Heroin
One of the most dangerous and highly addictive drugs in America today, heroin has been associated with a wide range of damaging effects and, as Nora Volkow, the director of the National Institute on Drug Abuse (NIDA) has expressed it, “repercussions that extend far beyond the individual user.”
About the Drug
A semi-synthetic opioid that is derived from morphine (which itself is a derivative of the opium poppy), heroin was first synthesized in London, England, in the late 1800s. During the first decade of the 20th century, the drug was marketed by the German pharmaceutical corporation Bayer as a cough suppressant and non-addictive alternative to morphine.
As scientists developed a greater understanding of the dangers of the drug – and as heroin began to be used for recreational purposes – governments began to exert increasing levels of control over the sale and possession of the substance. In the United States, it became illegal to sell, import, or manufacture the heroin in 1924. Today, the drug is classified as a Schedule I controlled substance, meaning that the U.S. government has determined that heroin has a high potential for abuse, no currently accepted medical use, and a lack of accepted safety (even under medical supervision).
Heroin may be snorted (inhaled in powder form), smoked, or injected. It the street version that remains popular to this day, heroin usually appears as a white or brown powder. Popular nicknames for the drug include “H,” “smack,” and “junk.”
Extent of Use
NIDA estimates that at least 3.7 million Americans have used heroin at least once, with more than 314,000 having used in the past year, and 119,000 in the past month.
The National Survey on Drug Use and Health (NSDUH) that was completed in 2003 reported between 121,000 and 164,000 new users each year between 1995 and 2002. About three of every four new users were over the age of 18, and most were male, the survey indicated.
The NSDUH also documented the degree to which heroin remains dangerously addictive, reporting that more than half (57.4 percent) of those who used the drug in the previous 12 months met the criteria for abuse or dependence, and than more than 280,000 were estimated to have received treatment for their abuse of the drug.
NIDA's annual nationwide Monitoring the Future survey revealed that 1.6 percent of U.S. eighth graders, and 1.5 percent of 10th-graders and 12th-graders had used heroin at least once in their lives.
In a survey of 21 metropolitan areas, the 2002 Drug Abuse Warning Network documented 93,519 heroin-related emergency room visits.
Health Hazards
It is difficult to overestimate the degree of damage that heroin can inflict upon users. In addition to the very real risk of fatal overdose, the drug also puts users at increased danger for a range of infectious diseases (including hepatitis and HIV/AIDS), spontaneous abortion, collapsed veins, liver damage, and a number of other conditions, diseases, and disorders.
Because the quality and content of street-level heroin can vary greatly, users may also experience a number of negative responses – including damage to the lungs, liver, kidney, and brain -- to additives with which the drug may have been “cut.”
Heroin’s short-term effects, which usually last a few hours, include a euphoric “rush” that is accompanied by a warm flushing of the skin, heaviness in the arms and legs, and a dry mouth. Users will often experience impaired mental functioning as they waver in and out of consciousness, and may become dependent upon the drug after this initial exposure.
Over the long term, health risks include infections of the heart, the development of abscesses, pulmonary complications, and difficulty breathing. Those who inject the drug are also at greater risk for contracting blood-borne pathogens, including those that cause hepatitis and HIV/AIDS.
Tolerance, Addiction, & Withdrawal
In addition to fostering dependence and addiction, heroin use also results in the development of tolerance – which means that an individual needs to take progressively larger amounts of the drug in order to experience the same intensity of effects that previously followed the ingestion of smaller doses. This tolerance is a primary precursor of long-term dependence and addiction – states in which the body has adapted to the presence of the drug, and which lead to withdrawal symptoms if usage is reduced or ceased.
Depending upon the nature of a person’s dependence, withdrawal symptoms can begin to manifest themselves within hours of the last exposure to heroin. Common effects of withdrawal include strong cravings for the drug, restlessness and insomnia, nausea and diarrhea, muscle pain and involuntary twitching, and disorientation. The most drastic symptoms begin to subside after about 48 to 72 hours – but heavy users who attempt to stop suddenly and without the benefit of medical supervision risk severe health problems, including (in extreme cases) death.
Treatment
Individuals who are abusing, dependent upon, or addicted to heroin have a variety of treatment options that involve medications, therapies, or some combination thereof. Most experts advocate on behalf of treatment plans that incorporate medication (for example, methadone), therapy, and participation in a strong ongoing support network.
In 1997, the U.S. National Institutes of Health (NIH) convened a panel of national experts who concluded that an addiction to an opiate such as heroin is a disease of the brain and a medical disorder that is capable of being effectively and successfully treated. In addition to calling for increased access to methadone maintenance programs and the removal of laws that preclude access to treatment, the panel also stressed the value of counseling, therapies, and other support programs and services.
Though methadone is perhaps the most widely known medication for treating heroin addiction, it is not the only one that is used for this purpose. Naloxone and Naltrexone are both used in treatment programs, and other medications are currently under study.
As far as the therapeutic component is concerned, some individuals are able to be treated as an outpatient, while others require hospitalization or a stay at a residential treatment facility. In most cases, cognitive-behavioral therapies, individual counseling, group therapy, and a variety of other techniques are employed as part of a comprehensive effort to prepare the addicted individual for long-term sobriety and a health, drug-free lifestyle.