Many people who talk about opioid addiction think of prescription medications. That’s certainly what I thought. Prescription narcotics are more readily available, easier to access, and more prevalent; or so I thought. Heroin, aka Smack, is more often than not, the end of the line for opioid addicts. It’s incredibly hard to break free from this particular addiction. You’re both physically and mentally addicted. In severe cases, the withdrawal symptoms can be deadly and at times, last for weeks or even months.
History of heroin
Heroin was originally derived from poppy seeds. The poppy seeds are taken, refines and the resin is turned into morphine. Then with the addition of other substances, it’s purified and turned into heroin. Developed in 1948 the Bayer Pharmaceutical it was originally pushed is as a tuberculosis treatment. It can cost almost $200 per day for a long-time addict to keep up with his needs.
Life as an addict
When we imagine what the life of an addict looks like, we often think of disgusting trap houses filled with junkies. Though this can be the case, the truth is far more sinister. Anyone can become an addict. One injury. A few bad choices have a domino effect, quickly overtaking someone’s life. Once heroin has its hooks in all you can think about is the next score. You stop eating, sleeping, and taking care of yourself.
A high functioning addict can appear, for a while, to have their life together. On the outside, they might look like a successful salesman or a quirky bus driver but internally they’re struggling with the “monkey on the back” They go home, and the darkness takes over. The duality of these 2 realities is impossible to maintain. The drug eventually takes over relationships, affects job performance, and mental health.
As addiction takes its toll, you’ll notice the “heroin addict look”. They’ll get dark circles permanently under their eyes, sunken cheeks, and a blank stare as if they’re not truly there. If you know someone with a heroin addiction let them know they are not alone but they must get help. It’s not a choice, it is a sickness that you must fight or end up losing everything. People become unrecognizable while in the grips of addiction and loving patience is necessary on the path to recovery. The road to healing is a long one.
What is heroin?
As one of the strongest opioids out there, Heroin is derived from morphine originating from the poppy plant. Once prescribed by doctors, it was quickly outlawed by medical professionals in the early 1900s due to negative effects.
Heroin can be snorted, smoked, and even injected. It looks like a white to brown powder, or a sticky “Black tar heroin” depending on purity. It’s often cut with other substances for higher profit margins. Some of these substances are not particularly good for you. Mixing agents sometimes include things like baking soda, over the counter pain meds, sometimes laundry detergent, or even rat poison making it much more dangerous and possibly fatal. This rarely is enough to stop an addict. Certain stimulants like caffeine have been found to mask the effects of an overdose. Furthermore, increasing the likelihood of permanent brain damage or death. A newer, extremely dangerous addition used to increase the “Rush” is Fentanyl.
How does heroin addiction start?
Many begin using other prescription meds. According to drugabuse.gov, a whopping 80% began using other opioids during or after their prescription ran out. It can happen to anyone. Many strong-willed executives couldn’t stop their addiction. The drug’s effects on brain chemistry make it extremely difficult to overcome. We still don’t know everything about addiction due to its complex nature, but we know volumes more than even 10 years ago.
Most cases of addiction begin as voluntary. Maybe following surgery or just on time for fun at a party. It gets less and less voluntary the more times you do it. It becomes easier until it becomes necessary.
How does it affect me?
Heroin is an opioid that binds the receptors in the brain. It floods the brain with “feel good” hormones. Now, this might not sound too bad, but read on.
Short-term
Users feel a “rush” as their body releases dopamine. There’s a warm flushing of the skin. Additionally, the body becomes heavy. Users relax. Initially, it reduces anxiety and kills pain. The “high” can last for hours. Many feel drowsy. Others feel nauseous and will vomit.
It’s a depressant that also affects breathing and heart rate, especially in large doses. This is where it gets increasingly dangerous. Since it’s long-lasting you risk brain damage from lower oxygen circulation in the bloodstream. Additionally, if your system begins to shut down you can slip into a coma, one you might never wake up from.
I read about this 21-year-old who started experimenting with sniffing heroin. “He passed out shortly after and was rushed to a hospital. There he stayed in a coma for 2 months before waking up with severe disabilities. He was unable to walk, talk, and even read to this day. It took away any hope he had for the future. From just a short time partying, his life is over, and he will forever be reliant on others for care.”
Long-term
The effects over time can be truly terrifying. It’s highly addictive. Physical dependence becomes so powerful it consumes people’s lives. Intense, long-term use takes its toll both physically and psychologically. Here’s a small list of common effects of long-term heroin use.
- Insomnia
Withdrawal increases anxiety, the body is sending signals to the brain that it needs the drug. That in addition to depression, contribute to sleepless nights fighting an internal war. Like dominoes falling in sequence, insomnia also amplifies these other factors.
- Stomach Problems
The digestive system is important for absorbing nutrients from food and houses some 80% of our immune system. It’s critical to life. Heroin long-term can cause constipation, severe acid reflux, and incredible abdominal pain. Drug abuse will damage the lining of your GI tract and leave you with permeant health issues.
- Impotence
According to the National Library of Medicine anywhere from 34% to 85% of heroin users experience some form of sexual dysfunction. This can be devastating if you plan on starting a family. Not to mention the effects on psychological distress.
- Memory Issues
Your brain is the hardware used by your mind as a tool to interact with the world. We shape our personality based on past experiences, by learning and growing. Heroin changes your brain chemistry for the worse. It changes who you fundamentally are. Sometimes forever. Decreased gray brain matter density occurs in the frontal cortex from heroin use. This affects abilities like speech, muscle movement, decision-making, and behavior. This study by The National Library of Medicine explores the rapid decline a single year of heroin use has on somebody.
- Increased risk of infections
When sharing things like needles and pipes sterilization is rarely a thought. The transmission of infectious diseases like HIV or hepatitis increases exponentially.
Heroin and pregnancy
Using drugs during a pregnancy can be extremely harmful to the baby. Heroin can be absorbed by the fetus through the placenta. The baby will also become dependent along with mom. Babies at that stage are very fragile so all your symptoms will be worse for the little one. Since they’re so tiny and undeveloped death is also an unfortunate consequence.
Neonatal abstinence syndrome (NAS) is the name they give to the baby’s withdrawal symptoms. They’ll be fussy, might have long-term health and behavioral issues. Using while the baby’s in the womb will condemn them to a life-long struggle and developmental issues.
How addictive is heroin?
Abuse statistics
The opioid epidemic is a serious problem in the US. According to data from drugabuse.gov as of 2018, 128 people fatally overdose every day from opioids. That’s an amazingly terrifying statistic. Most are people who never thought they would be addicted, never chose this were overwhelmed by this vicious drug. There are now over 20 million people in the U.S. struggling with addiction. While there are rehabilitation programs, it’s getting progressively worse.
What happened?
How did heroin abuse become so prevalent? Is there any way we can definitively say, for sure, this caused it? Not quite but let’s look at the evidence. Until around the turn of the centuries, big Pharma had a policy of convincing medical professionals that opioids were non-addictive. From this thought, doctors would prescribe them at a higher rate because, by all accounts, it seemed effective. The truth slowly came out but it was too late. Overdose rates skyrocketed and it became clear opioids were much more harmful than originally thought.
Where is it coming from?
Now you might think with the war on drugs that it would be harder to come by, but this isn’t true. Heroin is being smuggled in the US from Mexico, Asia, even Africa.
Treatments for heroin addiction
Narcotic Anonymous (NA) is a 12-step based addiction recovery program that’s built around a community of others who have gone through some of the same things you have. Members of NA are recovering from addiction to various substances. Heroin Anonymous (HA) is a similar 12-step program to NA but the sole focus is recovering specifically from heroin addiction.
- Medications to reduce withdrawal symptoms
There are some medications doctors might prescribe to help reduce the withdrawal symptoms. Withdrawal can be excruciating and if not monitored many will go right back to using to get relief. Doctors might prescribe Suboxone a partial opioid that blocks the receptors and won’t get users high. Effectively weaning you off. They might also recommend Lofexidine® designed to manage some of the more difficult symptoms. Withdrawal is the main reason for relapse, nobody is immune from it.
- Behavioral therapy
We all deal with stress in our own ways. For some, that is managed through drugs and it can be a weight holding us in the cold hands of addiction. There are a few therapies designed to promote abstinence from drugs, develop other coping mechanisms, and treat depression. Contingency management (CM) Therapies is a counseling-based approach that reinforces positive behavior in a subject. Voucher-based Reinforcement provides actual vouchers for food, other goods, and services in exchange for a passing UA. These have all been shown to reduce relapses and help addicts stick with treatment.
Heroin overdose
As addiction intensifies, more heroin is needed to feel the “rush”. Tolerance builds as the body adapts to its effects. Where once you’d get nausea, your body recognizes the high, handles it better this means overdose is more likely. Dependence and tolerance are 2 vastly different things, but they often go hand in hand. Tolerance is the ability to effectively feel the drug, for pain killers, the higher your tolerance the more you’ll need to take for the same pain-numbing effects. Dependence is the body adapting to the drug’s presence, making changes to the system to deal with the substance. Then, needing the substance present to function normally.
Overdose rates
As of 2018, according to drugabuse.gov, 67,300 Americans died from opioids (this is illicit and prescription meds combined total) Most of these were preventable if actions had been taken beforehand.
The places with the highest rates of death according to the CDC are West Virginia (51.5 per 100,000), Delaware (43.8 per 100,000), Maryland (37.2 per 100,000), Pennsylvania (36.1 per 100,000), Ohio (35.9 per 100,000), and New Hampshire (35.8 per 100,000).
Signs of an overdose
During an overdose, every moment is critical to save a life. If you walk in on someone you suspect is overdosing on heroin you must act quickly. They can die without medical help. These are the most common symptoms but not every possible symptom of a heroin oversode:
- Extreme drowsiness
As a depressant, drowsiness will last for a long-time. A person experiencing overdose can be awake but in a lethargic, unresponsive state.
- Slowed breathing
It slows down the breathing to where the person overdosing will lose oxygen to the brain. This can lead to coma or death. It can also lead to blue lips or fingertips.
- Loss of consciousness
This is a scary scenario. At this point, the body has shut down to the point where it can no longer function. This can lead to severe consequences and possibly death.
- Small pupils
Pupils do the opposite of dilate. Sometimes called “Pinpoint Pupils”
- Slow erratic heartbeat
The heart will likely beat slowly due to the depressant’s effects. It might also beat erratically as it struggles to deal with the amount of drugs coursing through your system.
- Choking or gurgling sounds
Called the “death rattle” it’s a bodies final struggle to come back.
What to do when someone is overdosing?
We aren’t doctors, so make sure you ask a medical professional for advice on the proper way to proceed. This is advice based on research but is no guarantee to save a life. Sometimes horrible things happen and we arrive too late. This is an educated strategy that will hopefully mitigate the consequences of heroin overdose. The best prevention is absence.
- Call emergency services immediately
Don’t worry about getting them in trouble. I’m sure they would rather be alive and getting help than dead.
- Naloxone (Narcan)
Naloxone comes as an auto-injector, Evzio® it’s a fast-acting opioid block that reverses the effects of opioid overdose. It’s injected into a muscle (the thigh, butt, or arm muscle) or under the skin. Narcan® is naloxone as a nasal spray, the tip is pressed into a person’s nose and released. This is for emergencies only and an ambulance must still be called.
Final thoughts
It’s a terrible reality in today’s world things like heroin and other opioids need to exist. At times it’s true a doctor will deem certain opioids necessary and it’s not my place to argue. It breaks my heart to see people afflicted with addiction and it’s so powerful that they really don’t know how to stop. Addiction can be a lonely road for many, and isolation seems to make things worse.
I hoped today to at least bring a little light to the heroin problem plaguing our country, poisoning our fellow citizens. I wanted to show you some ways you can spot the symptoms, see what a loved one is going through, so you can prevent an overdose from ever happening in the first place. There are treatment centers in every major city and most smaller communities as well. There are many people out there who have been through it and fought their way from the bottom, out of the mud. Back into daylight. They can help guide and nurture that living spirit back into addicts and many one day we can beat heroin addiction once and for all.
References & Resources
- https://www.drugabuse.gov/publications/research-reports/prescription-opioids-heroin/prescription-opioid-use-risk-factor-heroin-use
- https://www.cdc.gov/drugoverdose/data/statedeaths.html
- https://medlineplus.gov/ency/article/007313.htm
- https://www.cdc.gov/drugoverdose/index.html
- https://www.dea.gov/factsheets/heroin
- https://pubmed.ncbi.nlm.nih.gov/21448097/