Exploring Heroin Abuse & Addiction
What is heroin?
Heroin is a highly addictive illicit drug prepared from opioids. It is one of the most commonly abused opioid. Opioids trigger the brain to release dopamine (a chemical associated with pleasure and satisfaction) in excess, relieving pain while also making individuals feel more relaxed and contented (albeit briefly).
Heroin is also known as ‘smack, ‘thunder,’ ‘dope,’ ‘poppy,’ ‘hammer,’ ‘white junk,’ and ‘dead on arrival’ on the street. Heroin typically comes in a white or brown powdered form. The term “black tar heroin” refers to a viscous and dark variety of heroin. Heroin abuse can happen in a number of different ways, including inhalation, smoking, and intravenous (IV) injection.
Regardless of how it’s taken, heroin’s effects are felt quickly because of its rapid absorption into the blood. The purity of the drug is not known to users, making it a dangerous drug that can cause overdose toxicity.
Heroin, a depressant that affects key biological processes like breathing and heart rate, is often abused in combination with a range of other drugs and alcohol, which increases its toxicity.
Understanding a substance abuse disorder: heroin abuse
Heroin is considered an opioid due to its similarities in chemical structure to opioids and its synthesis from opioids. Further, heroin addiction is classified as an opioid use disorder (OUD). OUD is often a long-term, relapsing (recurring) condition that leads to severe complications and even death.
Use of opioids leads to euphoria (an experience of pleasure) and analgesia (a loss of pain sensation). The younger generation uses opioids to feel ‘high’. People are often exposed to opioids in one of two ways. The first is through regular use of prescription painkillers, and the second is through experimenting with street drugs like heroin during social gatherings.
Long-term opioid use causes brain changes that result in opioid tolerance (the need to use increasing amounts of drugs to get the same euphoric effect), dependence (adaptation of the mind and body to heroin use), and addiction. The effects of heroin use can be physical and psychological, and they can have an impact on social relationships.
What causes heroin addiction?
Heroin acts on the brain’s opioid receptors, causing dopamine release in the brain. Users of heroin report euphoria as a result.1 Unfortunately, long-term and frequent use of opioids results in tolerance.
Due to increased tolerance, users continue to increase their heroin dose, resulting in further damage to the brain and other vital organs of their bodies. This results in heroin addiction. Researchers attribute the onset of heroin addiction to a combination of genetic, physical, and social factors.2
Addiction is often passed from generation to generation by families. Addiction to heroin or other drugs is more likely if a person has a first-degree relative who is also addicted to the substance. It’s important to note that not everyone who becomes an addict comes from a family of addicts. Approximately 50% of opioid use disorders can be attributed to genetics.3
Since heroin induces the release of dopamine in the brain, people who are deficient in dopamine (dopamine deficiency syndrome) may seek out heroin or other drugs to feel pleasure. Furthermore, patients with a history of mood disorders, post-traumatic stress disorder (PTSD), or anxiety are at a higher risk of developing a substance use disorder.4
Substance use disorder may be more likely to occur in those whose social circles include regular opioid use.
Heroin addiction crisis: alarming facts & key statistics
A marked increase in both OUD and opioid overdose deaths has been seen since the 1990s.5 A National Institutes of Health assessment from 2020 found that 80% of heroin users first abused prescription opioids and that 400,000 Americans aged 12 years or older are currently addicted to heroin.6 These numbers show the impact of heroin abuse on a young population.
Recognizing the symptoms of heroin addiction
The symptoms of heroin addiction vary based on the period and frequency of abuse, the amount used, the use of other drugs or alcohol, the individual’s genetic makeup, and the purity of heroin.
While needle marks are indicative of heroin use, new users rarely turn to injecting the drug. Common symptoms of heroin use include:
1) Behavioral symptoms
- Impulsive behaviour
- Social withdrawal
- Sudden change in hobbies
- Increased libido
- Inability to stop using heroin
- Stealing money for drugs
- Engaging in risky behaviours
- Bloodshot eyes
- Small pupils
- Increased alertness while high
- Flushing of skin
- Slurred speech
- Nausea and vomiting
- Dry mouth
- Slow breathing
- Mood swings
Health consequences of heroin use
The long-term effects of heroin abuse depend on a number of factors, including the extent and frequency of use, the purity of the heroin used, the user’s history of drug abuse and other risk-taking behaviours, and the user’s genetic background. Heroin abuse causes irreversible changes in neuronal and hormonal systems, altering brain function.7
The most common long-term effects of heroin use are as follows:
- Tolerance to heroin
- Dependence on heroin
- Pneumonia (due to heroin-induced depressed breathing and the user’s poor health)
- Heart attack
- Collapsed veins
- Impaired decision-making ability
- Withdrawal symptoms upon stopping/reducing heroin use
Apart from the direct effects of heroin with long-term use, risky behaviours such as engaging in unprotected sexual activity might increase the likelihood of contracting sexually transmitted diseases (STDs). In addition, sharing an injection needle with a partner might spread infectious diseases.
Treating heroin addiction
Often, people with heroin addiction have co-occurring disorders. Addiction to heroin can be aggravated by the presence of an untreated co-occurring underlying mental illness. Furthermore, co-occurring conditions may make recovery from heroin addiction more challenging.
Disorders associated with heroin abuse and addiction include:
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Treatment options for heroin addiction include medicinal and behavioural interventions. Research suggests that while both behavioural and pharmacologic therapies can be beneficial on their own, for many people, combining them is the most successful approach.
Quitting heroin results in withdrawal symptoms (nausea, diarrhea, pain, and vomiting), and they can be severe. Detoxification (detox) is a set of interventions aimed at reducing withdrawal symptoms that may lead to relapse during the heroin clearing stage. Lofexidine is an example of a detox medication that has been approved by the US Food and Drug Administration (FDA). Often, detox is followed by some form of evidence-based treatment.
Three types of medications used by healthcare providers are as follows:
Methadone is an opioid agonist. Oral use of methadone reduces the ‘high’ associated with other methods of administration and prevents withdrawal symptoms. Methadone has been used to treat heroin addiction since the 1960s and remains an effective therapeutic choice for some. However, this it is noteworthy that coming off Methadone is in itself very hard, so the Beekeeper advocates for a complete detoxification process.
Buprenorphine acts as an opioid partial agonist. Buprenorphine reduces the urge for illicit drugs without the “high” or harmful effects of other opioids.
Naltrexone is an opioid receptor antagonist. Naltrexone blocks the effects of opioids without inducing addiction, sleepiness, or physical dependency. However, compliance issues among patients can hamper Naltrexone’s success.
Several behavioural therapies are available to treat opioid addiction. They work most effectively when combined with a medicinal treatment approach.
1) Contingency management
Patients participating in contingency management receive “points” for passing drug tests that may be used for rewards that promote a healthy lifestyle.
2) Behavioral therapy
Cognitive-behavioral as well as other approaches to therapy aims to improve the patient’s ability to deal with daily stress by altering their behaviors and beliefs in relation to drug use.
Common heroin withdrawal symptoms
Long-term heroin use leads to dependency and addiction in users. Quitting heroin suddenly causes anxiety, nausea, vomiting, sleeplessness, muscular spasms, and diarrhea. These are known as heroin withdrawal symptoms.
The primary reason heroin users relapse during the drug rehabilitation process is withdrawal symptoms. During detox, it is essential to use a medical approach in order to soothe withdrawal symptoms.