Heroin Addiction

What is Heroin?

Heroin is a synthetic opioid analgesic derived from the seed pod of the opium poppy plant, which is commonly found in regions like Colombia, Mexico, and Southeast and Southwest Asia. It typically manifests in three forms:

• White Powder Heroin: The purest and most refined type, easily dissolvable in water.
• Brown Powder Heroin: Less refined than white powder but still highly addictive.
• Black Tar Heroin: A dark, sticky form that is less pure and not easily dissolvable in water.

Heroin is classified as a morphinane alkaloid, which means it is a derivative of morphine, specifically modified with two acetyl groups at the O-3 and O-6 positions. When consumed, heroin is converted to morphine in the brain, where it binds to opioid receptors in various regions. This interaction results in a powerful surge of pleasurable sensations, commonly referred to as “a rush.” This intense feeling encourages repeated use, leading to increased tolerance, dependence, and ultimately addiction. Approximately 23% – 38% of new heroin users worldwide become dependent on the substance, as per the study, “Risk of Heroin Dependence in Newly Incident Heroin Users”. 

How is Heroin Used?

Heroin can be consumed in several ways:

1. Intravenous Injection: Black tar heroin is typically injected due to its lower purity. This method provides a rapid and intense rush of euphoria.
2. Inhalation: The purer forms, such as white or brown powder heroin, are often inhaled. While the effects take longer to onset compared to injection, the rush is less intense but lasts longer.
3. Smoking: Similar to inhalation, smoking heroin allows for slower onset and longer-lasting effects.

Regardless of the method, heroin acts the same way in the body. It crosses the blood-brain barrier and is converted to morphine, binding to opioid receptors that regulate pain and reward. This interaction results in decreased pain and a surge of pleasurable feelings.

Heroin Dependence

Common Classic Hallucinogens

Chronic use of heroin significantly alters the brain’s biochemistry, leading to both tolerance and dependence. Heroin dependence can be categorized into two types:

1. Physical Dependence: This occurs when an individual feels compelled to use heroin to avoid unpleasant withdrawal symptoms. These symptoms can include nausea, sweating, and muscle pain.
2. Psychological Dependence: In this case, the person believes they cannot function without heroin. Over time, heroin use becomes a priority, overshadowing other aspects of life. Behavioral changes may include irritability and distress when unable to obtain the drug.

As dependence deepens, it can transition into addiction, where the individual’s life increasingly revolves around obtaining and using heroin.

Heroin dependence and addiction are both treatable conditions. If you or someone you know is struggling to quit heroin, it’s important to understand that there is hope and support available. Reaching out for help is a crucial step, as many people are willing to assist in the journey to recovery. Various treatment options, including therapy and support groups, can provide the necessary guidance and resources to overcome addiction. 

Why Do People Use Heroin?

People may use heroin for different reasons. Usually, people begin to use heroin either recreationally or to self-medicate. Sometimes, heroin use is a symptom of something more deep-rooted and complicated. To deal with any psychological or social issues they may be struggling with or even to deal with chronic pain, people may turn to heroin.

Heroin is an illicit substance, but it is also a notorious substance. People may also begin using heroin out of a sense of curiosity, only to realize they might have gone too far.

The fact of the matter is, regardless of why people start using heroin, it can lead to dependence and addiction very quickly. Heroin is addictive, so tolerance for the substance builds up very quickly. Very soon, heroin users may start needing larger doses of the substance to achieve the same rush of pleasurable feelings. Larger doses of heroin can lead to life-threatening circumstances, including overdose and death. In fact 2022 alone, there were 5,871 overdose deaths related to heroin, as per the article, “Drug Overdose Deaths: Facts and Figures” by the National Institute of Drug Abuse. While the number has gone down considerably, heroin-related deaths can have devastating impacts on the family and community.

Is Heroin Addictive?

Yes, heroin is addictive. In fact, it is one of the most addictive substances in the world. This is why it has been made illegal in many countries.

Heroin addiction not only affects the person but has ripple effects across the community. The physical and social consequences of heroin addiction can be devastating, leading to disruptions in the family and community, crime, violence, and even HIV/AIDS, among others. It costs lives and disrupts the society.

Heroin is addictive because of the “rush” it gives. People who use heroin report a surge of pleasurable feelings. Moreover, it also alters the perception of pain. These properties can be highly appealing and make people crave more and more. However, heroin is no ordinary substance to be trifled with. It can affect the entire health of a person, but mostly, it can completely alter the brain’s chemistry.

Heroin rewires the brain. It alters the brain’s reward system to the point that it does not function properly without the substance, leading to addiction. Soon, the person begins to feel that they need heroin for daily functioning as the brain does not produce dopamine as it once used to. Heroin becomes the most important thing in life, and the person requires larger doses of heroin and experiences withdrawal symptoms if they stop using heroin.

Yes, heroin addiction is a severe medical condition and its symptoms can be very difficult to handle. However, it is not the end. With the right approach and treatment, heroin addiction can be overcome and users can lead a sober, fulfilling life.

Causes and Risk Factors for Heroin Addiction

Heroin use typically begins when people take it recreationally or to self-medicate. However, given its addictive properties, heroin alters brain chemistry, especially the reward system. The brain no longer produces dopamine as it once used to. Lower levels of dopamine in the brain lead to moodiness, low motivation, body stiffness, and difficulty in moving, among other things. People will soon start needing more and more heroin to keep going every day and keep the withdrawal symptoms at bay.

Heroin addiction can affect anyone. However, certain risk factors for heroin addiction can make some more prone to it than others.

• Personal and/or family history of addiction (to heroin or even other substances)
• Personal history of anxiety or depression
• History of risk-taking behaviors
• Exposure to high-risk environments
• Unemployment

What is important to remember here is that just because you or someone you may know has one or more of these risk factors, it does not necessarily mean heroin addiction. However, it is crucial to be aware of these risk factors for any signs of heroin addiction and seek professional help if you or someone you may know suffers from any of the same.

Signs and Symptoms of Heroin Addiction

The signs and symptoms can be varied. It mainly depends on genetics, frequency of use, and duration of use mainly. However, there are certain common symptoms of heroin addiction.

• Mood swings, from depression to euphoria
• Anxiety and paranoia
• Irritability and agitation
• Avoidance and/or hostility toward other people
• Delusions and hallucinations
• Weight loss
• Bruises over the skin because of injecting the substance
• A lack of personal hygiene
• Increased sleep
• Lack of motivation
• Decline in performance – academics or occupational
• Respiratory problems
• Dry mouth
• Slurred speech

The thing about heroin addiction is that it leads to behavioral and physical changes in the person. It is important to be acutely aware of these signs of heroin addiction. People suffering from heroin addiction drastically lose weight and have sallow skin that makes them appear to be older than their age. They may be in possession of needles and burned spoons. Even something as seemingly trivial as missing shoelaces can be a sign to look out for. They might also stash heroin in different places – be it at home, work, or even their car.

Seeing someone suffer from these symptoms can be as difficult as suffering from it. So, to increase the chances of recovery, early attention is vital. Early attention and treatment can increase the chances of successful rehabilitation and a sober, fulfilling life.

Effects of Heroin Addiction

Heroin use can lead to short-term and long-term effects. Once heroin enters the brain, there is a rush of pleasurable feelings, which can make the person feel good. On the flip side, this pleasurable rush is accompanied by dry mouth, nausea, vomiting, and sometimes even itching can occur.

However, in the long term, the effects of heroin addiction are dreadful. Decreased mental functioning, liver disease, skin disease, kidney disease, respiratory problems, stroke, heart attack, overdose, and death are some of these. Moreover, when heroin is injected, especially black tar heroin which can be very difficult to inject, it can increase the risk of contracting infections and lead to other complications. This includes the risk of contracting chronic, deadly diseases like Hepatitis B, Hepatitis C, and even HIV/AIDS.

Heroin addiction can completely change a person’s life – from personal life, and social life, to academic or occupational life. Nothing is too private or sacred for the substance to damage. Heroin addiction means the person prioritizes heroin use above all else. More time is spent on obtaining and using heroin than learning, working, socializing, or spending some time with loved ones. In fact, heroin addiction can lead the person to avoid their near and dear. This can lead to disruptions in family, educational, and professional environments.

Heroin addiction also has a devastating impact on the society; it breaks down families and the breakdown of the family unit slowly leads to the breakdown of the society. Its health and social effects, including increased hostility, crime, and violence, also cost billions of dollars every year.

Heroin Withdrawal

The most dangerous thing associated with heroin use is heroin withdrawal. The reason being, heroin withdrawal develops just a few hours after sustained heroin use and even if someone wants to stop using heroin, they cannot do so out of fear of these withdrawal symptoms. Major withdrawal symptoms can take place between 24 hours – 48 hours of heroin use and subside a week or so later. Some common heroin withdrawal symptoms are:

• Heroin craving
• Crying
• Nausea and vomiting
• Muscle stiffness and cramps
• Fever
• Cold sweats
• Diarrhea
• Insomnia
• Fatality (in case of other pre-existing medical conditions) 

Heroin withdrawal must not be taken lightly, and going cold turkey or completely withdrawing from heroin use or abuse, can be life-threatening. Despite age-old advice of overcoming weakness with sheer willpower, it is neither simple nor safe. In fact, going cold turkey leads to severe withdrawal symptoms and psychiatric conditions, so consequently, the risk of relapse increases.

The scientific and safe route to recovering from heroin addiction is medically supervised detoxification. It is known as Medication Assisted Treatment (MAT) and is available in rehabilitation centers. MAT combines psychotherapy and medication to ensure safe and successful detoxification. It also reduces the risk of relapse and paves the way for the journey toward recovery and sobriety.

Heroin Overdose

Heroin overdose is one of the major reasons for heroin-related fatalities. However, the tragedy of this is there are signs of a heroin overdose. Not being able to recognize these signs has led to many preventable heroin-related deaths over the years. Some signs of heroin dose to be aware of are as follows:

• Changes in Breathing Patterns – The person’s breathing can become erratic, slow, and shallow as a heroin overdose can shut down the lungs.
• Changes in the Pulse Rate – Heroin overdose can shut down the heart as well. The person’s pulse rate can become erratic or slow. Whenever they seem to alert, it is always crucial to check for these abnormal patterns in their pulse rate.
• Changes in Body Coloration – As heroin overdose can alter blood circulation, the coloration of the person visibly changes. They may turn blue, purple, ashy, gray, or become pale.
• Loss of Consciousness – Heroin overdose shuts down cognitive functions and the brain becomes starved of oxygen. This condition is known as “brain hypoxia,” and it can lead to a loss of consciousness. It is quite tricky, as it may seem like the person has dozed off and gone to sleep.
• Vomiting – Heroin overdose can lead to severe vomiting. The more dangerous thing about vomiting after a loss of consciousness is that the person is even at the risk of choking on their vomit.
• Changes in Muscle Responses – After a loss of consciousness, the person’s muscles may become limp and unresponsive. There might be changes in muscle responses of the eyes, so the pupils can shrink to the size of just dots.

If someone is showing one or more signs of heroin overdose, it is important to contact 911 or any local emergency number immediately. Staying with the person and monitoring their breathing is something really helpful, as it helps keep them awake for a longer time. If available, administering Naloxone as either an injection or nasal spray can reverse heroin’s effects and help save lives. Once the emergency responders arrive, providing them with as much information as possible can be extremely useful.

Heroin Addiction Treatment

Heroin disorder requires a multi-level treatment approach, meaning it needs medical, psychological, and social support.

Treatment programs for heroin addiction can be both, inpatient, and outpatient. With inpatient treatment programs, clients stay in a rehabilitation center where they receive 24*7 care, medically supervised detox, and psychotherapy in a structured environment. On the other hand, outpatient treatment programs offer more flexibility. They allow clients to stay at their homes while attending therapy sessions and group meetings. Outpatient programs best work with milder forms of heroin addiction.

 There are many effective treatments available for heroin addiction. Typically, the integration of pharmacological and psychotherapeutic treatments is the most efficient path to recovery.

Pharmacological Treatments (Medication) – Medications are typically useful for detox. Some of the FDA-approved medications for heroin addiction treatment are as follows:

• Iofexidine – A non-opioid medication, it is used to treat opioid withdrawal symptoms. While it cannot be used to treat heroin addiction, it is usually used in the first step toward recovery.
• Methadone – An opioid agonist, it prevents heroin (and even other opioids) withdrawal symptoms. Methadone is best used in outpatient treatment programs.
• Buprenorphine – A partial opioid agonist, it prevents heroin cravings and any other dangerous side effects of the substance.
• Naltrexone – An opioid antagonist, it works by blocking the action of opioids.

Behavioral Treatments – Behavioral therapies, like contingency management and cognitive behavioral therapy, are known to have high success rates when it comes to heroin addiction.  Contingency management uses a point-based system where clients earn points for negative drug tests. They can then use these points to exchange them for items of their need or desire. Cognitive behavioral therapy, meanwhile, changes thinking patterns and behaviors toward heroin use and equips the client with skills needed to cope with different life stressors.

While detox, treatment, and rehabilitation centers are initial and crucial steps to recovery, a life of sobriety requires consistent care. Aftercare programs and sober living environments play a crucial role in this. Similarly, informal peer groups like Narcotics Anonymous (NA) offer peer support and spaces to share experiences, seek encouragement, and take personal responsibility.

Finally, social support is something that every person recovering from heroin addiction needs. Love, understanding, compassion, and unconditional support are certain things that can go a long way when it comes to recovery from heroin addiction and sober living.

Heroin Harm Reduction Strategies

Heroin harm reduction strategies come in where immediate quitting is not possible. These are ideas and strategies that are meant to reduce the negative consequences that follow heroin use.

Needle Exchange Programs – Heroin users tend to inject the substance through a vein. It is a popular method of using heroin as it is rapid-acting and also produces intense effects. However, with needles comes the risk of wounds and infections, including Hepatitis B, Hepatitis C, and HIV/AIDS. Therefore, needle exchange programs can serve as crucial access points to services like providing sterile needles in exchange for used ones, testing for infectious diseases, and referrals to treatment programs.

Naloxone – Naloxone is a life-saving medication when it comes to heroin overdose. It is an opioid antagonist and works by reversing the effects of heroin. Therefore, having naloxone around either in the form of a nasal spray or injection can prevent many life-threatening circumstances, including heroin overdose and death.

Education – Education is always required, in any given circumstance. However, with heroin use, especially where people are not ready to quit, education about safe heroin use becomes vital. Many times, it is the line between life and death. Education on safe heroin use includes:

• Educating heroin users on the risks of heroin addiction and overdose.
• Educating heroin users on the signs and symptoms of heroin addiction and overdose.
• Educating heroin users on ways to reduce the risk of heroin overdose, including using smaller doses of heroin when its purity is unknown, not mixing heroin with other substances like alcohol or benzodiazepines, and using heroin only in safe and controlled environments.

While the heroin harm reduction strategies do not address the root causes of heroin addiction, they are important to reduce the risks associated with heroin use, like heroin overdose and even death.

For a deeper understanding of how heroin fits into the broader issue of opioid dependency and how treatment plans are structured, check out this guide on overcoming opioid addiction and the various methods available to support recovery.

Heroin and Co-Occurring Disorders

Heroin addiction can co-occur with different disorders. Some of the co-occurring disorders with heroin addiction are:

• Anxiety disorders
• Depressive disorder
• Bipolar disorder
• Eating disorders
• Personality disorders
• Post-traumatic stress disorder
• Alcoholism
• Other substance use disorders
• Schizophrenia

While people suffering from heroin addiction may suffer from other psychological disorders, it does not necessarily mean the addiction led to the disorder or vice-versa. It can be that common risk factors led to the development of both, the psychological disorder contributed to heroin addiction, or heroin addiction contributed to the development of the psychological disorder.

What to Do if You Suspect Someone Is Using Heroin

When heroin use is suspected, it can be deeply concerning and overwhelming. However, taking the right steps to approach them can be a crucial step toward recovery. The first thing to do is understand heroin addiction before engaging in a conversation. Then, approach the person from a place of empathy and understanding rather than judgment. For instance, use a lot of “I” statements – “I have noticed some changes in your behavior, and I am worried about you.” This opens the door for something more productive than confronting the person.

If the person is open to seeking professional help, support them in seeking professional treatment. Recovery is a personal decision, and pushing too hard may backfire. So, it is always important to encourage seeking professional treatment and offer unconditional emotional support.

Heroin addiction has a road to recovery, however, on this journey, even the loved ones and families of those suffering from heroin addiction also need care and support. There are several resources available for them that offer help to both, the person using heroin, and the family members to navigate this difficult journey. Informal peer support groups like Families Anonymous (FA) offer family members a space to share their experiences and learn how to cope with the challenges of supporting someone who is dealing with heroin addiction.

Individual counseling and psychotherapy or even family therapy can be beneficial. A licensed family therapist or addiction counselor can help families develop better communication strategies and set personal boundaries while also offering support to a loved one dealing with heroin addiction without enabling any further drug use.

Addiction can lead to severe repercussions within the family. Therefore, approaching it with understanding and offering meaningful support to the person while also protecting and caring for one’s own health and well-being is what is needed during this difficult journey.

Final Takeaways

Heroin is addictive – Heroin is illegal, addictive, and dangerous. It quickly builds up tolerance, leading to physical and psychological dependence.

Heroin alters the brain’s biochemistry – Heroin alters the brain’s reward system, leading users to prioritize heroin use above all else in their lives, even when it jeopardizes their well-being.

Heroin use is preventable – Nearly 3.4 million U.S. residents have used heroin at least once in their lives. While this indicates widespread use, heroin use is preventable. Education and easily accessible treatment programs can make all the difference.

Heroin treatment programs are effective – Inpatient and outpatient programs, medications like methadone or buprenorphine, and behavioral therapies like cognitive behavioral therapy can help overcome addiction.

Ongoing care is crucial – Recovery from heroin addiction requires ongoing care as well as family and peer involvement.