Heroin is a powerful opiate, known for its intense effects with rapid onset and dangerous potential for addiction. It gives users a surge or “rush” of euphoria initially, followed by a feeling of warmth, calmness, heaviness, and often sleepiness that’s known as “nodding out.”
As a member of the opioid drug class—along with prescription painkillers like Oxycontin and Vicodin—heroin can cause physical dependence and is extremely addictive. It’s made from morphine, a naturally-occurring substance that’s extracted from the seed pods of the Asian opium poppy plant.
Sometimes called “Smack,” or generally referred to as “Dope,” heroin is typically sold as a white or brown powder. It can be snorted or smoked, but most commonly users dissolve the drug in water and inject it into their veins or muscles. Most users report abusing prescription painkillers before starting to use heroin.
America’s Heroin Epidemic
According to the UN’s World Drug Report for 2016, heroin is currently the deadliest drug worldwide. Heroin is an extremely popular and deadly drug of abuse in the United States. As of 2014, there were about 1 million heroin users in the U.S.—nearly three times the number just 10 years earlier.
More than half of those users had a heroin use disorder, meaning they became physically dependent upon the drug and continued heroin use despite serious consequences in their lives. Heroin addiction affects people of all ages and in all socioeconomic groups. It’s grip on a user can be debilitating.
Not only problematic in terms of maintaining employment, finances, and personal relationships, but heroin addiction also causes people serious harm mentally and physically. Most troubling is the very real risk of death: more people in the U.S. die each year from drug overdoses than car crashes, in which heroin plays a huge role.
The Danger of Overdose
Overdose is a serious risk for heroin users and can cause a host of complications, including heart failure, shallow breathing, loss of consciousness, coma, permanent brain damage, and death.
For chronic users, overdose becomes extremely likely as they seek out higher doses. Although the drug Naloxone, or Narcan, can help to reverse the effects of an overdose, some street heroin today is too powerful for it.
The most common trend in the U.S. is that dealers are now lacing bags of heroin with more powerful opioids like fentanyl—which is about 80 times more potent than heroin—but users are often unaware of this deadly mixture. Often, users inject a “normal” dose similar to what they usually take and accidentally overdose.
Most troubling for the street-heroin user is the recent appearance of carfentanil in bags of heroin—a synthetic opioid that is 10,000 times more potent than morphine and is meant only for use as an elephant tranquilizer. It’s caused the most deadly series of drug overdoses in U.S. history, and is a threat spreading across the nation.
Heroin’s Effects on the Body
Heroin has several immediate effects after use:
- surge of euphoric feeling (particularly when injected)
- dry mouth
- nausea, vomiting
- warm flush on the skin
- feeling of heaviness
- foggy mental state
- “nodding out,” between wakefulness and sleep
- slowed breathing and heart rate
Heroin also has a host of long-term health risks:
- needle marks and bruising
- skin problems, such as abscesses or infections
- collapsed veins
- heart problems
- disease in the liver or kidneys
- infectious diseases (spread through dirty needles)
- HIV, hepatitis C
Heroin’s Effects on the Brain
Heroin enters the brain and binds to its opioid receptors, which creates a pain-killing effect. These receptors are also involved in the brain’s reward system, causing a heroin user to become caught in a cycle similar to that of a cocaine user—seeking higher doses to feel the same pleasure, and losing sight of basic needs like food and sleep.
Opioid receptors are located in the brain stem, which controls automatic functions of the body like breathing and blood pressure. This is makes high doses extremely dangerous. Breathing becomes suppressed, and this can limit the amount of oxygen that reaches the brain. This condition, known as hypoxia, can lead to coma and even permanent brain damage.
Because it’s so powerful, heroin abuse has complications:
- Tolerance—user needs larger doses, greater purity, or a more rapid form of delivery to achieve the desired results.
- Dependence—the body needs heroin in order to feel normal, or else a user endures serious withdrawal symptoms without the drug.
Building up tolerance causes many “recreational users” to quickly cross over the line into addiction. Buying one bag quickly turns into several. A user who only snorted heroin may start to inject the drug. Some users begin to abuse heroin alongside other prescription pills or alcohol. Most commonly, users need larger doses and seek out more intense highs.
Symptoms of Heroin Withdrawal
Similar to withdrawal from narcotic pain medications, a regular heroin user can experience physical withdrawal symptoms when they stop taking the drug:
- watery eyes, runny nose
- sweating, chills, goosebumps
- itching, burning, and numbness of skin
- muscle twitching, pain, or spasms
- abdominal cramping, diarrhea
- nausea, vomiting
- insomnia, restlessness
- feelings of “pins and needles”
- a “creepy-crawly” feeling of the skin
- “jumpy” legs.
The severity of withdrawal symptoms depends on each person and their usage habits. In general, withdrawal symptoms appear about 6-12 hours after last use of the drug. Symptoms peak at about 1-3 days, and will subside after about 5-7 days.
Physical dependence and the pain of withdrawal can make quitting heroin feel impossible—but addiction treatment offers hope.
How to Quit Heroin
If a heroin addict has the desire to quit, checking into a detox center is the safest and most effective way to begin the recovery process. Although many people attempt to quit heroin on their own, this often leads to severe illness, relapse, or accidental overdose. A user will be more safe and comfortable during the withdrawal process under medical supervision.
Medical detoxification is a safe way to eliminate the body of toxins. The resources at a detox facility will also make the process of withdrawal more tolerable than trying to quit “cold turkey.”
There are a variety of medications that might be used to help treat the withdrawal symptoms of quitting heroin:
- Clonidine—reduces muscle aches, sweating, cramping, and runny nose; alleviates anxiety and agitation.
- Buprenorphine—helps to stop withdrawal symptoms and eliminate pain; often considered to be the safest drug to use.
- Methadone—can reduce physical pain; can be used while pregnant.
- Suboxone—also reduces withdrawal symptoms and cravings.
There are others, but these are some of the most common.
The Importance of Rehab
Physically quitting and removing the body of substances isn’t enough—recovery has to be supplemented with therapy and support. In most cases, heroin addicts will check into a rehab facility after detox, where they can begin to learn methods of coping with their addiction. There are many different types of programs, including inpatient and outpatient rehabs.
Most treatment facilities offer addiction therapy in both group and individual sessions. They’ll teach skills that help an addict manage cravings, cope with thoughts and feelings, and avoid relapse. Underlying issues like trauma, mental illness, behavioral disorders, or family problems will be addressed alongside qualified therapists. They may also offer holistic therapy like massage or acupuncture.
Rehab programs often last anywhere from 30 days to 3 months, but longer stays in rehab have produced better results in achieving long-term sobriety. Many programs use a 12-step program (usually AA or NA), though there are many non-12-step treatment options. Long-term involvement in counseling and participation in recovery support groups (12-step or otherwise) after treatment is encouraged.
Post Acute Withdrawal Symptoms (PAWS)
For up to two years after quitting heroin, a user can experience PAWS symptoms:
- difficulty thinking clearly
- problems managing emotions and stress
- irregular sleep patterns
- poor physical coordination
- foggy memory
PAWS symptoms can be managed with continued addiction treatment beyond an inpatient or outpatient rehab program, and through the individual’s best efforts to live a healthy, balanced life. After-care is an essential component of long-term recovery, which can include regular counseling and therapy, staying at a sober-living facility, or case-monitoring to maintain motivation and growth in recovery.
You Can Quit Heroin
Each person will have different experiences with quitting heroin, but knowing what to expect can help. No matter what struggles you’ve faced, how many times you’ve tried to quit in the past, or how strong the grip of heroin feels on your life, you absolutely can recover. The first step is asking for help. Don’t wait any longer—the risks are too great.
With guidance from professionals, a strong recovery support network, and a genuine desire to change, you or your loved one can persevere and build a new life—free from heroin.