating and developing meaningful behavioral change. Cognitive-behavioral therapy (CBT) is among the most common in addiction treatment and it involves looking at the way thinking can lead to negative or positive behaviors. In the CBT model, clients learn to prevent relapse by practicing techniques that develop positive coping mechanisms and avoid thoughts that could lead to eventual relapse.