Heroin Effects: Short Term
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.
Short-term effects of heroin
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.
Heroin Effects: Long Term
One of the most detrimental long-term effects of heroin is addiction itself. Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse. As with abusers of any addictive drug, heroin abusers 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.
Long-term effects of heroin
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 swapes 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.
With regular heroin use, tolerance develops. This means the addict must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence develops. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold sweats with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.
What are the medical complications of chronic heroin use?
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. Of course, sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse - infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.
Symptoms Of Heroin Withdrawal:
How does heroin abuse affect pregnant women?
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. Pregnant women should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery; rather, treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely in the nursery. Research has demonstrated also that the effects of in utero exposure to methadone are relatively benign.
Why are heroin users at special risk for contracting HIV/AIDS and hepatites B and C?
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.
NIDA-funded 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.
Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. 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, orquinine. 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. 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."
According to the 1996 National Household Survey on Drug Abuse, which may actually underestimate illicit opiate (heroin) use, an estimated 2.4 million people use heroin at some time in their lives, and nearly 216,000 of them reported using it within the month preceding the survey. The survey report estimates that there were 141,000 new heroin users in 1995, and that there has been an increasing trend in new heroin use since 1992. A large proportion of these recent new users were smoking, snorting, or sniffing heroin, and most were under age 26. Estimates of use for other age groups also increased, particularly among youths age 12 to 17: the incidence of first-time heroin use among this age group increased fourfold from the 1980s to 1995.
The 1996 Drug Abuse Warning Network (DAWN), which collects data on drug- related hospital emergency department (ED) episodes from 21 metropolitan areas, estimates that 14 percent of all drug-related ED episodes involved heroin. Even more alarming is the fact that between 1988 and 1994, heroin-related ED episodes increased by 64 percent (from 39,063 to 64,013).
NIDA's Community Epidemiology Work Group (CEWG), which provides information about the nature and patterns of drug use in 20 cities, reported in its December 1996 publication that heroin was the primary drug of abuse related to drug abuse treatment admissions in Newark, San Francisco, Los Angeles, and Boston, and it ranked a close second to cocaine in New York and Seattle.
Monitoring the Future Study (MTF)
According to the 1997 MTF, an annual survey of drug use among 8th-, 10th-, and 12th- graders, rates of heroin use remained relatively stable and low since the late 1970s. After 1991, however, use began to rise among 10th- and 12th- graders, and after 1993, among 8th- graders. In 1997, prevalence of heroin use was comparable for all three grade levels. Although the annual prevalence rates for heroin use remained relatively low in 1997, these rates are approximately two to three times higher than those reported in 1991.
|Heroin Use by Students in 1997|
|Used in Past Year||1.3%||1.4%||1.2%|
|Used in Past Month||0.6%||0.6%||0.5%|
Community Epidemiology Work Group (CEWG)
In December 1996, CEWG reported that the availability of low-priced, high-quality heroin continues to increase, especially in the East and some areas of the Midwest. This increase has also been reported in some cities that previously had escaped the influx of high-quality heroin.
Quantitative indicators and field reports continue to suggest an increasing incidence of new users (snorters) in the younger age groups, often among women. One concern is that young heroin snorters may shift to needle injecting, because of increased tolerance, nasal soreness, or declining or unreliable purity. Injection use would place them at increased risk of contracting HIV/AIDS.
In some areas, such as Boston and San Francisco, the recent initiates increasingly include members of the middle class. In Newark, heroin users are usually found in suburban populations.
National Household Survey on Drug Abuse (NHSDA)
The 1996 NHSDA shows a significant increase from 1993 in the estimated number of current (once in the past month) heroin users. The estimates have risen from 68,000 in 1993 to 216,000 in 1996.
Among individuals who had ever used heroin in their lives, the proportion who had ever smoked, sniffed, or snorted heroin increased from 55 percent in 1994 to 82 percent in 1996. During the same period, the proportion of users who injected heroin remained about the same, at about 50 percent.