do I have a problem with heroin?

OK, let’s be serious: If you’re sitting around wondering, “Do I have a problem with heroin?,” then you probably already know the answer.

For one thing, individuals who don’t have a problem with drugs and alcohol don’t sit around wondering if they do. If you’ve reached the point that it’s even a question, chances are good that you're aware you do. But secondly:

You’re doing heroin.

Here’s the deal with addictive drugs like heroin: “No one ever starts out using drugs intending to become a drug addict,” according to Dr. Alan Leshner, director of the National Institute on Drug Abuse (NIDA) [1]. “All drug users are just trying it, once or a few times … but as time passes and drug use continues, a person goes from being a voluntary to a compulsive drug user. This change occurs because over time, use of addictive drugs changes the brain — at times in big dramatic toxic ways, at others in more subtle ways, but always in destructive ways that can result in compulsive and even uncontrollable drug use.”

Can you “casually” use a drug like heroin? Sure, but the chances of developing an addiction are high — as many as a third of all new heroin users develop an addiction within the first 12 months, according to a 2018 study reported in the JAMA Psychiatry. As reported on in a 2018 article on the science news website Live Science [2] researchers in that study “identified more than 1,000 new heroin users and found that, overall, about 30 percent of new users developed a heroin dependence.”

In other words, while “casual” or “controlled” heroin use exists, it’s often an anomaly. Heroin has the reputation it does for a reason — it’s a destroyer, of families, careers and lives. So if you’re asking, “Do I have a problem with heroin?” The answer is, most likely, yes. So what next?

What Is Heroin?

To understand whether you do have a problem with heroin, it’s important to identify what, exactly, heroin is.

Like most other natural or semi-synthetic opioids, heroin traces its origins to the sap of the opium poppy, “whose growth and cultivation dates back to the ancient civilization of Mesopotamia around 3400 BC,” according to the University of Arizona [3]. “Opium was initially used by Egyptians and Persians, eventually spreading to various parts of Europe and to India and China.  During the 18th century, physicians in the U.S. used opium as a therapeutic agent for multiple purposes, including relieving pain in cancer, spasms from tetanus, and pain attendant to menstruation and childbirth.  It was only towards the end of the 18th century that some physicians came to recognize the addictive quality of opium.”

On the global stage, opium was at the center of two wars fought between Western powers and China in the 1800s, and as Chinese laborers immigrated to America, they brought with them opium. Opium dens sprung up through the American West, but by that point, according to History.com [4], scientists had succeeded in formulating a powerful opium derivative: “German scientist Friedrich Sertürner first isolated morphine from opium in 1803,” and “in 1874, an English chemist named Alder Wright first refined heroin from a morphine base. The drug was intended to be a safer replacement for morphine.”

By 1898, according to the University of Arizona, the Bayer Pharmaceutical Company began producing heroin commercially, but in less than two decades, the drug’s true nature revealed itself: “It wasn’t long until addiction, along with a surge in heroin-related admissions to hospitals, rose to alarming rates,” Laura Secorun Palet writes for the media website Ozy [5]. “As a result, Bayer stopped producing heroin in 1913 and, in 1914, its use without prescription was banned in the U.S. In 1920, the House of Delegates of the American Medical Association adopted a resolution ‘that heroin should be eliminated from all medicinal preparations and prohibited in the United States.’”

The Dangerous Drugs Act simply drove it underground, however, and over the next decade, there were “at least two major heroin epidemics in the United States,” according to the University of Arizona [3]. “The first one began after World War II and the second began in the late 1960s. During the first epidemic, the highest incidence of use occurred in the late 1940s and early 1950s; during the second, the highest incidence occurred between 1971 and 1977.  Both epidemics appear to have subsided due to lack of purity in the heroin that was available, and the increasing cost of heroin.”

While no one is calling the current statistics on heroin use an epidemic, the numbers are alarming, according to the NIDA [6]: “According to the National Survey on Drug Use and Health (NSDUH), in 2016 about 948,000 Americans reported using heroin in the past year, a number that has been on the rise since 2007. This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. The number of people using heroin for the first time is high, with 170,000 people starting heroin use in 2016, nearly double the number of people in 2006 (90,000).”

‘Do I Have a Problem With Heroin?’ How It’s Ingested and What It Does

do I have a problem with heroin?According to the NIDA [7], heroin “is typically sold as a white or brownish powder that is ‘cut’ with sugars, starch, powdered milk, or quinine. Pure heroin is a white powder with a bitter taste that predominantly originates in South America and, to a lesser extent, from Southeast Asia, and dominates U.S. markets east of the Mississippi River.

“Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use. 'Black tar' heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River. The dark color associated with black tar heroin results from crude processing methods that leave behind impurities. Impure heroin is usually dissolved, diluted, and injected into veins, muscles, or under the skin.”

According to an article in Harm Reduction Journal [8], “Heroin can be taken into the human body in a wide variety of ways, including snorting or sniffing powder or heroin solution (intranasal use), inhalation of the heated vapors (‘chasing’), orally and as anal suppositories (‘plugging’). Injecting, whether intravenous, subcutaneous or intramuscular, is the method of administration carrying the highest risk for multiple types of infections, overdoses and their complications. However, despite these risks, injection appeals to users because it is the most efficient, cost-effective method of use, and intravenous injection in particular has the most intense onset of effect (‘rush’).”

So what does heroin use feel like? According to the nonprofit organization Drug Policy Alliance [9], “People who use heroin describe a feeling of warmth, relaxation and detachment, with a lessening sense of anxiety. It is a powerful sedative, and due to its analgesic qualities, physical and emotional aches and pains can also be diminished. These effects appear quickly and can last for several hours, depending on the dosage and the mode of administration. When it is injected or smoked, it is quickly introduced into the bloodstream and leads to an instant rush of euphoric pleasure.”

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‘Do I Have a Problem with Heroin?” The Drug’s Effects on the Body

do I have a problem with heroin?So how does heroin affect the user? According to NIDA [9], “Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.” Short-term effects can include:

  • Clouded thinking;
  • Flushed skin and/or severe itching;
  • Heaviness of the limbs;
  • Nausea and/or vomiting;
  • Dry mouth; and
  • A euphoric stupor known among heroin users as “the nod,” essentially “a back-and-forth state of being conscious and semi-conscious.”

Long-term effects of heroin use can be more damaging:

  • Collapsed veins in intravenous users;
  • Insomnia;
  • Damaged nasal tissues in those who snort it;
  • Infection of the heart lining and valves;
  • Abscesses, or pockets of infection, in or around injection sites;
  • Constipation and/or stomach cramps;
  • Liver and kidney disease;
  • Pulmonary complications, including pneumonia;
  • Depression; and
  • Sexual dysfunction in men and irregular menstrual cycles in women.

Perhaps the biggest effect, the Drug Policy Alliance [10] reports, is that “prolonged use can lead to physical dependence. Some people who use heroin do so because this physical dependence means that if they stop using heroin, they will experience severe withdrawal symptoms that will make them physically sick.” Heroin (and all opioid) addicts know this as withdrawal: the excruciating pain and discomfort from the body’s rebellion over not having access to the drug.

What is that like? It varies from addict to addict, but Brian Pennie, writing for the Irish mental health charity A Lust For Life, describes it this way [11]: “It is often compared to flu, which is close, but with several key omissions. It is a roller coaster of emotions, feelings, and physical sensations, many of which have not been felt for a long time. My gums were throbbing, my feet were on fire, my insides were a mess, and I was terrified of the craziest things, even my wardrobe.”

Even worse are the psychological cravings: The gnawing, consuming realization that heroin, which is the reason you’re in such misery, can make it all go away. You want to stop, but your brain is screaming at you with a bullhorn the size of a small plane that just one more will make everything better. It is a form of torture that’s nearly impossible to describe to anyone who hasn’t experienced it firsthand.

How Do People Become Addicted to Heroin?

To understand exactly why heroin is so addictive, one needs a rudimentary understanding of how it affects the brain. As the NIDA describes [12], “Heroin binds to and activates specific receptors in the brain called mu-opioid receptors (MORs). Our bodies contain naturally occurring chemicals called neurotransmitters that bind to these receptors throughout the brain and body to regulate pain, hormone release, and feelings of well-being. When MORs are activated in the reward center of the brain, they stimulate the release of the neurotransmitter dopamine, causing a reinforcement of drug taking behavior.”

In other words, the body’s natural chemicals stimulate a moderate amount of dopamine. It’s why we feel good after we exercise, or eat a delicious meal, or have sex. When heroin, which converts to morphine in the brain, binds to those receptors, it forces them to release a torrent of dopamine, many times more powerful than a natural release, thus flooding the body with the euphoria associated with the drug.

At the same time, however, “Other areas of the brain create a lasting record or memory that associates these good feelings with the circumstances and environment in which they occur,” according to the NIDA paper “The Neurobiology of Opioid Dependence: Implications for Treatment” [13]. “These memories, called conditioned associations, often lead to the craving for drugs when the abuser re-encounters those persons, places, or things, and they drive abusers to seek out more drugs in spite of many obstacles.”

Because the brain’s reward system is stimulated, the user is quickly, and quite naturally, conditioned to use repeatedly. However, because of the changes taking place in the brain, the desire for pleasure soon gives way to a compulsive need [13]: “Repeated exposure to escalating dosages of opioids alters the brain so that it functions more or less normally when the drugs are present and abnormally when they are not. Two clinically important results of this alteration are opioid tolerance (the need to take higher and higher dosages of drugs to achieve the same opioid effect) and drug dependence (susceptibility to withdrawal symptoms). Withdrawal symptoms occur only in patients who have developed tolerance.”

The brain cells that house those opioid receptors grow tolerant of the external application of heroin; as a result, because the body is functioning abnormally without heroin, they require larger amounts of the drug to achieve the same flood of euphoria. At the same time, another area of the brain — the locus ceruleus (LC) [13], located in the base — contains its own opioid receptors, which when activated suppress the release of the chemical noradrenaline (NA), which when distributed to other parts of the brain “stimulates wakefulness, breathing, blood pressure, and general alertness, among other functions.”

The suppression of that chemical results “in drowsiness, slowed respiration, low blood pressure — familiar effects of opioid intoxication. With repeated exposure to opioids, however, the LC neurons adjust by increasing their level of activity. Now, when opioids are present, their suppressive impact is offset by this heightened activity, with the result that roughly normal amounts of NA are released and the patient feels more or less normal. When opioids are not present to suppress the LC brain cells’ enhanced activity, however, the neurons release excessive amounts of NA, triggering jitters, anxiety, muscle cramps, and diarrhea.”

It’s a vicious, self-perpetuating cycle that begins as the simple pursuit of euphoria. Eventually, the destabilization of those brain chemicals means that the introduction of heroin is only enough to sedate the brain back to “normal.” The flood of dopamine is reduce to a trickle, and a great many addicts find that what once was pleasurable has now become an anxiety-ridden race against the clock to keep from going into the debilitating effects of heroin withdrawal.

‘Do I Have a Problem With Heroin?’ Yes. So What’s Next?

do I have a problem with heroin?By the time a heroin user traverses the stages of addiction and gets to the end, the problem has likely gotten out of hand. By that point, the ability to stop without addiction treatment and safe, comfortable medical detox is possible, but also a Herculean feat of willpower and determination.

Because withdrawal, in case it hasn’t been discussed enough, is brutal. The musician Art Pepper, writing more than 50 years ago for the publication “Lapham’s Quarterly” [14], described it thus: “The agony of kicking is beyond words … It’s awful but it’s quiet. You just lie there and suffer. You have chills and your bones hurt; your veins hurt; and you ache. When water touches you it feels as if it’s burning you, and there’s a horrible taste in your mouth, and every smell is awful and becomes magnified a thousandfold. You can smell people, people with BO, their feet, and filth and dirt … the depression you feel is indescribable, and you don’t sleep. Depending on how hooked you are, you might go three weeks or a month without ever sleeping except for momentary spells when you just pass out. You’ll be shaking and wiggling your legs to try to stop the pain in the joints, and all of a sudden you’ll black out and you’ll have a dream that you’re somewhere trying to score.”

Fortunately, those who want to escape the bondage of heroin addiction can find the help they need at a drug and alcohol treatment center. There, a full continuum of care will include medical detox, during which those seeking treatment for addiction to heroin or other drugs are monitored around the clock by medical and clinical staff members. Comfort medication may be administered, and over a period of three to five days, individuals are slowly and safely taken through the withdrawal process with a minimum of discomfort.

On the other side of that is an opportunity to enter a treatment program that can provide coping skills to prevent a return to heroin use, as well as therapy for issues that may have precipitated or coincided with heroin addiction. The most important thing to remember is that addicts and alcoholics aren’t “bad” people who need to be good; they’re sick people who need to get better, and addiction and alcoholism are diseases recognized as such by the medical and scientific community.

If you’re wondering, “Do I have a problem with heroin?,” chances are good, if you’re using any heroin at all, you do. If you don’t want to develop one, don’t do it, but if you do, and it becomes a problem, then it’s vital to your health and well-being to understand that there are drug and alcohol treatment options available that can intervene at any point in the evolution of that problem — hopefully before it becomes a life-threatening one.

SOURCES

[1]: https://archives.drugabuse.gov/oops-how-casual-drug-use-leads-to-addiction

[2]: https://www.livescience.com/62701-odds-of-heroin-dependency.html

[3]: https://methoide.fcm.arizona.edu/infocenter/index.cfm?stid=174

[4]: https://www.history.com/topics/crime/history-of-heroin-morphine-and-opiates

[5]: https://www.ozy.com/flashback/the-deadly-drug-that-used-to-be-a-popular-medicine/39174/

[6]: https://www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states

[7]: https://www.drugabuse.gov/publications/research-reports/heroin/what-heroin

[8]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956544/

[9]: http://www.drugpolicy.org/drug-facts/what-is-heroin

[10]: https://www.drugabuse.gov/publications/drugfacts/heroin

[11]: https://www.alustforlife.com/personal-stories/this-is-what-heroin-withdrawal-feels-like

[12]: https://www.drugabuse.gov/publications/research-reports/heroin/how-heroin-used

[13]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/

[14]: https://www.laphamsquarterly.org/intoxication/withdrawal-symptoms