Heroin and Heroin Addiction — Everything You Need To Know

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Heroin addiction is caused by heroin, an opioid drug that comes from morphine, a substance found on the seeds of poppy flowers. These poppy flowers usually grow in Mexico, Southeast and Southwest Asia, and Colombia. 

There are different types of heroin such as white powder, black powder and black tar heroin.

What is Heroin?

Heroin or Diacetylmorphine is a bitter-tasting white powder drug that is consumed by people to get euphoric effects. 

Heroin is one of the extremely addictive substances. It comes from morphine found in Opium poppy seeds. Heroin is 2–3 times potent than morphine and is consumed primarily by injecting, smoking or snorting up the nose. 

No matter how you take it, heroin starts to show its effects almost instantly. Right after consumption, you will feel dizzy, euphoric; you will feel the rush of happiness. Then after a couple of hours, your brain slows down. You think slowly, talk slowly, and you stroll. You will feel like walking in a dream. 

Heroin also blocks out your pain receptors and slows the heart rate down. If overdosed, it may cause your heart to stop beating and cause death. 

Heroin is very addictive. After one or two usages, it can be challenging to stop using it. 

People start to consume heroin to cope with mental stress, anxiety, and other types of health issues such as bipolar disorder, depression, or ADHD.

History of Heroin & Heroin Addiction

Heroin is initially found in opium. Opium has been around throughout history. It was being used as a medical drug and as a recreational drug for centuries. 

And in 1804 a german scientist discovered a way to isolate morphine. Morphine is one of the chemicals that contribute to the sedative and narcotic effect of opium. 

Soon after the discovery, companies learned to perfect the process of morphine extraction. They began to market it as a medicine for all types of diseases, from TB to bronchitis, to diarrhoea to insomnia, pneumonia and alcoholism. 

In the American civil war, many people lost their lives, Over a million people died in battle, and over 50,000 people lost their limbs. Injured people were given morphine to relieve, and it saved a lot of lives. But as a side effect for that, many soldiers got addicted to morphine. 

Heroin came to picture in the year 1897, when a chemist, Felix Hoffman, accidentally extracted a chemical from morphine which is twice as effective as morphine. 

The Buyers Company started to produce heroin commercially in the year 1898. And its dependence and addiction were soon discovered. But its ban wasn’t implemented until the 1920s. 

After the ban, heroin was not available legally. So smuggling began to rise. 

Slowly scientists, politicians and the common people began to realise how heroin was causing more damage than it’s curing. 

Methods of Heroin Use

There are various methods of heroin consumption. 

Although most commonly it is injected intravenously (IV) there are also other methods of consumption. Such as:

• Smoking (“Chase the Dragon”) — Many people smoke heroin in a pipe or with marijuana as a joint. Smoking is one of the quickest ways to feel the effects of heroin.  

• Sniffing (“snorting”) — As a powder, heroin can be snorted. It transports a large number of drugs to the brain. 

• Oral Ingestion — Oral ingestion of heroin doesn’t produce the same amount of effect as other types of drug intake, but it can produce intense euphoria. 

People who inject heroin feel its effects almost instantaneously. But when smoked, the effects start to show within 10–15 minutes. Injection users tend to develop addiction rapidly than other types of consumption. 

However, no matter how it is used, heroin is a highly addictive substance due to its rapid tolerance build-up, which requires a higher dosage of heroin to achieve the same effects.  

How Long Does Heroin Stay in Your System?

Heroin deteriorates in your body extremely fast. 

It has a rapid half-life of two to five minutes. And it metabolises into our body and creates 6-acetyl morphine and morphine. 

Morphine has a half-life of 90 minutes to 7 hours. 6-acetyl morphine has a half-life of 6 to 25 minutes.

 And it takes roughly four to six half-lives to eliminate the drugs from the system effectively. 

Detection in the Body

With a short half-life, heroin is very difficult to detect in the body. That is why drug tests look for 6-acetylmorphine( 6-AM) and morphine in the body. Heroin metabolises into these substances within a couple of minutes.

In Urine

In urine 6-acetyl morphine can be found within one or three days after consumption. The presence of 6-AM confirms the usage of heroin. Heroin also contains acetylcholine, which is then metabolised into codeine in the body. Traces of codeine and morphine in urine also indicate heroin usage.

In Saliva

Heroin may be detected in oral fluid for 24 to 36 hours after consumption. 6-monoacetylmorphine (6-MAM) and morphine may be found in high levels in saliva. The chances of detection of heroin use are high in saliva. 

In Hair

Traces of heroin can be found in hair for a much more extended period than urine or saliva. Tests can detect heroin in the hair within 90 days after the last usage. 

People with a long history of heroin usage have much higher hair detection windows. 

Effects of Heroin Use

In our body heroin is metabolised to morphine and other metabolites. They bond with different opioid receptors in your brain and show different effects. 

Short-Term Effects

After the ingestion of heroin, people experience a “rush” (a quick boost in happiness and pleasure) and euphoria along with some other effects such as

• Dry mouth
• Nausea and vomiting
• Heavy feeling in the arms and legs
• Warm flushing of the skin
• Excessive itching
• Clouded mental functioning
• An alternate state of wakefulness and sleepiness.

Long-Term Effect

People who are using heroin for a long term may experience 

• Insomnia
• Nausea
• Collapsed veins- for injection users 
• Damaged tissue inside the nose for sniffers
• Infection of the heart lining and valves
• Respiratory depression
• Abscesses (swollen tissue filled with pus)
• Constricted pupils
• Stomach cramping and constipation
• Liver and kidney disease
• Lung complications
• Pneumonia
• Depression
• Antisocial personality disorder
• Sexual dysfunction 
• Irregular menstrual cycles for women

Other Effects

Heroin often is mixed with sugar, starch or powdered milk. These substances can enter your bloodstream and clog blood vessels leading to liver, kidney, heart and brain failure. It can result in permanent organ damage. 

Also, sharing used injections to inject drugs can increase the spread of HIV/AIDS, hepatitis and toxic reactions to impurities. 

Heroin Addiction and Withdrawal

Heroin is a very addictive substance. Tolerance of heroin develops rapidly after regular usage, and the user must take more substance to get the same level of effect. With the use of higher doses repeatedly, physical addiction to heroin develops.

If you are a regular heroin user, and suddenly stop using it, you may experience a range of withdrawal symptoms. The withdrawal symptoms occur as early as a few hours after the last dose. Symptoms are

• Restlessness
• Muscle and bone pain
• Insomnia
• Diarrhoea and vomiting
• Cold flashes
• Uncontrolled kicking movements 
• Withdrawal symptoms peak within 48 to 72 hours after the previous use and stay for about a week. 
• Abrupt withdrawal can be fatal for heavy dependent users with poor health conditions. But heroin withdrawal is considered not as dangerous as alcohol withdrawal.

Heroin Overdose

Heroin is an addictive substance. And most people using heroin, don’t usually know what is in it. And it is hard for people to tell if they are overdosing it or not. 

Overdosing heroin can be fatal. It can make you pass out, stop your breathing and eventually cause death. Even if you survive, overdosing heroin may cause different health problems, including brain damage. 

Heroin Addiction in India

According to a report published by the UN, over one million heroin users are registered in India. And the number is far bigger unofficially. The usage of heroin started off as a casual drug among a small group of high-income youth in metro cities. But now it has permeated through all sections of society.

The UN drug report has said that India is the biggest consumer of heroin in South-Asia. Not only that, India also produces and exports heroin to other countries such as Sri Lanka, Bangladesh, Nepal, Pakistan, etc.

Treatment of Heroin Addiction

There are several types of treatments available for heroin addiction disorder. These treatments include Medical-Assisted-Treatments (or detox), therapy, support groups and several lifestyle changes. 

Detox is the primary step towards heroin addiction recovery. And detoxification is most effective when coupled with behavioural therapy.

When a person addicted to heroin quits consuming, it can cause painful withdrawal symptoms. And these symptoms can last for weeks. But medication can help ease the detoxification process and ease the craving for heroin and other symptoms that can cause a relapse. 

Medication of Heroin Addiction

Medication for heroin addiction works the same way as heroin does. They bind with the same opioid receptor as heroin and work as agonists. There are three types of medication available. 

1. Agonists — Agonists mimic the action of heroin and activate the same opioid receptors in the brain. 
2. Partial–agonists — Partial agonists don’t excite the opioid receptors like full agonists. They slightly activate the receptors.
3. Antagonists — Antagonists block the opioid receptors and reverse the rewarding effect of the opioid. 

There are several other risk factors involved in the process of detoxification. Hence, medical supervision by a trained professional is highly required. 

• Methadone

Methadone is an agonist medicine. It is consumed orally, and it starts it’s work very slowly. Methadone has helped to treat heroin withdrawal for decades. And it still is an excellent choice of medicine, especially for the people who do not respond well to other types of medication.

Methadone is itself an opioid. And it can build up in the body if taken too frequently. And it has a high addictive characteristic. Methadone is used for long term medical-assessment-treatment. Because methadone can be addictive, it’s usage should be maintained by a trained physician.

Methadone is available through an approved outpatient treatment programme, and it is available in the form of oral tablets, solutions, oral concentrations, injections etc. 

Brands- Dolophine, Methadose.

• Buprenorphine

Buprenorphine impacts the same opioid receptors in the brain that are affected by heroin. Buprenorphine helps to ease the heroin craving and withdrawal symptoms, it also helps to maintain the chronic pain that occurs due to withdrawal. 

Common brands of Buprenorphine are Buprenex and Subutex.

Use of Buprenorphine can be dangerous for some cases. If someone in treatment with buprenorphine uses heroin, they put themselves under extremely high risk of going through acute withdrawal syndrome and overdose. Because when in buprenorphine, more heroin is required to feel the same effect. 

However, buprenorphine is used for medicine assisted therapy as well as during acute withdrawal, to alleviate the symptoms of withdrawal. Buprenorphine can cause addiction if not used properly. That is why it should be used with proper guidance from a trained physician. 

• Naltrexone

It is an opioid antagonist medicine. It prevents the opioid from reaching the opioid receptors in our brain. Naltrexone is not addictive to the body and does not cause physical dependence. 

Naltrexone usage is limited because patients have trouble complying with the treatment.

But naltrexone is given for mild opioid disorders because naltrexone blocks the pathway of opioid. Thus the individual does not feel any effects of euphoria.

Common brands of Naltrexone are Vivitrol, ReVia.

• Suboxone

Suboxone is a combination of naltrexone and buprenorphine. This combination not only relieves from withdrawal pain but also  restrains the euphoria or “high” someone gets from heroin. 

However, it can be fatal if someone tries to get high when on suboxone. Because it suppresses euphoria, the individual may try to take a more massive dose of heroin to get the same effect, causing heroin overdose.

Common brands of Naltrexone are Suboxone (and generics), Zubsolv. 

Behavioural Therapy

There are different types of behavioural therapy available for heroin addiction. These therapies can be delivered in inpatient or outpatient treatment settings.

• Contingency Management- This type of therapy includes a point-based system where patients get points for negative drug tests, which they can exchange for something healthy in return. 
• Cognitive behaviour therapy(CBT) — This type of treatment helps to modify the thought process and behaviour of patients and eventually increase their ability to deal with stress. 

Not every type of therapy will work for everyone. The vital task is to identify the treatment which will work best with a patient. 

Behavioural therapy helps to —

• Identify the trigger for drug usage
• Build a skill to deal with cravings
• Help to cope with emotional stress.

Heroin use is a severe condition. But with proper help and strategic approach, it is treatable. 

If you think you or someone you know is suffering from heroin addiction, do not hesitate to consult a doctor or a physician. They can help you with further resources and guide you to recovery.

References

https://www.drugabuse.gov/publications/drugfacts/heroin

https://www.webmd.com/mental-health/addiction/heroin-use#2

https://www.drugs.com/illicit/heroin.html