Heroin is known around the world as one of the most addictive and dangerous illegal drugs; since it was first produced and brought onto the market at the end of the 19th century. It has been responsible for the destruction and premature end of countless lives. Heroin’s effects take hold very quickly (intravenous use in particular has an almost instantaneous effect) and comprise a profound feeling of relaxed euphoria, wellbeing and contentment which typically persists for up to a couple of hours (though the peak effects do not usually last that long.
Yet, despite this grim record, the terrifying reputation it has engendered, and the efforts of governments and judiciaries in every corner of the planet to restrict and discourage its use (including the imposition of extremely severe criminal penalties), each year the allure of this “demon drug” proves too strong to resist for many thousands of users. A tragically large proportion of them will go on to develop addictions with all the terrible consequences this entails. If you or someone close to you is struggling with a heroin addiction, don’t delay: contact an addiction specialist today as the first step along the path to recovery.
What Is Heroin?
“Heroin” is the brand name given in 1895 by German pharmaceutical company Bayer to diamorphine, an opioid (a drug derived from the opium poppy) made from morphine (which was already widely available as a medicine, as well as a substance of recreational use and abuse).
Usually found as a powder (commonly brown, although especially pure heroin is often white), heroin is often injected (it is the substance most commonly associated in the public eye with intravenous drug abuse) although it can also be smoked, snorted or inhaled (with these methods usually being deployed by newcomers to the drug).
Usually causes pronounced feelings of (often enjoyable) drowsiness which can tip over into sleep or, at higher doses, unconsciousness.
Heroin use poses a broad range of potentially catastrophic health risks for the user which can include death by overdose. It is also notorious for being one of the most addictive drugs on the market, creating both physical and psychological addiction (often after a comparatively small number of doses) and, once dependence has been established, associated with significant and often extremely unpleasant withdrawal symptoms.
Because of the high risk of addiction and resultant damage to a person’s wellbeing and life circumstances, and the danger to health posed by even one dose of heroin, authorities the world over invariably class the drug within the most serious categories provided for by their respective legal frameworks, with the most severe penalties for possession and supply.
In the UK, heroin is a Class A controlled substance with potential prison sentences even merely for possessing the drug; while first-time offenders are relatively unlikely to be incarcerated just for possession, heroin’s infamy is such that it tends to produce stronger reactions on the part of the authorities (and, indeed, by society generally) than even other Class A drugs. As far as British society is concerned, when it comes to illegal drugs, heroin really is the worst of the worst.
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How Does Heroin Affect the Body?
When heroin is consumed, it is broken down in the brain into morphine which binds to specific receptors resulting in euphoric, analgesic and anxiolytic (anti-anxiety) effects; simultaneously, it causes a release of histamine, producing feelings of itchiness in the user.
Repeated use results quite quickly in the development of tolerance in the user (whereby their system gets used to certain dosages of heroin and requires more than previously in order to produce the same “high”) and in dependency, which occurs when the user’s brain chemistry adjusts to deal with the presence of heroin in the system.
When that presence is no longer felt, the body then reacts to the absence in the form of a series of potentially very unpleasant responses known as withdrawal symptoms (see below) until the readjustment to the previous state of normality is complete. If too much heroin is consumed at once for the user’s system to cope with, overdose may result (see below) which can prove fatal, even after only one dose.
Heroin Addiction Causes
What causes a person to develop a substance addiction remains a matter of debate within the medical community. Clearly, it is impossible to get addicted to something if it is never consumed in the first place, but amongst those people who do take addictive substances there is a great range of responses:
Some people can engage in repeated substance use over a prolonged period without developing psychological addictions (for details of the difference between psychological and physical addiction, see below) while others can find themselves addicted after a very few doses. It is commonly accepted that genes and environment are both at play – with certain environmental factors such as exposure to substance abuse during childhood being a trigger for later addiction.
As heroin is a strongly physically addictive substance, however, even people who may not be especially susceptible to psychological addiction can become addicts fairly quickly if they engage in repeated heroin abuse within a short period of time – especially if the user has been injecting heroin (a good rule of thumb is that most aspects of heroin abuse and addiction, from the strength of the “high” to the severity of withdrawal symptoms, are intensified by intravenous consumption).
The Difference Between Abuse & Addiction
It is possible to consume heroin – even intravenously, the above caveat notwithstanding – without developing an addiction. Heroin abuse occurs when someone consumes heroin in quantities or in ways and/or circumstances which cause damage to themselves and/or others – when recreational use passes the point of being “fun”. Addiction is the state of desiring – often obsessively – to take heroin regardless of the negative repercussions of doing so, and the feeling that the addict cannot feel “normal” or achieve a state of wellbeing without consuming the drug. In the case of heroin, this can also be accompanied by a physical dependency upon the drug which means that cessation of use will result in the onset of withdrawal symptoms.
Heroin Physical Dependence & Tolerance
Heroin is, notoriously, physically addictive: unlike many other drugs (even some infamously dangerous ones) it creates a physical dependence on the part of the user which leave their body craving the drug and manifesting an array of negative responses – withdrawal symptoms – when heroin is no longer present in the system.
As noted above, dependence develops when the user’s brain becomes used to the presence of heroin and adjusts its chemistry accordingly: a “normal” state then becomes one in which heroin is present, and in order to maintain this normal functioning (and feelings of stability and wellbeing on the part of the user) heroin must continue to be consumed.
Only after a period of detoxification (usually accompanied by withdrawal symptoms) when the system is cleansed of heroin can “normal” revert to being what it was prior to the onset of dependence.
Tolerance is similar to dependence in that it describes the process whereby the user becomes used to the presence of heroin in the system at certain doses, and they need to take greater amounts of heroin to achieve the same “high” as before. Tolerance is an element in a number of deaths by overdose: addicts who have built up a tolerance to heroin require significantly larger doses than newcomers to the drug.
But if they stop using heroin and go through detoxification that tolerance decreases. However, if they then relapse after a period of recovery, they may not drop their dosage accordingly, and therefore may take far too much of the drug for their post-detoxification system to handle.
Psychological addiction to heroin is the state of craving the drug constantly despite an awareness of the negative consequences of taking the drug. Someone who has developed a psychological addiction will prioritise taking heroin above most if not all other things and their life will typically revolve around the drug, with its procurement and consumption taking the place of other life goals.
Although a physical addiction/dependence will diminish and disappear following a period of detoxification, it is the psychological addiction which lingers and which may be responsible for a recovering addict relapsing and recommencing heroin consumption even after a long period “clean”. Psychological addiction is far more pernicious than its physical equivalent and usually requires therapy – sometimes for long periods – to overcome completely.
Heroin Use vs Heroin Abuse/Addiction
It is possible to use heroin recreationally without developing an addiction (though it is such a powerfully addictive substance that even occasional recreational use very frequently leads to addiction before long).
Recreational heroin use becomes abuse when it becomes damaging: when dosages or the method of consuming heroin risk harm to the user, or other aspects of its consumption pose a threat to the wellbeing of others. Similarly, abuse does not always lead to addiction, but the risk is high and the path from use through abuse to addition is often a short one.
Some of the symptoms of addiction are:
As the word suggests, a heroin overdose occurs when a user consumes too much heroin for their system to handle, and they cannot cope effectively with its toxicity. Overdose can occur almost immediately after consuming the drug intravenously.
Symptoms include shallow breathing, contracted pupils and unconsciousness, which can lead to death within minutes if not treated, either directly as a result of the patient being unable to breathe sufficiently, or indirectly, for example from inhaling their vomit or hitting their head after a fall.
Even those who survive an overdose can suffer permanent brain damage as well as conditions such as oedema and rhabdomyolysis (muscular degeneration).
Heroin Overdose Treatment
Overdose is the main cause of death amongst heroin addicts and until fairly recently doctors were relatively powerless to stop its worst effects – especially if an addict was already weak and/or ill, it was often just a matter of sheer luck whether or not someone came round from an overdose.
In recent years, however, a drug known as naloxone has become available to doctors, paramedics and other medical professionals in the UK which reverses the effects on a patient’s breathing: the administration of naloxone can often bring an overdosing addict back to consciousness remarkably quickly and while it is not an absolute guarantee of survivability naloxone has saved countless lives since its use was expanded in 2015.
If someone near you suffers an overdose, contact the emergency services immediately. Whilst waiting for the ambulance place them in the recovery position and attempt to revive them safely (ensuring their airway is clear at all times): do not administer any medication they may have, including naloxone, unless you have been trained in its use or are able to be instructed by someone who has.
The Consequences of Heroin Addiction
In the 1980s, in an attempt to combat what was threatening to become an out-of-control heroin epidemic in the UK, the British government launched one of its most famous public information campaigns: “Heroin screws you up.” That message remains as valid today as ever: few if any drugs have the potential to ruin a person’s life as comprehensively and as quickly as heroin, and the consequences of heroin addiction can be as catastrophic as they are wide-ranging.
Although heroin is by no means as expensive as some other drugs, an addiction to it nevertheless represents a significant financial burden. An addict’s daily dosage varies from one person to another but in order to maintain addiction-level consumption a user will probably spend at the very least £20 every day – and this can easily rise to three figures if the addict is a heavy user
For many people at the lower end of the wage scale even the minimum figure represents a significant proportion of take-home pay, while heavy users or those without an income simply will not be able to fund their habits through normal channels: they may burn through savings before having to resort to theft or fraud, or even prostitution, to keep feeding their addiction.
It’s quite possible for a heroin addiction to transform someone from an upwardly mobile affluent professional with a house and other assets into a destitute beggar and/or criminal in a terrifyingly short period of time.
Addiction to heroin can wreak emotional havoc; most obviously, the cost to a person’s self-esteem of being an addict (especially if they have resorted to humiliating measures to fund a habit) can be catastrophic – likewise the abandonment of hitherto treasured life goals and ambitions. Heroin abuse is a furtive, secretive activity and an addict may find themselves having become a very deceitful person, which can be very traumatic.
They may experience the loss of important friendships and other relationships – emotionally damaging in itself but doubly so when those relationships are replaced by a sense of isolation and loneliness. They may find themselves unable to see a way out from their addiction and be seized by a terrifying despair.
Depression and even suicidal ideation is, unsurprisingly, a common corollary of heroin addiction – with depression also even occurring frequently as part of post-acute withdrawal syndrome (PAWS) amongst recovering addicts.
Along with the risk of overdose and possible permanent damage discussed above, heroin abuse almost invariably takes a heavy toll on the user’s body – especially if they are injecting the drug, as lesions and abscesses can develop around injection sites which can develop into blood poisoning and even gangrene and necrosis, potentially requiring amputation; injecting heroin also greatly increases a person’s risk of contracting diseases such as HIV.
Because of the typically poor lifestyle of a heroin addict, malnutrition, skin and dental complaints, conditions (such as parasites) related to inadequate hygiene and many others may develop and go untreated as the user focuses purely on maintaining their habit.
Having an addict for a family member can be devastating and heroin addiction is responsible for a horrendous number of family breakdowns as those living with the addict grow unable to tolerate the deceitfulness, aggression and risky behaviour which characterises the condition.
As well as the impact upon their own self-esteem which can result when a loved one “chooses heroin over them”. Parents of addicts risk losing custody of their children, while accidents and/or acts of violence whilst under the influence can have calamitous consequences. The wellbeing of the family can also be affected by the financial cost of addiction, especially if shared assets (such as the family home) are threatened.
How Is Heroin Addiction Treated?
As with most addictions, the most successful approach to treating heroin addiction is usually considered to be a combination of therapies, provided after a medically supervised detoxification (possibly in a residential rehabilitation – “rehab” – setting), and probably augmented by attendance at support groups for some time (possibly even years) after the addiction is broken initially.
There are numerous types of therapy which have been proven to be effective; as each case of addiction is unique and each individual responds differently to different therapy models, a few different models may need to be tried before the patient settles upon the approach which feels right to them.
There are a huge number of different treatment methods on the market (especially accessible via the internet) and only some of these are approved by doctors (and some are considered extremely dangerous); always consult with your GP and/or an addiction specialist before beginning any course of treatment.
A period of detoxification is considered imperative before therapy begins – and this detoxification should be carried out with the assistance of a medical professional. (For more information see our page on Detoxification.)
Residential rehabilitation (“rehab”) is treatment of addiction at a dedicated confidential facility where an addict can receive therapy whilst enjoying 24/7 access to health professionals in a relaxed environment in which they can focus on their recovery away from the temptations of daily life. (For more information see our page on Rehab & Heroin Addiction.)
Living with Heroin Dependence and Medication
Various medications have been developed to help heroin addicts break their addictions without moving straight to an entirely drug-free life – which can prove very stressful and often results in relapse. Substances such as methadone, which acts as a substitute for heroin, are available through the NHS; patients usually begin with a prescription for a certain dose and then have this dose reduced gradually over time (“tapering off”).
Methadone is not without its problems, and is addictive in its own right, but can help especially problematic heroin users move away from a life of crime. There are also a number of drugs which impede the effects of heroin itself, making the consumption of the drug pointless (as the user can no longer feel the “high”, and their body reacts unpleasantly to the presence of heroin).
These include buprenorphine (under the brand name Subutex) and buprenorphine/naloxone, marketed as Suboxone, amongst others. Addicts may feel concerned about treating their addiction with other drugs – especially those substituting for heroin – but in some cases pharmaceutical treatment is considered a necessary first step along the path to recovery, especially in cases where the addict has been involved in criminal activity to fund their habit.
The duration of treatment varies from one case to another (and may be affected by court orders, in cases involving criminal activity) but the long-term goal remains a drug-free life and if potentially habit-forming medication is seen as a necessary stepping-stone towards that goal it is at any rate a better option than continuing to abuse heroin itself.
Heroin Addiction & Mental Health
As noted above, heroin addiction can have devastating mental health implications, both directly as a result of the effects of the drug on the brain, and indirectly resulting from the impact of addiction on the addict’s life circumstances and wellbeing.
Heroin use is also often a consequence, rather than a cause, of mental health issues: many people begin using drugs, especially pain-relieving ones such as heroin, to try to self-medicate mental health disorders; in particular, there have been connections established via research between post-traumatic stress disorder, and anxiety disorders, and heroin use.
Heroin Addiction & Depression
As noted above, heroin abuse can cause depression, either directly as a result of changes in brain chemistry (either during an addiction or as a consequence of withdrawal syndrome) or because of the damage done by the addiction to life circumstances, relationships, employment prospects and more.
Treating the addiction in these cases will also require addressing the depression itself, as users may be self-medicating and the sudden absence of heroin may have a dangerous effect on brain chemistry, potentially driving users towards suicidal ideation.
Heroin Addiction & Bipolar Disorder
There have been multiple connections made between drug abuse and bipolar disorder – up to 60% of people with the latter also engage in some form of substance abuse – and heroin in particular, with its “numbing”, comforting effects, is a comparatively popular option for bipolar disorder sufferers looking to stave off the worst extremes of the condition; meanwhile, long-term heroin use may have the potential to cause the onset of bipolar disorder and related conditions, according to some research.
As with depression, treating a heroin addiction alongside bipolar disorder will require a particular approach so as not to risk exacerbating the “lows” of bipolar disorder with potentially tragic results.
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Why is heroin addiction hard to beat?
Heroin is an extremely addictive substance, both physically and psychologically. The body becomes dependent upon heroin in order to function “normally”, while psychologically the user becomes almost entirely focused on the acquisition and consumption of the drug and loses sight of everything else which previously made life enjoyable. Stopping taking the drug usually results in very unpleasant withdrawal symptoms which many users are terrified of undergoing.
Can heroin addiction be cured?
Yes, it is possible to live a happy, successful life after a heroin addiction. Treatment – possibly at a residential rehab – usually involves a combination of detoxification and therapy, and the latter may need to be sustained for a long time (possibly alongside attendance at support groups) if the addict is to avoid relapsing; however, with dedication and perseverance even the most deeply entrenched heroin addiction can be beaten and the user can go on to have a wonderful, drug-free life.
Can heroin abuse cause diabetes?
Some research implies that regular consumption of heroin can have an impact upon the pancreas which can cause hyperglycaemia; more studies are underway in order to establish the nature of this relationship.
Can heroin abuse cause brain damage?
Yes: long-term heroin use can cause neurological damage, while overdose can result in significant brain damage amongst survivors if they are starved of oxygen for protracted periods.
How has heroin abuse become an epidemic?
Heroin’s ready availability and comparative affordability mean that it tempts users all over the UK, many of whom become addicted.
Why is heroin abuse rising?
Heroin abuse is often associated with financial deprivation, and in the wake of the financial crisis many parts of Britain are significantly underperforming economically. At the same time, as a result of various conflicts in the Middle East and Central Asia (especially the war in Afghanistan, where much of the world’s opium is produced) there is now much more heroin available on the market than was the case even a decade or so ago. The result is a “perfect storm” of poverty and addiction which is ruining countless lives.