Heroin, also known as “dope,” “big H,” “black tar,” “chiva,” “hell dust,” “horse,” “smack,” “thunder,” and “negra,” is a highly-addictive “downer” or depressant that is derived from morphine, a legal drug acquired from the African poppy plant. Heroin is used in medicine to treat severe pain under the name “diamorphine;” and is only called “heroin” when referring to the illegal form of the drug.
As heroin is an opiate, which cause central nervous system depression leading to feelings of euphoria, it carries a very strong risk for physical dependence and addiction. Addiction is a chronic, relapsing disease that is caused by changes in the structure and function of the brain. It is also characterized by uncontrollable drug-seeking behaviors regardless of the negative consequences.
Heroin crosses the blood-brain barrier rapidly which increases the addiction potential of the drug. Rough estimates are that a quarter of all people who try heroin later become addicted and develop a tolerance, requiring more and more heroin to achieve the same high as initially experienced.
User preference dictates the manner in which heroin is abused. Heroin is often mainlined, meaning that it is injected into a vein or muscle. Heroin can also be smoked through a pipe, mixed with a marijuana joint, inhaled through a straw aka “chasing the dragon”, or snorted through the nasal passages.
As illegal street smack is not regulated by the FDA, it may be “cut” or mixed with any number of substances such as baby powder, starch, and strychnine. This means that a heroin addict will be unable to determine the purity of the dope or know precisely what substances they are consuming. This can greatly increase the number of ill-effects of the drug as well as increase the risks for overdose and death.
Co-Occurring Disorders
Many mental health disorders co-occur with addiction. These disorders can include:
- Depressive disorders
- Bipolar disorder
- Anxiety disorders
- Antisocial personality disorder
- Borderline personality disorder
- Conduct disorders
- Intermittent explosive disorder
Statistics
The lifetime prevalence of heroin addiction for individuals in the United States ages 12 and older is 1.6%, or 4.2 million Americans. Individuals between the ages of 12-17 have a prevalence of heroin abuse of approximately 0.3%, while individuals ages 18-25 have a much higher percentage at 1.7%. The highest age group likely to abuse heroin are ages 26 and older, at 1.8%. Estimates are that 23% of individuals who use heroin later become dependent upon it.
Causes
While there exist a number of theories about addiction and heroin abuse, it’s generally agreed upon that the cause for addiction is multi-factorial and not the result of a single root cause.
Genetic: Addiction has been shown to run in families. Those who have first-degree relatives with an addiction to heroin or other substances are at a higher risk for developing addictions.
Biological: The discovery of opiate receptors in the brain and their relationship with the messenger chemicals in the brain (i.e. enkelphalin and endorphins) may play a role in the development of addiction to heroin. Research has also unearthed marked disruptions in brain circuitry may underlie addiction.
Environmental: Growing up in a chaotic home environment in which one or more caregivers openly abused substances may lead to the development of an addiction to heroin.
Psychological: Many who struggle with addiction also struggle with mental illness and may use drugs to self-medicate the symptoms they experience. The continuing usage of heroin can quickly lead to addiction.
Symptoms
Short-Term Symptoms
The short-term symptoms of heroin abuse appear quickly after a single dose and dissipate after a few hours. The short-term effects of heroin abuse include:
- Rush, or feelings of euphoria
- Flushing of the skin
- Dry mouth
- Heavy extremities
- Wakeful/drowsiness cycle called “on the nod”
- Cloudy mental functioning
- Slurred and slowed speech
- Slowed movements
- Nausea and vomiting
- Droopy eyes
- Impaired night vision
- Constriction of the pupils
- Constipation
Long-Term Symptoms
The long-term symptoms of heroin appear after a person has repeatedly used heroin for a period of time and include:
- Tolerance
- Withdrawal symptoms
- Addiction
- Unsuccessful attempts to stop or curb heroin usage
- Spontaneous miscarriages
- Drug paraphilia
- Needle marks
- Chronically runny nose
- Weight loss
- Cravings
- Collapsed veins
- Abscesses
- Pericarditis
- Cellulitis
- Liver disease
- Pneumonia
- Respiratory depression
- Damage to major organ systems
- Death of areas of major systems
Effects of Heroin Addiction
Heroin and the substances that it is cut with destroys the body with repeated, prolonged use. Effects of heroin addiction include:
- Homelessness
- Poverty
- Legal problems
- Interpersonal relationship challenges
- Unemployment
- Collapsed veins
- Infections of the heart lining and valves
- Liver disease
- Lung disease
- Hepatitis
- HIV/AIDS
Withdrawal Effects
After an individual develops physical dependence and addiction to heroin, attempts to cut down or quit smack cold turkey can cause major withdrawal effects. For regular heroin abusers these effects can occur within a few hours of the last dose, usually peak between 48-72 hours after the last dose and subside after a week or so. These include:
- Drug cravings
- Restlessness
- Bone and muscle pain
- Insomnia
- Diarrhea and vomiting
- Cold flashes
- Goosebumps
- Kicking movements (“kicking the habit”)
- Death