Heroin | Heroin Addiction | Heroin Withdrawal
Heroin is an illegal, highly addictive opiate drug. Its abuse is more widespread than any other opiate. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as “black tar heroin.” Although purer heroin is becoming more common, most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.
Other names for heroin
“smack”, “junk”, “horse”, “skag”, “H”, “China white”, Thai White, Brown Sugar
Opium, Morphine, Codeine, Merperidine , Hydrocodone (Lortab, Vicodin), Oxycodone (Percodan, Roxicet, Roxiprin, Tylox, Percocet), Stadol, Talwin, Dilaudid, Fentanyl, Buprenorphine, Methadone, Propoxyphene (Wygesic, Darvocet)
How is heroin used?
Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while musculature injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a “rush” as quickly or as intensely as intravenous injection, researchers have confirmed that all three forms of heroin administration are addictive.
Injection continues to be the main method of use among heroin addicts; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now a widely reported means of taking heroin among users admitted for drug treatment With the shift in heroin abuse patterns comes an even more diverse group of users. Older users (over 30) continue to be one of the largest user groups in most national data. However, several sources indicate an increase in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been appearing in more affluent communities to a much larger extent.
Short-term effects of heroin use
Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a “rush.” The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching. After the initial effects, abusers usually will be drowsy for several hours. Mental function is clouded by heroin’s effect on the central nervous system. Cardiac functions slow. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot be accurately known.
Long-term effects of heroin addiction
One of the most detrimental long-term effects of heroin is heroin addiction itself. Addiction is a chronic problem, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse. As with abusers of any addictive drug, heroin addicts gradually spend more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers’ primary purpose in life becomes seeking and using drugs.
The drugs literally change their brains. Physical dependence develops with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhoea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements.
Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to addicts who have heart conditions and to the foetus of a pregnant addict. At some point during continuous heroin use, a person can become addicted to the drug. Sometimes addicted individuals will endure many of the withdrawal symptoms to reduce their tolerance for the drug so that they can again experience the rush.
Physical dependence and the emergence of withdrawal symptoms were once believed to be the key features of heroin addiction. We now know this may not be the case entirely, since craving and relapse can occur weeks and months after withdrawal symptoms are long gone. We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict.
Medical complications of heroin addiction
Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin’s depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.
One of the greatest risks of being a heroin addict is death from heroin overdose. Each year about one percent of all heroin addicts in the United States die from an overdose of heroin despite having developed a fantastic tolerance to the effects of the drug. In a non-tolerant person the estimated lethal dose of heroin may range from 200 to 500 mg, but addicts have tolerated doses as high as 1800 mg without even being sick.
Heroin abuse, HIV/AIDS and hepatitis B and C
Because many heroin addicts often share needles and other injection equipment, they are at special risk of contracting HIV and other infectious diseases. Infection of injection drug users with HIV is spread primarily through reuse of contaminated syringes and needles or other paraphernalia by more than one person, as well as through unprotected sexual intercourse with HIV-infected individuals. Research has found that drug abusers can change the behaviours that put them at risk for contracting HIV, through drug abuse treatment, prevention, and community-based outreach programs. They can eliminate drug use, drug-related risk behaviours such as needle sharing, unsafe sexual practices, and, in turn, the risk of exposure to HIV/AIDS and other infectious diseases. Drug abuse prevention and treatment are highly effective in preventing the spread of HIV.
Heroin abuse and pregnancy
Heroin abuse can cause serious complications during pregnancy, including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome), as well.
Heroin and Methadone
The majority of treatment programs in the United States utilize the 12 steps derived from the Alcoholics Anonymous and Narcotics Anonymous programs as their foundation. In the past, the 12 step philosophy was combined with inpatient treatment in a hospital setting for a period of at least 28 days. Addicts would attend AA or NA meetings while receiving group therapy. Unfortunately, this model proved to be less than successful and the insurance industry has become unwilling to pay for extended stays. The current trend is to admit someone with a heroin problem to a hospital just long enough to get them through the worst of the physical withdrawal and then to send him to outpatient counselling. However not many hospitals will admit them. This method of treating heroin addiction is the most widely used and also the least successful. A program should utilize unique therapeutic training drills and instructional courses which address the underlying causes of addiction in an intensive manner and from many different angles. The result is a person who has dealt with the sense of hopelessness which, as it turns out, causes a person to start using heroin in the first place. This individual, in most cases, no longer feels the need to use heroin or any other drugs.
Heroin addiction treatment programs
Heroin is a highly addictive drug. Recovery and rehabilitation from heroin addiction may require a treatment program ranging from certified addiction counselling to treatment at a residential alcohol and drug rehab centre, depending on the extent of the addiction and a number of other factors.
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