The abuse of heroin has been steadily increasing in recent years.
At present, there are between 2 and 4 million users of heroin in Europe and North America.
Recent scientific data from the US suggests that approximately 4.2 million Americans over the age of 12 have tried heroin at least once.
This is cause for grave concern considering estimations that up to 23% of people who use heroin eventually become addicted, and considering the harmful consequences associated with heroin addiction.
For example, heroin-related fatalities increased by just under 400% between 2010 and 2017, partially due to the increasingly popular practice of adding powerful adulterants like fentanyl to heroin.
In 2017 alone, approximately 15,000 people died from a heroin-related overdose in the U.S.
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Heroin is a semi-synthetic recreational street drug that is synthesised from the opium poppy plant and morphine.
Also known as diacetylmorphine or diamorphine, heroin belongs to the opioid family of drugs that are primarily used to relieve pain and induce anaesthesia.
When ingested, heroin binds to pain receptors and other receptors that are associated with reward.
When heroin binds to this reward pathway, it triggers the release of a chemical messenger called dopamine which causes feelings of intense euphoria, happiness, and relaxation.
Heroin is a highly addictive drug as a consequence of these short-term pleasant effects.
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Heroin is most often administered via the following three routes:
Heroin can be injected into a vein (intravenous injection), into a muscle (intramuscular injection), or under the skin (subcutaneous injection).
Injecting is the most efficient method of administration, meaning that heroin goes immediately into the bloodstream, quickly making its way to the brain.
Smoking heroin often referred to as “chasing the dragon”, involves heating heroin up on a piece of aluminium foil and inhaling the vapour that is produced.
Snorting heroin, on the other hand, involves merely snorting the white powdered form of heroin through the nose.
Method of administration can determine how quickly a person transitions to using the drug daily.
A recent study showed that people who injected heroin on their first occasion of use were 4 times more likely to have started using the drug daily within 4 weeks.
Injecting heroin is also considered the most harmful method of administration.
The high bioavailability and rapid onset of injected heroin make users more susceptible to overdose, addiction, and contracting blood-borne viruses.
Heroin is not absorbed as quickly when it is smoked or snorted, and the effects are not as intense.
The maximum intensity high after injecting heroin can last for hours, as opposed to minutes when people smoke or snort heroin.
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There are several reasons why someone might decide to experiment with heroin.
It is important to understand that heroin can be a very effective reliever of physical and emotional pain.
Although this reprieve is relatively short-lived, many people become addicted and continue to use heroin despite its well-established harmful side effects.
The three most common reasons for heroin abuse are explored further below.
Interestingly, medical and subsequent non-medical use of prescription opioids can lead to heroin abuse.
Heroin abuse has increased significantly among people using prescription opioids non-medically in particular.
In 2014, 10.3 million people in the United States said that they had used prescription opioids for non-medical reasons.
People who use prescription opioids start by administering them orally, before moving on to more efficient methods like snorting, smoking, or injecting.
Eventually, people who misuse prescription opioids such as oxycodone, hydrocodone, and morphine start to develop a tolerance and switch to the much more powerful and cost-effective option in heroin.
Overprescribing prescription opioids has seen a huge increase in the number of people presenting at emergency departments with medical complications.
However, attempts to combat over-prescribing have led to an increase in heroin use and related deaths.
Studies suggest that people who have previously used non-medical prescription opioids may be up to 19 times more likely to initiate heroin use than people with no previous non-medical use.
Up to 86% of people who inject heroin have used prescription opioids non-medically before initiating their heroin use.
It has been estimated that heroin use has increased by approximately 140% among nonmedical users of prescription opioids.
Of course, transitioning from prescription opioids to heroin carries with it significant risks considering the uncertainty surrounding street heroin’s actual contents.
Environmental factors can also play a role in heroin use.
Environmental risk factors that have been associated with heroin use include:
Regarding family attitudes, a person who is reared in a household where drugs are regularly used as a means of dealing with emotional distress may learn that this is the normal way to manage negative emotions.
Conduct issues in childhood have also been associated with future heroin use. The more conduct-related problems you experience in childhood, the more likely you are to initiate heroin use later in life.
Genetics also play a substantial role in an individual’s choice to begin using heroin.
The consensus among the scientific community, having gathered data from adoption, twin, and family studies, is that genetic factors account for between 40% and 60% of a person’s vulnerability to substance abuse.
For instance, depression and drug abuse in parents are both major risk factors for addiction.
Interestingly, genetic risk factors play more of a role in persistent drug abuse among women, whereas environmental risk factors have more of an influence on the persistence of drug abuse in men.
People often use heroin in attempts to self-medicate for psychological issues and painful negative emotions.
Self-treatment efforts offer short-term relief and enables people to exist somewhat peacefully in an otherwise bleak world.
However, this psychological and emotional reprieve experienced is temporary, and the long-term effects of drug abuse can be extremely detrimental.
Victims of a traumatic event or abuse in childhood may turn to illicit drugs like heroin in an attempt to relieve their emotional distress and regulate their mood.
This is understandable considering the effectiveness of drugs like heroin to alleviate, suppress, and/or numb feelings of extreme distress that might otherwise prevent people from coping in the world.
Clinical and epidemiological evidence has shown a very high prevalence of psychiatric problems in childhood among heroin users, indicating the presence of two co-occurring, apparently separate, conditions.
It seems there is an overlap of the same or at least very similar issues concerning the association between negative emotional states like depression and heroin use.
People who use drugs of abuse are often:
Evidence from studies investigating the relationship between drug abuse and psychological health suggests that drug abuse use is not a cause of personal and social maladjustment, but a symptom.
Further, drug abuse can be properly understood only when personality type and developmental history are considered.
Major depression, which occurs quite frequently in adolescents, is associated with heroin abuse and addiction.
Not only that, but major depression usually precedes problem drug use and is seen as an important risk factor for addiction as a consequence.
It is suggested that preventative programmes to reduce drug abuse are erroneous. Such programmes tend to focus on symptoms of drug abuse rather than the underlying psychological causes.
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After a user injects heroin, they experience an immediate “rush” of intensely pleasurable sensations, initiating a feeling of well-being and relaxation.
The central nervous system depressant effects of heroin may slow down breathing and sedate users in what is referred to as “being on the nod”.
The euphoriant activity of heroin also helps people to temporarily deal with physical and emotional distress, but in fact will exacerbate distress long-term.
Heroin affects people differently depending on a number of factors including:
Short-term mental effects of heroin include:
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Continued use of heroin can cause a whole host of changes in the way the brain functions.
Some of the most harmful consequences of long-term heroin use include reduced grey and white matter, stroke, and depression. These long-term effects are explored further below.
Neuroanatomical studies have examined reductions in grey and white matter density in the brains of people addicted to heroin.
Specifically, reductions have been seen in brain areas responsible for cognitive control, recognising sound and language, emotional processing and behaviour regulation.
Notably, there is evidence to suggest that gray matter density can return to normal after a period of abstinence from heroin.
Leukoencephalopathy is the term used to describe all diseases of the brain’s white matter.
Both injected heroin and inhalation of heroin vapour have been associated with the degeneration of white matter cells found beneath the cerebral cortex.
Injury to and loss of the brain’s connecting nerve fibres called axons as a consequence of inhaling heroin vapour can be fatal.
This demonstrates the extreme dangers associated with long-term heroin abuse.
Heroin abuse has been associated with an increased risk of sustaining an ischemic stroke characterised by a loss of blood flow to the brain.
Heroin can cause blood vessels to contract, which in turn causes the narrowing of arteries and a reduction of blood flow.
Ischemic stroke can also be caused by the inflammatory effects of heroin on blood vessels, or by the formation of blood clots which are a consequence of intravenous heroin use.
People that use heroin have substantially higher mortality rates than the general population.
Estimates of increased risk of death range from 2.4 times to over 50 times.
The proportion of these deaths among heroin users that can be attributed to suicide ranges between 3% and 10% on average, indicating 14 times increased risk of dying by suicide than the general community.
The longer a person has been using heroin, the more likely they are to attempt and complete suicide. Although heroin use in and of itself is a risk factor for suicide, heroin addiction increases the risk.
Depression among heroin users is a significant risk factor for suicide. Studies show that between 25 and 35% of heroin users meet the criteria for a diagnosis of major depression, which is significantly higher than levels seen in the general population.
Some of these studies suggest that up to 40% of heroin users attempt suicide at least once in their lives.
However, psychosocial factors like isolation and dysfunction have also been associated with attempted suicide among heroin users, so heroin use alone cannot be solely attributed.
Mortality studies have shown that female heroin users are more likely to attempt suicide, whereas male users of heroin are more likely to complete suicide.
People who regularly use heroin over a prolonged period may also experience some of the following long-term mental effects:
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The severity of heroin withdrawal changes from person to person, largely because it is dependent on several factors related to heroin use.
These factors include:
The above factors determine not only how physically and psychologically addicted a heroin user may become, but also how severe their withdrawal symptoms will be.
Additional factors that may impact dependence and withdrawal are the presence of comorbidities and prior experience of heroin withdrawal.
Heroin is a fast-acting drug, which means that its onset of action is relatively rapid, but so too is the speed at which it exits the bloodstream.
Heroin has a short half-life of approximately 30 minutes, meaning that withdrawal symptoms are quick to set in, often beginning just 6 hours after a person last used, and usually lasting for between 5 and 10 days.
The symptoms of heroin withdrawal are quite the opposite of the pleasant, euphoric sensations synonymous with the heroin rush.
Psychological effects of heroin withdrawal may include:
Ordinarily, heroin withdrawal is not life-threatening.
However, exacerbation of psychological withdrawal symptoms like depression could end up being life-threatening, for instance by manifesting into suicidal ideation.
That is why professional treatment is always recommended for people who wish to recover from addiction.
Expert medical care provided by trained professionals at rehabilitation centres gives patients the best possible chance of successfully navigating and triumphing over heroin withdrawal and all that goes with it.
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After admission to rehab, patients go through detox with the assistance of medication.
Medications make the detoxification process considerably easier and safer.
Methadone, Buprenorphine, Suboxone and Naltrexone are the drugs most commonly used to treat heroin withdrawal and maintain abstinence.
Each of these drugs binds to the same opioid receptors associated with heroin use, however they work in different ways.
For instance, Buprenorphine and methadone are opioid receptor agonists, meaning they induce similar effects to heroin, but effects that are considerably less intense and much longer-lasting.
Suboxone and naltrexone on the other hand are opioid receptor antagonists, meaning they completely shut off the effects of opioids like heroin.
Methadone, which is typically administered in pill form, stays in the bloodstream for an average of 24 hours, working to reduce withdrawal symptoms and heroin cravings.
Methadone does have addiction potential, however, so caution should be taken with its use.
Buprenorphine has a half-life of 37 hours and reaches a plateau after a certain amount has been administered.
This means that buprenorphine has a lower potential for abuse, addiction, or overdose than methadone.
One study reported 1-year abstinence in 75% of patients being treated with buprenorphine for heroin addiction.
Once all traces of dangerous toxins and trace amounts of heroin have been successfully eliminated from the body, patients have the option to engage in several intensive therapy treatment options to ensure that the initial causes for their use do not resurface.
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Heroin can be a force that utterly ruins lives, but it doesn’t have to be.
If you or a loved one of yours is suffering from heroin addiction, the key towards a better life lies in getting help.
That is what our team is here to do.
We will help you find the best possible heroin rehab services for your needs, making sure that you get the ideal help to overcome addiction once and for all.
Call our experts today on 0800 140 4690 and begin your journey towards a better life.
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
