Heroin is a highly addictive drug derived from the morphine alkaloid which is found in the opium poppy plant (Papaver somniferum). Opioids are a group of drugs with very strong analgesic potential and include heroin, morphine, codeine, and synthetic drugs such as pethidine, methadone, and dipipanone.
Opioids are powerful analgesics and are used to manage pain as a last resort. Heroin and other opioids stimulate opioid receptors in the brain to release dopamine. Apart from analgesia, heroin has potent euphoric and anxiolytic effects for which it is often abused.
Heroin has no acceptable medical uses in the United States and is classified under a Schedule 1 Drug under the Controlled Substances Act. Other opioids are only available through prescription due to their abuse potential and include codeine, hydrocodone, hydromorphone, fentanyl, and oxycodone.
Types of Heroin
Pure heroin, known as diacetylmorphine is a white powder and has a bitter taste. Most illegal forms of heroin sold as brown, black, or white powder are usually cut with a variety of compounds to increase the volume and effect.
White and brown powder forms are often cut with sugar, starch, powdered milk, quinine, or even strychnine. Other potent opioids such as fentanyl and carfentanyl are also cut into heroin vastly increasing the chances of overdosing. Black tar is a form of heroin that is usually smoked or snorted. Heroin can be administered intravenously, subcutaneously (skin popping), or it can be sniffed (snorting) or inhaled.
Effects of Heroin
• Analgesia reduced sense of pain - for which opioids (but not heroin) are used medically.
• Euphoria, the rush.
• Respiratory depression due to depression of the central nervous system, constriction of pupils (pinpoint pupils), nausea.
• Constipation, reduced appetite.
• Decreased sexual activity.
• Infections such as Hepatitis B, AIDS due to the sharing of needles by addicts.
• Needle marks if the injection is the method of administration.
• Runny nose or nose sores if snorting the drug is the method of administration.
• Memory loss, slurred speech, agitation, and drowsiness.
• Changes in appearance, a decline in personal hygiene.
• Economical problems.
• Problems at work and school.
• Death due to overdose, infections such as HIV, and Hepatitis B.
Opioid Use Disorder
Opioid Use Disorder, is the medical term used to define heroin and opioid addiction. Heroin stimulates the production of dopamine, which gives a euphoric feeling. When dopamine levels go back to normal, the user craves it more and repeatedly takes opioids. This results in the person taking higher and more frequent doses of the opioid to achieve the same level of euphoria felt previously.
Risk Of Addiction
Addiction is multifaceted. The risk of addiction depends on psychological, environmental, and genetic factors.
Some of the risk factors associated with heroin addiction are;
• Family history or a personal history of addiction to other substances
• Living in an environment with other heroin addicts
• Risk-taking tendency
Withdrawal symptoms appear 6 hours after stopping use and peak after 36-48 hours and reduce afterwards. Withdrawal symptoms rarely threaten the life of the patient, but they cause great distress driving the patient to consume the heroin. Withdrawal symptoms include;
• Intense craving for the drug
• Restlessness and insomnia
• Pain in muscles and joints
• Running nose and eyes
• Abdominal cramps and diarrhea
• Disturbances in temperature control
• Pilo-erection, sweating, increased heart rate, and dilated pupils
Management of Heroin Addiction
Heroin addiction is not easy to manage due to its strong addictive potential and severe withdrawal symptoms. A multifaceted approach is employed to manage heroin addiction and treat the symptoms.
• Behavioral - The main goal is to achieve abstinence.
• Predisposing factors in the patient's life leading to addiction are identified and are systematically removed. For example, friends who consume heroin should be avoided.
• Motivational therapy
• Family support
• If needed, a rehabilitation center should be used
• Developing better hobbies such as playing sports
• Pharmacological -
• Medications such as lofexidine, buprenorphine, methadone are used to control withdrawal symptoms
• Co-existing medical conditions such as infections are treated appropriately.
• Overdose - if you think someone is overdosing, take action right away.
• Naloxone- Naloxone can block the effects of a heroin overdose if used quickly and is lifesaving. It comes as an autopen and as a nasal spray. A doctor's prescription is not required to get naloxone.
1. Harrison, P. Shorter Oxford textbook of psychiatry (6th ed., pp. 471-473).
2. H., Know, C., Blogs, W., Center, N., Health, M. and Addiction, S., 2020. Heroin. [online] WebMD. Available at: <https://www.webmd.com/mental-health/addiction/heroin-use#3> [Accessed 9 October 2020].
HEALTH RISK OF PROBLEMATIC TO DEPENDENT USE OF HEROIN
Heroin is a highly addictive drug used illegally as a recreational drug. Long-term heroin use leads to severe addiction.
Heroin is produced from a plant called the poppy plant, abundantly found in North America, Mexico, and Afghanistan. Surprisingly one of the poorest countries in the world, Afghanistan, is the leading producer of heroin. Most of the world's population consumes Afghani heroin.
Approximately more than 340 tons of heroin is consumed each year and is responsible for thousands of deaths. The death rate is high because the lethal dose and regular dose are too close to each other.
Heroin is a derivative of morphine.
It contains two components:
Active component - Diacetylmorphine.
Psychoactive component - Diacetylmorphine and Diamorphine.
Diacetylmorphine and Diamorphon are responsible for the classic "rush" euphoria and addiction.
Routes of Administration
Types of Heroin
Heroin has three types:
1.Black tar heroin.
2.Brown powder heroin.
3.White powder heroin.
Health Risks of Heroin Use
• Mental health problems
• Physical health problems
• Social problems
Mental Health Problems
There are both short term and long term effects.
• Acts on the autonomic system to slow cardiac and respiratory functions.
• Acts on the limbic system to alter emotions
• Acts on the spinal cord tract to suppress pain sensation
Short Term Effects
Heroin enters the brain in the form of morphine and binds to opioids receptors. Opioid receptors, when stimulated, cause a pleasure-able sensation known as the “rush." The rush is directly related to the amount of drug taken.
Short term effects of heroin use include:
• A rush of euphoria: It lasts for 3 to 4 hours
• State of trance that lasts for 4 to 6 hours
• Anxiety and flushing of the skin
• The sensation of heaviness in arms and legs
• Loss of appetite
• Nausea and vomiting
• Increased lacrimation and runny nose
• Drowsiness, pupil constriction
• Impaired thinking
• Dry mouth
• Slowing of cardiac functions
• Slowing of respiratory rate: Sometimes, breathing rate decreases to a dangerous level and can result in coma and death.
Long term effects
Chronic use of heroin causes a change in the brain's physiology and physical structure, thus affecting the hormonal and neuronal systems.
Research shows that long-term usage of heroin causes changes in the white matter of the brain, which can cause a variety of problems.
• Withdrawal symptoms: These can occur within a few hours after the last dose. These are characterized by restlessness, nausea, vomiting, body aches, cold with goosebumps, and bone pain. These symptoms peak at 24 to 48 hours after the last dose. Withdrawal subsides within a week, but for some users, it can take months.
Physical Health Problems
Physical health problems can be due to the drug itself or the route of administration:
Due to injecting :
• Chronic liver diseases: Hepatitis A and Hepatitis B
• Collapsed veins
• Cellulitis at the injection site
• Skin abscess
• Scaring: needle marking
• Infectious endocarditis
• Valvular cardiac diseases
Due to snorting:
• Formation of crust in nasal cavities
• Bleeding ( epistaxis)
• Perforation of the nasal septum.
• Pulmonary infections
• Pulmonary fibrosis
Due to the drug itself:
• Renal problems
• Men: sexual dysfunction and infertility
• Women: menstruation disturbance
Effects on pregnancy:
• Neonatal abstinence syndrome: If the mother is using heroin during pregnancy, then the drug crosses the placenta and reaches the fetus's circulation. The presence of heroin in fetal circulation results in the fetus becoming dependent on morphine. After birth, the baby shows withdrawal symptoms such as excessive crying, lacrimation, irritation, etc.
• Preterm labour
For these reasons, the sudden withdrawal of the drugs is contraindicated. The drug should be withdrawn slowly over weeks to months. Either mother should stop the drug before the pregnancy or after the pregnancy, gradually.
Like every other drug, heroin causes a lot of social problems. Since the level of addiction and tolerance is so high with heroin, unlike other recreational drugs such as cannabis or ecstasy, social problems are also of higher magnitude.
• Interpersonal relationship problems: Chronic heroin user fails To provide for the family and give them proper attention as a result of which such patients have broken families. These patients mostly have a divorce, and children also prefer to stay away from a violent parent.
• Violence: As with every other drug or chronic heroin user, can I also have violent tendencies. An addict can hurt his family members are other people.
• Increase crime rate: There is always an increase in the crime rate, no matter its drug. Increased crime is related to decreased inhibition and disorganized thinking.
• Family problems: A chronic drug user is a burden on the family socially as well as financially.
• Driving under the influence: can be a problem for a person himself and also for others. Annually there are many reports of accidents happening because of the usage of the drugs.
• Social stigma: Chronic drug users are rejected by society.
• The decrease in the quality of life: It is difficult for an addict to maintain a good quality of life as he spends much of his earnings on the drug
• Problems in the workplace: Heroin is known for its harmful effects on the brain. This includes a decrease in cognitive abilities, a reduction in a problem-solving capacity coma, and productivity. Hence a person is unable to complete his task and end up losing his job.
• Economic problems: Spending most of the time in the euphoria obtained by the drug, an addict fails to focus on earning a good living
"The ASV Rehab at Home program provides evidenced based drug treatment and alcohol rehab options across Melbourne, Victoria. Developed to meet an identified need within the Victorian community, our support programs provide any person, including the families of addicts, with genuine opportunities at positive change (recovery)." - Jase Bowman - ASV CEO - Drug and Alcohol Rehab Services - Melbourne.