Heroin abuse is one of the fastest growing and deadliest forms of drug abuse in the United States. After declining in the ‘80s and ‘90s, rates of heroin abuse have been steadily climbing for the last decade. Rehab facilities across the country are expanding to accommodate the growing number of people seeking treatment for heroin addiction.
The opioid epidemic of the new millennium has been characterized by record numbers of overdose deaths in the United States. As law enforcement, policymakers and health care providers implemented strategies to reduce prescription painkiller abuse, a similar drug began rising in popularity.
From 2012 to 2014, rates of heroin abuse rose to numbers rivaling the heroin epidemic of the 1960s and ‘70s. The number of people addicted to heroin increased by at least 8 percent each year during the time frame.
Heroin is made from morphine, a natural chemical in the opium plant. People who use the drug to get high experience significant pain relief and euphoria. However, the crash from heroin use includes nausea, vomiting, slowed breathing and slow heart rate.
The drug is one of the leading causes of drug overdose deaths, and it’s also associated with the spread of HIV, hepatitis and tuberculosis when used intravenously. In the past, heroin was always injected, but increases in purity now allow people to get high by smoking or snorting it. And the uncertainty of the drug’s purity increases the likelihood of overdose.
Heroin addiction is incredibly difficult to overcome on your own, and quitting cold turkey without supervision can cause severe withdrawal symptoms. Fortunately, treatment centers across the country are expanding to keep up with the influx of patients trying to recover from heroin addiction.
Addiction can occur after trying heroin only once. However, most people addicted to opioids today began by using prescription painkillers for either medical or nonmedical purposes, according to epidemiological studies.
They find out that heroin relieves those negatives just like the OxyContin used to, and it’s a lot cheaper and it’s easier to get. Now you appear as the traditional drug addict that’s buying stuff off the streets and is exposing him or herself to all of the potential problems that street drugs can cause.
Dr. Glen Hanson, the former interim director for NIDA, explained how many Americans became addicted to opioids.
“They start off using a narcotic such as OxyContin to treat pain,” Hanson told DrugRehab.com. “It relieves the pain. That’s great. Then on top of that, these narcotics stimulate reward systems in the brain for some people. So you’ve got a two-for: less pain and some stimulation and some reward.”
Opioids also relieve stress and anxiety, so people get used to feeling relaxed, he said.
“When the pain is gone, the stress is still there,” Hanson said. “So you want to keep using the drug, not for the pain anymore, but for the stress relief. It gets out of control, and now you become addicted.”
However, prescriptions for opioids expire. When injuries heal, a doctor should no longer prescribe the painkiller. But because the patient has been misusing the drug, he or she will experience withdrawal symptoms upon discontinuation. That’s when people turn to the streets to find the drugs, he said.
during the 2000s
“They find out that heroin relieves those negatives just like the OxyContin used to, and it’s a lot cheaper and it’s easier to get,” Hanson said. “Now you appear as the traditional drug addict that’s buying stuff off the streets and is exposing him or herself to all of the potential problems that street drugs can cause.”
Heroin is derived from the same plant as prescription painkillers such as oxycodone, hydrocodone, fentanyl and codeine. They are made of similar chemicals, which cause similar effects but to different degrees.
Today’s heroin epidemic is not like the one that occurred 50 years ago. In the ‘60s and ‘70s, the majority of heroin trafficking, abuse and addiction was contained in the cores of large metropolitan areas. Heroin was the first opioid that people addicted to opioids were exposed to. The overwhelming majority of heroin users were black, teenage men, according to multiple studies.
Today, heroin users are more likely to be older, white men and women living in nonurban areas, who were introduced to opioids through prescription drugs or who chose heroin as a cheaper and more accessible alternative to prescription painkillers, according to a 2014 study published in JAMA Psychiatry.
Three factors contributed to the increase of heroin abuse among this new demographic:
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The Office of National Drug Control Policy measures drug purity using a standard called “average expected purity.” The highest average expected heroin purity in the country occurred in the mid and late ‘90s.
Heroin purity rose consistently from 1981 to the early ‘90s, then spiked in the years leading up to the new millennium. The average expected purity slowly decreased between 2000 and 2007, with the exception of small spikes in 2002, 2005 and 2007, according to ONDCP.
There is no scientific data available for nationwide trends in purity since 2007, but anecdotal accounts and media reports suggest that heroin purity has been increasing in recent years.
“In the late 1970s and early 1980s, the average street purity was almost always below 40 percent, usually in the 20 to 30 percent range,” Dr. Tim Huckaby of the Orlando Recovery Center said. “It was not mixed with fentanyl. The street purity today is usually in excess of 60 percent, frequently in excess of 75 percent.”
Heroin purity also tends to be different between regions and cities. For example, purity is usually higher in New York City than in Washington, D.C., according to ONDCP.
In the late 1970s and early 1980s, the average street purity was almost always below 40 percent, usually in the 20 to 30 percent range. It was not mixed with fentanyl. The street purity today is usually in excess of 60 percent, frequently in excess of 75 percent.
Heroin has never been a leading drug of abuse among teens and adolescents. Heroin abuse among 12th-graders dropped from 1.0 percent to 0.5 percent from 1975 to 1979 and remained stable until 1994. Heroin use tripled among high schoolers during the next decade, possibly because an increase in purity allowed the drug to be smoked and snorted, according to the national Monitoring the Future survey.
The prevalence of heroin use declined in the early 2000s, and there is no evidence of any increase since then. In 2015, the lifetime use of heroin was 0.5 percent for 8th-graders, 0.7 percent for 10th-graders, and 0.8 percent for 12th-graders.
In comparison, the OxyContin prevalence of use was 0.8 percent, 2.6 percent, and 3.7 percent for grades 8, 10, and 12, respectively. The prevalence of Vicodin use was 0.9 percent, 2.5 percent, and 4.4 percent for grades 8, 10, and 12, respectively.
Lacing heroin with fentanyl creates a deadly combination. Fentanyl is an extremely powerful opioid painkiller used to treat severe pain after surgery or in cancer patients. It’s 25 to 50 times more potent than heroin and 100 times more potent than morphine.
Dr. Huckaby told DrugRehab.com that people purchasing the drugs on the street usually have no idea of the drug’s potency or how much fentanyl has been added to it.
“Say you happen to purchase heroin that is 10 times more potent than what you purchased last week and contains 15 percent more fentanyl than what you purchased last week,” Huckaby said. “You inject roughly the same amount that you did OK with last week, but now you fall asleep and never wake up.”
It’s 25 to 50 times more potent than heroin and 100 times more potent than morphine.
Several states have reported increases in fentanyl-related emergency department visits and overdoses in recent years, according to the CDC.
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Heroin addiction is a life-threatening disease that can lead to overdose or the contraction of deadly diseases such as HIV, hepatitis or other sexually transmitted diseases.
If you suspect someone you know is suffering from heroin addiction, look for drastic changes in appearance, hobbies and attitudes. Other symptoms and warning signs of heroin addiction include:
The side effects and risks of heroin addiction increase the longer someone uses the drug and the more their tolerance increases. Side effects and risks of heroin addiction include:
Heroin overdoses typically occur when the user is unaware of the potency of the drug he or she is consuming or when someone relapses after trying to quit and returns to the same dose. In the latter scenario, the person’s tolerance dropped during their abstinence and the drug hits them harder than it would have days or weeks before.
Individuals addicted to heroin should seek professional treatment as soon as possible to avoid permanent health problems.
Heroin addiction is difficult to recover from because of the drug’s highly addictive nature. Without medical treatment, detoxing from heroin causes intense cravings and withdrawal symptoms.
“Heroin causes such profound brain changes that the person caught up in this kind of madness is powerless, and cannot help themselves,” Huckaby said. “At this point it has become a real brain disease called addiction, and they need immediate treatment before it is too late.”
Treatment for heroin addiction begins with detox — which is usually assisted by medication — and is followed by behavioral therapy, attendance at support group meetings and time in a sober living environment. Severe cases of addiction may require long-term maintenance medication because of drastic changes to the brain.
Detoxing from heroin addiction usually lasts 30 days. Withdrawal symptoms generally occur within 12 hours of last heroin usage. Heroin withdrawal symptoms include:
Several medications can ease cravings and withdrawal symptoms during the detox process. Medications for heroin addiction include:
At an inpatient detox center, a team of nurses and licensed therapists provides 24-hour supervision during detox. In outpatient treatment, patients typically meet with a physician or therapist once a day or multiple times a week. If treatment is mandated by the criminal justice system, treatment providers may implement drug tests to assure abstention.
Heroin metabolites — molecules that are produced when heroin is metabolized — can be detected in urine, blood and hair. Drug tests most commonly examine blood and urine to detect heroin use. Drug tests include:
Can detect occasional heroin use for 24 hours or less.
Can detect heroin use 48 to 72 hours after a single injection. The length of time is longer for repeated heroin use.
Can detect heroin for 90 days.
Several factors affect how long heroin can be detected in the body, including the method of administration, frequency of use, dosage and a person’s metabolism. When heroin is metabolized, 6-monoacetylmorphine (6-MAM) is produced. 6-MAM is quickly metabolized into morphine. Thus the presence or morphine in a drug test neither rules out nor proves heroin use.
Detox alone is not sufficient for recovery from heroin addiction. Behavioral therapy, family and peer support, and long-term maintenance medication decrease the chances of relapse.
“You never treat these conditions with just medications,” Hanson said. “Behavior always has to be a piece of it.”
Cognitive behavioral therapy, contingency management, community reinforcement and 12-step programs have proven to be successful approaches in patients recovering from opioid addiction, according to the National Institute on Drug Abuse.
Research also shows that living in sober living homes or other transitional living environments after treatment increases recovery outcomes such as employment rates, incarceration rates and relapse rates.
Recovering from heroin addiction is possible. It takes hard work, motivation and commitment, but it’s worth it. People who recover say they feel less stress, have a sense of purpose and live happier lives.