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Addiction Facts – Heroin

What is heroin?

Addiction Facts – Heroin

Heroin is an illegal, highly addictive, opiate drug that is abused more 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.

It is also known by a number of slang terms including smack, junk, horse, skag, H,  and China white.

Other opiates that are similar to heroin include 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 (seven to eight seconds), while musculature injection produces a relatively slow onset of euphoria (five to eight 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, all three forms of heroin administration are addictive.

Injection has been traditionally favoured among heroin addicts, although sniffing/snorting heroin now also widely reported.

Most heroin originates from opium poppy farms in SE Asia (Myanmar, Laos, and Thailand), SW Asia (Afghanistan, Pakistan, and Iran), Lebanon, Guatemala, and Mexico. The opium gum is converted to morphine in labs near the fields and then to heroin in labs within or near the producing country. Drug dealers cut, or dilute, the heroin (1 part heroin to 9 to 99 parts dilutor) with sugars, starch, or powdered milk before selling it to addicts. Quinine is also added to imitate the bitter taste of heroin so the addict cannot tell how much heroin is actually present. One pound of diluted heroin yields roughly 4,500 doses.

What are the immediate (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 to create a surge of pleasure, a “rush.”  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 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.

What are the long-term effects of heroin addiction and use?

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 a profound degree of tolerance and physical dependence, which are 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.

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

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, diarrhea, 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.

Signs of Heroin Addiction

Heroin addiction affects the user’s brain. It enters their brain quickly and slows down the way they think, their reaction time, and their memory. It also affects the user’s body, posing special problems for those who inject it because of the risks of HIV, hepatitis B and C, and other diseases that can occur from sharing needles.

Heroin, when pure, comes as a white powder but it usually contains other substances such as glucose, talcum powder or brick dust. When heroin is impure it comes as a brown powder and usually contains caffeine. Heroin is normally wrapped in small packets of paper.

Signs of heroin addiction include paraphernalia for injecting heroin. This consists of hypodermic needles, small cotton balls used to strain the drug, and water and spoons or bottle caps used for “cooking” or liquefying the heroin.  Paraphernalia for inhaling or smoking heroin includes razor blades, straws, rolled dollar bills, and pipes.

It is important to know the signs of heroin addiction. Here are several common signs of heroin addiction:

  • Dry mouth
  • Droopy appearance, as if extremities are “heavy”
  • Alternately wakeful and drowsy
  • Disorientation, poor mental functioning
  • Signs of injection; infections
  • Drowsiness
  • Constricted pupils
  • Nausea
  • Unkempt appearance/hygiene issues
  • Missing cash/valuables, stealing/borrowing money
  • Change in performance, academic or otherwise
  • Drug paraphernalia
  • Apathy and/or lethargy
  • Possession of unexplained valuables
  • Runny nose
  • Lying/deception
  • Change in friends
  • Withdrawal from usual friends, activities, or interests
  • Eyes appear “lost” or have faraway look
  • Slurred speech
  • Broken commitments
  • Hostility towards others
  • Unexplained absences at work, school or family events
  • Difficulty in maintaining employment

What are the medical complications of chronic heroin addiction and use?

Chronic use can lead to 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.

Are heroin users at special risk for contracting 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.

What are the symptoms of heroin withdrawal?

Heroin withdrawal symptoms are some of the nastiest an addict can experience compared to withdrawal from any other drug. The individual who has become physically as well as psychologically dependent on heroin will experience heroin withdrawal with an abrupt discontinuation of use or even a decrease in their daily amount of heroin intake.

The onset of heroin withdrawal symptoms begins six to eight hours after the last dose is administrated. Major heroin withdrawal symptoms peak between 48 and 72 hours after the last dose of heroin and subdue after about one week. The symptoms of heroin withdrawal produced are similar to a bad case of the flu and can include: dilated pupils, goose bumps, watery eyes and runny nose, loss of appetite, tremors, panic, chills or profuse sweating, nausea, muscle cramps, insomnia, stomach cramps, diarrhea, vomiting, and irritability.

What are the symptoms of a heroin overdose?

Overdose can occur when a dose taken is greater than that you’re used to. A tolerable dose for an addict could be fatal to a first-time user. Tolerance to heroin is quickly acquired. Even occasional weekend users need to take more to get the same effect over time. Tolerance can also drop if it the drug is not used for a period of time. Some users have overdosed on their ‘regular dose, after just a few week’s break.

Symptoms of a heroin overdose can include: muscle spasticity, slow and labored breathing, stopped breathing (sometimes fatal within 2-4 hours), pinpoint pupils, dry mouth, cold and clammy skin, tongue discoloration, bluish colored fingernails and lips, spasms of the stomach and/or intestinal tract, constipation, weak pulse, low blood pressure, drowsiness, disorientation, delirium and coma.