Heroin information, use, testing and treatment

Years ago, thoughts of using a needle kept many potential heroin users at bay. Not anymore. Today's heroin is so pure users can smoke it or snort it, causing more kids under 18 to use it. Kids who snort or smoke heroin face the same high risk of overdose and death that haunts intravenous users. Yet 40% of high school seniors polled do not believe there is great risk in trying heroin.

Recent studies suggest a shift from injecting to snorting or smoking heroin because of increased purity and the misconception that these forms of use will not lead to addiction.

Heroin is processed from morphine, a naturally occurring substance extracted from the seed-pod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names associated with heroin include "smack," "H," "skag," and "junk." Other names may refer to types of heroin produced in a specific geographical area, such as "Mexican black tar."

The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system.

Reports from the Drug Abuse Warning Networks (DAWN) Annual Medical Examiner Data from 1997 show that heroin/morphine was the top-ranking drug among drug-related deaths in 14 US major metro areas. It ranked second in another eight.

According to DAWN’s Year End 1998 Emergency Department Data, 14 percent of all emergency department drug-related episodes had mentions of heroin/morphine in 1998. From 1991-1996, the number of heroin/morphine mentions more than doubled.

Heroin Health Hazards

Irreversible effects. Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and infectious diseases, including HIV/AIDS and hepatitis.

Long-term effects. Long-term effects of heroin include collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration.

Infection. In addition to the effects of the drug itself, street heroin may have additives that do not readily 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.

A) Heroin is an illegal, highly addictive, opiate drug. Its abuse is more widespread than any other opiate. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder, or as the black sticky substance known on the streets as "black tar heroin." Although purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.

A) Heroin enters the brain, where it is converted to morphine and binds to receptors known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem—important for automatic processes critical for life, such as breathing, blood pressure, and arousal. Heroin overdoses frequently involve a suppression of respiration.

After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, and a heaviness of the extremities. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Mental functioning becomes clouded. Users who do not inject the drug may not experience the initial rush, but other effects are the same.

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity of effect. Eventually, chemical changes in the brain can lead to addiction.

A) Opium, Morphine, Codeine, Merperidine , Hydrocodone (Lortab, Vicodin), Oxycodone (Percodan, Roxicet, Roxiprin, Tylox, Percocet), Stadol, Talwin, Dilaudid, Fentanyl, Buprenorphine, Methadone, Propoxyphene (Wygesic, Darvocet)

A) Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while musculature injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

Injection continues to be the main method of use among heroin addicts; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now a widely reported means of taking heroin among users admitted for drug treatment in Newark, Chicago, New York, and Detroit.

With the shift in heroin abuse patterns comes an even more diverse group of users. Older users (over 30) continue to be one of the largest user groups in most national data. However, several sources indicate an increase in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been appearing in more affluent communities.

A) Most heroin originates from opium poppy farms in SE Asia (the "Golden Triangle": Myanmar, Laos, and Thailand), SW Asia (primarily Afghanistan, Pakistan, and Iran), Lebanon, Guatemala, and Mexico. The opium gum is converted to morphine in labs near the fields and then to heroin in labs within or near the producing country. After importation, drug dealers cut, or dilute, the heroin (1 part heroin to 9 to 99 parts dilutor) with sugars, starch, or powdered milk before selling it to addicts. Quinine is also added to imitate the bitter taste of heroin so the addict cannot tell how much heroin is actually present. It is sold in single-dose bags of 0.1 gram (0.03 oz.), each costing between $5 and $46 (1992). One pound of diluted heroin yields approximately 4,500 doses.

A) Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching.

After the initial effects, abusers usually will be drowsy for several hours. Mental function is clouded by heroin's effect on the central nervous system. Cardiac functions slow. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot be accurately known.

A) One of the most detrimental long-term effects of heroin is heroin addiction itself. Addiction is a chronic problem characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces a profound degree of tolerance and physical dependence, which are powerful motivating factors for compulsive use and abuse. As with abusers of any addictive drug, heroin addicts gradually spend more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers' primary purpose in life becomes seeking and using drugs. The drugs literally change their brains.

Physical dependence develops with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the fetus of a pregnant addict.

At some point during continuous heroin use, a person can become addicted to the drug. Sometimes addicted individuals will endure many of the withdrawal symptoms to reduce their tolerance for the drug so that they can again experience the rush.

Physical dependence and the emergence of withdrawal symptoms were once believed to be the key features of heroin addiction. We now know this may not be the case entirely, since craving and relapse can occur weeks and months after withdrawal symptoms are long gone. We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict.

A) Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin's depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily 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. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

One of the greatest risks of being a heroin addict is death from heroin overdose. Each year about one percent of all heroin addicts in the United States die from an overdose of heroin despite having developed a fantastic tolerance to the effects of the drug. In a non-tolerant person the estimated lethal dose of heroin may range from 200 to 500 mg, but addicts have tolerated doses as high as 1800 mg without even being sick.

Q) Are heroin users at special risk for contracting HIV/AIDS and hepatitis B and C?

A) Because many heroin addicts often share needles and other injection equipment, they are at special risk of contracting HIV and other infectious diseases. Infection of injection drug users with HIV is spread primarily through reuse of contaminated syringes and needles or other paraphernalia by more than one person, as well as through unprotected sexual intercourse with HIV-infected individuals. For nearly one-third of Americans infected with HIV, injection drug use is a risk factor. In fact, drug abuse is the fastest growing vector for the spread of HIV in the Nation.

Research has found that drug abusers can change the behaviors that put them at risk for contracting HIV, through drug abuse treatment, prevention, and community-based outreach programs. They can eliminate drug use, drug-related risk behaviors such as needle sharing, unsafe sexual practices, and in turn the risk of exposure to HIV/AIDS and other infectious diseases. Drug abuse prevention and treatment are highly effective in preventing the spread of HIV.

A) Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, and—particularly in users who inject the drug—infectious diseases, including HIV/AIDS and hepatitis. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the abuser, as well as from heroin’s depressing effects on respiration. In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog the blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.

Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, they may experience severe symptoms of withdrawal. These symptoms, which can begin as early as a few hours after the last drug administration, include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), kicking movements (“kicking the habit”), and other symptoms. Users also experience severe craving for the drug during withdrawal, precipitating continued abuse and/or relapse. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and typically subside after about a week; however, some individuals may show persistent withdrawal symptoms for months. Although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal, sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal.

Heroin abuse during pregnancy, together with related factors like poor nutrition and inadequate prenatal care, has been associated with adverse consequences including low birth weight, an important risk factor for later developmental delay. If the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from serious medical complications requiring hospitalization.

A) Heroin abuse can cause serious complications during pregnancy, including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome), as well.

A) With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

A) Heroin addiction like all opiate addictions occurs when heroin is administered over a sustained period of time. The onset of heroin addiction can be both rapid and severe, dependent on the amount used and frequency in a designated period of time. Heroin addicts will "crave" more of the drug and experience withdrawal symptoms if they do not get their regular "fix" or dose. Not all of the mechanisms by which heroin and other opiates affect the brain are known. Likewise, the exact brain mechanisms that cause tolerance and addiction are not completely understood. Heroin stimulates a "pleasure system" in the brain. This system involves neurons in the mid-brain that use the neurotransmitter called "dopamine." These mid-brain dopamine neurons project to another structure called the nucleus accumbens which then projects to the cerebral cortex. This system is responsible for the pleasurable effects of heroin and for the addictive power of the drug.

A) According to the 2007 Monitoring the Future survey, there were no significant changes since 2006 in the proportion of students in 8th, 10th, and 12th grades reporting lifetime,2 past-year, and past month use of heroin overall.

Heroin use has been steadily declining since the mid-1990s. Recent peaks in heroin use were observed in 1996 for 8th-graders, 1997–2000 for 10thgraders, and 2000 for 12th-graders. Annual prevalence of heroin use in 2007 dropped significantly, by between 38 percent and 40 percent, from these recent peak use years for each grade surveyed.

*Heroin Use by Students* *2007 Monitoring the Future Survey*
	8th Grade	10th Grade	12th Grade
Lifetime	1.3%	1.5%	1.5%
Past Year	0.8	0.8	0.9
Past Month	0.4	0.4	0.4

According to the 2006 National Survey on Drug Use and Health, the number of current (past-month) heroin users in the United States increased from 136,000 in 2005 to 338,000 in 2006. The corresponding prevalence rate increased from 0.06 to 0.14 percent. There were 91,000 first-time users of heroin aged 12 or older in 2006, down from 108,000 reported in 2005. Among persons aged 12 to 49, the average age at first use of heroin was 20.7 years.

A) A range of treatments exist for heroin addiction, including medications and behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop using heroin (or other opiates) and return to stable and productive lives.

Treatment often begins with medically assisted detoxification, to help patients withdraw from the drug safely. Medications such as clonidine and, now, buprenorphine can be used to help minimize symptoms of withdrawal. However, detoxification alone is not treatment and has not been shown to be effective in preventing relapse—it is merely the first step.

• Methadone, which has been used for more than 30 years to treat heroin addiction. It is a synthetic opiate medication that binds to the same receptors as heroin; but when taken orally, as dispensed, it has a gradual onset of action and sustained effects, reducing the desire for other opioid drugs while preventing withdrawal symptoms. Properly prescribed methadone is not intoxicating or sedating, and its effects do not interfere with ordinary daily activities. At the present time, methadone is only available through specialized opiate treatment programs.

• Buprenorphine is a more recently approved treatment for heroin addiction (and other opiates). It differs from methadone in having less risk for overdose and withdrawal effects, and importantly, it can be prescribed in the privacy of a doctor’s office.

• Naltrexone is approved for treating heroin addiction but has not been widely utilized because of compliance issues. It is an opioid receptor blocker, which has been shown to be effective in highly motivated patients. It should only be used in patients who have already been detoxified in order to prevent severe withdrawal symptoms. Naloxone is a shorter acting opioid receptor blocker, used to treat cases of overdose.

For pregnant heroin abusers, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. Preliminary evidence suggests that buprenorphine also is a safe and effective treatment during pregnancy, although infants exposed to either methadone or buprenorphine prenatally may require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with medical supervision, although potential risks to the fetus and the likelihood of relapse to heroin use should be considered.

There are many effective behavioral treatments available for heroin addiction— usually in combination with medication. These can be delivered in residential or outpatient settings. Examples are: contingency management, which uses a voucher-based system where patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living; and cognitive-behavioral therapy, designed to help modify a patient’s expectations and behaviors related to drug abuse, and to increase skills in coping with various life stressors.

A) Heroin Withdrawal symptoms are some of the nastiest an addict can experience compared to withdrawal from any other drug. The individual who has become physically as well as psychologically dependent on heroin will experience heroin withdrawal with an abrupt discontinuation of use or even a decrease in their daily amount of heroin intake. The onset of heroin withdrawal symptoms begins six to eight hours after the last dose is administrated. Major heroin withdrawal symptoms peak between 48 and 72 hours after the last dose of heroin and subdue after about one week. The symptoms of heroin withdrawal produced are similar to a bad case of the flu.

dilated pupils	watery eyes
piloerection (goose bumps)	runny nose
loss of appetite	yawning
muscle cramps	tremors
insomnia	panic
stomach cramps	chills
nausea	diarrhea
chills or profuse sweating	vomiting
shaking	jitteriness
irritability

A) Heroin works on the central nervous system. The abusers heartbeat slows as well as their breathing. They may lose consciousness. Any of these effects can be fatal if the dose is too high. Depending on purity and tolerance, a lethal dose of heroin may range from 200 to 500mg, but hardened addicts have survived doses of 1800mg and over. However, with street heroin there is no absolutely certain "safe dosage". It depends on tolerance, amount, and purity of the drug. Overdose can occur when a dose taken is greater than that you're used to. A tolerable dose for an addict could be fatal to a first-time user. Tolerance to heroin is quickly acquired. Even occasional weekend users need to take more to get the same effect over time. Tolerance can also drop if it the drug is not used for a period of time. Some users have overdosed on their 'regular dose, after just a few weeks break.

Q) How do you stop using heroin forever without becoming addicted to drug substitutes such as methadone?

A) The majority of treatment programs in the United States utilize the 12 steps derived from the Alcoholics Anonymous and Narcotics Anonymous programs as their foundation. In the past, the 12 step philosophy was combined with inpatient treatment in a hospital setting for a period of at least 28 days. Addicts would attend AA or NA meetings while receiving group therapy. Unfortunately, this model proved to be less than successful and the insurance industry has become unwilling to pay for extended stays. The current trend is to admit someone with a heroin problem to a hospital just long enough to get them through the worst of the physical withdrawal and then to send them to outpatient counseling. This method of treating heroin addiction is the most widely used and also the least successful. There is an alternate and more successful approach. The addiction starts with a person who has dealt with a sense of hopelessness, which as it turns out caused the person to start using heroin in the first place. This program utilizes unique therapeutic training drills and instructional courses which address the underlying causes of addiction in an intensive manner and from many different angles. The individual, in most cases, no longer feels the need to use heroin or any other drugs after completing the program.

A) Heroin detoxification is paramount to a successful recovery. If residue from heroin continues to exist in the addict’s body, cravings for heroin will arise and withdrawal symptoms persist. The goal of heroin detoxification is to ultimately eliminate the drug, and all its metabolites from the body to increase the chance of a successful recovery. The human body will eventually expel the remaining heroin residue through urination and sweating. There are scientifically proven methods to expedite the detoxification process, which in turn, makes for a faster and easier recovery.

A) Heroin Addiction Recovery is similar to the recovery of most addictive drugs, except that heroin addiction withdrawal can last several weeks to months. Attempting heroin addiction detoxification without professional assistance is not only dangerous, but sometimes deadly. Heroin addiction withdrawal can cause serious physical and emotional trauma including stroke, heart attack, and even death. Methadone is often used to ease heroin withdrawal, though this typically ends with the individual acquiring an addiction to another drug. Recovery from heroin addiction involves detoxification as the initial step. Secondly, the individual needs to be willing to participate in a rehabilitation program and continually exert themselves daily throughout their heroin addiction rehabilitation program. The highest documented success rates for heroin addiction recovery are through long term drug rehabilitation treatment lasting at least 3 to 6 months. This gives structure and support to provide long term recovery from heroin addiction.

A) Heroin use has long been associated with crime because its importation and distribution are illegal. Many addicted people turn to theft and prostitution to obtain money to buy the drug. In addition, violent competition between drug dealers has resulted in many murders and the deaths of innocent bystanders. From 1979 through 1990 arrests for heroin manufacture, sale, or possession in the United States held steady In the 1990s, arrests rose as the drug's popularity began to increase once more. The heroin trade can be enormously lucrative to those in the upper echelons. For decades the Mafia has been involved in heroin trafficking operations, including the "French Connection" of the 1950s and 1960s and the more recent "Pizza Connection," which used pizza parlors as fronts. Other trafficking groups are more loosely based on ethnic or national ties; for example, groups of Chinese, Thai, Nigerian, or Mexican nationals have operated in different parts of the country. In contrast to those in the higher tiers, many dealers on the street level are addicted or imprisoned frequently, and their financial gains are limited. U.S. laws and law enforcement efforts focus on interrupting the flow of heroin into the country as well as the arrest of distributors and persons who commit crimes to support their habits.

A) Heroin, (an opium derivative) is unfortunately a very popular choice of drug in the American culture today. The drug didn’t just "show up" in the late 1960’s. Beginning in the late 1800’s opium was rather popular. They had opium dens scattered throughout the "wild west". It arrived here via Chinese immigrants that came to work on the railroads. Instead of belling up to the bar drinking whiskey, the cowhand was in a prone position in a candle lit dim room smoking opium. It wasn’t uncommon for cowhands to spend several days & nights at the den eventually becoming physically addicted to the drug. However, at the time alcoholism was a bigger problem.

From the late 1800’s to the early 1900’s the reputable drug companies of the day began manufacturing over the counter drug kits. These kits contained a glass barreled hypodermic needle and vials of opiates (morphine or heroin) and/or cocaine packaged neatly in attractive, engraved, tin cases. Laudanum (opium in an alcohol base) was also a very popular elixir that was used to treat a variety of ills. Laudanum was administered to kids and adults alike - as freely as aspirin is used today.

Heroin, morphine, and other opiate derivatives were unregulated and sold legally in the United States until 1920 when Congress recognized the danger of these drugs and enacted the Dangerous Drug Act. This new law made over-the-counter purchase of these drugs illegal and deemed that their distribution be federally regulated. By the time this law was passed, however, it was already too late. A market for heroin in the U.S. had been created. By 1925 there were and estimated 200,000 heroin addicts in the country. It was a market which would persist until this day.

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