Unless you have been living in another country without access to the internet or television, it’s hard to ignore the current state of affairs of the United States. The opioid crisis has been described as the single worst public health emergency that the country has experienced, and it is changing us on many different scales.
According to the National Institute on Drug Abuse (NIDA), more than 130 people in the United States die after overdosing on opioids. While these figures have reached incomprehensible levels, they are still predicted to increase exponentially over the next five to 10 years.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that the total economic burden of prescription opioid misuse alone in the United States is a staggering $78.5 billion a year. These figures include the costs of healthcare, lost productivity (calling out sick), addiction treatment, and criminal justice involvement.
The opioid crisis has decimated some communities, and the emergence of synthetic opioids such as fentanyl have inflated these numbers massively. Fentanyl, in comparison to heroin, is a much cheaper alternative for drug dealers. Fentanyl has grossly inflated their profits, and the dealers continually lace their drugs with the potent narcotic.
Fentanyl has wholly changed the opioid epidemic, and it continues to get worse. According to experts, heroin will eventually be phased out by the cheap synthetic drug leaving heroin users searching for alternatives.
Many describe fentanyl as “too strong” and lacking the euphoria that heroin produces, and many are not equipped to handle its strength. When someone consumes fentanyl unexpectedly, it can kill them almost instantly.
Overdosing on heroin is a common occurrence, but it is nothing like fentanyl. That doesn’t mean heroin isn’t still highly sought out or isn’t used by many people. On the contrary, many people still are active heroin users.
A study in 2016 highlighted that 948,000 Americans reported using heroin in the past year, a number that continues to rise steadily since 2007. The trend is primarily driven by adults ages 18 to 25, the population in which the figures have increased the most. The number of Americans using heroin for the first time has remained high as well with the number set at 170,000 in 2016; this number almost doubles the rate of people who tried it in 2006 (90,000).
Despite the rise in heroin use, the emergence of fentanyl has indeed caused many to rethink their drug habit and seek solutions. When someone is trying to abstain from heroin, however, they’ll seek out alternatives that can help ease the transition into sobriety.
Tapering off heroin is not recommended for those who are trying to quit because the dose and purity are impossible to control. It makes it nearly impossible to implement an active tapering schedule. Fortunately, there are opioid replacement medications approved by the U.S. Food and Drug Administration (FDA) that can be used in place of heroin to alleviate withdrawal symptoms.
When heroin is introduced to the body, it binds to and activates receptors in the brain. The action triggers the release of dopamine and rewards the person with pleasurable feelings that eating or sex will activate. The emotions lead to strong desires to continue using heroin over and over.
Continued heroin use is reinforced by the activation of our brain’s reward system, and over time, people are driven to keep using because of physiological dependence and to avoid withdrawal symptoms.
Prolonged use of heroin diminishes the sensitivity of the receptors that are activated by the drug. The brain, in turn, becomes less responsive to heroin and what’s known as tolerance begins to develop.
The phenomena create the need to consume higher doses to achieve their desired level of intoxication. As time passes by, the dose will continually increase and eventually wire the user’s brain to function normally only when heroin is present in their system.
Dependence on heroin will result in withdrawal symptoms when someone cuts back or reduces their intake. When someone is dependent on heroin, abrupt cessation, or going cold turkey can cause unbearable withdrawal symptoms. These withdrawal symptoms can occur in as little as six to 12 hours after the last dose.
While heroin withdrawal is not inherently dangerous, it causes extreme discomfort that can push someone right back into using the drug. Some of the most common symptoms experienced during heroin withdrawal include:
Heroin is notorious for its withdrawal symptoms, and it is not recommended attempting to stop the use of the drug on your own. Fortunately, alternative methods are available that can help you kick the drug.
As we mentioned above, a tapering schedule for heroin is nearly impossible given the inability to measure the potency or the dose that someone has been using. For this reason, other medications can be used to supplement the effects without causing euphoria but stave off withdrawal symptoms. Heroin is a short-acting drug, meaning someone would require several doses throughout the day and will be more likely to cycle through rapid highs and lows.
The most common and highly effective method that is used in heroin addiction treatment is to use an opioid substitute medication. Medication-assisted treatment (MAT) treats the client with medication prescribed by a doctor usually once a day. The medicine may only be used during detox, but some may use the rest of their life. It all depends on the situation, as each case is unique.
Medication-assisted treatment is often paired with counseling or behavioral therapies to increase its effectiveness and retention during rehabilitation.
Methadone, a long-acting opioid receptor agonist is one of the most common medications used in this treatment. Methadone clinics have been around for many years, and the drug helps reduce the cravings and withdrawal from heroin. Consistent methadone use will build a cross-tolerance that blocks the effects of other opioids such as heroin.
Another commonly used drug is Suboxone, and it is also a long-acting opioid receptor partial antagonist. It serves the same purpose by reducing cravings and withdrawal symptoms and stops the effects of other opioids.
A less commonly used opioid receptor antagonist known as naltrexone does not produce any opioid effects, but it does block the effects of other opioids. It is primarily used after the withdrawal period to prevent relapse.
Medication-assisted treatment is a highly useful weapon in the opioid crisis, and it has shown to increase the survival rates of clients in treatment significantly. There is information that points to increased retention of clients in treatment, the reduction of illegal opioids and criminal activity, and a smoother transition back into society to find a job.
Opioid addiction is something that will be maintained for a lifetime if you have developed it, but medication-assisted treatment can take the edge off Post-Acute Withdrawal Syndrome (PAWS), which can present challenges for years after abstaining from heroin.
Once clients go through detox at one of our heroin rehab centers, they can be recommended for treatment, which tackles the mental and emotional aspects of heroin addiction.
Residential treatment at our Haverhill, Mass., location is recommended for clients with severe addictions. This treatment model provides clients with housing and services to get well. In residential, clients will be provided with evidence-based therapy and care for their heroin addiction, including behavioral, group and family therapy, and life skills training.
For milder cases, clients may be selected for an outpatient program, which also provides them access to proven therapies to treat addiction on a part-time basis.
Heroin is a significant player in the current opioid epidemic. Thousands of overdose deaths involve heroin each year. It’s a powerful opioid, but on its own, in the proper doses, heroin is like any prescription opioid. It can cause sedation, pain relief, and euphoria. It can also cause uncomfortable side effects like constipation. But if it’s like any prescription, why is it so dangerous? Heroin is dangerous for a few reasons. The first is because it’s extraordinarily addictive. Heroin can cause chemical dependence and addiction after repeated use. It’s notoriously difficult to overcome addiction after you develop a severe substance use disorder.
Addiction is characterized by the continuous use of a drug despite negative consequences. These compulsions can drive you to become desperate, making reckless decisions in order to maintain your addiction. Risky behaviors can lead to several complications like legal issues, financial problems, strained relationships, and an increased risk of contracting blood-borne viruses like hepatitis B and C, HIV, and others.
Heroin is typically obtained from illicit sources, which can be unpredictable. Illicit heroin is often adulterated with other substances. Sometimes those substances are inert, only serving to weaken the drug without adding any effects.
In other cases, substances can add additional mild to severe effects. But even inert adulterants can be dangerous. If you get used to heroin that’s been adulterated, you may increase your normal dose.
When you encounter heroin that’s closer to purity and take your typical dose, it might be too much to handle, and you overdose.
Heroin can also be mixed with other substances that can be even more dangerous. For instance, the powerful opioid fentanyl is often mixed into illicit heroin to intensify its effects. However, fentanyl can be 50 times stronger than heroin. Even a small amount in heroin can cause it to be significantly more potent. People taking fentanyl-laced heroin without knowing, are likely to relapse.
Heroin addiction is a chronic and progressive disease. If it’s left untreated, it can get worse over time, affecting many aspects of your life, including your health, relationships, finances, and legal standing. Getting treatment as early as possible can help you to avoid some of the most dangerous consequences of addiction. Still, it’s possible to achieve sobriety, even if you’ve relapsed several times. Start seeking the right treatment options for your needs today.
National Institute on Drug Abuse. (2018, June). What are the medical complications of chronic heroin use? Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/what-are-medical-complications-chronic-heroin-use
National Institute on Drug Abuse. (2019, January 22). Opioid Overdose Crisis. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
Psychology Today. (n.d.). What Is Dopamine? Retrieved from https://www.psychologytoday.com/us/basics/dopamine
SAMHSA. (2019, April 26). Medication-Assisted Treatment (MAT). Retrieved from https://www.samhsa.gov/medication-assisted-treatment
United States Drug Enforcement Administration. (n.d.). Fentanyl. Retrieved from https://www.dea.gov/factsheets/fentanyl