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What is Heroin?
Heroin is an illegal opioid drug derived from morphine, a naturally occurring substance obtained from the seed pod of the opium poppy plant. Manufactured heroin is commonly available in the form of a white or brown powder or as a black sticky substance, known as “black tar heroin.”
Heroin comes in powder form, ranging in color from white in its purest state to dark brown, depending on impurities from the manufacturing process or dilution to increase street value. It can be inhaled by snorting or sniffing, or smoked, as well as injected. Black tar heroin, which generally comes from Mexico, contains impurities and is usually dissolved and then injected, although it can also be smoked or snorted. Powdered heroin is cut, or diluted, using various substances including starch, powdered milk, quinine, laxatives for infants, or other material.
All three routes of administration rapidly deliver the drug to the brain resulting in potential health risks. Heroin is classified by the United States Drug Enforcement Agency (DEA) as a Schedule 1 drug under the Controlled Substances Act. That category is reserved for drugs with no currently accepted medical use and a high potential for abuse and addiction. Addiction to heroin can be difficult to overcome on one’s own, which is why it is important to enter an addiction program, such as the heroin treatment centers at Drug Treatment and Rehab Centers (DTRC).
Sources of Heroin
Afghanistan continues to be the leading global cultivator of opium and producer of heroin; opium poppy cultivation increased 36 percent in 2013, reaching a record high. Meanwhile, opium production reached a new high of 5,500 metric tons, an increase of almost 50 percent over 2012, according to the United Nations’ Office on Drugs and Crime (UNODC).
Mexico is both a producer and a conduit of illegal drugs from South America destined for the U.S., and may have recently overtaken Colombia as the main supplier of heroin to the U.S. In 2005, estimated production of heroin was 8 metric tons; by 2009, estimated production has risen to 50 metric tons. Mexico has been known for production of black tar heroin, which is easier and cheaper to manufacture than white heroin.
In 2012, a total of 1.855 metric tons of heroin were seized at the 2,000-mile southern U.S.-border with Mexico, up 223 percent from .5588 metric tons in 2008.
Heroin Use in the U.S.
The National Survey on Drug Use and Health (NSDUH) for 2012 says that 669,000 people in the U.S. reported using heroin in the previous 12 months, up from 620,000 in 2011. The 2012 figure includes 156,000 individuals 12 or older who reported using heroin for the first time, down from 178,000 in 2011 but almost double the number in 2006. Average age of first use is between 21 and 23.
Until the 1980s, heroin was mainly administered by injection, sometimes in combination with cocaine, a mixture known as a speedball. Access to increasingly pure heroin, combined with the stigma of needle use and awareness of the risk of HIV and hepatitis infection from sharing needles, all contributed to the rising popularity of alternate routes of administration.
The NSDUH estimates the number of persons with heroin dependence or abuse in the U.S. in 2012 at 467,000; approximately twice the number in 2002 (214,000). Most of the people reported as heroin-dependent are 26 or older.
The 2011 NSDUH supports other data indicating that heroin use is increasing, particularly among young adults. There appears to be a trend of growing heroin use as an alternative to abuse of opiate prescription drugs, which may be harder and more expensive to obtain.
Federal data indicates that as of 2011, 4.2 million people aged 12 or older had used heroin at least once in their lives. An estimated 23 percent of people who use heroin become dependent. The average number of people who received heroin drug treatment in the previous 12 months during 2009-2011 was 289,000, up from 181,000 during 2002-2005. Because of the associated health risks, it is important that those addicted to heroin seek treatment at a heroin rehab center.
Cumulative data from the annual Monitoring the Future Survey of high school students shows that the prevalence of heroin use among 12th graders was between 0.5 percent and 1 percent from the mid-1970s through the mid-1990s. The prevalence of use peaked in 1996 among 8th graders (1.6 percent), in 1997 among 10th graders (1.4 percent), and in 2000 among 12th graders (1.5 percent). The use has since declined with the annual prevalence in all three grades ranging between 0.7 percent and 0.9 percent from 2005 to 2011.
Data from 2012 shows a significant decrease in the use of heroin without a needle for 8th and 12th graders. Use with a needle has remained more or less steady over time, with the trends showing a significant increase to 0.7% in 12th graders in 2010. In 2012, all three grades were at 0.4% using with a needle, and there was little change reported in 2011.
How Heroin Works
Heroin, whether injected, sniffed or smoked, is converted back to morphine, and binds to opioid receptors (mu, delta and kappa opioid receptors) in the brain, brain stem, and other locations in the body. These receptors are activated by naturally-occurring peptides or amino acids, which are released by neurons. Opiate receptors are activated by morphine – the active ingredient in heroin and other opiate drugs – which has a similar chemical structure to endorphins. Endorphins inhibit the release of neurotransmitters including dopamine.
The body’s opioid system modulates addictive behaviors, and affects mood as well as sensations of pain and well-being. It also affects the central nervous system. When activated, the mu-opioid receptors (MORs) in particular stimulate the release of the neurotransmitter dopamine by triggering the brain’s reward system, creating feelings of pleasure.
Over time, if the opioid system is repeatedly activated through the administration of heroin or other substances, the brain’s reward system becomes reliant on the drug. When a drug begins to have a diminished effect after repeated use of the same dose (known as tolerance), people have to use increasing amounts of the substance to achieve the same effect. Addiction occurs after a person associates positive feelings with use of a substance; when that conditioning is reinforced enough, the brain becomes conditioned and the drug use becomes compulsive and uncontrollable.
Heroin is highly addictive, both physically and behaviorally. Use of heroin, whether injected, smoked or snorted, results in an initial state of euphoria, called a rush, that is felt within seconds when heroin is injected or smoked. That is followed by a period of drowsiness, known as “going on the nod,” and reduced activity rates of central nervous system functions such as pulse and breathing.
Physical symptoms of withdrawal in an addict can begin within hours after the heroin wears off, and become severe if use is reduced or if the person stops. Symptoms include restlessness, pain, insomnia, diarrhea, vomiting, cold flashes and muscle twitches. These symptoms peak within about 48-72 hours following the last dose, and usually subside after about a week.
Heroin detox can not only be uncomfortable, it also poses medical risks that can be severe and even life-threatening, and should only be undertaken under medical supervision. At DTRC, our heroin rehab center includes heroin withdrawal treatment, such as natural and medically assisted detox for heroin.
Long-term Cognitive Danger of Heroin Use
There are many dangers associated with heroin use in addition to addiction and the risk of overdose. Like alcohol, heroin causes direct toxicity to the brain cells. It also induces an autoimmune reaction against the brain tissues. Heroin use over an extended period of time changes the way both the body and brain work.
Chronic use of heroin may lead to long-lasting impairments in brain function. Heroin users demonstrate profoundly impaired visual pattern recognition memory. Heroin abuse for more than a year is associated with impairment of short-term memory, as well as delayed verbal memory. The intensity of impairment is higher with addicts who commonly use a higher daily dose of heroin. It further has a negative impact on impulse control, selective processing and intellectual functioning. Heroin abuse affects decision-making as well as working and episodic memory. Heroin recovery should include cognitive remediation, such as the Brain Wellness Program at the heroin treatment center at DTRC.
Long-term heroin use is strongly associated with anxiety, mood swings, confusion, and paranoia. Heroin users show behavioral changes over a period of time along with disorientation, irresponsible behavior at work or school, increased tendency towards lying, increased sleeping and slurred speech. Heroin is known to cause mental confusion, affecting the decision-making ability of the consumer. The user tends to take irrational decisions. Above all, heroin creates a “false sense of normality.” Help for heroin addicts should take into account all underlying and co-occurring conditions in order to reduce the risk of relapse. The dual diagnosis treatment at DTRC’s heroin rehabilitation centers provides holistic care for all co-occurring conditions.
Physical ailments that can affect long-term, regular users of heroin include collapsed veins and infection of the lining and valves of the heart. They are also susceptible to liver disease and respiratory conditions such as pneumonia.
Treating Heroin Addiction at Drug Treatment and Rehab Centers
Drug Treatment and Rehab Centers (DTRC) offers heroin addiction treatments that help people recover from dependencies on heroin and other drugs or alcohol. Patients are screened and treated for all underlying and co-occurring conditions in order to reduce the risk of relapse. Through customized programming that combines individual and group psychotherapy and complementary alternative therapeutic activities such as yoga, meditation, art therapy, equine therapy, and music therapy, the heroin rehabilitation programs at DTRC provide balanced, holistic treatment for the person, not the disorder. Call our Admissions team at (415) 366-6922 to learn more about our treatment for heroin addicts.