Heroin, one of several opioid drugs, is a highly addictive drug. Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for 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." People take heroin through snorting, smoking, and injecting. These three methods are equally dangerous.

Heroin depresses the central nervous system. A dose of heroin causes a surge of euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. These short-term effects appear soon after a single dose and disappear in a few hours.

With regular heroin use—sometimes as little as two to three days—tolerance develops. This means the abuser must take more heroin to feel the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

Health Hazards

Heroin abuse is associated with many serious health effects. Some of these complications are due to the drug itself and others are caused by the unsanitary conditions in which heroin use usually occurs. For example, street heroin may have additives that clog the blood vessels leading to the lungs, liver, kidneys, or brain. This clogging can cause infection or even death of small patches of cells in vital organs.

Common negative effects of heroin include:

  • Lung disorders and infections, including pneumonia
  • Liver problems, including viral hepatitis A , B , and C
  • Musculoskeletal problems, including osteomyelitis (inflammation or infection of the bone)
  • Abnormalities in the immune system, including frequent infections
  • Brain effects, including coma and cerebral anoxia (decreased blood supply to the brain)
  • Spontaneous abortion or birth defects, if a woman uses heroin during her pregnancy
  • Collapsed veins
  • HIV/AIDS and other infectious diseases (from sharing needles)
  • Decreased mental function, due to depression of the central nervous system
  • Overdose, which can be fatal; signs of an overdose include:
    • Flushing
    • Itching of the skin
    • Contracted pupils
    • Sleepiness
    • Decreased breathing rate
    • Decreased blood pressure
    • Slowed heart rate
    • Decreased body temperature

Tolerance, Addiction, and Withdrawal

A heroin user experiences withdrawal symptoms as early as four to six hours after the last dose. Major withdrawal symptoms peak between 36 and 72 hours after the last dose and can last for a week. The symptoms of withdrawal are those associated with a stimulated nervous system, which is a backlash to heroin's depression of the nervous system. These symptoms include the following:

  • Drug cravings
  • Anxiety, restlessness, and insomnia
  • Increased breathing rate and yawning
  • Increased release of sweat, tears, and nasal mucus
  • Dilated pupils
  • Muscle aching and twitching, including uncontrolled kicking movements
  • Bone pain
  • Diarrhea and vomiting
  • Hot and cold flashes with goose bumps
  • Trembling and shaking
  • Loss of appetite

Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal. However, heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.

Treatment

Treatment of heroin addiction is quite difficult and should be done at a specialized treatment facility. The treatment options for heroin addiction include medications and behavioral therapies. A combination of medication, therapy, and other support services appears to be the most effective in helping people to stop heroin (or other opiate) use and return to more stable and productive lives. Treatment may be done in outpatient clinics or in communal residential treatment facilities.

Medications

Methadone is a synthetic opiate medication that is given to block the effects of heroin for about 24 hours. When prescribed at a high enough dosage level for people addicted to heroin, it has a proven record of success in helping people to manage their withdrawal symptoms and avoid returning to heroin use. LAAM, also a synthetic opiate medication for treating heroin addiction, can block the effects of heroin for up to 72 hours. Other approved medications are naloxone and naltrexone, both of which block the effects of morphine, heroin, and other opiates. Several other medications for use in heroin treatment programs are under study.

Behavioral Treatment

There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Residential programs provide training, education, and redirection to help people build new lives as they recover from their addictions. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient's thinking, expectancies, and behaviors, and to increase skills in coping with various life stressors.