What to Know About Heroin Use

Heroin is a highly addictive drug that is processed from morphine, which comes from the seedpod of the opium Asian poppy plant. Its use is a serious problem in the United States. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction.

Also Known As: Street Names for heroin include smack, H, ska, junk, big H, blacktar, brown sugar, dope, horse, mud, and skag.

Drug Class: Heroin is a depressant that inhibits the central nervous system.

Common Side Effects: Short-term side effects can include skin flushing, nausea, vomiting, severe itching, and dry mouth. The initial high is usually followed by extreme drowsiness and sometimes dangerously slowed respiratory function. Long-term side effects can include physical and physiological changes and imbalances in the brain that are very difficult to reverse.

Users who inject heroin will feel a euphoric surge or "rush" as it is often called. People often begin or continue using heroin because of the rush of happiness and positive feelings that come from the initial high. Following this period of euphoria, people often describe feeling like they are in a dream-like state where they feel safe and worry-free. The effects of heroin last three to four hours after each dose has been administered.

After years of declining use in the United States, in 2006 heroin use began to steadily increase across cultural and geographic lines throughout the country. The increase coincided with a nationwide crackdown on prescription drug use. Some observers believe the resulting declining supply and increasing prices of pain pills, namely opioids, drove users to turn to more available and cheaper heroin.

Between 2000 and 2014 the death rate from drug overdoses in the United States increased 137% and there was a 200% increase in the rate of overdose deaths involving opioid pain relievers and heroin, according to the Centers for Disease Control and Prevention (CDC).

The euphoric effects of heroin often lead people to use the drug as a way to self-treat stress, anxiety, or depression. However, the initial pleasant effects are usually followed by unpleasant or dangerous side effects. Continued heroin use may not only worsen symptoms of depression and anxiety, but it can also lead to other negative health and legal consequences.

In addition to the initial high, people who use heroin will experience physical side effects. Their mouths may become dry. They may begin to nod in and out, and their arms and legs will feel heavy and rubbery. They may also experience a diminished mental capacity and dulled emotions.

There are many health risks to using heroin. The short-term risks include fatal overdose and the high risk of infections such as HIV/AIDS. The long-term user has additional risks such as:

• Collapsed veins
• Infection of the heart lining and valves
• Abscesses
• Cellulitis
• Liver disease
• Pulmonary complications, including various types of pneumonia
• Overdose

Heroin use can also lead to additional health problems. Because heroin use depresses respiration, many users develop lung complications, which along with the general poor health of the user can result in contracting tuberculosis and some types of pneumonia.

Heroin abuse during pregnancy usually has adverse consequences including low birth weight, an important risk factor for a child's later development.

In addition to the effects of the drug itself, street heroin may have additives that fail to dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys or brain. This can cause infection or even death of small patches of cells in vital organs.

Heroin use is typically accompanied by significant and noticeable behavioral changes. Once addicted, people will often change everything about their life to center around continued heroin use. 

Some common signs that someone might be using heroin include:

• The presence of drug paraphernalia
• Mood changes
• Withdrawal from friends and loved ones
• The sudden appearance of new, mysterious friends
• Needle marks on the body
• Nosebleeds
• Weight loss
• Financial problems
• Secretiveness and lying
• Legal problems

One myth surrounding heroin is that it is primarily a drug used by younger people from lower socioeconomic backgrounds. The CDC reports that the greatest increase in heroin use in recent years is among women, the privately insured, and those with higher incomes.

Another persistent myth is that taking prescription opioid pain killers is a gateway to heroin use. The National Survey on Drug Use and Health found that most people who take opioids recreationally obtained them from non-prescription sources, which means that they were not prescribed to treat acute or chronic pain. And only a small proportion of these opioid users—around 4%—end up using heroin within a five year period.

Heroin use can result in tolerance to and dependence on the drug. When tolerance occurs, it means that people need more of the drug to achieve the same effect. Dependence means that people need to use heroin to prevent withdrawal symptoms.

Heroin can be injected into the veins, smoked, or snorted. It acts quickly and has an extremely fast half-life of just two to six minutes. How long the drug remains detectable in the body depends on a variety of factors including weight, metabolism, and the amount of the drug that was used. For light use, heroin remains in the system for a day or two. For heavy or chronic use, it may remain in the system for up to a week.

Once heroin enters the brain, the body converts it back to morphine and it binds to opioid receptors, located in many areas of the brain and body. The changes heroin causes in the brain are responsible for heroin's high risk for addiction and the chronic relapsing that may follow after treatment. 

Tolerance to heroin develops with regular use. This means it will take more heroin to produce the same level of intensity, which can result in developing a physical addiction over time. Once addicted, people will experience both physical and psychological reliance on the drug.

Heroin's increases the amount of dopamine and hijacks the brain's pleasure system. As increasing amounts of the drug are needed to achieve the same euphoric effects, it leads to a relentless pursuit of more frequent or more intense highs.

When the drug is discontinued, the user will experience physical withdrawal. The withdrawal can begin within a few hours since it was last administered.

Withdrawal symptoms include:

• Restlessness
• Insomnia
• Diarrhea
• Vomiting
• Cold flashes with goosebumps
• Kicking movements
• Muscle and bone pain

There are a range of treatment options for heroin addiction including medications and behavioral therapies. When medication treatment is combined with other supportive services, patients are often able to successfully stop using heroin.

Treatments include:

• Methadone: Methadone is a synthetic opiate that has a proven record of success for helping people addicted to heroin. The medication blocks the effects of heroin for around 24 hours.
• Buprenorphine: Buprenorphine is the most recent medication developed. It is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor's office.
• Naloxone and Naltrexone: Other approved medications include naloxone, which is used to treat cases of overdose, and naltrexone, which block the effects of morphine, heroin, and other opiates.
• Behavioral Treatment: There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient psychological care.