Heroin can be abused in a number of ways, including through injection, inhalation, or by smoking. These methods deliver the substance to the brain very rapidly, which makes heroin highly addictive. NIDA reports that heroin, when consumed, is converted into morphine upon entering the brain. Morphine binds to opioid receptors located in areas of the brain associated with pain and reward, as well as the brain stem, which controls processes like blood pressure and respiration. The heroin affects these areas of the brain and nervous system, leading to the “high” associated with drug use, as well as physiological symptoms such as suppressed breathing.
Effects of Heroin Use
When heroin enters the bloodstream, it is carried instantly to the brain, where it attaches to opioid receptors. This leads to the euphoria that is felt, along with other effects, including flushing, dry mouth, and a heavy feeling in the extremities.
Heroin can have many effects on the body and mind. Immediate effects of heroin use may include:
- Dry mouth
Other symptoms may be more delayed, including:
- Feeling drowsy and tired
- Having a confused or foggy mental state
- Slowed breathing
- Slowed heart rate
- Alternating periods of being awake and asleep, referred to as nodding
NIDA reports that overdose can cause:
- Very slow breathing
- Very slow heart rate
- Loss of consciousness
- Permanent brain damage
Intravenous injection of heroin leads to an immediate surge of euphoria, as well as the symptoms listed above. Using heroin in other ways, including inhalation and smoking, leads to many of the same symptoms, but may not cause the initial rush of euphoria.
Overdose of opiate drugs like heroin can be extremely dangerous. Dosages of heroin can be difficult to measure due to variability in purity of street drugs, as well as some heroin being mixed with, or “cut” with, unknown substances.
An overdose of heroin frequently leads to shallow or ceased breathing. This can cause hypoxia, or a lack of oxygen reaching the brain. Hypoxia can cause serious damage to the brain, leading to short- and long-term psychological and neurological effects, including coma and possibly death. Naloxone, a medication which blocks heroin from entering the brain, can be administered by a medical professional to help reverse an overdose.
According to NIDA, opioid addiction can have many long-term effects, including tolerance and dependence. Repeated use of the drug may also cause deterioration of the brain’s white matter, which negatively impacts decision-making and self-control. Repeated use of heroin can lead to addiction.
Addiction is defined as a chronic disease that causes compulsive substance-seeking and use, despite harmful consequences to the individual’s health or life. The areas of the brain affected by drugs like heroin involve reward and motivation, learning and memory, and impulse control. While addiction begins with the voluntary act of using alcohol or drugs, the changes within the brain that occur as a response to drug abuse compromise an individual’s ability to stop using the substance.
Injecting heroin carries a high risk of contracting transmittable diseases, including HIV and hepatitis C (HCV). These diseases are carried in the blood and bodily fluids; transmitting these fluids through sharing needles or other drug paraphernalia can lead to exposure to contaminated fluids. NIDA reports that treatment for drug addiction can help lessen the risk of exposure to transmittable diseases by decreasing drug use and associated risky behaviors, including unsafe sex.
In addition to increased risk for infectious diseases, heroin abuse can cause serious health conditions, including fatal overdose and spontaneous abortion. Chronic drug use can cause collapsed veins, heart infection, abscesses, constipation and gastrointestinal cramping, and liver or kidney damage. Pneumonia can also result from the poor health of people addicted to heroin. Some heroin also contains toxic contaminants that can clog blood vessels, causing permanent damage to vital organs.
Detox and Withdrawal
If individuals are physically dependent on heroin, they will experience withdrawal symptoms when they stop using the drug. Withdrawal is the period of time during which the body adjusts to the absence of the drug. Withdrawal can cause may unpleasant symptoms.
The early symptoms of withdrawal may include the following:
- Anxiety and agitation
- Weepy eyes and runny nose
- Muscle pain
- Difficulty sleeping
Later symptoms of withdrawal can include:
- Diarrhea and abdominal cramping
- Dilated pupils
- Nausea and vomiting
Opiate withdrawal can be very unpleasant, but it is not life-threatening. Very occasionally, some people experience complications that require medical intervention. Aspiration – breathing stomach contents into the lungs – is the most common complication. Vomiting and diarrhea can also lead to electrolyte imbalance and dehydration.
Symptoms of withdrawal from heroin begin a day or two after last use. Acute symptoms of withdrawal typically last several days, though they may last weeks. Other symptoms, like depression and anxiety, may last months.
While addiction is a chronic and relapsing disease, it can be treated. Some people require several periods of treatment before they can establish lasting sobriety. According to NIDA, the most successful treatment programs involve the following steps:
- Behavioral counseling
- Treatment for co-occurring mental health issues
- Long-term follow-up care to help prevent relapse.
Opiate addiction is often treated with medications. Medications may be used during withdrawal to help lessen symptoms, or throughout treatment to encourage sobriety and prevent cravings. The National Institutes of Health list methadone, buprenorphine, and naltrexone as being used in the treatment of opioid dependence.
Methadone is one of the most common and well-known medications used to treat dependence and addiction to heroin and other opiates. Methadone lessens symptoms of withdrawal and prevents cravings by imitating the effects of illicit opioid drugs. This medication may be used only during detox, or as a maintenance drug throughout the course of treatment. While methadone has been used for several decades within drug rehabilitation, it is still a very carefully controlled substance. As a result, it can only be administered within licensed methadone clinics.
Buprenorphine is another medication that treats cravings and withdrawal from heroin by mirroring the effects of opiates within the brain. This medication differs from methadone in that it can be prescribed and administered by physicians in an outpatient setting. This makes it more readily available than methadone, leading to a steady increase in its use.
Another drug sometimes used in heroin dependence rehabilitation is naltrexone. This drug blocks opioid receptors in the brain, stopping opiate drugs from having any effect. This drug is most often used to treat overdose.
There are many different approaches to therapy that are used to treat addiction. The American Psychological Association lists the following therapy modalities as being supported by scientific evidence:
- Cognitive Behavioral Therapy: This type of therapy focuses on detrimental patterns of thought and behavior that are contributing to addiction. The individual in treatment learns to identify these patterns, and use new, healthy patterns of behavior and thought instead.
- Motivational Interviewing: This modality helps the addicted individual recover by encouraging the existing motivation that person has. The therapist assists the individual in discovering the reasons for wanting to recover through structured conversations.
- Multidimensional Family Therapy: This type of therapy was originally developed to treat addiction in adolescents. Family therapy focuses on the entire family unit. This helps to address influences on problematic behaviors like drug use, and it can improve family relationships and functioning, helping to support the person in sobriety.
- Contingency Management: Contingency Management creates positive associations with treatment, to encourage the individual to engage in the treatment process and maintain sobriety. Positive reinforcement is used to support certain behaviors, like reaching goals or staying abstinent from drug use.