Heroin is perhaps the most infamous street drug in the world. It is notorious for being extremely addictive, having high overdose rates, and being almost impossible to quit without considerable outside help. Heroin deserves this reputation. Once a person has developed a heroin addiction, they immediately begin to experience a wide range of consequences that can cause absolute devastation in their lives.
Heroin users may recognize that heroin is the source of their problems, but they are generally unable to stop using the drug no matter how strongly they wish to do so. As a result, the harms of heroin abuse tend to increase over time, often resulting in death.
Over the last decade or so, heroin addiction and heroin overdoses have been on the rise. The rise of heroin addiction has been in large part driven by prescription painkiller addiction. Many people who would never dream of touching heroin are motivated to abuse heroin to feed opioid addictions that developed while they were using prescription opioid painkillers. Understanding the nature of heroin and the factors that lead to heroin addiction is essential for achieving long term recovery from this rampant disease.
What is Heroin?
Heroin is a member of the opiate family. Like other opioids, heroin is derived from the opium poppy plant. It may come as a surprise that heroin, despite being a notorious “street drug,” is part of the same drug family as perfectly legal prescription medications. Opioids like oxycodone, morphine, and fentanyl are often used in the treatment of pain. This is because opioids block pain signals to the brain.
While legal opioid painkillers are primarily prescribed to treat severe and chronic pain, heroin comes with a number of additional effects. When people consume heroin, they experience strong feelings of euphoria and pleasure, sometimes known as a “high.” These feelings are extremely addictive, leading people to abuse heroin uncontrollably. For this reason, heroin is classified by the Drug Enforcement Administration (DEA) as a Schedule I controlled substance.
Heroin is a semi-synthetic opioid, meaning that it is not simply a natural byproduct of the opium poppy. Heroin is made out of morphine. However, when heroin reaches the brain, it actually changes back into morphine. At this point, it binds to opioid receptors that are located throughout the brain and spinal cord. All mammals have opioid receptors; they control feelings of pleasure and pain. When heroin activates opioid receptors, the centers of the brain that control mood and pleasure are altered.
This not only results in the typically euphoric feelings associated with a heroin high, it also affects the brain stem, which controls important automatic life-sustaining bodily functions, including breathing, blood pressure, and arousal. This obviously can have catastrophic consequences in the case of an overdose.
How Do People Use Heroin?
There are a variety of routes of administration for heroin. Heroin can be sniffed or snorted, in the same way that people traditionally use cocaine (it can also be mixed with cocaine, which increases the risks). Cocaine can also be smoked. The most notorious form of cocaine abuse occurs when a person injects the drug directly into their veins.
All of these routes of administration result in a heroin high, and all of them are dangerous. However, different routes of administration result in slightly different experiences, and the risks are somewhat different.
Many people avoid injecting heroin at first, because of the stronger stigma associated with that form of substance abuse, but most heroin addicts eventually turn to intravenous injection. This is because injecting heroin results in a stronger high, wastes less of the drug than smoking, and is the fastest way to experience the heroin high.
However, injecting heroin is the route of administration with the highest risk of a life-threatening overdose. Unsafe needle practices also increase the likelihood of a number of health problems, from collapsed veins to sexually transmitted infections (STIs).
Other routes of administration pose slightly lower overdose risk. When people smoke heroin for instance, they can choose to stop at any time, whereas someone using a needle consumes their dose all at once. However, it is important to understand that smoking, snorting, or sniffing heroin is just as addictive as injecting it. In fact, some research suggests that smoking heroin, while less effective at producing a heroin high, is somewhat more addictive than injecting heroin.
Heroin is often also consumed alongside other substances. The practice of mixing heroin with crack cocaine or any stimulant is known as speedballing. Speedballing is extremely dangerous. Heroin, which is a central nervous system (CNS) depressant, is inherently dangerous on its own. However, when this CNS depressant is combined with a CNS stimulant like crack cocaine, it can be too much for the body to handle. Engaging in polydrug abuse with heroin causes the risk of overdose to skyrocket.
Effects of Heroin Addiction
Heroin is an extremely potent opioid, which means that people experience the effects very quickly after consuming it. When heroin is broken down into morphine and binds to opioid receptors in the brain, the result is a variety of psychological and physical effects.
Many of these effects are experienced as pleasurable to heroin users. In this case, these effects are known as a “high.” However, it is important to understand that the short-term effects of heroin lead to a wide range of effects that are not all pleasurable — and many of which are extremely harmful. The long term effects of abusing heroin, it should also be noted, make it more difficult for a person to get high at all, and they also make it difficult for a person to function in their everyday life.
Common short-term effects of heroin abuse include:
- Warm flushing of the skin
- Extreme pleasure or euphoria
- Dry mouth
- Nausea and vomiting
- Heavy feeling in the arms and legs
- Clouded mental functioning
- Severe itching
- Going “on the nod” — a state during which one vacillates between being conscious and being semiconscious
Long term effects of abusing heroin include but are not limited to:
- Infection of the heart lining and valves
- Damaged tissue inside the nose (when it is snorted and sniffed)
- Collapsed veins (when it is injected)
- Abscesses (swollen tissue filled with pus)
- Irregular menstrual cycles (for women)
- Sexual dysfunction
- Mental disorders, including depression, anxiety, and antisocial personality disorder
- Lung complications, such as pneumonia
- Liver and kidney disease
- Constipation and stomach cramping
These physical effects of heroin are often disastrous enough, but the consequences of heroin abuse in a person’s life are often far more disastrous. We will be examining the broader consequences of heroin addiction later in this article.
What Does Heroin Look Like?
If you suspect that a close friend or family member is abusing heroin, it is important to be able to recognize the drug. Heroin is available in many different forms, and for this reason its appearance can differ wildly. The most common form of heroin is powder. This powder can vary in terms of its color: it is often white or brown.
The location where a specific batch of heroin comes from can affect its appearance. Heroin on the east coast of the United States is generally white or off-white, for instance. Powdered heroin that is whiter in color is generally purer heroin, compared to brown or off-white powdered heroin.
In recent years, however, a different form of heroin has achieved enormous popularity and success in the United States. This form of heroin, known as black tar heroin, is not a powder. Rather, it is a solid, sticky substance that is generally black in color. It is hard to the touch and tends to smell slightly like vinegar.
Sometimes known as sticky tar, black tar heroin is generally found on the west coast, though it has been rapidly spreading throughout the United States. Black tar heroin is often far cheaper than powdered heroin, and though its quality can vary considerably, it is extremely potent and therefore life-threatening.
Most heroin that is sold to users is not pure. Drug dealers and distributors generally cut their heroin with contaminants and drugs. This enables them to sell more heroin while saving money. Cutting heroin with other drugs, such as fentanyl or crack cocaine, can also increase the perceived potency of heroin. However, this practice also increases the risks of heroin abuse.
Heroin is commonly cut with a number of substances, such as:
- Laundry detergent
- Baking soda
- Rat poison
- Talcum powder
- White sugar
Many of these ingredients, such as fentanyl, can directly increase the risk of a life-threatening overdose. Others, such as rat poison and laundry detergent, are toxic substances with their own unique risk profiles. However, even seemingly harmless contaminants, such as caffeine, pose a number of risks. When people consume heroin alongside caffeine, for instance, they are often less able to detect a heroin overdose, and they may consume more heroin to counteract the stimulating effects of caffeine.
Heroin Street Names
Heroin goes under many names. Its chemical names are diacetylmorphine and diamorphine. However, heroin users and drug dealers often use a variety of street terms to refer to the drug. They do so for a number of reasons. People engaged in a heroin sale often use code names to avoid detection by law enforcement authorities. Users of recreational drugs are often part of a drug culture, where alternative names are a way of celebrating drug use. While the street names for heroin are ever-evolving and changing, we’ve listed a few of today’s most common street names below:
- Mexican black tar heroin
- Mexican tar
- Black tar
- White stuff
- White boy
- White girl
- White horse
- White lady
- White nurse
- Number 8
- Number 4
- Number 3
- Mexican horse
- Mexican mud
- Mexican brown
- China white
- Brown tape
- Brown sugar
- Brown rhine
- Brown crystal
- Black eagle
- Black staff
- Black pearl
- Black tar
What Causes Heroin Addiction?
People use heroin because of the effect it has, which is undeniably pleasurable — at least at first. However, given heroin’s reputation as a dangerous drug, it may come as a surprise that so many people try it. Most people don’t wake up in the morning and think, “Today I’m going to try heroin — it can’t be so bad!” In fact, most people who develop heroin addictions didn’t start by abusing heroin at all.
The vast majority of people who abuse heroin started by getting addicted to prescription opioids. Since the 1990s, prescription opioids have been prescribed at increasingly higher rates. These prescription drugs quickly lead to physical dependence even among people who use them exactly as prescribed. However, there is also a high potential for misuse and abuse with prescription opioids. Many, in fact, are just as potent as heroin. Others, such as fentanyl, are many times stronger than heroin. Prescription opioids have driven the opioid addiction epidemic in the United States, and heroin addiction is merely a byproduct.
People with addictions to prescription opioids, such as oxycodone or fentanyl, are often hesitant about using heroin — at least at first. However, their strong drive to consume opioids generally overpowers their reservations. Heroin is widely available, extremely affordable, and often far easier to obtain than prescription opioids. For this reason, prescription opiate addiction is the most common route to heroin addiction.
What Makes Opioids Addictive?
It doesn’t matter whether a person started their journey toward opioid addiction with heroin or a prescription painkiller; opioid addiction tends to follow a predictable course. When an opioid drug activates opioid receptors, these receptors cause the brain to release high quantities of dopamine. Dopamine is a neurotransmitter that plays an important role in the brain’s motivation and decision-making centers.
The job of dopamine is to reinforce healthy behaviors by causing people to associate these behaviors with pleasure. It is released when people have sexual intercourse, play sports, or accomplish personal goals. Opioids release such high quantities of dopamine that a person’s drug-taking behavior becomes greatly reinforced. As a result, even after using heroin once, most people are drawn to do so again.
It doesn’t take long for an individual’s brain and body to adapt to the effects of opioids. This phenomenon is known as tolerance. How do brains and bodies adapt to opioids? At their core, opioid drugs are central nervous system depressants, slowing down mental and bodily processes. When people regularly take opioids, their brains and bodies try to achieve balance by putting the central nervous system into overdrive, a form of self-stimulation that counteracts the depressant effects of opioids.
Once the body has learned to balance out the effects of opioids, that same dosage will no longer produce the same high that users are accustomed to. In order to get high, a heroin user will have to regularly increase their dosage, their frequency of consumption, or switch to a more potent opioid. This process can continue indefinitely.
With increased tolerance comes physical dependence. Physical dependence occurs when a person’s body is so acclimated to the effects of opioids that it actually begins to suffer side effects when opioids are not in the system. These side effects are due to opioid withdrawal. Ultimately, withdrawal effects occur because an individual’s brain and body continue to overcompensate for opioids long after opioids have left the body.
For people who have developed physical dependence on heroin, withdrawal symptoms are often not only excruciatingly painful, they can make it extremely difficult to function in everyday life. For this reason, most heroin users go to great lengths to ensure they have a steady supply of heroin and that they can continue to use it.
Heroin Withdrawal Symptoms
Heroin withdrawal generally begins as early as a few hours after a person’s last dose of heroin. Common opioid withdrawal symptoms include:
- Severe muscle and bone pain
- Sleep problems
- Diarrhea and vomiting
- Uncontrollable leg movements
- Cold flashes with goosebumps
- Severe heroin cravings
The symptoms of acute opioid withdrawal tend to reach peak intensity after two or three days. It is at this point that most people relapse. The vast majority of symptoms begin to fade after approximately one week, though many people experience some degree of withdrawal symptoms for many weeks or months afterwards. Having support during this challenging heroin detox period is essential for individuals who hope to remain sober.
Addiction vs Physical Dependence
It is important to recognize, however, that physical dependence on heroin is not the same thing as heroin addiction. In fact, it is possible for a person to withdraw completely from heroin and remain obsessed with the drug, despite experiencing no physical cravings. Heroin addiction, which is a type of opioid use disorder, is a mental health disorder that makes it nearly impossible for a person to control their heroin use, no matter how strongly they desire to do so. In contrast to physical dependence, addiction centers in the brain. This partly explains why so many people relapse even after conquering their physical dependence. To achieve lasting recovery, it is therefore essential for people to treat their underlying addiction while they withdraw from heroin, and long afterward. Outpatient treatment programs can help people accomplish both goals.
Risk Factors for Heroin Addiction
Why do some people become addicted and others do not? What makes someone an addict? Is there such a thing as an “addictive personality”? Ultimately, the answers to these questions are always going to be a little fuzzy. Addiction can never be attributed to one single cause. Researchers are only beginning to understand the underlying causes of addiction, but current evidence points to a broad range of overlapping factors.
Researchers have long understood that addiction runs in families. If your family has a history of alcohol abuse or drug addiction, there is a higher likelihood that you are predisposed toward those very same behaviors and conditions. Studies of identical twins who grew up in separate environments and never met show that if one of them develops an addiction, more often than not the other one will too. Addiction has a strong genetic component. Certain genes affect how a person processes opioids and other substances, and genetics can also control a person’s impulsivity and stress responses.
Environment plays a crucial role as well. Having a family history of addiction affects far more than a person’s “genetic destiny” — it also determines their upbringing. Being exposed to unstable parents who abuse drugs and alcohol make people more likely to turn to substances later in life. This is partly because family members normalize substance abuse, but also because growing up in an unstable environment adversely affects the developing brains of children, predisposing them to impulsivity, mental illness, and low achievement.
In fact, aside from genetics, adverse children experiences (ACEs) are often considered the other top factor that is predictive of later substance use disorders. “Adverse childhood experiences” is a clinical term used to refer to a broad range of traumatic or stressful events, including sexual abuse, neglect, witnessing household dysfunction of domestic violence, and growing up with a family member who has a substance use disorder. ACEs increase a person’s susceptibility to mental illness, health problems, and the adoption of high-risk behaviors like substance abuse.
Suffering from adverse childhood experiences increases the likelihood that a child or adolescent will begin engaging in substance abuse at an earlier age. Unfortunately, this only increases the risks, since early onset of substance abuse is associated with addiction. When people whose brains are not fully developed begin using drugs or drinking alcohol, addictive patterns become more deeply reinforced, and they often suffer from cognitive impairments or emotional difficulties from having their brain development interrupted.
Other factors that can make a person more likely to develop a heroin addiction include:
- Suffering from severe or chronic pain
- Being prescribed opioid painkillers
- Having a family history of substance abuse
- Suffering from trauma as a child
- Suffering from a mental health disorder, such as depression or anxiety
- Economic distress and lack of opportunities for advancement
- Using heroin at an earlier age
- High levels of stress
- Peer pressure
- Having a history of abusing alcohol or other recreational drugs
Signs and Symptoms of Heroin Addiction
The clinical term for heroin addiction is “opioid use disorder.” Opioid use disorders are mental health disorders that can be diagnosed by psychiatrists and other mental health professionals. Clinicians use a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make diagnoses.
The DSM-5 classifies opioid use disorder as a spectrum condition that can be experienced at a wide range of severities. As such, the DSM-5 lists 11 symptoms of opioid addiction. Those who experience 2-3 symptoms are said to suffer from mild opioid use disorder, with 4-5 symptoms representing moderate opioid use disorder, and more than 5 symptoms representing severe opioid use disorder.
The symptoms of opioid use disorder, as defined by the DSM-5, include:
- A person often takes opioids in larger amounts or over a longer period of time than they intend to
- A person has a persistent desire to cut down or control their opioid use, but they are often unsuccessful
- A person spends a large portion of their time in activities necessary to obtain heroin, use heroin, of recover from the effects of heroin abuse
- They experience cravings, or a strong desire to use heroin or other opioids
- Their regular heroin use results in failures to fulfill role obligations at work, school, or home
- Heroin or opioid use continues despite the occurrence of persistent social or interpersonal problems caused by or worsened by the effects of opioids
- Important activities are given up in order to engage in heroin abuse
- Using heroin or other opioids in situations in which it is physically hazardous, such as driving while under the influence
- Continuing to use heroin despite knowing that one has a persistent or recurrent physical or psychological problem that is caused by or exacerbated by opioids
- Developing a tolerance, causing one to need increased quantities of opioids to achieve the desired effect
- Suffering from opioid withdrawal symptoms
For concerned friends and family members, however, it is often difficult to determine whether someone has a problem. Individuals addicted to heroin often take great pains to conceal or disguise their substance abuse. However, physical and behavioral signs will always manifest themselves in one way or another. Common signs of heroin abuse include:
- Unusual drowsiness, such as falling asleep without warning
- Notable weight loss (and in some cases weight gain)
- Changes in sleep habits
- Frequent flu-like symptoms
- Lack of attention to personal hygiene and grooming
- Changes in exercise habits
- New financial difficulties
- Itchy or flushed skin
- Constricted or small pupils
- Dealing with friends, family, classmates, or colleagues
- Isolating from friends or family
- Decreased libido
- Uncontrollable cravings
- An inability to control opioid use
- Losing jobs or failing classes
- Problems with the law
- Lying or deceptive behavior
- Developing mental illnesses, such as depression or anxiety
If you notice any of the above symptoms and are concerned that your loved one might have a problem with heroin, it is often a good idea to approach this person. Instead of treating their heroin abuse as a moral failing, however, it is generally best to treat them with compassion. More likely than not, they have already tried and failed on multiple occasions to stop using heroin. Help them to understand that you are on their side and that recovery is possible if they make use of the support and resources of an outpatient treatment program.
Long Term Dangers of Heroin Addiction
Heroin addiction causes people to prioritize heroin abuse above all else in their lives. This can cause people to isolate themselves from friends, family members, and loved ones. They may stop engaging in hobbies or activities that once gave them joy. At the same time, work or school performance can suffer, and in many cases, people stop being able to function at all in these environments.
The result can be extreme loneliness, financial destitution, and abject misery. Lacking financial resources but still feeling strong cravings for heroin, many addicts are tempted to engage in thievery or other crimes in order to obtain drugs. It often takes only a short period of time for heroin addicts to begin experiencing severe consequences, including legal problems, homelessness, and mental illness.
Heroin itself can also lead to a number of severe harms. It can cause health problems such as collapsed veins and sexually transmitted infections (STIs), especially when needles are not used safely. Heroin use over time also changes the physical structure of the brain. It causes the deterioration of the brain’s white matter, which affects an individual’s ability to make decisions, regulate behavior, and respond to stressful situations. The lifestyle effects of heroin abuse can also cause a person to develop mental health disorders, such as major depressive disorder and anxiety disorder.
Unfortunately, active heroin users are unlikely to seek treatment for their physical or mental health disorders. Instead, they are often driven to use more heroin as a form of escapism. This can solidify their addiction even further while exacerbating their problems.
Heroin Overdose Statistics
By far the greatest danger of heroin abuse is the danger of a life-threatening overdose. In 2018, approximately 15,000 people died from a heroin overdose in the United States. A heroin overdose occurs when an individual uses more of the drug than their body can handle. The amount it takes to produce a heroin overdose can vary from person to person, and it depends in large part on their opioid tolerance level. Taking a dose of heroin far above their tolerance level can produce a life-threatening reaction.
Heroin overdoses occur because heroin is a central nervous system depressant. The central nervous system is responsible for controlling the body’s automatic life-sustaining processes. During an overdose, central nervous system depression can result in slowed or entirely stopped breathing. This can damage organs and result in hypoxia, a condition where the brain does not receive enough oxygen. Respiratory depression can lead to a wide range of short and long-term effects of the brain, body, and nervous system. Severe heroin overdoses can result in comas, permanent brain damage, and even death.
In the event of a heroin overdose, it is essential for people to receive treatment immediately. Often by the time a person gets to the hospital, it is too late. Friends and family members of heroin users can carry a drug on them called naloxone. Naloxone, an opioid antagonist that can be administered in a nasal spray, can immediately reverse the symptoms of a heroin overdose. Administering naloxone to someone who is overdosing can save their life. However, it is still essential that they get proper medical treatment right afterward. Beyond that, long term addiction treatment is even more crucial, since many people relapse even after surviving a near-fatal heroin overdose.
Outpatient Treatment for Heroin Addiction
Our culture prizes self-control, autonomy, and a stoic silence when it comes to personal problems. For this reason, many people who develop addictions to heroin are reluctant to reach out for help. Instead, they try to manage their heroin use on their own, trying and failing to work up the will power they believe they need. Few people can quit heroin using personal will power alone. Heroin abuse leads to neurological changes in the brain that affect an individual’s desire to apply will power at all. For this reason, it is absolutely essential that anyone suffering from a heroin addiction reach out for help. NuView Treatment Center offers heroin detox and rehab for heroin addicts in Los Angeles.
Outpatient treatment programs are a type of addiction treatment program that allows individuals to address their substance use disorders, mental health conditions, and other underlying problems. Unlike residential treatment programs, outpatient programs encourage clients to live at home so they can continue to benefit from their social support system. This also enables them to make progress toward rebuilding their lives in the outside world. At the same time, clients engage in addiction treatment for multiple hours a day, several days a week, providing them with the support and resources they need.
Heroin Addiction Treatment Center Los Angeles
NuView Treatment Center is an outpatient treatment center located in West Los Angeles. At NuView Treatment Center, we offer a comprehensive range of outpatient treatment programs that cover all levels of care. Our programs include:
- Partial hospitalizations programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning services
Whether you are quitting heroin for the first time or trying to do so yet again after countless relapses, whether you are new to recovery or working on rebuilding your life after finishing an inpatient treatment program, NuView Treatment Center is here for you. Our trained and compassionate staff offer the latest in evidence-based treatment methods for addiction and mental health disorders. We also recognize that no addiction is the same as another, and for this reason our programs emphasize individualized treatment plans.
Clients work daily to develop strategies for dealing with triggers and address the underlying issues that are motivating their addiction. More importantly, they work to rebuild their lives, so that they can lead sober lives that are happy, prosperous, and free.
If you are ready to finally let go of heroin and begin a new way of life, reach out to NuView Treatment Center today.