Overview of Heroin Use and Abuse
Heroin is an opiate that can be injected, snorted, or smoked.
The effects of heroin include euphoria, warm flushing of the skin, a heavy sensation in the arms and legs, and slowed breathing.
Signs and symptoms of addiction include tolerance, using to avoid withdrawal symptoms, and giving up social, occupational, or recreational activities to use heroin.
Heroin overdose deaths dramatically increased from 2001 to 2014.
Heroin is very addictive and often requires treatment to stop .
Because of the potential intensity of withdrawal, those attempting to quit heroin should consider medical supervision during detox and beyond.
What Is Heroin?
Heroin belongs to a class of drugs known as opiates, which have been used for thousands of years for both recreational and medicinal purposes.1
Heroin addiction kills thousands of people across the United States each year and is a growing problem. It was initially viewed as a low-income, inner-city problem. But now it has spread to middle-class, suburban communities as well as all other neighborhoods and demographics.3
- Black tar
- Brown sugar
- China white
- Mexican brown
- Number 2
- Number 8
How Is It Used?
Heroin can be injected into the veins, snorted, or smoked. It is often sold on the street as a black tar-like substance or brownish powder and less commonly found in a more pure, white powder form.15
Substances Added to Heroin
Heroin is rarely sold in its pure form and may contain additives such as:
Sugar or sugar substitutes.
Quinine (an anti-malaria drug).
Strychnine (a poisonous pesticide).
Fentanyl (a powerful synthetic narcotic pain reliever).
Phenobarbital (an anti-seizure medication).
Methaqualone (once marketed as Quaalude, a sedative medication).
Procaine (an anesthetic).
Heroin binds to and activates the brain's mu-opioid receptors. The activation of these receptors stimulates the release of dopamine, a neurotransmitter that controls sensations of pleasure. 4, 5, 15
Heroin's effects last 2-5 hours. If heroin is injected, the effects usually occur within 20 seconds. If heroin is smoked, the peak onset of effects will take place about 10 minutes after it is smoked. 1
Effects of heroin include:
- Decreased pain.
- Dry mouth.
- Constricted pupils.
- Skin itching.
- Nausea and vomiting.
Signs and Symptoms of Addiction
Addiction isn't always easy to recognize. Symptoms of a heroin addiction may include:
Taking the substance in larger amounts or for longer than you meant to.
Wanting to cut down or stop using heroin, but being unable to.
Spending a lot of time getting, using, or recovering from the use of heroin.
Cravings and urges to use heroin.
Failure to meet obligations at work, home, or school because of heroin use. 12
Withdrawal from heroin can lead to a number of symptoms, including:
Muscle aches. 12
Overdose Symptoms and Risks
Overdose risk is increased when the drug is mixed with other substances. Alcohol is the most commonly co-abused substance, followed by benzodiazepines (e.g., Valium , Xanax ), cocaine, and amphetamines.
Additionally, the presence of substances - including fentanyl - in some batches of heroin can markedly increase the chances of overdose in unsuspecting users.
If you suspect someone has overdosed on heroin, you should call 911. Without emergency medical treatment, a heroin overdose can lead to death. A person who has overdosed on heroin may need respiratory support, IV fluids, and emergency medication such as naloxone , which reverses the effects of opiates like heroin. 2
Symptoms of Heroin Overdose
Shallow or stopped breathing.
Pinpoint pupils, unreactive to light stimuli. 22
How Heroin Abuse Is Treated
The treatment of heroin addiction consists of:
The combination of these methods provides the recovering heroin addict a foundation for staying sober, saying no to heroin and other drugs, and taking control of his or her life.
Medications Used in Treatment
The most commonly used medications for the treatment of heroin addiction are the following:
Methadone , which has been used to treat heroin addiction since the 1960s and was previously the only medication available for the treatment of heroin addiction.
Buprenorphine , which was approved by the U.S. Food and Drug Administration in 2002.
These medications are synthetic opioids that mimic the effects of heroin. They are stabilizing and, in some cases, maintenance drugs for heroin addicts - beneficial for both treatment retention rates of addicts as well as overall reduction of heroin use .
Replacement therapy is not always a short-term solution for heroin addiction; people will sometimes require years of medication treatment to maintain sobriety.7
Heroin Addiction Recovery Options and How to Pay for Treatment
How to Find the Best
Finding the best heroin recovery program means looking at a couple of important factors and learning more about what to expect out of heroin treatment.
It's crucial that you research the process of heroin treatment. You or your loved one will be more likely to get the most out of your rehab experience and increase your chance of long-term sobriety if you know what to look for and what to expect.
Treatment Cost and How to Pay
The cost of a heroin rehabilitation will depend on a number of different things:
The type of program.
How much your insurance will cover.
Whether you have insurance or not.
What kind of amenities the facility has.
Where the program is located.
Below are insurance considerations:
If you do not have insurance. Contact the Substance Abuse and Mental Health Services Administration's toll-free helpline to learn more about finding a rehab program without insurance. If you don't have insurance, don't worry. Many treatment centers offer payment plans or only require you to pay what you realistically can.
Heroin Recovery Options
Heroin addiction can be very dangerous and present with a number of maladaptive behaviors. When looking for treatment, some options are as follows:
Dual diagnosis treatment facilities . You participate in an integrated treatment program that helps you recover from an addiction and co-occurring mental or physical health problems.
12-step programs . You gather with other people who are in recovery to share experiences and work with a sponsor through a series of recovery steps.
Inpatient or residential rehabilitation centers . You live at the treatment center while going through a structured program that includes detox, group and individual therapy, and possibly 12-step meetings.
Outpatient rehabilitation centers . You live at home while going to a treatment facility a few days a week for a few hours at a time.
Current users. Nearly 830,000 people aged 12 or older reported past-year heroin use in 2015, similar to previous years. Past-month use has also remained steady, with 329,000 people reporting heroin use in the past 30 days at the time of survey.18
Addictiveness. The Wisconsin Medical Journal reports 53% of individuals who have ever used heroin become addicted, as opposed to 11% of alcohol users and 15% of marijuana users. 6
Addiction rate. In 2015, 591,000 people struggled with a heroin use disorder in 2015, similar to previous years.18
Death rate. Despite relatively stable use rates, the National Institute on Drug Abuse reports that from 2001 to 2014, there was a6-fold increase in the total number of heroin overdose deaths. More than 10,500 heroin overdose deaths were reported in 2014.13
Suicide. Heroin users have a death rate 13-17 times that of their age-matched peers and a 14-fold risk of suicide.6
Emergency department visits. In 2011, heroin was the third-most-common illicit substance involved in emergency department visits.21
Gender. Heroin abuse does not seem to show an effect of gender, with similar abuse rates for both men and women.19
Teen Heroin Statistics
In 2015, the annual Monitoring the Future Study reported the following statistics on teen heroin abuse:20
8th graders - 0.5% lifetime use, 0.3% past year use
10th graders - 0.7% lifetime, 0.5% past year
12th graders - 0.8% lifetime, 0.5% past year
Compared to 2014, these findings demonstrate a slight reduction in rates of heroin use, with the only statistically significant reduction occurring among 8th graders for both lifetime and past-year use. These findings may be indicative of the fact that many heroin users begin using the drug after their teenage years.11,14
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Image of Philip Seymour Hoffman by Georges Biard, via Wikimedia.
. Goldstein A. Heroin addiction: neurobiology, pharmacology, and policy. J Psychoactive Drugs 1991 Apr-Jun; 23 (2): 123-133.
. Boyer EW. Management of opioid analgesic overdose. N Engl J Med 2012; 367: 146-155.
. National Institute on Drug Abuse. January 2012. Epidemiologic Trends in Drug Abuse, in Proceedings of the Community Epidemiology Work Group . Bethesda, MD: National Institute on Drug Abuse, 66.
. Waldhoer M, Bartlett SE, Whistler JL. Opioid receptors. Annu Rev Biochem 2004; 73: 953-990.
. Johnson SW, North RA. Opioids excite dopamine neurons by hyperpolarization of local interneurons. J Neurosci 1992; 12 (2): 483-488.
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. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect 2002 Jul; 1 (1): 13-20.
. Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend 1999; 54 (2): 155-161.
. Darke S, Zador D. Fatal heroin 'overdose': a review. Addiction 1996 Dec; 91 (12): 1765-1972.
. Substance Abuse and Mental Health Services Administration (SAMHSA). 2015. Results from the 2014 National Survey on Drug Use and Health: Volume I. Summary of National Findings. Rockville, MD: Office of Applied Studies, SAMHSA.
. Miech, R. A., Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national survey results on drug use, 1975-2014: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 599 pp.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.
. National Institute on Drug Abuse. (2015). Overdose Death Rates .
. NIDA for Teens. Drug Facts: Heroin .
. National Institute on Drug Abuse. (2014). Heroin .
. National Institute on Drug Abuse. (2014). DrugFacts: Heroin .
. U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal . Medline Plus.
. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
. Substance Abuse and Mental Health Services Administration. (2014). The TEDS report: gender differences in primary substances of abuse across age groups .
. Johnston, L. D., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R. A. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Volume 2, College students and adults ages 19-55 . Ann Arbor: Institute for Social Research, The University of Michigan.
. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits . HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
. U.S. National Library of Medicine. (2015). Heroin overdose .
. Cole, C. et al. (2010). Cut: A Guide to Adulterants, Bulking agents and other contaminants found in illicit drugs . Liverpool John Moores University.
- Intensive partial and outpatient programs, independent living and mandatory after care
- Comprehensive Assessment Program that focuses on a compassionate advocacy-based evaluation
- A RiverMend Health recovery program
- Treats non-professionals as well.