When it comes to heroin addiction, America's struggle is real, and it doesn't just affect the addicts themselves. Every 25 minutes a baby is born already addicted to opioids. One third of all children in foster care are placed there because of their parents' addiction, and hundreds of emergency service calls are placed each year by children calling in to report a parent overdosing. The opioid crisis is devastating an entire generation of children and it's painting a disturbing picture of what they might become in the near future.
How did this happen? Where did it start? What can be done about it? We don't have all the answers; but in this article, we'll delve into the dark and dreary world of heroin dependency and analyze its causes, effects, and solutions. Below you'll find 11 things that are important to know if you or someone you know has succumb to the throes of heroin dependence.
Heroin is part of a class of drugs called opioids. These include any drugs, either prescription or illicit, that are derived from opium - a sap-like substance harvested from the opium poppy flower. Although opium has been used for medicinal and recreational purposes for thousands of years, opioid pills are more recent. Opioids in prescription pill form were only developed in the last 150 years.
The current opioid crisis is severe, but it's hardly a modern problem. The first recorded cultivation and harvest of opium poppies goes back to 3,400 B.C. and it has been used and abused in almost every civilization since. Although it was used by every culture from Egypt to Greece in ancient times, the first major opium epidemic wasn't recognized until the 1700s when Great Britain began using opium as currency to trade for Chinese goods along the Silk Road. This continued for over 200 years. By the early 1900s, over 13.5 million Chinese people were addicted to opium. It took an all-powerful communist regime to end the epidemic in the 1950s. Even after a brutal come-down on opium production and abuse in the 1950s, opioid abuse continues in China today, although it is now mostly fueled by the prescription variety.
During this same time period, laudanum and then morphine were both derived from opium and used widely as pain remedies through Europe and the United States. Addiction to these two pain medications were not uncommon during the 1800s, but the problem increased exponentially during the 1900s as war after war made widespread use of the drugs more necessary.
With each war involving the USA and Europe, more soldiers who were treated for pain with opium-derived medicines became addicted to the drugs. The Civil War, both World Wars, and the Vietnam War all helped attribute to a growing male population of opioid addicts. As many as 20% of soldiers who served in the Vietnam war returned with a morphine or heroin addiction, some of them sharing the habit with friends and family when they returned home.
Heroin abuse in the United States continued through the 1970s and '80s, and then exploded in the late '90s with the introduction of mainstream painkillers like Oxycontin.
Humankind's love affair with opiates is as old as any existing written record, maybe even older. It's safe to say that a 6,000 year old problem is not going to be solved easily or quickly, but that does not mean that there are no solutions for the average person. Addiction will torment mankind as long as people and drugs both exist on the same planet, but we can treat it - one person at a time.
In 2007, medical journal The Lancetpublished a study that announced heroin as the most addictive substance on the planet. One reason for this is the overpowering rush of pleasure that is produced by heroin; the feeling is so intense that the comedown is acute and depressing. Since heroin releases an enormous flood of dopamine (the brain's happy chemical), it depletes the natural balance of dopamine in the brain even after a single use, creating cravings to repeat the drug after the very first push. Even though heroin (or any other drug) cannot create a physical dependence after only one use, heroin may be the only drug that engenders strong psychological cravings after the very first time.
It is estimated that one in four people who try heroin will eventually become addicted; this number is far higher for heroin than any other substance. Although addiction rates for prescription opioids are not quite as high if they are taken as directed, abuse of opioids - taking more than the amount prescribed or taking them more often - can also cause a fast and powerful addiction.
This makes it wildly dangerous to try or abuse opioids recreationally, even once.
Although the earliest recorded cultivation of the opium poppy took place in ancient Mesopotamia, it was also farmed in Egypt, Greece, Europe, India, China, and other places throughout ancient history.
In 1874 an English researcher extracted diamorphine from the opium-derived medication morphine, and heroin was born. Although the poppies it was derived from were still mostly cultivated in Asia and the Middle East, heroin itself was produced mostly in Europe and the United States throughout the early 20th century and was prescribed by doctors for everything from common coughs to morphine addiction. It wasn't until the 1920s that the dangerously addictive properties of heroin were recognized and it began to be regulated.
After mainstream legal production of heroin stopped in the 1920s, illegal production of the drug became common in Asia and eventually Latin America. It was mostly imported through European mafia suppliers until the 1990s, when large smuggling operations began coming in through Latin America and Mexico. Today, heroin comes in from Asia, Latin America, and Mexico.
At one time, street heroin was almost pure, but those days are long gone. Fillers such as cornstarch, powdered milk, caffeine, strychnine (rat poison), or sugar may be used to cut the heroin and reduce its production costs, while other drugs like crack cocaine, fentanyl, or acetaminophen may be added in to amplify the perceived potency of low-quality heroin. In some cases, fillers may be harmless; they make the heroin dose weaker but do not pose risk to the user. Other cutting agents - like fentanyl - are incredibly dangerous and add a huge risk of overdose to the drugs they are cut into. The scary part? Street buyers have no way of knowing what lies inside their illegal heroin purchases.
In its most common form, heroin comes as a fine powder. The color of the powder will depend on its purity and which substances are used to cut the drug. The most pure forms of heroin are usually white, but may also be brown, gray, or black.
Heroin that is produced in Mexico may come as a black, sticky substance instead of powder. This occurs when the drug is not fully processed into powder and is often referred to as 'black tar'. Black tar heroin may be somewhat weaker and less expensive, which is why it is becoming increasingly more popular in the western United States.
Like most illicit substances, heroin goes by many nicknames and slang references. The most common heroin street names include:
Although there were several severe opium epidemics in Europe and Asia between the 18th and 20th centuries, the current crisis is by far the most severe that has occurred on U.S. soil. In 2017, over 2 million people were reported with opioid addictions. More than 70,000 died from drug overdoses that year - that's more than car accidents and gun violence combined. Of those deaths, over 42,000 were attributed to opioids and more still associated with opioids in combination with other substances. These numbers are higher than any other year in United States history.
While opioid prescription pills have existed in some form since the late 1800s, doctors were somewhat cautious in doling the prescriptions out because of the known addictive nature of opium and its derivatives. Then, in 1995 Purdue Pharma invented a slow-release form of opioid pill called Oxycontin.
Purdue marketed Oxycontin as a less-addictive opioid that, due to its 12-hour slow-release mechanism, could be safely prescribed for any type of chronic or persistent pain. The company spent millions marketing the new drug. Hundreds of thousands of doctors were invited to days-long parties in luxury resorts, wined and dined, and educated about this safe, less addictive form of painkiller that would change the face of pain management. The doctors bought it. Opioid prescriptions rose in general as doctors began to change their perceptions of proper pain management, and Oxycontin sales soared. Between 1997 and 2002, Oxycontin prescriptions rose from about 670,000 to 6.2 million - an 825% increase.
Let that sink in.
As many as 6 million people were taking Oxycontin at one time. Of course, the inevitable happened quite quickly. People from every walk of life, profession, and class of society were prescribed high-strength opioids for minor aches and pains. Tolerances developed, and the 12-hour release Oxycontin prescription no longer had the same effect. Then people discovered that the pills could be crushed, snorted, or injected to achieve a much more pronounced euphoric effect, and it was all over.
Within a five year span, millions of people were suddenly and unintentionally addicted to opioids. The lawsuits came rolling in, yet Purdue refused to backtrack. They continued to market Oxycontin as "less addictive" even as class-action lawsuits were being brought to court from hundreds of thousands of people with unintentional and debilitating addictions. It took 12 years and a $634-million fine for the company to admit their error. By then, it was too late.
Between 1995 and 2010, drug overdose deaths in the United States almost tripled. As the problem gained international attention, the CDC and FDA both launched campaigns to educate the public about the dangers of opioid abuse, and doctors began scaling back on opioid prescriptions. When the prescriptions began dwindling, however, the thousands of people who were addicted to prescription opioids were faced with pain and drug withdrawal. The prescriptions ended, but those patients who had been using them for months or years were not offered treatment or counseling to help them cope with their unintentional addictions. As pain, misery, and opioid withdrawal symptoms set in, people turned to black market dealers and street heroin to feed their cravings.
Since then, opioid addiction rates have only increased. As less and less opioid prescriptions are doled out by doctors, black market profiteers are producing more heroin and synthetic opioids to sell on the street, and heroin sales are skyrocketing. Each year brings higher addiction rates and more overdose deaths. As of this moment, there is no solution or end in sight for the nation's heroin epidemic. The government is scrambling to approach the problem as a whole, while addiction treatment centers work to treat the victims of the crisis, helping one person at a time.
Because of its association with death and overdose, many cultural depictions of heroin addiction paint an ugly, frightening picture. Think Trainspotting or Requiem for a Dream.
Despite the stigma that surrounds heroin addiction, however, it also has an influence in creative circles. Creative cultures have been associated with heroin since at least the 1920s. One of jazz music's most famous contributors - Charlie Parker - openly attributed his genius to the use of heroin. Painter Jean-Michel Basquiat was also forthright about his addiction, admitting to consuming the drug on a daily basis. Both artists died due to the health complications of substance abuse.
Heroin has also had an influence on other types of music. The grunge rock scene of the 1990s was famously intertwined with heroin culture. Bands like Nirvana and Alice in Chains embraced their vices openly, even singing about their use of heroin on occasion. The New York Times labelled Seattle as the hub of "espresso, beer and heroin" in the '90s.
There are plenty of movies that attempt to describe heroin dependence, but many more songs exist that try to capture the heartache of addiction. Sarah Mclaughlin wrote "Angel" to describe a life lost to a heroin overdose, while "Under the Bridge" by the Red Hot Chili Peppers and "Hurt" by NIN both pay tribute to the hardships of the heroin-afflicted lifestyle.
Despite its reputation as a dangerous drug, society gives heroin a sort of tragic glamour that may appeal to young people, especially those that embrace the goth or emo mindset of delicious despair. While pop culture may not glorify heroin, it does give the substance its own pedestal of glorious tragedy.
Perhaps the darkest and most disturbing burden of the opioid epidemic is its effect on the youngest members of society. In the past 20 years, babies born with neonatal abstinence syndrome (NAS) have increased five-fold. NAS is the condition of being born addicted to drugs and immediately being thrown into drug withdrawal as a result of separation from the mother and her substance abuse.
Over 20,000 babies per year are born already going through opioid withdrawal, and that number increases with each passing year. Anyone who has gone through heroin withdrawal knows that it is incredibly painful; health practitioners say that the process is even worse for newborn babies, whose health is severely compromised by the process. Often born too early, babies with NAS may suffer from some of the following health problems:
Beyond the health risks, babies who go through drug withdrawal undergo weeks or even months of agony as their bodies detox from poisonous substances. They tremble, writhe, and scream for hours on end, unable to understand the pain and misery they feel. It is hard to imagine, much less watch, but hundreds of babies are born to opioid addicted mothers each day. Until the heroin epidemic begins to abate, these numbers can only continue to rise.
The first thing heroin does after it enters your bloodstream is to bind to opioid receptors in the brain. This causes an outpouring of the neurotransmitter dopamine into the body, a happy chemical that creates feelings of euphoria, well-being, and intense pleasure. It also has the short-term effect of erasing all pain, both physical and emotional, from the conscious mind.
The comedown from heroin is quick and pronounced, even after your very first use. After only three or four hours, the brain's supply of dopamine will be depleted and you will notice the return of minor aches and pains, as well as melancholy and dissatisfaction. The more often a person uses heroin, the more pronounced this effect will be. After each use, the lack of available dopamine in the brain will be more noticeable, and feelings of anger, depression, or pain will feel more pronounced than before. Your ability to enjoy previously pleasurable activities, like playing games, eating good food, and sex, will seem less satisfying due to the imbalance of dopamine levels, as well as in comparison to the euphoric rush of the heroin high. Soon, life's simple pleasures will seem boring and unfulfilling; the only way to receive pleasure and happiness will be through the use of opioids.
We've already discussed how heroin binds to opioid receptors and stimulates the release of floods of happy chemicals into your brain. But what long-term ramifications are caused by heroin side effects?
Alarmingly enough, heroin's effects actually change the physical structure of the human brain. This happens predominantly because your brain is unable to function properly under a consistent rush of dopamine, so it tries to compensate for the imbalance of happy chemicals by inhibiting opioid receptors and trying to reduce the amount of dopamine that is released. Because of this effect, heroin will not give you the same high as before, and you will need to take more heroin with each use to get the same euphoric feelings. This is called tolerance.
Another effect of heroin abuse is the consistent slowing of basic Central Nervous System (CNS) processes like breathing and heart rate. This slowing of the body's processes is not healthy for the body or the brain, so your brain will increase the production of excitatory neurotransmitters (those that cause wakefulness, energy, and increase the body's activity) in order to keep the body functioning at a normal rate despite the drugs. Now, your brain has rewired itself to compensate for heroin abuse and can no longer operate normally without heroin. It has forgotten how. So guess what happens when you try to quit? That's right - heroin withdrawal symptoms.
At this point, your brain and body are dependent on heroin to function normally. They have no choice but to compensate and rewire their activities to keep things running smoothly despite the chronic use of heroin.
One last effect of long-term opioid abuse on the brain is the deterioration of brain cells that occurs when heroin slows breathing and the flow of oxygen to the brain. Over time, the lack of oxygen being delivered to brain cells can damage them, causing changes to behavioral patterns, decision-making, and cognitive abilities.
Thought we were done covering the effects of heroin? We haven't even begun to talk about what it does to the body. Depending on your method of ingesting the drug, heroin can have a range of effects on the body itself, such as:
There are several reasons behind the fact that opioids are responsible for the vast majority of drug overdose deaths. The first is the array of dangerous substances that are cut into heroin. Besides Tylenol, strychnine, and crack cocaine, fentanyl is becoming more popular as a cutting agent. While all of these substances create a dangerous mix with heroin, fentanyl is a volatile, strong synthetic opioid that presents enormous risk of overdose. When mixed with heroin, it is often deadly. Fentanyl-related overdoses have increased 47% in the past two years.
Another factor in overdose risk is variance of purity. The purity of heroin that is coming into the U.S. black market ranges from 3% to 90%, with the average purity at about 35%. What makes this scenario so dangerous is that it most heroin users have no idea what kind of potency they are buying on the street. If someone who is accustomed to using heroin of about 30% purity stumbles upon a strain that is 85% pure, overdosing on heroin is almost certain if they consume their usual dose.
Even people who take prescription opioids are at a high risk of accidental overdose, since opioids have a such a pronounced sedative effect on the CNS. On average, people with opioid use disorder lose at least 20 years of life due to the effects of heroin addiction.
One facet of heroin abuse that contributes to high overdose rates is the popular practice of mixing heroin with other drugs. Since heroin use can severely slow the CNS, heart rate, breathing, and other vital life functions, it is incredibly dangerous to mix these heroin side effects with the effects of other drugs at the same time.
For example, mixing heroin and alcohol has an unintentional double-CNS slowing effect that compounds the ability of heroin to slow bodily processes like respiration and heartbeat. The result is devastating. According to the CDC, up to 20% of opioid overdose deaths involve alcohol.
Another deadly combination is "speedballing" - the mix of heroin and cocaine. This mix is dangerous because heroin can hide the obvious effects of a cocaine-induced stroke while cocaine can hide the first visible signs of heroin overdose. When mixed together, the two can lead to a quick death that gives you zero time to seek medical attention. Celebrities like John Farley, Jean-Michel Basquiat, and John Belushi all died from the effects of speedballing.
Don't take our word for it. According to the American Psychiatric Association and the National Institute on Drug Abuse, substance use disorder is a chronic brain disease with no known cure.
After drug abuse has persisted long enough to create a physical dependence, the chemical balance and neural pathways inside the brain will be altered. Some of these changes are permanent, which is why substance use disorder (drug addiction) is a chronic, life-long disease. After you have become dependent on heroin or any type of drug, your brain will be forever changed and you may experience cravings for the rest of your life. This is why your approach to recovery is so very important.
Yes, substance use disorder is a chronic, life-long condition. That is not to say that it cannot be treated. There are thousands of different approaches and addiction treatment techniques to help heroin addicts get clean and stay clean. Although cravings could come back at any time, you can learn to recognize their triggers and cope with the longings they cause. Relapse is always a possibility, as with any chronic disease, but it can be overcome, or even prevented, with the right treatments and coping mechanisms.
Don't let the words "permanent", "chronic", or "lifelong" discourage you from working towards recovery. Millions of people have come back from addiction to live healthy, fulfilling lives. It is a matter of finding your own path to recovery.
This is a tricky question, but it's one that is asked often. One way to interpret this question is to ask "How long does heroin stay in your system?" The heroin half-life is about 20-30 minutes for most people, although some researchers insist that it is only 3-6 minutes. Either way, the effects of the drug do not last long and it can be flushed from the blood fairly quickly.
Because of its short half-life, heroin can only be detected in the blood and saliva for a few hours after it is consumed. The substance stays in the urine for one to four days or in the hair for up to 90 days.
But just because heroin leaves your system quickly does not mean withdrawal and recovery are quick processes. Heroin withdrawal takes just as long as most other drugs - about seven days on average, sometimes longer. The drug will leave your system long before you stop feeling its effects.
Even after there is no heroin left that can be detected in any part of your body, heroin addiction will leave its mark on your brain and body, as well as your mental and emotional health. Quitting heroin will be a long battle that may have some effect on the way you live the rest of your life. So in one sense, if you ask, "How long does it take to quit heroin?" The answer may be, "A lifetime."
Heroin withdrawal is one of the most severe and dangerous types of drug withdrawal. It is known for the unique combination of flu-like symptoms and psychological effects. The process lasts about seven days on average but it can go on for several weeks depending on each case. The more severe and long-lasting the addiction, the more difficult the withdrawal period. Here is a heroin withdrawal timeline to map out some of the heroin withdrawal symptoms:
First Stage: 12 Hours - 2 Days
Second Stage: 2 Days - 7 Days
Step one: Don't quit heroin cold turkey.
Also, don't go through it alone. Heroin withdrawal is not only incredibly unpleasant to go through, it can also be quite dangerous. In fact, it is one of the only drug withdrawal processes that could actually be deadly. The combination of nausea, vomiting, diarrhea, excessive sweating, and fever can result in severe dehydration that, without treatment, could kill you.
In order to safely undergo heroin withdrawal, you would ideally consult with an addiction specialist physician who could prescribe a combination of medications and therapeutic actions to reduce the severity of the worst heroin withdrawal symptoms and make the process safer.
It is also important to go through heroin detox in the presence of trusted individuals (preferably medical personnel) who can recognize danger signs like severe dehydration and help you to get emergency care if necessary.
Quitting heroin cold turkey - especially if alone - is the worst way to get clean from heroin, and it is also the most dangerous method. If you go through heroin detox with a little bit of help, you can greatly reduce the risks and agony of heroin withdrawal.
You're starting to get the idea that heroin withdrawal is not easy. If you suffer from an ongoing addiction to heroin, you undoubtedly already know this. Most people say it's the hardest thing they've ever done. In fact, this is how recovering heroin addicts describe detoxing from heroin:
OK, you get it, right? But do you really? How many thousands of people have prepared themselves to get clean, or even showed up at an addiction center to start treatment, only to relapse halfway through detox?
It's impossible to truly understand the pain and suffering of heroin withdrawal symptoms until you've been through them. Even after you've tried and relapsed, it doesn't make it any easier to know what detox feels like. No matter how many times you've tried or even been through the process successfully, heroin detox will be the hardest thing you ever do, each and every time. This is why the way you manage heroin withdrawal symptoms is absolutely crucial to success. You see, it doesn't have to be quite so bad.
Undergoing heroin withdrawal with the help of a professional drug detox and rehab facility can transform the entire experience. Will a professional detox program help you to avoid withdrawal altogether? Of course not. It will be difficult and unpleasant no matter how you do it. There are a variety of treatments to ease the symptoms and make the process more bearable, however. Here are a few ways that professional heroin detox treatment can help you through the withdrawal process:
Medically Assisted Treatment (MAT): Specialized medication protocols like opioid replacement therapy (ORT) can be enormously helpful throughout the detox and recovery process. Prescription medications can soothe heroin withdrawal symptoms, reduce cravings, and help to prevent relapse. Some of the most common heroin detox prescriptions are:
Holistic Detox: Holistic measures are important during detox because they provide both physical and mental outlets to soothe the nervous, antsy energy that is associated with heroin detox. In addition, holistic activities improve the overall health and wellness of a mind and body that is wracked by addiction. Here are some examples of holistic detox therapies:
Traditional Counseling and Group Therapy: Although a full schedule of counseling methods and process groups is not advisable during detox, some traditional counseling and group therapy can help to address the psychological symptoms of heroin withdrawal, such as depression and anxiety.
Many people prefer to go through heroin withdrawal from the comfort of their own homes; however, this is not always the safest option. We've already discussed the risks of quitting heroin cold turkey, but that doesn't mean it's impossible to detox from heroin at home. In some cases, outpatient detox could be completed safely with the approval of an addiction specialist doctor (FASAM). These are some of the requirements that will be necessary for a successful home detox from heroin:
If you do decide to undergo heroin detox at home, there are also some definite Don'ts:
If the above requirements do not sound doable, for any reason, a home detox plan might not have high chances of success. Contact an addiction hotline to discuss other options like inpatient heroin detox.
Getting clean is far more complicated than simply detoxing from the poisonous effects of drugs. Some patients assume that once heroin withdrawal symptoms have passed, they can be deemed as officially sober and go back to life as usual.
Being sober is not the same as being recovered, however. For one thing, relapse will always be a possibility, especially right after detox. Here are some facts about relapse to reveal the big picture:
A great many overdose deaths can be attributed to relapse. The reason why is that drug tolerance decreases as soon as you stop taking a drug, meaning that a smaller amount will have a stronger effect even after only a few days of sobriety. Many users who relapse attempt to use the same amount they were taking before detox, however, consuming far too much and inducing an overdose.
What does rehab have to do with relapse? Prevention. One of the key tenants of a good rehab program is to prevent relapse by teaching effective coping mechanisms for drug cravings and providing patients with relapse prevention strategies. Since relapse is 20% less likely for patients who complete a full heroin rehab program, these strategies appear to be working.
Another reason why drug rehab is necessary to a long-term recovery plan is the advantage of dual diagnosis care. As many as 60% of people who suffer from heroin use disorder also have a co-occurring mental health problem, such as depression or bipolar disorder. Heroin detox alone is insufficient to properly address dual diagnoses.
In order to properly diagnose co-occurring disorders, a team of psychiatrists and medical professionals will need to perform full mental, biosocial, and physical exams. After this process is finished, if a dual diagnosis is made, an individual integrated treatment plan can be developed to treat both disorders at one time. If co-occurring disorders are not treated together in a dual diagnosis drug rehab center, the chances of long-term recovery for either condition are pretty low.
In short, if you're serious about achieving long-term recovery and preventing a potentially life-threatening heroin relapse, drug rehab is not an option. It's a must.
Like drug rehab, a good aftercare program is essential to maintaining a healthy recovery from heroin. This could take several different forms:
Partial Hospitalization: For the most severe addictions, a slow transition back into everyday life can be achieved through a partial hospitalization program. This scenario only works for post-inpatient care and involves six hours of continued inpatient care for five days of every week.
Outpatient Aftercare: For less severe addictions, heroin treatment can be continued for several hours per week in an outpatient program as the patient becomes re-accustomed to a sober lifestyle.
Support Groups: Even after rehabilitation is complete, attending meetings and support groups may be key to staying clean for years or a lifetime after you have defeated addiction. Long-term sobriety is about 15% more successful for people who continue to attend support groups after addiction treatment is over.
Watching a loved one struggle with substance use disorder is heart wrenching, frustrating, and sometimes infuriating. In order to help them though, you must come to terms with the fact that addiction is a disease; not a choice. The addict in your life does not make mistakes out of spite, and he or she probably hates their own actions as much as you do. Before attempting to help someone with heroin addiction, educate yourself. Learn about the causes and effects of addiction, as well as possible treatment options in your area, before attempting to help.
One way to help a heroin addict is to stage an intervention. Staging an intervention will not be an easy or comfortable experience. Make sure you have the correct preparations in place before following an intervention plan like the following:
Heroin addiction is the most deadly of all substance use disorders. Whether you're reading this article for you or someone you know, time may be running out. Don't wait until your child, parent, friend, or spouse is forced to call 911 to report your overdose. Remember that addiction affects everyone you know, and most especially your current or future children. You know it will be hard, but you also know it will be worth it to find your road to recovery. What's your Day One?
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