Heroin and the damaging effects

Heroin is one of the most addictive illegal drugs.

Heroin is a synthetic derivative of morphine. The pure substance is a white, pink or beige, odorless powder with a bitter taste. It can be smoked, snorted, or less commonly, inhaled. But the most effective way of getting it into the bloodstream without losing some along the way is to inject it. So most users inject it. Experienced users will inject between two and four times per day.

The effect on users is most intense in the few minutes after injection after which follow several hours of lethargy and sleepiness. During this time;

the person's consciousness fluctuates � eyelids may droop, close and open again
they sweat and itch, scratching themselves continually
they have trouble urinating, even though the bladder is full
they feel nauseous and may vomit, though the nausea doesn't distress them
they breathe more slowly than normal
the pupils of their eyes get much smaller
they get constipated

When the effect wears off, the person may feel slightly drowsy for a day or so. After that they return to normal. However, if they start using heroin on a daily basis after a period � usually a few weeks � tolerance to the drug develops.

When it is no longer in the body there are a number of physical and biochemical changes which give rise to withdrawal symptoms, including: irritability, anxiety, muscle cramps, abdominal pains, chills, nausea, diarrhea, sweating, sniffing, sneezing, weakness and insomnia. These sensations begin within 12 hours of not using, and peak after two to four days; subsiding after about a week. Death from withdrawal is rare.

People who use the drug regularly suffer a range of physical conditions. Some of these relate to the effects of the drug itself, some relate to the way the drug is administered, and others relate to the lifestyle that often accompanies regular use of the drug.

Those to do with injecting the drug include:

Infections at the injection site � If a syringe isn't sterilized, and if it is shared, it may have come into contact with bacteria that can cause abscesses at the injection site.
Collapsed veins � Impurities in the mixture that is injected may irritate the walls of the veins and they become inflamed and scarred, and can close up. The longer someone uses, the more likely this will happen. Eventually they may have trouble getting access to a vein.
Introduction of bacteria and viruses into the bloodstream � Contaminated blood from other users when sharing a syringe can introduce viruses, such as HIV and hepatitis B and C into the bloodstream. They may also contain bacteria, giving rise to blood infections and/or abscesses in organs like the lungs, brain or liver. People with a preexisting disease of the valves of the heart are especially susceptible to a chronic infection of the heart valves, which is difficult to treat and can be fatal.

More general effects include:

Menstrual irregularities � female users may stop getting periods altogether.
Loss of weight and general susceptibility to illness.
About half of all heroin users die before the age of 50.

Heroin has an effect of depressing the respiratory system. If enough is taken, users can stop breathing altogether. This is most likely in the minutes following an injection but can occur later. The user loses consciousness, stops breathing and turns blue. If breathing doesn't start again, after about three or five minutes, irreversible brain damage can occur. This is most likely if;

the drug is unusually pure, or is purer than the drug they're used to,
they're a first time user, unused to the drug and they have a large dose,
they have not used for a long period, which reduces their tolerance and they give themselves the same dose they used to take when they had a higher tolerance, or
they are taking other drugs at the same time, especially respiratory depressants like alcohol or sedatives. Most overdoses occur because heroin has been mixed with the depressant drugs.

The more of the drug a person is using, the greater their chance of respiratory depression because while they develop tolerance to the euphoric effects of the drug, they don't develop tolerance to the respiratory depressant effects of heroin. So as a user increases their dose of the drug to get the same effect, they increase the chance of an overdose.

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People who are addicted to heroin take the drug because it relieves them of problems like low self-esteem, distrust and fear of abandonment. They may have poor communication skills, and poor relationship skills. They may have been sexually abused in the past, or have been involved in a violent or abusive relationship. They use heroin and other drugs to bring relief. Counseling and therapy, which should be conducted by qualified counselors experienced in drug and alcohol treatment, aims to help them identify these issues, understand and overcome them, using techniques like behavioral modification, motivational programs, and self-help groups.

The live-in approach is often more successful because living-in removes a person from their usual heroin-using environment. Also a person who opts to give up their regular lifestyle to live-in is usually more motivated to become drug free. But not all dependent users can afford to spend time in a therapeutic community if it means they have to leave their job. There's a high drop out rate, especially in the first few weeks.

There are several Drug maintenance programs that many users can find helpful when kicking the habit. Drug maintenance programs involve giving a person addicted to the drug a substitute drug that acts on opiate receptors in the brain but does not give the 'high' that the drug does. This allows the user to come off the drug without experiencing side effects. The person is no longer exposed to the health problems of injecting the drug, or the need to sell the substance or commit crimes to finance a drug habit.

Methadone, a synthetic opioid developed in Germany during the Second World War as a painkiller, is the most frequently used. Methadone isn't a cure for type of drug addiction, but it does allow the addict to stabilize his or her life, stay free (hopefully) of using it, avoid health problems like overdose, transmission of HIV, skin abscesses from injecting and withdrawal symptoms from detoxing. On methadone, they can put their lives together, get (or keep) a job, and maintain relationships. After a period ranging from months to years, ideally they can gradually reduce their dose of methadone to zero and become drug-free, though some choose to stay on methadone indefinitely.

Buprenorphine is another opiate replacement drug. It lasts longer in the body than methadone, so can be taken every two days. And it's safer than methadone � a person taking buprenorphine is less likely to overdose than one taking methadone. It doesn't produce the euphoric and sedative effect of methadone; users report feeling more 'normal' on buprenorphine. Nevertheless buprenorphine has been shown to be very effective in reducing heroin use and crime and allowing the user to take control of his/her life.

Naltrexone is also a drug, but it isn't a heroin substitute like methadone and buprenorphine. It's an antagonist � it blocks the brain's opioid receptors so that if someone who is taking naltrexone then uses heroin, the heroin will have no effect. So they will cease using heroin � at least that's the idea. A person must have completely 'detoxed' from heroin before taking naltrexone which is taken daily by mouth, or slow-release Naltrexone capsules can be inserted into the body.

Coming off and staying off heroin is hard work. One of the important factors is support from friends and family, who can do things like supervising the treatments, acting in the event of an overdose, going to appointments attending couple or family counseling, and involving them in social networks away from the drug scene. If you think your teen is addicted to heroin, click here for a list of resources to help you and your family.

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