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Heroin Addiction Treatment

Heroin is a very potent drug of abuse and one that is easy to fall prey to addiction. Tolerance to the drug develops quickly, leading to physical dependence and a potential opioid use disorder.

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The withdrawal symptoms associated with heroin are uncomfortable enough to spur individuals to keep using the drug. Treatment for heroin abuse involves medical detox, intensive counseling, treatment of co-occurring disorders like depression or anxiety, and a long-term commitment to abstinence.

Medication-assisted treatment (MAT), methadone maintenance, is offered to individuals who have made numerous unsuccessful attempts at recovery. These individuals receive methadone as a substitute for heroin. The goal is often to gradually wean people off methadone, but some people remain on it for years or even for the rest of their lives.

The Basics

Heroin was developed as a potential solution to morphine abuse in the late 1800s.

The goal was to develop an opioid pain reliever that would not be addictive, but still have the pain-relieving properties of morphine. This focus eventually led to the development of heroin. The Bayer Company marketed their new wonder drug as a potential cure-all for many different things, including coughing and pain.

The number of individuals abusing heroin skyrocketed, and heroin abuse became a major issue across the country. Eventually, the drug was prohibited in the United States.

Heroin is currently classified in the Schedule I (C I) category of controlled substances. Substances in this category are illegal to possess, cannot be prescribed, and are deemed unsafe for personal use even if you are under the supervision of your physician. They can only be obtained with the permission of the federal government, and they are typically confined to use in research studies.


Abuse Rates

The Substance Abuse and Mental Health Services Administration (SAMHSA) released the following estimates based on survey data:
  • In 2016, about 5 million people admitted to some lifetime of heroin; 948,000 people admitted to using heroin within the year prior to taking the survey; and 475,000 admitted to using heroin within the month prior to taking the survey.
  • In 2017, about 5.3 million people admitted to some lifetime use of heroin; 886,000 admitted to using heroin within the year prior to the survey; and 494,000 people admitted to using heroin within the month prior to the survey.

Despite heroin’s reputation as a major drug of abuse, a very small percentage of Americans have ever used the drug.

How Heroin Works

Heroin is a derivative of opium, which comes from the poppy plant grown in Asia.

When you take heroin, it is converted to morphine in your body. Then, it attaches to the opioid receptors in the brain. These neurons are specialized for endogenous neurotransmitters that are involved in the subjective experience of pain and stress.

Heroin is primarily taken via injection, although the drug can also be smoked or snorted. Injecting the drug results in a very fast transition from the bloodstream, across the blood-brain barrier, into the brain. The effects occur very rapidly. Smoking or snorting the drug also results in a rapid administration to the brain.

The Effects

When you use heroin, you will experience the following:

  • A sudden strong sensation of warmth and euphoria, often known as the rush
  • Flushing of the skin
  • A feeling of heaviness in the arms and legs
  • A reduction in pain, anxiety, and stress
  • Decreased breathing rate, heart rate, and blood pressure
  • Pinpoint pupils
  • Dry mouth
  • Issues with judgment and rational thinking

Signs of Abuse

In addition to the above, there are some consequences associated with using heroin in any manner.
  • Needle marks or track marks where the drug is typically injected are clear signs of injection drug use.
  • Skin abscesses often occur at injection sites.
  • Individuals who snort heroin often have frequent runny noses or nosebleeds.
  • Using heroin in any way can lead to respiratory issues due to a decreased breathing rate from the drug; however, people who smoke the drug will have more chronic respiratory problems.
  • Teary eyes in conjunction with pinpoint pupils suggest heroin use.
  • Long-term users of heroin begin to neglect personal hygiene and responsibilities.
  • When you start to develop physical dependence on heroin, you will have issues with anxiety, pain, nausea, and irritability as part of the withdrawal syndrome when you cannot get heroin.

If you are regularly using heroin, the legal system assumes you are abusing the drug. The drug is illegal to use in this country in any capacity. It is deemed unsafe for private individuals to use it under any circumstances.

Medical Complications

There are major complications associated with heroin abuse. The severity of these issues can vary greatly from person to person, depending on the degree of abuse and personal factors.

Medical complications that can occur due to heroin use include:
  • Issues associated with injecting the drug, such as collapsed veins, cardiovascular issues, heart disease or heart infections, and the contraction of blood-borne diseases like hepatitis or HIV due to needle sharing.
  • Respiratory issues due to suppressed breathing rates.
  • Potential liver damage.
  • Significant issues with emotional control and judgment due to alterations in the brain.
  • Problems experiencing pleasure from activities that once gave you pleasure. This happens due to changes in the brain pathways associated with chronic heroin use.
  • Organ damage, including brain damage due to hypoxia (decreased oxygen delivery to organs).
  • Lower levels of achievement, problems with personal relationships, financial problems, and legal issues.

Opioid Overdose

The National Institute on Drug Abuse (NIDA) says there has been a slight rise in heroin use. A good percentage of overdoses on opioid drugs are associated with the use of heroin combined with the very potent synthetic opioid fentanyl.

Fentanyl is so potent that a minute amount could easily kill you. Some dealers add it to heroin to enhance the potency of their product, but this is an extremely dangerous practice. Most often, people overdose on fentanyl, not even realizing it is in the batch of heroin they purchased.

Even on its own, heroin can result in overdose. The CNS depressant effects of the drug rapidly reduce breathing and heart rates to the point where the brain is deprived of oxygen, and you can literally suffocate to death (anoxia).

The following are signs of a heroin overdose:

  • Lethargy
  • Slurred speech
  • Pinpoint pupils
  • Confusion
  • Bluish tint to the lips, fingers, and/or toes
  • Depressed or labored breathing
  • Vomiting
  • Inability to stay awake
  • Weak pulse

The three major signs of heroin overdose — known as the opioid overdose triad — are pinpoint pupils, lethargy or unconsciousness, and respiratory suppression.

While a heroin overdose can be deadly, it can be reversible if care is administered in time. The opioid antagonist Narcan (naloxone) can reverse the effects of opioid overdose, but it needs to be administered quickly. The medication bumps heroin or other opioids from the opioid receptors, essentially pushing the person into withdrawal and stopping the overdose.

If fentanyl or a very high dose of heroin has been taken, multiple doses of Narcan may be needed.

Further medical treatment is required to stabilize the person. Otherwise, the heroin overdose could return once the naloxone wears off.

Am I Addicted to Heroin?

If you are using heroin on a regular basis, you are likely addicted to the drug. Other signs of addiction include:

  • You find you need more heroin to get the effects you once got with smaller doses.
  • When you have not taken heroin, you begin to experience headaches, shakiness, irritability, and achiness (the early stages of withdrawal from heroin).

If either of these two conditions is present, you most likely qualify for diagnosis of an opioid use disorder as a result of your heroin use.

Other formal signs of a substance use disorder are:

  • Problems with controlling drug use.
  • Continuing to use heroin even though it causes you significant problems.
  • Declining performance at school or work due to drug use.
  • Health problems associated with heroin use.
  • Financial difficulty due to spending significant amounts of money on heroin.

Treatment for Addiction

If you want to break free from the grips of heroin but have strong doubts you cannot, it is likely time to seek help. When you begin to use the drug frequently and develop tolerance and physical dependence, you have a diagnosable opioid use disorder. Addiction is a disease and should be treated like one.

Treatment for heroin abuse includes several components.
  • Rehab often begins with a thorough evaluation by a clinician to determine your level of heroin abuse and its effects on your emotions, physical functioning, social functioning, and thinking abilities.
  • You will generally be screened for any other substance abuse issues or co-occurring mental health disorders.
  • The evaluation will help the clinician develop a treatment plan for you that is based on the principles of effective treatment. Your treatment plan is tailored to fit your unique needs.
  • The first stage of treatment is medical detox (withdrawal management). Heroin withdrawal usually requires medication-assisted treatment (MAT). Usually, Suboxone or methadone is used.
  • The backbone of treatment is therapy. Various forms of behavioral therapies are used in addition to complementary therapies.
  • Completion of a structured treatment program does not mean that you are finished. Aftercare must continue for several years following treatment, but its intensity will decline over time as you find a stronger foothold in recovery.
  • Continuing care is focused at your ability to remain abstinent, avoid relapse, and develop the skills needed to live a drug-free life.

Aftercare programs are not short-term solutions. They are long-term commitments, and involvement in various interventions will continue for years in most cases.

If you relapse, you should accept your relapse as a learning situation instead of viewing it as a treatment failure. Address the situation with your treatment providers and move forward in your recovery.

Inpatient vs. Outpatient

One of the initial issues you will have to address is whether you should begin treatment in an inpatient unit or as an outpatient.

Inpatient treatment may be required for medical detox. This will allow you to get needed medical treatment and isolate yourself from potential temptations to relapse.

Outpatient treatment allows you much more freedom, but you need a safe home environment and a strong support system in place. If you don’t have a solid home environment, you can reside in a sober living home while undergoing outpatient treatment.

The decision on which of these modes of treatment is best for you can be made during the assessment phase. If you have a long history of heroin abuse with numerous attempts to quit and many relapses, initial inpatient treatment may be recommended. If outpatient treatment is appropriate, a sober living home is a good idea.

Methadone Maintenance Programs

Some people who have a history of multiple attempts at recovery and subsequent relapses may be placed on methadone maintenance programs. Instead of tapering down the methadone dose, they are prescribed an ongoing regime of methadone treatment.

Many of these people will remain on methadone indefinitely. They may continue in therapy, attend support groups, and participate in other interventions.

Methadone maintenance programs help to cut down on the transmission of diseases due to needle sharing and reduce the probability of engaging in crime to support a heroin habit. They do not address the body’s physical dependence on opioids.

Oftentimes, the ultimate goal is to move toward total sobriety down the road, but the person may remain on methadone for several years until they have a good foundation in recovery.


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