Heroin Addiction & Treatment
Heroin is believed to be the most addictive drug of all time
The short term effects would appear to explain the reason why, as first time users quickly find themselves wanting to return to the euphoria heroin so easily provides. But it is the way our brains respond to heroin on a chemical level that seals its grip. The human brain contains receptors which are ingeniously designed to respond to exactly the chemicals contained within heroin. From the first moment the two are introduced, heroin can change the physical structure of the brain, creating a dependency that is extremely – though by no means impossibly – hard to shake.
What type of drug is Heroin?
Heroin is an opiate, meaning it is made from the black and sticky resin of certain types of poppy flowers. It is not the only drug to be made this way – a number of common medical painkillers come from exactly the same substance, and anyone who has ever been treated for a serious accident or had a major operation might well have been given an opiate by a doctor to ease the pain.
But of all the opiates in recreational use, heroin is by far the most common. Users prefer it to other opiates for two key reasons: its strength – heroin is around three times stronger than morphine, its closest relative – and the fast speed with which it travels to the brain. These qualities mean that a heroin high is intense but short-lived, with a strong initial rush that soon wears off, leaving users needing more and more regular hits to reach the desired high.
Other opiates include:
- Hydrocodone (Vicodin)
- Oxycodone (Oxycontin)
What happens when you take heroin?
When most people think of heroin, they imagine a hypodermic needle. But though injection is the most common method by which people take heroin, it is by no means the only way heroin can be consumed. Heroin can be smoked, snorted, swallowed or injected intramuscularly or intravenously – i.e. into the muscle tissue or into the veins.
The effect of the heroin is dependent in large part on the speed with which it can get to the brain, and this varies dramatically with each method of consumption.
Intravenous injection is the fastest – research suggests that the strongest effects can be felt just 7 – 8 seconds after injection as the drug floods the brain, giving users an intense rush of pleasure which last around two minutes. By comparison, the effects of intramuscular injection take 5-8 minutes to appear, and up to 15 minutes if the drug is snorted or smoked.
Following the intial rush of heroin, a period of deep contentment and physical relaxation set in. Breathing and heart rate slows, muscle strength dissipates and the mind settles. Life’s problems seem to melt away. This is the heroin ‘high’, and it happens as the drug circulates through the bloodstream and then slowly diffuses into the brain.
But many first time users find the ‘high’ of heroin a deeply unpleasant experience. The slowing effect heroin has on the body’s functions causes a number of very unwelcoming side effects and many users report severe nausea and vomiting, as well as itchiness, hot flushing and a dry mouth.
But even the best heroin high ends. Between three and five hours after the drug is taken, the pleasant effects fade and the user might start to feel irritable and depressed. For many, this is followed by a choice; face the discomfort of life in the wake of a heroin high, or return to the comfort and safety that the drug so easily appears to offer. It doesn’t take much for the second option to seem preferable, and it doesn’t take much for a heroin user to become a full blown addict.
How the brain is tailor made for heroin addiction
In the early 1970’s, brain researchers in Baltimore, America, made a discovery that changed the way we understand opiate addiction. The human brain, they found, contains neuron receptors that are perfectly designed to receive and respond to the chemical components found within heroin, morphine and other opiates. The easiest way to understand this is to think of neuron receptors as eggcups that are designed to fit only one very particular size and shape of egg. The chemicals within opiates are the perfect fit, and when the brain has access to them, it latches on to them hard and fast.
The reason for this, the researchers found, is that the chemical structure of opiates is almost identical to that of endorphins, the naturally produced feel-good chemical that rushes around our brains when we take exercise, experience pain or have sex. But unlike endorphins, which are naturally regulated and kept in check by the body, opiates can be taken in any quantity we choose. And of course, the higher the dose, the greater the pleasure.
But the brain quickly adapts to this new bumper source of endorphin-like chemicals. The neuron receptors, which had previously been inhabited only sporadically and in lower doses by endorphins, physically adjust to the higher and more regular levels provided by opiates. As the brain adjusts, tolerance builds, with ever increasing amounts of opiates needed just to feel normal. Then, when the opiates stop flowing, the brain floods itself with other naturally occurring chemicals to compensate for the change. This imbalance of chemicals in the brain interacts with the nervous system, causing the physical symptoms of opiate withdrawal: nausea, fatigue, fever and more.
The human body is designed for survival, and one of its methods for staying alive is to try and adapt to anything that is thrown at it. With Heroin and any other drug, the body adapts to the new chemicals and build up a tolerance, meaning more and more of the drug is needed to cause an effect.
Every heroin addict lives with the fear of withdrawal. It is never far away – the first effects of withdrawal can start as little as 3 hours after the drug is last taken, and the most severe symptoms occur between 48 and 72 hours later. It is this inevitability that drives addicts to their next fix, and keeps the spiral of addiction going.
There are many symptoms that can come with withdrawal, and any addict going through it is likely to experience a number of them. It is not, in general, life threatening, though sudden withdrawal in addicts with poor health can occasionally be fatal.
There is no solid timeline for the length or severity of withdrawal, and both can differ greatly for different people. How an individual is effected by the withdrawal depends in large part on how long they have been an addict and how much heroin they have consumed, as well as their general health.
Physical withdrawal symptoms include:
- Severe drug craving
- Nausea and vomiting
- Bone and muscle pain
- Cold flushes and goose-bumps
- Kicking movements and involuntary muscle spasms
- Shortness of Breath
Heroin addicts often compare the physical effects of withdrawal to a heavy bout of flu, but say that the psychological symptoms are much harder to explain. Some addicts report that it is akin to a love affair, that there is a deep fear that without it, they would be all alone in the world. While physical symptoms general pass after five to seven days, the psychological effects of heroin withdrawal can stay around for longer, often weeks or months.
The physical effects of withdrawal can be greatly reduced with an effective detox program, making the withdrawal process safer and smoother. Detox is normally the starting point for heroin addiction treatment, but not an end in itself. In general, it is followed by an integrated approach involving medication and therapy, designed to ensure the greatest assurance of long-term abstinence.
Alongside the physical discomfort of withdrawal, addicts may experience a range of emotional side effects. These include:
- Sudden mood swings
- Suicidal thoughts
What are the health consequences of long term heroin use?
When heroin is used regularly over a long period of time, it can have all sorts of negative effects on both physical and psychological health. Here are some of the key areas that bear the brunt of heroin’s damaging effects:-
Heroin slows down the workings of the lungs and if users take too much they can stop breathing completely. This type of overdose is the highest risk for heroin users, and is the reason for 23% of all heroin deaths. In other cases, the slowing of the respiratory system causes user’s lungs to fill up with fluid, effectively drowning the user. In the long term, heroin’s effects on the lungs can cause a number of lung diseases – pneumonia, lung abscesses and tuberculosis are all common among heroin addicts.
Heroin also slows the heart and large doses can stop it completely. But the cardiovascular system also takes a beating in a number of other ways from long term heroin use. The most common problem arises from the repeated piercing of the veins and arteries when heroin is injected. Over time this often causes abscesses and infections which are often left untreated, causing them to spread. The regular exposure of the blood stream to often unclean needles also allows bacteria into the body. This can build up around the heart, causing infections and blocking and destroying valves. This too is a common cause of death among heroin users.
The digestive system is another area of the body that is severely slowed by heroin use. This sedation causes the blocking of the bowels, leading to chronic constipation that for many addicts is so unpleasant they let themselves go into withdrawal at regular intervals just to allow the onset of diarrhoea. The wider effects of these intestinal problems are malnutrition, haemorrhoids and anal fissures.
When heroin enters the body, it rarely travels alone. In most cases, the drug is mixed, often with highly toxic substances. On top of this, bacterial contamination of the needles is commonplace. The liver and kidneys act as the bodies filter, and over time heroin can cause them serious and irreparable damage.
Heroin Addiction Recovery
The first step of heroin addiction treatment is generally a medically assisted detox program, designed to get the patient comfortably and safely through the withdrawal period as their brain and body adjust to life without heroin.
Medically assisted detox uses specific medical drugs that are designed to mimic some of the effects of heroin, but without giving the patient the high or altered state of heroin use. In general, the detox period will last between 5 and 10 days and will be tapered off slowly as the body gradually clears itself of all residues of heroin. Throughout the detox the patient receives close support and medical supervision.
The first week of withdrawal is generally the hardest part of the recovery process. Medical detox is a vital part of addiction treatment as it gives the patient the tools and support to successfully adjust to a life of sobriety. However, detox cannot work alone. The National Association for Health and Clinical Excellence points out that for effective rehabilitation, detox should be one part of a bigger picture, in which the patient works through a series of support groups and therapies.
Detox medications are tailored to each patients need. Mostly, patients will be prescribed Subutex (buprenorphine) to help them through withdrawal. Sometimes, in particularly difficult cases, methadone is prescribed, with the dose being slowly reduced over the course of a few weeks. Towards the end of the detox, the patient m be prescribed lofexidine, to help alleviate some of the uncomfortable physical symptoms as they finish the detoxification medication process.