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Table of Contents
Heroin: A Brief History
In seeking help for someone addicted to heroin, going it alone is rarely a good idea. Acquiring professional help and/or undergoing medical detox is a smart choice and ongoing professional rehab services are necessary for long-term recovery from heroin. There are a plethora of treatment providers specializing in dealing with opioid addiction. Facilities can provide a range of helpful services from intensive, extended inpatient rehabilitation programs to outpatient rehabilitation programs, to hybrids of the two. Finding a treatment provider will be a highly individualized choice that will depend on several factors.
The American Society of Addiction Medicine (ASAM) reports that each day, 100 people in the U.S. die from drug overdoses an nearly half of this number is the result of heroin overdoses. Heroin is classified as an opioid drug, derived from the red poppy plant, that can have devastating consequences.
According to the National Institute on Drug Abuse (NIDA), more than 20 percent of people who try heroin will become physically dependent on the drug. The effects of heroin are felt almost immediately, which is why it is so hard to overcome the addiction to this powerful substance. To successfully combat heroin addiction and resist the urge to relapse, individuals need a combination of intensive therapy and comprehensive rehabilitation.
Derived from the red poppy plant, native to a 4,500-mile span across mountainous regions from Central Asia throughout Turkey and surrounding regions. Cultivation of this beautiful but dangerous plant has even spread to some regions in South America as well.
The journey from plant to the addictive substance known as heroin happens through a process in which the sap is extracted from the seed pod of the plant. The sap begins to turn black, similar to the color of tar, and it is then bundled by the harvester and is sent to the black market to be sold as heroin.This substance is highly intoxicating and addictive and is responsible for historically high death rates, with 2014 being the deadliest year in terms of heroin-induced fatalities. Statistics also show that in the general population, a person who abuses heroin is has a death rate 13 times higher than their peers.
The Resurgence of Heroin
Heroin has been around since the 1800s when chemist Charles Romley developed the drug as an alternative to morphine. Though it was originally intended to be non-addictive, as its prevalence grew, more people began to abuse the painkiller and by the 1940s heroin was a huge problem in the U.S, particularly in New York City. The popularity of heroin began to wane in the 1980s as the crack cocaine epidemic took over but the drug has seen a substantial resurgence in the past decades. This resurgence has resulted in an all-out heroin epidemic.
The statistics of heroin addiction are staggering, to say the least. According to the CDC, today’s heroin epidemic impacts all people of all age groups an socioeconomic status and the number of heroin-related deaths has increased nearly fourfold from 2002 to 2013. In addition, addition rates among men have increased by 50 percent while addiction rates in women have increased by 100 percent.
In addition to the prevalence of today’s heroin use, the problem is much worse than it was in the 1970s mainly because many people also use heroin in conjunction with other illicit drugs. Studies show that those with a history of alcohol and/or cocaine abuse are more likely to try heroin and that those who have developed an addiction to opioid painkillers are at the greatest risk of becoming addicted to heroin. Per the National Survey on Drug Use and Health, people addicted to opioid painkillers are 40 times more likely to become addicted to heroin compared to just 2 times as likely as someone addicted to alcohol.
Although heroin can impact any person of any age, a study conducted by The Journal of the American Medical Association (JAMA) stated that the average heroin user is 32-years-old, white, male, and from a small urban or rural area. Addiction to heroin as a progression from abuse of opioid painkillers is making its use less taboo in society but the problem of heroin addiction is rapidly spiraling out of control.
The Path to Heroin Addiction
Heroin is one of the most addictive illicit drugs available but despite this, tens of thousands of individuals try heroin and become highly addicted. Like most addictions, heroin abuse does not start overnight – there are usually a series of events that lead up to heroin and opioid dependency. About 23 percent of those who try heroin will end up physically addicted or physically dependent on the drug. It’s important to understand the difference between the two.
Today, many individuals try heroin for the first time after becoming addicted opioid-based painkillers such as oxycodone, hydrocodone, codeine, and fentanyl. Prescription painkillers can be relatively easy to obtain despite a national database designed to track the prescribing of controlled substances. Once people become addicted to prescription opioid painkillers, the need for more becomes more pronounced, costlier, and the drugs may become difficult to obtain if a doctor will not prescribe more. In these cases, some will turn to heroin as an alternative because it has the same effect as prescription opioid drugs but is less costly and easier to acquire. According to CNN, about 50 percent of those who use heroin by injection started off abusing prescription opioid medications.
Per the National Institute on Drug Abuse, once a person tries heroin, there are several short-term side effects that are likely to occur soon after exposure. These side effects include intense feelings of euphoria, reduced heart rate, drowsiness that lasts for hours, confusion, itching, flushed skin, and, in some cases, nausea and vomiting. Consuming adulterated heroin, or heroin that has additional, questionable chemical additives, may increase the severity of these effects and, in some cases, can be fatal. There is an increasing prevalence of adulterated heroin on the streets an consuming adulterated heroin can result in atypical side effects such as chest pain, severe anxiety, heart palpitations, shortness of breath, tremors, and headaches.
Some turn to heroin because it has the same effect as prescription opioid drugs but is less costly and easier to acquire.
The extreme potency of heroin is best explained by how it affects a person’s brain. Heroin, like other opioids, increases the amount of dopamine produced in the brain. Dopamine, a part of the limbic system, is a feel-good brain chemical that is responsible for feelings of pleasure or euphoria. This is the same chemical that is responsible for the pleasurable feelings people experience when eating and drinking. When engaging in these activities, the body gradually releases dopamine but with heroin use, dopamine is produced much more rapidly, resulting in a rush. This feeling causes the individual to repeatedly seek the drug, which quickly turns in to dependence and addiction.
The Dangers of Heroin
Using heroin is inherently dangerous just based on the potency and unregulated nature of the drug. In addition to the typical side effects, using heroin comes with additional risks, some of which are life-threatening. Intravenously shooting heroin can expose the user to blood-borne pathogens. Since many heroin users share their needles and other drug paraphernalia with others, the risk of contracting diseases like HIV and hepatitis B an C increase exponentially. HIV has lifelong implications as the immune system is permanently compromised. In the case of hepatitis, severe liver damage can result, which limits the body’s ability to properly filter toxins.
Injecting heroin can also cause irreversible damage to blood vessels, particularly in those who inject multiple times per day. Collapsed and hardened veins are common problems seen in individuals addicted to heroin. Once veins are damaged, blood flow is impeded and this results in restricted circulation, which lowers the body’s wound healing capabilities.
Abscess and skin infections are also common in intravenous heroin users. Puncturing the skin during injection puts the individual at risk for inflammation and cellulitis (swelling) that can turn into skin abscesses if left untreated. Failure to seek treatment for an infection increases the risk of septicemia (blood poisoning), tissue death, or amputation, or death.
In addition to the typical side effects, using heroin comes with additional risks, some of which are life-threatening.
One cause of concern that is sometimes mentioned is the danger of additives. When heroin is manufactured, there is often no way for the heroin user to know exactly what it contains. Some common heroin additives include, but are not limited to, cornstarch, quinine (an antimalarial drug), fentanyl (a narcotic painkiller), caffeine, sugar, strychnine (a toxic pesticide), and a host of others. Heroin is extremely dangerous in its unadulterated form, so adding various additives can lead to catastrophic results.
There is a lot of ongoing research that focuses on how heroin use affects the brain, which can be useful in studying relapse rates. Studies show that brain changes caused by heroin use can increase the chances of a relapse because the brain’s white matter is altered an this, in turn, affects a person’s decision-making ability. Even after achieving sobriety, someone who has a history of heroin abuse is more likely to use again, compared to those with no use history.
Heroin use also adversely impacts hormones in both men and women. From infertility to disruption in menstrual cycles, women disproportionately face health complications as a result of heroin use. Data shows that heroin use has been linked to spontaneous miscarriages an for those who do not miscarry, there is a higher likelihood of premature delivery. INfants born to heroin-addicted mothers are at increased risk of low birth weight as well as the possibility of being addicted to heroin at birth. For men, abuse of heroin can cause sexual dysfunction as well as erectile dysfunction. Men and women may experience diminished sex drive as a result of long-term heroin use.
Signs of Heroin Overdose
The CDC reported that since the year 2000, drug overdoses have increased by more than 130 percent, with a significant number being heroin overdoses. Heroin and opioid-related deaths have increased by approximately 200 percent due to the increase in individuals who abuse not only heroin but prescription opioid medications as well. Heroin users between the ages of 18 and 44 have experienced the highest overdose rates.
Overdose occurs when a person ingests too much of a drug and a physical reaction occurs. The risk of overdose is always present, regardless of the drug being ingested. However, since heroin is so dangerous due to its potency, the risk of overdose is particularly high. Most research overwhelmingly suggests that heroin significantly increases the likelihood of overdose and many heroin overdoses are fatal.
One of the main reasons overdose risk is so high with heroin is because users are often unaware of how strong the drug is. As mentioned earlier, heroin is often cut with a variety of additives in varying concentrations that adversely impact consistency. Even if a user purchases heroin from the same person, there is no guarantee that it will be exactly the same as before. With this level of uncertainty, it is virtually impossible for an individual to know exactly how a dose of heroin may affect them.
When a heroin user overdoses, they need access to immediate emergency medical treatment. Many overdose-related deaths occur because proper treatment was not sought in time or the individual was alone when they used. Instant medical intervention is so critical because the effects of overdosing have a quick onset and the person may need respiratory support or medication designed to counter the effects of heroin.
Recognizing the symptoms of an overdose is a key step in getting someone the emergency help they need. One of the most common signs of a heroin overdose is stopped or decreased breathing, which happens because opioids reduce pulmonary (breathing) function. This typically looks like the person is gasping for air, taking short or shallow breaths, and/or the fingernails and lips have a bluish tint indicating a lack of oxygen. Other symptoms of heroin overdose include confusion, seizures, nausea and vomiting, pinpoint pupils, a weak pulse, drowsiness (often referred to as ‘nodding’) and coma, to name a few.
The process of overdose is often sudden but some initial signs to look out for include shortness of breath and disordered or fuzzy thinking, and various psychological symptoms. Changes in the person’s personality may be especially obvious and can include hallucinations, delusions, and the inability to speak clearly. Someone who is about to overdose may not realize the changes that are happening in their body but the signs of overdose are fairly easy to recognize by others. If a person shows psychological symptoms of overdose but you are unsure whether they use heroin or not, physical signs are a good way to tell.
In terms of physical signs of heroin use, track marks – the scars left over from repeated injection of heroin or other drugs. Track marks are the result of injecting drugs at the same site over a period of time, resulting in thick scarring and damaged veins at the injection site. Dirty needles and tainted drugs can also cause or aggravate track marks. It may be easier to tell how recently a person has used heroin by the appearance of the track marks. Marks acquired recently often look like a fresh wound that has not healed and scabs, puncture marks, or bruises may be present. Older track marks result in scarring and skin discoloration; these marks get worse over time and can crack, bleed, and/or become infected.
Some heroin users attempt to hide track marks by wearing long-sleeved clothing and these marks usually do not go away, even after a person stops using heroin. Alternatively, some drug users start injecting in the forearm but then move on to other areas of the body in an attempt conceal their drug use. Common alternative injection sites include the neck, between the toes, and the groin.
Someone who is about to overdose may not realize the dangerous changes that are happening in their body, but the signs of overdose are fairly easy to recognize by others.
Other outward physical signs of heroin use and abuse include hyperactivity, drug cravings, dry mouth, slurred speech, headaches, and dizziness. Internally, heroin overdose has a adverse effect on the heart and lungs due to a lack of oxygen. Within four minutes of oxygen deprivation, permanent brain damage can occur. CPR performed before this critical time can substantially lower the risk or severity of brain damage from lack of oxygen. Another outward sign of opioid overdose is foaming at the mouth, which happens when fluid leaks into the lungs. Foaming at the mouth can present a serious risk of choking after an overdose.
Not all overdoses are fatal but many overdoses can lead to death if immediate medical attention is not sought and the person is at a higher risk of overdose, including those with compromised immune systems, those taking high doses of opioid medications, and persons who use heroin in conjunction with other illicit drugs. With statistics like these, it’s important for family members, friends, treatment providers, and first responders to know the sign of a heroin overdose. If you happen to be around someone whom you believe has taken heroin and overdosed, it’s critical to call 9-1-1 immediately. It is not recommended that you attempt to treat the person on your own.
In addition to seeking emergency medical treatment for someone who has overdosed on heroin, there are other immediate antidotes that can help a person recover. Naloxone (also known by the brand name Narcan) is a drug designed specifically for the purpose of restricting heroin’s effect on the brain. In some cases, addicted individuals must be given several doses of Narcan if there is a higher concentration of heroin in their system. When administered intravenously, Narcan can work to counter the effects of heroin within seconds when administered as a nasal spray.
After a heroin user has become medically stable, they will likely undergo inpatient monitoring. This monitoring typically includes observing vital signs like blood pressure, heart rate, and respiratory rate. If the patient is suffering from respiratory depression as a result of the overdose episode, breathing treatment or apparatus may be employed to help restore respiratory function. In some cases, medical tests may be run on the individual to check for additional complications.
Once a person becomes medically stable after overdose, detox and recovery are the next steps to take. It is extremely important for person who has overdosed on heroin to get help for the underlying substance abuse problem. Seeking treatment will help to avoid future overdoses and put a person on the road to sobriety.
Signs, Symptoms and Effects of Heroin Use
When a person uses heroin repeatedly over a period of time, they are referred to as chronic users. Individuals who abuse the drug are likely to experience harmful brain changes that can result in a host of life-long problems. Areas of the brain that are damaged by heroin include the prefrontal cortex and the medial temporal lobe, which are associated with decision-making and long-term memory. Over time, heroin use contributes to lifelong changes in behavior.
Chronic heroin users may also experience insomnia, constipation, kidney disease, and specific complications can vary depending upon how the person chooses to ingest the drug. For example, those who snort heroin can result in damage to the nasal passages, chronic nosebleeds, and a deviated septum. Individuals who inject heroin will likely experience long-range effects such as heart infections, abscesses, collapsed veins an increased risk of infectious disease. People who ingest heroin by smoking in can experience lung damage including cancer and emphysema, tuberculosis, pneumonia and breathing problems such as asthma.
- Depressed respiration
- Clouded mental function
- Constricted pupils (while under the influence)
- Nausea and/or vomiting
- Suppression of pain
- Emotional irregularity (manic behavior)
- Flushed (red) skin
- Loss of appetite
- Infectious diseases (HIV, Hepatitis, etc) as the result of shared needles
- Bacterial infections
- Abbscesses on the body and/or face
- Arthritis and other rheumatologic disorders
- Emotional irregularity (manic behavior)
Spot these Signs of Heroin Use:
- Burnt spoons
- Small baggies (heroin residue may or may not be present)
- Dark, sticky residue on hands, clothes, surfaces, etc.
- Rubber tubing
- Small glass pipes
- Sticky residue
CHANGES IN BEHAVIOR
Anyone abusing heroin will likely have major changes to their behavior. You will notice a lethargic attitude when abusers are under the influence of heroin, and severe anxiety when they are not. Withdrawal from heroin is physiologically traumatic, and anyone abusing heroin will certainly exhibit symptoms of withdrawal from time to time. Other behavior changes include; dishonesty, stealing, criminal activity, and a singular focus on obtaining and using the drug. In social situations, heroin abusers will likely have to excuse themselves to the bathroom after a relatively short period of time so they can use the drug to regain their composure. Heroin abusers, due to their singular focus on heroin itself will very likely become unreliable. Abusers will have a difficult time making or keeping commitments. Abusers will also display many selfish and self-centered behaviors.
One of the most obvious symptoms of heroin abuse is weight loss. Any individual who has been abusing heroin for some time is certain to lose weight. Depending on the method of ingestion, be it intravenous, through the nasal cavity, or smoking, weight loss is inevitable. For abusers who are using heroin intravenously, abscesses, track marks, and scars on the skin in the hands, feet and arms are very common. When heroin is ingested in any form, the pupils become incredibly constricted and appear incredibly small. This is one of the most consistent symptoms of heroin use, and abusers will certainly exhibit this sign when intoxicated.
OVERALL DEMEANOR CHANGES
Generally speaking, individuals who are heroin abusers will have drastic changes to nearly all facets of their personalities. Unfortunately, as heroin is such a powerfully addictive substance, those who abuse heroin grow quickly dependent. This dependence causes many shifts in behavior and personality and it is not difficult to identify such changes. Heroin abusers who become dependent begin to arrange their entire lives around obtaining and using the drug and all other commitments and obligations fall to the wayside. The loved ones of heroin abusers are often easily able to spot this shift because it tends to happen so quickly. The grip of heroin is strong and relentless and those who abuse it become prisoners to its grasp almost immediately. If you or someone you know is experiencing these symptoms it is advisable to seek the assistance of a professional immediately.
Due to the long-term health consequences of heroin use, a person who abuses this drug can have a lifespan up to 18 years shorter than someone how does not use heroin. According to The Drug Abuse Warning Network, in 2011 alone, nearly 9 percent of drug-related emergency room visits were due to heroin use.
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