What is Heroin?
Heroin is an illegal, highly addictive opioid drug synthesized from morphine1 that can produce strong feelings of well-being and pleasure in its user.2 Despite its many serious risks, heroin remains a popular drug for both casual and regular users.
Heroin Use Stats
A 2013 survey in the United States estimated that 6.9 million individuals aged 12 or older had an illicit drug use disorder in the previous year.3 An estimated 517,000 of these individuals were abusing heroin or heroin-dependent, and about 169,000 were first-time heroin users in the same year.3
The need for treatment is clearly evident, yet many still do not seek it out—in some cases, costing their lives. Knowing the signs of addiction is a good first step in determining if you or a loved one has a serious problem that needs real help.
Signs and Symptoms of Heroin Withdrawal
When you are addicted to heroin and abruptly stop using it, withdrawal symptoms occur. The severity of the symptoms is dependent on how long you used heroin as well as how high your doses were toward the end of the time you used.4 Withdrawal symptoms in some people have persisted for many months.4 Avoiding heroin withdrawal, also known as dope sickness, is a big reason many people enter heroin addiction treatment.6
Symptoms of heroin withdrawal include:4,6,7
- Muscle and bone pain.
- Cold flashes with goose bumps.
- Uncontrolled leg movements.
- Flu-like symptoms.
- Dilated pupils.
- Watering eyes.
Heroin withdrawal symptoms can be highly uncomfortable, but are not life-threatening.7 The danger these symptoms do pose is that the intense discomfort can drive you to use heroin to avoid feeling the effects of the withdrawal further.
The first step in the heroin addiction treatment process is detox. In and of itself, detox is not considered a comprehensive addiction treatment program, but it is an essential first step. Because of the potential for a severely unpleasant withdrawal syndrome, the process should be ideally take place in a comfortable, medically supervised environment.8 Detox programs alone tend to cost around $600 to $1,000 per day depending on the addiction severity and length of detox required, and they will provide the best medical and psychological care to a recovering individual.9
In many cases of heroin detox, the recovering individual will be stabilized on a pharmaceutical opioid FDA-approved for treating opioid dependence—such as buprenorphine, Suboxone, or methadone.10 The dose of these treatment drugs will be gradually reduced after you are stabilized.10 Your body then adjusts to this new lower level of opioid in the system, and gradually becomes less physically dependent on the drug.
Successful tapering relies on your body’s ability to adjust with each reduced dose, eventually reaching a dosage so low that your body no longer needs the drug. When you reach this point, you no longer receive the drug and will then likely experience only mild withdrawal symptoms or none at all.
The process typically takes 5 to 7 days, with an 80% retention rate in an inpatient setting. Outpatient detoxification may take longer to minimize withdrawal symptoms.10
There are some people who may not tolerate the substitute drug, so they receive a smaller dose at the beginning of the tapering process until their withdrawal symptoms stabilize.10 If withdrawal symptoms continue to occur, a slightly higher dose of the substitution drug may be given until withdrawal symptoms subside.10
At the completion of the taper, you’ll continue to be medically supervised for a brief period to preclude from any late-to-arrive complications. After the supervisory period ends, you generally enter a heroin rehab program to treat the underlying causes of and supporting factors for your addiction.10
Inpatient or Outpatient Heroin Rehab Programs
Putting the skills learned during heroin rehab to use is just as important as going through the detox and rehab process.
The most effective heroin addiction treatment program integrates both behavioral and pharmacologic treatments (or medically assisted treatment).11 For severe cases, inpatient or residential treatment may be the best fit, especially for those who went through the detox phase, which has shown to help patients become more open to behavioral treatments.12 Inpatient programs cost between $200 and $900 per day, with longer programs costing less per day.9
In an inpatient treatment program, you are primarily helped with the psychological aspects of your heroin addiction, which is often much harder to beat since it is based on more than the cravings for the euphoria and contentment provided by taking the drug. The underlying reasons for any person to begin abusing heroin usually extend far beyond simple physical cravings. In some cases, previous trauma lies at the heart of many who abuse heroin, as well as social issues such as poorly formed coping skills and interpersonal relationships.
During inpatient heroin treatment, you work with qualified medical personnel to uncover what your reasons are for using and to learn how to heal from past hurts and find new ways to cope with them in the future. The rehab portion of the treatment process can last far longer than detox, since the issues of psychological addiction are complex. Staying in treatment for as long as you need is crucial to your long-term success.12
Therapy is usually conducted on an individual or group basis and often involves family therapy.13 Residential treatment programs that focus on changing patient attitudes and behaviors are highly structured and typically last between 6 and 12 months, though the exact length is determined by your specific needs.12 This approach to treatment can be a period of pure discovery as you learn about the primary motivators that guide your actions.
The eventual goal of treatment is to help you stop using heroin and stay heroin-free.12 Long-term abstinence may be one of the most difficult parts of addiction treatment, and it is important to note that relapse can occur.
An inpatient heroin addiction treatment program is only one step in the recovery process. Putting the skills learned during heroin rehab to use is just as important as going through the detox and rehab process. To help you remain drug-free, there are a number of long-term support programs.
Heroin addiction aftercare treatment may include a peer- or family-based recovery support program where you interact with others who have stopped their own heroin use or who have similar experiences with dependency on other addictive drugs.12
But the most important step of this whole process is the first one: deciding to find the treatment you need.
What Are the Warning Signs of Heroin Abuse?
If you aren’t sure if you or your loved one is addicted to heroin, the following information will answer many questions you may have.
As an opioid, heroin attaches itself to the opioid receptors of the brain. The interaction of opioid drugs with opioid receptors is accompanied by an activation of the brains pleasure/reward system, temporarily flooding the user with feelings of euphoria.2 Unfortunately, the more you use the drug, the more tolerance develops.4 This forces your brain to need greater amounts of the drug to feel the same level of pleasure you first experienced.4 As drug use escalates to counter a growing tolerance, users may quickly develop dependence on the drug.4 Once you are dependent, if you stop taking heroin, withdrawal symptoms surface, usually within a few hours from the last time you used to as long as a week, with the symptoms peaking between 24 and 48 hours.4
These physiological processes of tolerance, dependence, and withdrawal are a large part of what characterizes addiction.
How Long Does It Take to Become Addicted to Heroin?
Heroin is made from morphine, making it one of the most addictive drugs that a person can use. It’s a fast-acting opioid that enters the brain and binds to opioid receptors in many areas of the brain and nervous system, most significantly those that control feelings of pain and pleasure, heart rate, sleeping, and breathing.13
Regardless of the administration route, as soon as it enters the body, it quickly moves to the brain and starts affecting and changing the functioning of the central nervous system. Opioid receptors respond by triggering a release of dopamine, a neurotransmitter that generates a “rush” — a surge of pleasure, satisfaction, and well-being, that also dulls sensations of pain.13
When the brain gets used to the euphoric rush that heroin produces, the user starts feeling an intense craving for the drug. The reward-response reactions that take place in the part of the brain called the limbic system play a crucial role in the development of addiction. These dopamine-caused feelings reinforce the behavior that produced them and make the brain keep wanting more.14
One of the most common factors leading to heroin addiction is the misuse of prescription opioids. Data from 2011 showed that 4-6% of people who misuse opioid medications switch to heroin and about 80% of heroin users first misused prescription opioids.1 Most of those people simply replaced one addiction with another since heroin is cheaper and easier to obtain.15
However, not everyone is equally prone to addictive behavior in general, so the time it takes to develop a full-blown addiction to heroin varies significantly. The amount and frequency of use, as well as the individual’s overall health, weight, or metabolism play a part too. However, heroin is such a potent drug that everyone is at significant risk of developing both physical and psychological dependence in case of repeated use.13
Increasing the frequency of heroin use causes faster adjustment of the brain and nervous system to the chemical changes the drug causes. The physical structure of the brain goes through changes as a result of repeated heroin use. This can lead to long-term neuronal and hormonal systems imbalances that may be hard to reverse. Some studies detected deterioration of the brain’s white matter, affecting decision-making, behavior regulation, and stress response.16
Heroin Short Term Effects
Short-term effects can occur soon after a single dose and may last a few hours. Intensity and duration of effects may vary by the person and depend on a number of factors, including which method you used (e.g., injection, smoking, snorting).5 Aside from the initial rush, you may experience the following short-term effects:5
- Warm flushing of skin
- Feeling of heaviness
- Alternating wakeful and drowsy state
- Mental confusion
- Dry mouth
- Constricted pupils
- Severe itching
- Slowed heart function
- Slowed breathing
- Possible respiratory failure
- Permanent brain damage after respiratory failure
Heroin Long Term Effects
Long-term heroin use may result in the following:4,6
- Tolerance and severe addiction
- Neuronal and hormonal imbalances
- Brain white matter deterioration
- Decreased decision-making abilities
- Decreased ability to regulate behavior
- Decreased ability to respond to stressful situations
- Collapsed veins
- Heart lining and valve infection
- Higher risk for contracting HIV, Hepatitis B and C, and other blood-borne pathogens
- Liver disease
- Lung-related complications (e.g., pneumonia)
- Muscle and bone pain