Health Hazards
Heroin abuse is associated with serious
health conditions, including fatal overdose, spontaneous
abortion, collapsed veins, and, particularly in users who
inject the drug, infectious diseases, including HIV/AIDS and
hepatitis.
The short-term effects of heroin abuse
appear soon after a single dose and disappear in a few
hours. After an injection of heroin, the user reports
feeling 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. Mental functioning
becomes clouded due to the depression of the central nervous
system. Long-term effects of heroin appear after repeated
use for some period of time. Chronic users may develop
collapsed veins, infection of the heart lining and valves,
abscesses, cellulitis, and liver disease. Pulmonary
complications, including various types of pneumonia, may
result from the poor health condition of the abuser, as well
as from heroin's depressing effects on respiration.
Heroin abuse during pregnancy and its
many associated environmental factors (e.g., lack of
prenatal care) have been associated with adverse
consequences including low birth weight, an important risk
factor for later developmental delay.
In addition to the effects of
the drug itself, street heroin may have additives that do
not readily dissolve and result in clogging the blood
vessels that lead to the lungs, liver, kidneys, or brain.
This can cause infection or even death of small patches of
cells in vital organs.
The Drug Abuse Warning Network* lists
heroin/morphine among the four most frequently mentioned
drugs reported in drug-related death cases in 2002.
Nationwide, heroin emergency department mentions were
statistically unchanged from 2001 to 2002, but have
increased 35 percent since 1995.
Tolerance, Addiction, and Withdrawal
With regular heroin use, tolerance
develops. This means the abuser must use more heroin to
achieve the same intensity of 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.
Withdrawal, which in regular abusers may
occur as early as a few hours after the last administration,
produces drug craving, restlessness, muscle and bone pain,
insomnia, diarrhea and vomiting, cold flashes with goose
bumps (“cold turkey”), kicking movements (“kicking the
habit”), and other symptoms. Major withdrawal symptoms peak
between 48 and 72 hours after the last dose and subside
after about a week. Sudden withdrawal by heavily dependent
users who are in poor health is occasionally fatal, although
heroin withdrawal is considered less dangerous than alcohol
or barbiturate withdrawal.
Treatment
There is a broad range of treatment
options for heroin addiction, including medications as well
as behavioral therapies. Science has taught us that when
medication treatment is integrated with other supportive
services, patients are often able to stop heroin (or other
opiate) use and return to more stable and productive lives.
In November 1997, the National Institutes
of Health (NIH) convened a Consensus Panel on Effective
Medical Treatment of Heroin Addiction. The panel of national
experts concluded that opiate drug addictions are diseases
of the brain and medical disorders that indeed can be
treated effectively. The panel strongly recommended (1)
broader access to methadone maintenance treatment programs
for people who are addicted to heroin or other opiate drugs;
and (2) the Federal and State regulations and other barriers
impeding this access be eliminated. This panel also stressed
the importance of providing substance abuse counseling,
psychosocial therapies, and other supportive services to
enhance retention and successful outcomes in methadone
maintenance treatment programs. The panel's full consensus
statement is available by calling 1-888-NIH-CONSENSUS
(1-888-644-2667) or by visiting the NIH Consensus
Development Program Web site at
http://consensus.nih.gov.
Methadone, a synthetic opiate
medication that blocks the effects of heroin for about 24
hours, has a proven record of success when prescribed at a
high enough dosage level for people addicted to heroin.
Other approved medications are naloxone, which is
used to treat cases of overdose, and naltrexone, both
of which block the effects of morphine, heroin, and other
opiates.
For the pregnant heroin abuser, methadone
maintenance combined with prenatal care and a comprehensive
drug treatment program can improve many of the detrimental
maternal and neonatal outcomes associated with untreated
heroin abuse. There is preliminary evidence that
buprenorphine also is safe and effective in treating heroin
dependence during pregnancy, although infants exposed to
methadone or buprenorphine during pregnancy typically
require treatment for withdrawal symptoms. For women who do
not want or are not able to receive pharmacotherapy for
their heroin addiction, detoxification from opiates during
pregnancy can be accomplished with relative safety, although
the likelihood of relapse to heroin use should be
considered.
Buprenorphine is a recent addition to the
array of medications now available for treating addiction to
heroin and other opiates. This medication is different from
methadone in that it offers less risk of addiction and can
be dispensed in the privacy of a doctor's office. Several
other medications for use in heroin treatment programs are
also under study.
There are many effective behavioral
treatments available for heroin addiction. These can include
residential and outpatient approaches. 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.
Extent of Use
Monitoring the Future Survey (MTF)**
According to the 2003 MTF, rates of
heroin use are almost 50 percent lower than recent peak
rates in all three grades surveyed. However, only annual use
by 10th-graders showed a significant decline.
