Heroin Addiction: Signs, Symptoms, Risks, and Treatment Resources

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    What you will learn
    • Heroin is a potent, highly addictive opiate derived from opium poppies
    • As a Schedule I drug, heroin is defined as a drug that has no currently accepted medical use and a high potential for abuse
    • Known for its signature rush of euphoria, heroin works on the opiate receptors of the brain
    • Heroin may be injected, smoked, or snorted, and each of these methods of ingestion comes with risks
    • Heroin overdoses can easily turn deadly due to the drug’s depressant effects on breathing, heart rate, and other essential bodily systems
    • Naloxone can reverse the effects of a heroin overdose in the short term
    • Heroin addiction is classified as an Opioid Use Disorder in the DSM-5
    • Treatment for heroin addiction includes withdrawal management, psychological treatment, and long-term medications and lifestyle changes

    What is Heroin?

    Heroin is a highly potent opiate drug derived from the seed pod of several varieties of poppy plants. It may appear as a white or brown powder or in the form of a black sticky substance known as ‘black tar heroin.’ This central nervous system depressant is known for a euphoric rush which quickly takes larger doses to achieve. 

    Heroin Quick Reference 

    Drug Category Commercial & Street Names DEA Schedule Administration
    Depressant Black Pearl, Black Stuff, Black Eagle, Brown, Brown Sugar, Brown Tape, Chiba, Chiva, China White, Dope, Dragon, H, Hero, Horse, Junk, Scat, Skag, Smack, Tar, White Boy/Girl, Witch Hazel, White Horse, White Lady, Mexican Brown, Mexican Mud, Number 3/4/8 Schedule I
    • Injection
    • Inhalation
    • Smoking

    Heroin’s Effects on the Mind and Body

    When heroin enters the body, it immediately activates opioid receptors in the brain. These receptors are responsible for modulating the experiences of pleasure and pain and are the reason for the instant euphoric rush that makes heroin so addictive. At the same time, heroin slows down the nervous system, resulting in a feeling of extreme relaxation. 

    How Does Heroin Affect the Brain?

    Heroin activates the opioid receptors in the brain and other areas of the body. As a result, the brain begins to flood with a much higher level of dopamine than what would ever occur naturally. Dopamine is a neurotransmitter that provides individuals with feelings of happiness, well-being, and satisfaction. 

    Heroin also alters an individual’s state of mind, with many users reporting:

    • Clouded mental functioning
    • A warm, calm feeling
    • An increased feeling of well-being and confidence

    How Does Heroin Affect the Body? 

    Heroin is a central nervous system depressant. This means it slows down critical bodily functions, including breathing, body temperature, blood pressure, and even heartbeats. Also, heroin overdoses have resulted in more than 13,000 deaths in the U.S. in 2020[1]

    Heroin’s depressants effects may be experienced as:

    • Warm flushing of the skin
    • A heavy feeling in arms and legs
    • ‘Pinpoint’ or very constricted pupils
    • Nausea and vomiting
    • Severe itching
    • Going ‘on the nod’, a back-and-forth state of being conscious and semi-conscious 
    • Slowed breathing
    • Slowed heart rate 


    What are the Long-Term Effects of Taking Heroin?

    Heroin use spanning weeks, months, or years can have serious physical and mental health consequences. These depend on factors including the method of taking heroin, the dosage, and the individual’s pre-existing level of health. These long-term effects may include: 

    • Insomnia
    • Infection of the heart lining and valves
    • Constipation and stomach cramping
    • Liver and kidney disease
    • Lung complications, including chronic pneumonia
    • Sexual dysfunction
    • Irregular menstrual cycle for women
    • Pervasive mental disorders, including depression and antisocial personality disorder


    The Risks of Injecting Heroin

    Considered the fastest and most intense way of dosing on heroin, intravenous injection or ‘shooting up’ puts individuals at risk of collapsed veins, skin abscesses, and serious bacterial infections of the blood vessels and heart.[2] Intravenous heroin use also increases the chances of contracting HIV and other viruses due to sharing needles. 

    The Risks of Smoking Heroin

    Smoking heroin is the second most common form of heroin consumption. This method increases the chances of potentially fatal coughing fits called bronchospasms. It also increases the likelihood of irreversible damage to the white matter in the brain, likely due to the chemicals in the aluminum.[3] 

    The Risks of Sniffing Heroin

    Sniffing heroin may seem less dangerous than injecting it, but it comes with different risks. In addition to damaging the tissues of the nasal passage, it results in damage to the structures that give the nose its shape. It also causes irritation and inflammation across the entire respiratory system. 

    The Dangers of A Heroin Overdose 

    One of the biggest risks of heroin is its potential for overdose. As a central nervous system depressant, heroin slows down essential bodily functions. And in cases of overdose, this can result in breathing and heartbeat stopping completely within 2-3 minutes. 

    Heroin and Fentanyl 

    The risk of overdosing on heroin is amplified by the increasing saturation of fentanyl[4] and other contaminants in the drug supply. Fentanyl is more potent than heroin, with stronger respiratory and cardiovascular depressant effects. A person may not realize that the drug they’re taking is much stronger than they’re used to until it’s too late. 

    How to Stop a Heroin Overdose

    Naloxone is a front-line defense in reversing the life-threatening effects of an overdose on heroin[5] or another opioid. Dispensed either as a nasal spray or an injection, naloxone contains an opioid antagonist, quickly restoring breathing and other basic bodily functions until emergency medical services can arrive. 


    Understanding Heroin Addiction 

    The reason heroin is highly addictive lies in the way it trains the brain. Like other opioids, heroin causes the neuron synapses to flood with an excess of naturally occurring endorphins and dopamine. But in a very short amount of time, the brain stops making these chemicals naturally, forcing individuals to rely on heroin for even a base level of comfort.

    This internal impact is reflected in the numbers we see in our society, with an estimated 23% of individuals becoming addicted after trying heroin[6]

    Diagnosing a Heroin Addiction 

    Heroin addiction is classified as an Opioid Use Disorder (OUD) according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

    In order to confirm a diagnosis of Opioid Use Disorder (OUD), at least two of the following should be observed within a 12-month period:

    • Opioids are often taken in larger amounts or over a longer period than was intended.
    • There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
    • A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
    • Craving, or a strong desire or urge to use opioids.
    • Recurrent opioid use results in a failure to fulfill major role obligations at work, school, or home.
    • Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
    • Important social, occupational, or recreational activities are given up or reduced because of opioid use.
    • Recurrent opioid use in situations in which it is physically hazardous.
    • Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
    • Users exhibit tolerance to opioids, requiring a markedly increased amount to achieve the desired effects.
    • User exhibits withdrawal symptoms.

    Recovering from Heroin Addiction 

    Heroin addiction affects individuals from a huge variety of backgrounds and demographics, but they all have one thing in common — they can recover. Treatment for heroin addiction follows the same path as other Opioid Use Disorders. This includes withdrawal management, psychological treatment, long-term relapse prevention, and lifestyle maintenance.   

    Managing Heroin Withdrawal Symptoms

    Heroin withdrawal, unfortunately, involves some difficult and unpleasant symptoms. The good news is that these can be made more manageable through medically assisted detoxification and the use of FDA-approved medications like naltrexone and methadone. 

    Early Heroin Withdrawal Symptoms 

    Some of the earliest symptoms of heroin withdrawal will show up within the first 8 to 24 hours and may include: 

    • Increased breathing rate and blood pressure
    • Elevated body temperature and low fever
    • A fast pulse and heartbeat
    • Dilated pupils
    • Unusually heightened reflexes
    • Sweating
    • Goosebumps
    • Water discharge from eyes and nose
    • Muscle pain and spasms, especially in the legs and back
    • Bone pain
    • Diarrhea, nausea, and vomiting

    Long-Term Heroin Withdrawal Symptoms

    After an initial short-term period of acute withdrawal from heroin, longer-term symptoms will show up. Typically these occur between 3-10 days after the last dose of this opiate and may include: 

    • Continued mood disorders, including pervasive dysphoria, depression, and anxiety, requiring additional treatment 
    • Heavy fatigue and exhaustion
    • A loss of interest in activities
    • Short-term memory problems
    • Decreased attention, impaired concentration, and difficulty making decisions
    • Drug craving

    Psychological Treatment for Opioid Use Disorder

    After withdrawal symptoms are manageable for an individual, the second stage of treatment can begin. This stage involves therapeutic and psychological interventions that help individuals understand the root of their heroin addiction and develop skills to avoid a relapse in the future. 

    The psychological treatment stage may take place as part of an inpatient or an outpatient program. One-on-one talk therapy, group therapy, and family therapy will be paired with behavior skills training. The most common behavioral skills training methodologies for Opioid Use Disorder include Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT).

    Long-Term Lifestyle Maintenance for Opioid Use Disorder

    Recovery from heroin addiction typically requires long-term medication for opioid use disorder (MOUD) along with ongoing outpatient counseling. Many individuals find attending a peer-led support group helpful, as it allows them to share challenges, share challenges, learn from others, and find social relationships that support continued recovery and sobriety.

    Frequently Asked Questions

    What is opioid antagonist treatment (OAT)?
    Is it okay to use heroin while pregnant?
    Can you mix heroin and alcohol?

    Are you or a loved one struggling with Heroine addiction?

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