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Description |
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Heroin
is an illegal, highly addictive drug. It is both the most abused and the
most rapidly acting of the opiates. 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 |
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Effects |
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Heroin
Effects: Short Term
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. Abusers typically report feeling a surge of pleasurable
sensation, a "rush." The intensity of the rush is a function of
how much drug is taken and how rapidly the drug enters the brain and binds
to the natural opioid receptors. 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.
Short-term
effects of heroin
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Rush |
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Depressed
respiration |
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Clouded
mental functioning |
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Nausea and
vomiting |
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Suppression
of pain |
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Spontaneous
abortion |
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 also 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.
Heroin
Effects: Long Term
One of the most
detrimental long-term effects of heroin is addiction itself. Addiction is
a chronic, relapsing disease, characterized by compulsive drug seeking and
use, and by neurochemical and molecular changes in the brain. Heroin also
produces profound degrees of tolerance and physical dependence, which are
also powerful motivating factors for compulsive use and abuse. As with
abusers of any addictive drug, heroin abusers 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. The drugs literally change their brains.
Long-term
effects of heroin
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Addiction |
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Abscesses |
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Collapsed
veins |
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Bacterial
infections |
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Infection of
heart lining and valves |
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Arthritis and
other rheumatologic problems |
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Infectious
diseases, for example, HIV/AIDS and hepatitis B and C |
Physical
dependence develops with higher doses of the drug. With physical
dependence, the body adapts to the presence of the drug and withdrawal
symptoms occur if use is reduced abruptly. 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 swapes 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. Heroin withdrawal is never
fatal to otherwise healthy adults, but it can cause death to the fetus of
a pregnant addict.
At some point
during continuous heroin use, a person can become addicted to the drug.
Sometimes addicted individuals will endure many of the withdrawal symptoms
to reduce their tolerance for the drug so that they can again experience
the rush.
Physical
dependence and the emergence of withdrawal symptoms were once believed to
be the key features of heroin addiction. We now know this may not be the
case entirely, since craving and relapse can occur weeks and months after
withdrawal symptoms are long gone. We also know that patients with
chronic pain who need opiates to function (sometimes over extended
periods) have few if any problems leaving opiates after their pain is
resolved by other means. This may be because the patient in pain is simply
seeking relief of pain and not the rush sought by the addict. |
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Treatment |
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A
variety of effective treatments are available for heroin addiction.
Treatment tends to be more effective when heroin abuse is identified
early. The treatments that follow vary depending on the individual, but
methadone, a synthetic opiate that blocks the effects of heroin and
eliminates withdrawal symptoms, has a proven record of success for people
addicted to heroin. Other pharmaceutical approaches, like LAAM (levo-alpha-acetyl-methadol)
and buprenorphine, and many behavioral therapies also are used for
treating heroin addiction.
Detoxification
The
primary objective of detoxification is to relieve withdrawal symptoms
while patients adjust to a drug-free state. Not in itself a treatment for
addiction, detoxification is a useful step only when it leads into
long-term treatment that is either drug-free (residential or outpatient)
or uses medications as part of the treatment. The best documented
drug-free treatments are the therapeutic community residential programs
lasting at least 3 to 6 months.
Methadone
programs
Methadone
treatment has been used effectively and safely to treat opioid addiction
for more than 30 years. Properly prescribed methadone is not intoxicating
or sedating, and its effects do not interfere with ordinary activities
such as driving a car. The medication is taken orally and it suppresses
narcotic withdrawal for 24 to 36 hours. Patients are able to perceive pain
and have emotional reactions. Most important, methadone relieves the
craving associated with heroin addiction; craving is a major reason for
relapse. Among methadone patients, it has been found that normal street
doses of heroin are ineffective at producing euphoria, thus making the use
of heroin more easily extinguishable.
Methadone's
effects last for about 24 hours - four to six times as long as those of
heroin - so people in treatment need to take it only once a day. Also,
methadone is medically safe even when used continuously for 10 years or
more. Combined with behavioral therapies or counseling and other
supportive services, methadone enables patients to stop using heroin (and
other opiates) and return to more stable and productive lives.
Methadone
dosages must be carefully monitored in patients who are receiving
antiviral therapy for HIV infection, to avoid potential medication
interactions.
LAAM
and other medications
LAAM,
like methadone, is a synthetic opiate that can be used to treat heroin
addiction. LAAM can block the effects of heroin for up to 72 hours with
minimal side effects when taken orally. In 1993 the Food and Drug
Administration approved the use of LAAM for treating patients addicted
to heroin. Its long duration of action permits dosing just three times
per week, thereby eliminating the need for daily dosing and take-home
doses for weekends. LAAM will be increasingly available in clinics that
already dispense methadone. Naloxone and naltrexone are medications that
also block the effects of morphine, heroin, and other opiates. As
antagonists, they are especially useful as antidotes. Naltrexone has
long-lasting effects, ranging from 1 to 3 days, depending on the dose.
Naltrexone blocks the pleasurable effects of heroin and is useful in
treating some highly motivated individuals. Naltrexone has also been
found to be successful in preventing relapse by former opiate addicts
released from prison on probation.
Another
medication to treat heroin addiction, buprenorphine, may already be
available by the time this Research Report appears. Buprenorphine is a
particularly attractive treatment because, compared to other
medications, such as methadone, it causes weaker opiate effects and is
less likely to cause overdose problems. Buprenorphine also produces a
lower level of physical dependence, so patients who discontinue the
medication generally have fewer withdrawal symptoms than do those who
stop taking methadone. Because of these advantages, buprenorphine may be
appropriate for use in a wider variety of treatment settings than the
currently available medications. Several other medications with
potential for treating heroin overdose or addiction are currently under
investigation by NIDA.
Behavioral
therapies
Although
behavioral and pharmacologic treatments can be extremely useful when
employed alone, science has taught us that integrating both types of
treatments will ultimately be the most effective approach. There are many
effective behavioral treatments available for heroin addiction. These can
include residential and outpatient approaches. An important task is to
match the best treatment approach to meet the particular needs of the
patient. Moreover, several new behavioral therapies, such as contingency
management therapy and cognitive-behavioral interventions, show particular
promise as treatments for heroin addiction. Contingency management therapy
uses a voucher-based system, where patients earn ÒpointsÓ based on
negative drug tests, which they can exchange for items that encourage
healthy living. Cognitive-behavioral interventions are designed to help
modify the patient's thinking, expectancies, and behaviors and to increase
skills in coping with various life stressors. Both behavioral and
pharmacological treatments help to restore a degree of normalcy to brain
function and behavior, with increased employment rates and lower risk of
HIV and other diseases and criminal behavior. |
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