Heroin Addiction
Heroin addiction is a very serious and sometimes life threatening
dilemma. Not only is it difficult for the addict, it is extremely
hard on those around them who care about them. For the addict,
admitting they have an addiction problem can be difficult.
However painful this may be, it must be acknowledged as the
first gradient to overcoming the problem. The next hurdle
is being willing to seek & accept help from an addiction
professional. It can be hard for an addict to confront the
fact that they can not do it alone. Once this fact is accepted,
it is time to seek the appropriate professional treatment.
Drug rehab programs based on the social education modality
are highly successful. This means that individuals who are
recovering from Heroin addiction are not made wrong for their
past indiscretions, but are taught how to avoid future ones.
They are provided with knowledge on how to change their lives
and how to live comfortably without Heroin. Receiving treatment
for addiction should be done in a safe & stable environment
that is conducive to addiction recovery.
Drug rehabilitation is a multi-phase, multi-faceted, long
term process. Detoxification is only the first step on the
road of addiction treatment. Physical detoxification alone
is not sufficient to change the patterns of a drug addict.
Recovery from addiction involves an extended process which
usually requires the help of drug addiction professionals.
To make a successful recovery, the addict needs new tools
in order to deal with situations and problems which arise.
Factors such as encountering someone from their days of using,
returning to the same environment and places, or even small
things such as smells and objects trigger memories which can
create psychological stress. This can hinder the addict's
goal of complete recovery, thus not allowing the addict to
permanently regain control of his or her life.
Almost all addicts tell themselves in the beginning that
they can conquer their addiction on their own without the
help of outside resources. Unfortunately, this is not usually
the case. When an addict makes an attempt at detoxification
and to discontinue drug use without the aid of professional
help, statistically the results do not last long. Research
into the effects of long-term addiction has shown that substantial
changes in the way the brain functions are present long after
the addict has stopped using drugs. Realizing that a drug
addict who wishes to recover from their addiction needs more
than just strong will power is the key to a successful recovery.
Battling not only cravings for their drug of choice, re-stimulation
of their past and changes in the way their brain functions,
it is no wonder that quitting drugs without professional help
is an uphill battle.
Q) What is heroin?
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.
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Q) What are the current trends for heroin abuse?
A) A generation ago, the heroin (colloquially known as "smack")
available in the U.S. was barely five percent pure and used
by a relatively small percentage of young people because it
had to be injected with a needle. Now, it appears smack is
back with a vengeance and it's addicting large groups of new
users.
The Office of National Drug Control Policy issued a report
(April 1992, No. 5, pp. 1-6) claiming "a massive increase
in heroin use and addiction is not likely." One reason
for this was, "...the apparent absence of new initiates
(i.e., heroin users with little or no prior drug-using experience)."
However, based upon recent news reports and other sources
(see the A.T. Forum Web site for News Updates), the ONDCP
report appears to have been premature, to say the least.
Just this past February, Attorney General Janet Reno admitted
heroin is more plentiful, purer, and less expensive than it
was just a few years ago. "If we do not counteract the
heroin threat now," she said, "we risk repeating
the terrible consequences of the 1980s' cocaine and crack
epidemic." Authorities estimate that heroin addiction
has increased 20 percent and worldwide production has grown
sharply, even as other illegal substance abuse is declining.
Reports of problems have sprung-up countrywide. In California,
heroin sold in the San Joaquin Valley is cheap, potent, and
plentiful - business is booming in area emergency rooms as
two or three overdose cases appear each day. In Colorado,
Boulder County officials may establish a methadone clinic
for the first time in 16 years to deal with increasing heroin
addiction. On the East Coast, heroin is reported to be 40
to 70 percent pure and around $10 for a small packet. The
number of heroin-related hospital emergencies has more than
doubled in New York City and surrounding areas.
Many drug abusers mistakenly believe inhaling heroin, rather
than injecting it, reduces the risks of addiction or overdose.
In some areas, "shabanging" - picking up cooked
heroin with a syringe and squirting it up the nose - has increased
in popularity. Street heroin carries prophetic names: "DOA,"
"Body Bag," "Instant Death," and "Silence
of the Lamb." Rather than scaring off young initiates,
the implied danger seems to actually increase the drug's allure.
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Q) What are some other names for heroin?
A) "smack", "junk", "horse",
"skag", "H", "China white"
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Q) So Heroin is an opiate. What are some of the other opiates?
A) Opium, Morphine, Codeine, Merperidine , Hydrocodone (Lortab,
Vicodin), Oxycodone (Percodan, Roxicet, Roxiprin, Tylox, Percocet),
Stadol, Talwin, Dilaudid, Fentanyl, Buprenorphine, Methadone,
Propoxyphene (Wygesic, Darvocet)
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Q) What are the statistics on heroin addiction in the United
States?
A) 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).
In 1996, it was reported 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.
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Q) How is heroin used?
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.
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Q) What are the immediate (short-term) effects of heroin
use?
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.
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Q) What are the long-term effects of heroin addiction and
use?
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 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 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.
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Q) What are the medical complications of chronic heroin addiction
and use?
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[1].
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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.
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Q) How does heroin abuse affect pregnant women?
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.
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