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
• Heavy tobacco use, marijuana use
• Severe depression or anxiety
• 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 afterward. 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].
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