Frequently Asked Questions: Heroin Addiction Rehab

The use of heroin in the U.S. has been increasing noticeably in recent years. One of the questions most often asked during the national opioid epidemic has been “Does prescription opioid use become a risk factor for heroin use?” The answer is a resounding “Yes.”Research from the NIDA shows that, after the year 2000, nearly 80% of heroin users reported using prescription opioids before their first heroin use. In 2015, a study found that misuse or dependence on prescription opioids has been associated with a 40-fold increased risk of dependence on or abuse of heroin.Furthermore, heroin is usually less expensive than black market prescription opioid drugs bought on the streets. The recent crackdown on prescription opioid overprescribing may actually lower the availability of these black market drugs for illegal use, thereby, boosting the sale and proliferation of heroin.

What is Heroin?  

Heroin is a highly addictive, illegal drug, derived from the morphine alkaloid found in the opium poppy plant (Latin name:Papaver somniferum), and abused for its euphoric effects. In its purest form, heroin is known chemically as diacetylmorphine hydrochloride or diamorphine, it’s physical form is a bitter-tasting white powder, and, although being illegal in the U.S., it is medically used in some other countries as an opioid painkiller for severe pain, being 2-3 times more potent than morphine. 

What Type of Drug is Heroin?

Heroin is an opiate. Opiates, which includes controlled prescription substances such as opioid painkillers, are derived from opium, which is a naturally-occurring chemical found in poppy seeds and plants. In the U.S., heroin is classified as a Schedule I drug under the Controlled Substances Act of 1970, and carries stiff criminal penalties for its production, possession, and sale, having no accepted medical use in the U.S.Common opiates available by medical prescription, but still classified as Schedule II narcotics by the DEA, include:

• Codeine
• Hydrocodone
• Hydromorphone
• Fentanyl
• Methadone
• Morphine
• Tramadol, and
• Oxycodone

What Does Heroin Look Like? 

The majority of illegal heroin is sold as a white or brownish powder. However, it is usually “cut” (mixed) with other drugs or substances like sugar, powdered milk, starch, or quinine (an alkaloid medicine which was previously used to treat malaria). Heroin can also be cut with strychnine or other poisonous substances. The white or brownish powder is the form that heroin users inject into a vein.Furthermore, highly potent opioids such as fentanylandcarfentanyl (far more powerful than heroin itself) have been found cut into heroin bought on the streets. As the user has no idea what substances have been used to cut the heroin they are getting on the street, they are at serious risk of a possibly fatal overdose.

What are the Street Names for Heroin?

Heroin is known commonly “on the streets” (being sold illegally by drug dealers) as:

• White China
• Smack
• Big H
• Black Tar
• Junk
• Brown Sugar
• Skunk
• White Horse, and Thunder 

What is Black Tar Heroin?

Another form of heroin frequently dealt by drug dealers is known as “black tar.” The name emanates from its consistency, which is sticky, like roofing tar, or hard, like coal. Its color varies from dark brown to black; this form is either smoked or snorted.

How Do People Use Heroin?

Heroin is usually either injected (usually intravenously – IV), smoked, or snorted up the nose. However, heroin may also be:

• vaporized (“smoked”)
• used as a suppository, and even
• orally ingested

Smoking or snorting heroin does not produce the euphoric “rush” as quickly or as intensely as when it is injected intravenously. However, when used as a suppository, it can also have intense, euphoric effects. Importantly, it doesn’t matter which route is used to take the heroin – it is highly addictive by all methods.

What are the Effects of Heroin?

Heroin is usually either injected (usually intravenously – IV), smoked or snorted up the nose. However, heroin may also be:

• vaporized (“smoked”)
• used as a suppository, and even
• orally ingested

Smoking or snorting heroin does not produce the euphoric “rush” as quickly or as intensely as when it is injected intravenously. However, when used as a suppository, it can also have intense, euphoric effects. Importantly, it doesn’t matter which route is used to take the heroin – it is highly addictive by all methods.

What are the Effects of Heroin?

Heroin produces euphoric (in an intense rush), anti-anxiety, and pain-relieving properties. After intravenous injection, the heroin user feels an extreme surge of euphoria (the rush) that lasts between 45 seconds to a few minutes, depending on the dose, which is accompanied by flushing of the skin, dry mouth, and a sensation of heaviness in the user’s limbs, which peak after 1-2 hours and wear off in 3-5 hours, except for its sedative effect which can last longer.Following the initial euphoria, the user experiences alternating states of both alertness and drowsiness. Their mental functioning decreases due to the depression of the central nervous system (CNS). These relatively short-term effects of use will appear after a single dose and then disappear after a few hours.

How Does Heroin Affect the Brain? 

Our brains are actually geared up to accept chemicals such as heroin and other opiates because brains have their own opioid receptors, which are designed to control respiration, arousal, blood pressure, and other normal physical processes. These receptors are present because we produce our own opioids, such as enkephalin, dynorphin, and endorphins.Opioids, like heroin, will bind to opiate-specific receptor sites, decreasing the perception of pain and increasing our mood by encouraging the release of dopamine – the brain’s “happy” chemical.” When the brain is subjected to a high influx of opioids, this promotes extremely high levels of dopamine – up to 10 times the normal level.

What are the Dangers of Using Heroin?

When heroin is used, it metabolizes to produce morphine and other metabolites, which then bind to opioid receptors in the brain. Physical effects of heroin use can include:

• Slowed or shallow breathing, known as respiratory depression
• Nausea, and
• Constricted (“pinpoint”) pupils

Overdose symptoms can include:

• Respiratory depression
• Hypotension (low blood pressure)
• Muscle spasms
• Convulsions
• Coma, and
• Possible death

Intravenous use can be complicated by the sharing of contaminated needles, hepatitis, HIV/AIDS, and toxic reactions to any impurities in the drug (contained in whatever the heroin has been cut with). Other medical issues that can arise include:

• Abscesses
• Collapsed veins
• Endocarditis (the inflammation of the heart’s lining and valves)
• Pneumonia
• Spontaneous abortion, and
• Addiction

What are the Short- & Long-Term Side Effects of Heroin Use?

People who engage in regular heroin use will develop a tolerance to the drug, and so will require more of the drug to experience the same euphoric effects. Additionally, some will experience a decrease in their pain threshold, so will grow more sensitive to pain generally. This process usually occurs over an extended period of use; however, it can occur after only a few uses of the drug.As users gradually increase the amount of heroin they are using per “rush,” they are unknowingly putting themselves at a greater risk of overdose, which can include hypoxia, a condition of decreased or delayed breathing. Hypoxia can eventually result in coma and permanent brain damage.

What Happens If You Overdose on Heroin?

Overdosing on heroin is serious – it can be fatal. If you are with someone who has overdosed, you must contact the emergency services immediately, as it requires treatment with naloxone – a medication formulated to effectively block or reverse the effects of opiate use, including respiratory depression, drowsiness, and the loss of consciousness. Naloxone is administered by injection, and, importantly, should not be used in place of emergency medical care, because respiratory support, intravenous fluids, and other medications may also be required.

What is the History of Heroin? 

Heroin was first synthesized legally from morphine in the late 1800s, and the Bayer Company of Germany was the first to introduce heroin in the U.S. for the purpose of treating tuberculosis, and, ironically, as a remedy for morphine addiction. However, because of the highly addictive nature of the drug, its abuse was widespread, and so, in 1924, federal law made all heroin use illegal in the U.S. Heroin is rarely grown and cultivated in the U.S., so opium is trafficked into the country, primarily being brought in from Latin American countries. Afghanistan is the world capital of opium harvesting and produces three-quarters of the world’s heroin supply.

What is Heroin Withdrawal?

As with all potent addictive substances, the cessation of heroin use will prompt a physical reaction within the body, including the brain, known as “withdrawal” – a number of specific symptoms that may cause incredible discomfort, even pain, and other medical problems in the ex-user, where they feel there is no alternative but to resume using the drug.Major withdrawal symptoms normally peak between 48 and 72 hours after the last use and then subside after about a week. However, heroin withdrawal is not the same for everyone. The intensity and duration of withdrawal are dependent on:

• The length of time heroin was used
• The method of use, eg. smoking, injection, etc.
• How much heroin was used each time 

During withdrawal, the symptoms experienced are the direct opposite of the effects of intoxication. Therefore, instead of the feeling of euphoria, a reduced heart rate, and its sedative effect, the individual may experience a depressed mood, anxiety, and rapid heart rate, among other symptoms. An individual with a history of mental illness or someone who has had a prior opioid withdrawal may experience a more intense withdrawal.

What are the Symptoms of Heroin Withdrawal?

Because withdrawal from heroin can vary from mild (for low-level users) to severe (for high-level users), here are the most common symptoms that are usually experienced during the process:Mild Heroin Withdrawal SymptomsThese can include:

• Nausea
• Stomach cramps
• Yawning
• Runny nose and tearing
• Sweating/Chills
• Muscle/bone aches

Moderate Heroin Withdrawal SymptomsThese can include:

• Vomiting
• Diarrhea
• Agitation / Restlessness
• Tremors
• Difficulty concentrating
• Piloerection (goosebumps)
• Fatigue

Severe Heroin Withdrawal SymptomsThese can include:

• Anxiety
• Insomnia
• Depression
• Hypertension (high blood pressure)
• Increased heart rate
• Muscle spasms
• Impaired respiration
• Cravings for heroin

Heroin withdrawal is not considered life-threatening on its own; however, some of its physical and psychological symptoms may have complications that can be life-threatening if not medically monitored. For example, withdrawal can induce a severe state of depression, which may lead someone to consider suicide.Therefore, heroin use should not be stopped suddenly without the support of medical and/or mental health professionals, as they can manage the side effects of withdrawal. Withdrawal symptoms can be effectively managed in a clinical detox setting, with professional medical staff and the appropriate medications.Sudden withdrawal by high-level users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal. Abruptly stopping the use of a substance like heroin that you are addicted to is known as “cold turkey” – a reference to the appearance of goosebumps on the skin, symptomatic of heroin withdrawal.

When Does Heroin Withdrawal Start?

The symptoms of heroin withdrawal usually start within 6-12 hours of the last dose, and peak between 2-3 days.

How Long Does Heroin Withdrawal Last?

The intensity and duration of heroin withdrawal vary; however, it normally lasts 5-10 days in total.

How Long Does Heroin Stay in Your System?

Heroin is a fast-acting drug (intravenous injection is relatively immediate) and has a short “half-life” (also known as the biological half-life), which is the length of time it takes the human body to reduce the maximum concentration of the drug by half.In biological terms, half-life refers to the body’s natural cleansing process through the function of the liver and the excretion of the measured substance through the kidneys and intestines. This measurement is used in both pharmacology and medicine to determine how much of a drug needs to be taken, and how frequently, to maintain a certain level of concentration.Heroin can be metabolized quickly by the body and has a half-life of only 0.1-0.25 hours. It is not normally detectable by most standard drug tests after 3 days. In different testing methods for heroin, it is present and detectable as follows:

• Blood: Up to 6 hours
• Saliva: Up to 24 hours
• Urine: Up to 3 days
• Hair: Up to 90 days

Because heroin is illegal and, more often than not, cut with other drugs or substances, there is a severe lack of purity. Some doses may be purer and/or stronger, which will increase the dose’s half-life

What is Rehab?

The most successful way of recovering from heroin addiction, and other substance addictions, is to attend an inpatient course of treatment at a professional and accredited heroin addiction rehabilitation facility (often shortened to “rehab” or “drug rehab”) or hospital. Although dependent upon the substance of abuse, drug rehabs usually involve:

• Detox: Detoxification or “detox” is the process of removing the substance of abuse and its associated toxins from the patient’s body safely.
• Therapy: The term “therapy” encompasses any psychotherapeutic methods used by clinicians and medical rehab staff to help patients change their addictive behavior, eg. one-to-one counseling, group support, and clinical therapies such as cognitive behavior therapy (CBT). Therapy only begins after the patient has been fully detoxed.
• Education: Learn new ways of coping with cravings and other behavioral triggers to stay sober.

Apart from inpatient rehab (also known as “residential rehab”), other forms of rehab include:

• Outpatient treatment: Patients remain living at home and attend a clinic or facility for regularly scheduled sessions with addiction professionals.
• Recovery housing: Patients live in supervised, temporary housing, where they can also participate in addiction treatment programs.

How Does Rehab Help Drug Addicts?

Rehab provides a number of benefits to addicts which are designed to give them the possible chance at a successful recovery. These are:

• Safe and secure environment, away from a patient’s normal access to drugs, eg. heroin
• Individualized treatment plan
• Detoxification: Used to ensure patients detox safely during withdrawal
• Medically-assisted treatment (MAT), if required – see below
• One-to-one therapy/counseling
• Group support
• Specialized therapies, eg. CBT
• Additional therapies, such as art and music therapy, horticultural therapy, and equine therapy
• Education, eg. exercise, nutrition, addiction
• Individualized relapse prevention plan on departure

What is Medically-Assisted Treatment (MAT) in Detox?

To ensure a patient is safely detoxed, and without any medical complications, medication is often used in the detox process – this is known as medically-assisted treatment or MAT. MAT options for heroin and other opiate addictions can include the use of the following medications: 

• Buprenorphine
• Naloxone
• Naltrexone, and
• Methadone

How Long is Drug Rehab?

The length of addiction rehab inpatient/residential programs vary, but, generally, are normally:

• 28 or 30-day program
• 60-day program
• 90-day program
• Extended programs, ie. sober living facilities, like recovery housing or halfway houses

How Much Does Inpatient (Residential) Drug Rehab Cost?

The actual cost of inpatient / residential rehab will vary according to the individual rehab chosen, the treatment program required, and the healthcare plan of the patient; rehab costs can vary from thousands of dollars per day to free.Estimated costs associated with rehab reported by various studies and individual facilities:

• Outpatient detox ranges from $1,000 to $1,500 in total

Note: Most inpatient / residential rehabs include detox in the cost of their treatment program.

• Inpatient / residential rehabs can cost around $6,000 for a 30-day program. For those requiring longer programs, the total average cost can range from $12,000 – $60,000
• Outpatient programs normally cost around $5,000 for a 3-month program
• Medication is normally used as part of the treatment for alcohol and opiate (eg. heroin) addiction and can cost several thousand dollars a year; for example, a year-long course of methadone or heroin users costs around $4,700

Insurance is one of the most common ways of covering the cost of rehab. The actual amount that insurance will cover depends on the insurer, and what healthcare plans the rehab accepts. Types of insurance that may cover rehab include:

• Medicaid
• Medicare
• State-financed health insurance
• Private insurance
• Military insurance

Can You Involuntarily Commit Someone to Drug Rehab?

Although it is far better for an addict to agree to drug or alcohol addiction rehab, it is possible to involuntarily commit a person in certain U.S. states, using the Involuntary Commitment Law, which applies to 37 states and the District of Columbia. Involuntary commitment can be for either substance use disorder (SUD) or alcohol use disorder (AUD), or both.It is far easier to involuntarily commit a minor or child if you are their parent or legal guardian than it is to commit an adult (though that is still possible in extreme cases, but will require a court hearing).Important: Idaho does not have the Involuntary Commitment Law.

How Northpoint Recovery Can Help with Heroin Addiction

Northpoint Recovery, located in Boise, Idaho, offers integrated care at our highly specialized addiction treatment facility. Our 28-day drug and alcohol rehab programs teach patients how to avoid relapse and maintain long term sobriety. Taking an integrated approach to treating addiction, our residential rehab program addresses substance abuse, co-occurring mental health conditions, and medical care needs.Our research shows that those who complete both detox and rehab together are less likely to relapse, and more likely to stay sober longer. During the detox and rehab process, patients benefit from a complementary mix of services that have proven to be effective in the recovery process; these include:

• Relapse prevention
• Integrated treatment and medical intervention
• Psychiatric care and medications for co-occurring disorders
• Family therapy
• Cognitive-behavioral therapy
• Dual-diagnosis therapy
• Process Groups