I really wish heroin wasn’t a necessary or relevant topic of conversation, but since it is, I hope this information will be helpful.
What is heroin?
Heroin is a white or brown powder that comes from the Asian poppy plant. It is related to morphine, in that it’s an opiate—a painkiller. Heroin, however, does not have any medical use.
People can use heroin by snorting the powder, injecting it (after heating it to liquefy the powder), or by smoking it in a pipe (or mixing it with other “smokable” substances).
Heroin works in much the same way as painkillers such as hydrocodone, morphine, Oxycontin, Oxycodone, etc. They’re all “downers,” in that they act on the receptor sites in the brain that relieve pain.
Generally, people who use heroin describe a sense of calm well-being and even a euphoric feeling, like all is well with the world. The effects are fairly fast once heroin is in the body, and lasts for 2-3 hours. Because it produces such a sense of well-being, people want to take more heroin to make that feeling come back.
Why are we talking about heroin?
Heroin use is on the rise in our area and many towns across the United States because heroin is a cheaper alternative for people who are addicted to or are abusing prescription painkillers. These painkillers are becoming harder to get, and are therefore becoming very expensive if obtained illegally. Think about your Economics class, it’s the principle of supply and demand.
For example, we know that Oxycontin on the street sells for about $1/milligram. A 40mg Oxycontin, then, is $40. Heroin, on the other hand, may run $10-25 for an amount that would have a similar effect.
In the last 3 years, we have had more substance abuse patients citing heroin as one of the drugs they use. It may not be their drug of choice at this time, but they are reporting having used it. Heroin has always existed, but used infrequently in the patients we treat. It’s my opinion that the reason heroin use is on the rise is that prescription drugs on the street have become more expensive, and are getting harder to obtain.
This is particularly concerning in that the cost and availability is making this drug very appealing to younger people who had been previously abusing prescription painkillers.
Why is increased heroin use a problem?
Addiction specialists are concerned about the rise in heroin use for several reasons. For one, it is highly addictive. It is rapidly absorbed by the body, and the effects are quick and strong. As with a lot of drugs, some people think they’re going to use heroin recreationally (every once in a while), just to relax and feel good. However, because it has such a strong effect on the brain receptors, the ability to resist its pull becomes less and less.
Tolerance also rapidly increases with heroin. More and more of the drug is needed to have the same effect. This raises the risk of an overdose because when someone needs a fix really badly, they may take more than they can handle.
Another concern is the health effects for someone who uses heroin. The toxins in the heroin can cause cardiac problems, lung infections, liver/kidney damage, and brain damage. And remember, every time someone gets heroin, it’s not going to be “pure” heroin. It’s going to be cut with some substance so that each level of dealer can make money. That substance can be any kind of dangerous or toxic material.
Also, because so many users inject heroin, the risk of getting skin infections, Hepatitis C and HIV are extremely high. Hepatitis C and HIV can be transmitted through the sharing of needles.
And then obviously, there’s concern for the effect of heroin addiction on a person’s overall life, as well as their family and our society.
What does heroin addiction look like?
Here are some physical symptoms of someone using heroin:
- Shortness of breath
- Cycles of alertness followed by suddenly nodding off
- A droopy appearance, as if the extremities are very heavy
- Constricted pupils
- Cold flashes
- Weight loss
- Runny nose (especially from snorting)
- Needle marks on inside forearms, hands, elbows, etc. Even in veins between the toes.
- Scabs or bruising, from picking at the skin because of a “crawling” sensation
Watch for drug paraphernalia (hidden or out in the open) that includes:
- Needles or syringes
- Burnt spoons (used to heat the powder to liquefy for injection)
- Foil wrappers with burn marks
- Small bags with a powdery residue
- Short pieces of straws or other tubing, used to snort
Watch for social signs that indicate heroin addiction:
How do I get help?
- Avoiding eye contact
- Increase/decrease in sleep
- Decreased hygiene
- Missing possessions—especially things that can be pawned
- Missing money
- Missing/quitting work or school
- Avoiding family obligations
The first step is evaluation, to determine what type of care the patient (heroin addict) needs—detox, inpatient treatment, or outpatient care. Some patients may need to enter a medication-assisted treatment program, to help their body physically wean off the addiction.
12 Step programs, such as Narcotics Anonymous (NA) provide support and a plan for living that helps the addict learn how to live without using.
Families need support, and they can attend Al-Anon or Families Anonymous for their own recovery. This helps people with the difficult task of no longer enabling an addict, and breaking their own co-dependency.
How to help a loved one addicted to heroin?
If you’re reading this because you’re worried about someone you love, stop keeping the secret. You know what you know--don’t keep it a secret any more. Addiction can become a deep, dark secret, and everyone suffers in silence. When you stop keeping the secret, and start discussing it with friends, family, your pastor, others in a 12 step program (like Al-Anon), etc. you begin to empower yourself and the addiction loses its power over the family. When you start talking about what’s going on, it demystifies the disease and allows others to reach out and help you.
Interventions can be helpful, but MUST be done properly. Before even considering an intervention, families should talk to a therapist who has expertise and experience in addiction. Most will actually recommend that the family attend Al-Anon meetings prior to any discussion of having an intervention. It may be tempting to put the person with the addiction in the car, and drive them somewhere and drop them off to “be fixed.” Unless the addicted person really believes their use is a problem, and they themselves want help, this approach can leave families feeling disappointed and without hope. That’s why Al-Anon or Families Anonymous are so important for someone who loves an addict.
I also want to tell you about a program I oversee here at Deaconess Cross Pointe, the Intensive Outpatient Program. This program is for anyone with a substance abuse problem—alcohol or drugs. We meet 3 evenings per week for 3 hours each evening for 6 weeks. We are abstinence based, and require 12-Step meeting attendance in addition to the program. Family education is also part of the program. We take most major insurances. (People should check with their own insurance to determine level of coverage.) For those who don’t have insurance, we can be helpful in locating an affordable program.
Deaconess Cross Pointe also operates a 24-hour, confidential assessment service called CARE.
Lastly, here are some websites that can be very helpful on the subject of heroin addiction.
Families Anonymous Great info, and also a local meeting/chapter finder.
Al-Anon family Groups Also has a chapter locater.
The National Institute on Drug Abuse (NIDA)