What Is Heroin?
Heroin is an illegal opioid synthesized from morphine, a naturally occurring substance extracted from the seed pods of opium poppies.[1] It can be administered through injection, snorting, or smoking and, once consumed, binds to opioid receptors in the brain and body, causing users to experience an immediate euphoric rush. After the euphoria subsides, users typically enter into a protracted period of drowsiness and sedation, followed by a “crash” that is so unpleasant it drives compulsive use just to avoid it.
Heroin is classified as a Schedule I Controlled Substance, meaning it has no currently accepted medical use and a high potential for abuse.[2] Much of the heroin available in the U.S. today has been contaminated with fentanyl, an illicitly manufactured synthetic opioid that is much more potent than heroin and exponentially increases the risk of fatal overdose.[3] The result is that heroin use is substantially more dangerous today than it was ten years ago, and access to heroin addiction treatment has never been more urgent.[4]
Heroin carries other health risks beyond overdose. People who inject heroin put themselves at a higher risk for blood-borne pathogens such as HCV, HIV, and hepatitis B. Long-term heroin use is also linked to deteriorating physical health, chronic disease, cognitive impairment, and damage to interpersonal relationships, employment, and well-being.[5]
Heroin Addiction and Abuse
Physiological dependence on heroin can occur in days; this is because the brain’s opioid receptors adapt very quickly to the presence of the drug, building tolerance, and requiring users to take increasingly higher doses to avoid withdrawal symptoms.[6] Most users report reaching a point where they need to take heroin simply to maintain a normal level of functioning, a critical point at which users realize they are no longer able to stop using on their own.
Heroin addiction commonly occurs alongside depression, anxiety, post-traumatic stress disorder (PTSD), and other mental health disorders that may have been present before heroin use began or have developed as a consequence of prolonged substance use, making integrated treatment especially important.[7]
Signs of Heroin Use
Recognizing the signs of heroin use is often the first step toward getting treatment for yourself or someone you love. Signs may vary person to person, but below are the most common to look for:
- Taking heroin in greater amounts or more frequently than intended
- Spending excessive amounts of money and time acquiring, using, or recovering from heroin
- Avoiding social interactions, family, friends, work, and activities previously enjoyed
- Neglecting personal care, hygiene, finances, and work responsibilities
- Continuing to use despite negative consequences to health or a previous overdose
- Track marks, abscesses, or collapsed veins in those who inject
- Constricted pupils, drowsiness, and slowed heart rate and breathing following use
If you recognize these signs in either yourself or a loved one, seeking treatment is recommended before heroin use escalates further and to prevent a fatal overdose.
Heroin Withdrawal
Withdrawal from heroin is often cited as a reason that people return to heroin use before establishing the foundation for treatment. Although withdrawal from heroin alone is usually not dangerous, the intense nature of the withdrawal symptoms, along with the knowledge that using heroin again would immediately stop the discomfort, makes the temptation to resume use very difficult to resist without medical supervision.
The typical onset of withdrawal from heroin is between 6 to 12 hours after the last dose, and symptoms generally peak between 48 and 72 hours, though this varies depending on age, weight, gender, and overall health.[8]
Typical symptoms experienced during acute withdrawal include:
- Muscle cramping and pain.
- Nausea, vomiting, and diarrhea.
- Sweating, chills, and goosebumps.
- Insomnia, excessive agitation, and irritability.
- Intense cravings.
- Anxiety, irritable mood, and emotional distress.
Post-acute withdrawal symptoms such as depression, anxiety, and persistent cravings may continue to exist for several weeks or even months after the initial acute withdrawal symptoms subside.[9] A medically supervised detoxification program using buprenorphine or methadone significantly diminishes the severity of withdrawal symptoms as well as provides protection against relapse during the vulnerable period of recovery.[10]
Heroin Addiction Treatment
To effectively treat heroin addiction, both the physical dependence and the mental and behavioral elements of addiction need to be addressed. Treatment usually starts with medical detox and proceeds through a continuum of care based on the client’s specific requirements.
Medication-assisted treatment (MAT) is considered the gold standard of interventions for heroin use disorder, providing the strongest evidence-based treatments for reducing overdose deaths, increasing treatment retention rates, and supporting long-term sobriety.[11]
There are three primary types of MAT used to treat heroin addiction:
- Buprenorphine (Suboxone) — A partial opioid agonist which reduces cravings and withdrawal symptoms while avoiding the euphoria associated with full opioids. Certified practitioners can prescribe Suboxone in office-based treatment settings, allowing many individuals to receive treatment in an outpatient setting.
- Methadone — A long-lasting full opioid agonist. Methadone maintains brain chemical stability, eliminating the highs and crashes caused by actively using heroin. Years of research have demonstrated methadone’s effectiveness for treating heroin addiction.
- Naltrexone (Vivitrol) — An opioid antagonist that completely blocks opioid receptors, resulting in no effects being produced by heroin. Vivitrol is administered through monthly injections, making it best suited for those who have undergone detox and are free from opioids.
Although medication can be highly effective as part of a treatment plan, it works best when combined with behavioral therapies.
