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What began as a problem with prescription painkillers has turned into a national heroin epidemic. Most people addicted to heroin became addicted to opioids they received from a doctor or family member. Heroin use comes with numerous risks, including the risk that the drug is mixed with other lethal substances. Addiction treatment helps relieve dope sickness and prepare people for new lives without heroin.

  • Drug Name Heroin
  • Addiction Liability Very High
  • Scientific Name Diacetylmorphine
  • Street Names Smack, Boy, Horse, Black Tar, Skag
  • How It's Used Swallowed, Injected, Smoked, Suppository
  • Side Effects Fatal Overdose, Collapsed Veins, Spontaneous Abortion, Abscesses, Constipation, Gastrointestinal Cramping, Liver or Kidney Disease
  • Psychological Dependence Very High
  • Physical Dependence Very High
Two people making a drug deal

How People Become Addicted to Heroin

No one wants to be addicted to heroin. Some people try it for the occasional high, but the recreation turns into a substance use disorder. Most people who use heroin turned to it as an alternative to opioid pills that they became addicted to after receiving a doctor’s prescription.

“They start off using a narcotic such as OxyContin to treat pain,” Dr. Glen 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.”

Opioids, such as OxyContin and heroin, relieve stress and anxiety. They make people feel a sense of calm and relaxation in addition to happiness.

“They want to keep using the drug, not for the pain anymore but for the stress relief,” said Hanson, the former interim director of the National Institute on Drug Abuse. “It gets out of control, and now they become addicted.”

Opioid prescriptions don’t last forever. When you’re addicted to prescription drugs and your prescription expires, you face a choice. Either power through withdrawal, find a drug rehab facility or find an alternative drug. Unfortunately, finding and using heroin is easier than recovering from addiction.

“Heroin relieves stress just like the OxyContin used to, and it’s a lot cheaper, and it’s easier to get,” Hanson said. “Now the person appears as the traditional drug addict that’s buying stuff off the streets and exposing him or herself to all of the potential problems that street drugs can cause.”

That’s how thousands of people become addicted to heroin every year. Nearly 600,000 people were addicted to heroin in 2015, according to the National Survey on Drug Use and Health. The epidemic has spurred a growth in prevention and treatment initiatives across the country. Today, there are more resources for people with heroin addiction than ever.

Man cradling his legs

What Heroin Users Looks Like

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.

Heroin has never been a leading drug of abuse among teens and adolescents. Less than one percent of 12th graders used heroin between 1975 and 1994. Heroin use tripled among high schoolers during the next decade, but it’s decreased since 2005, according to the Monitoring the Future study.

In 2015, less than 1 percent of eighth-graders, 10th-graders and 12th-graders had tried heroin in their lifetime. In comparison, 2.5 percent of 10th-graders and 4.4 percent of 12th-graders had tried Vicodin. Early exposure to prescription opioids may increase a person’s likelihood to use heroin later in life.

How Heroin Purity & Diluted Dope Increase Risks

The purity of heroin has been increasing for years. The rise in purity raises the risk of drug addiction because the drug has a more dramatic impact on the brain.

“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 told DrugRehab.com. “It was not mixed with fentanyl. The street purity today is usually in excess of 60 percent, frequently in excess of 75 percent.”

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.

Huckaby said people purchasing heroin on the street usually have no idea how potent the drug is 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.”

Communities across the country have reported increases in heroin- and fentanyl-related emergency department visits and overdoses in recent years.

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What Heroin Users Experience

When people switch from prescription pills to heroin, they’re usually trying to find relief from pain or opioid withdrawal. When a person has a low tolerance, heroin numbs pain and can cause relaxation. When a person has a high tolerance and they’re using heroin to avoid withdrawal, they need the drug to feel normal.

Heroin can be swallowed, smoked or injected. Most people inject heroin because it causes the most intense or fulfilling effects. Heroin can be injected into a vein in any part of the body, but most people inject in their arms.

Madeleine Ludwig began using heroin at the age of 18. She was prescribed Percocet as a teenager, and she’d eventually taken stronger drugs such as Dilaudid (fentanyl).

“In my experience, heroin felt like a calmness,” Madeleine told DrugRehab.com. “It was a wave of serene peace that would overcome any pain. Even though I had experience with other opiates, heroin itself was a bit overwhelming. I would feel a distinct heaviness throughout my body.”

She said the drug also made her feel tired, nauseated and constipated. She often vomited after injecting. Her tolerance grew as her health plummeted. She lost 30 pounds and felt weak.

“The more often I used it, the more unattainable those initial effects became,” Madeleine said. “Once I had an everyday habit, I was no longer using for the effects. I was using to avoid a painful physical withdrawal. I had to get high everyday just to feel normal.”

The side effects and risks of heroin addiction increase the longer people use the drug and the more their tolerance increases.

Side effects and risks of heroin include:

Heroin overdoses typically occur when someone 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 tolerance to heroin drops during abstinence and the drug hits harder than it would have days or weeks before.

A lifesaving drug called naloxone can reverse the effects of a heroin overdose in minutes. If the drug is mixed with other opioids, such as fentanyl, it may take multiple doses of naloxone to reverse the overdose.

Woman releasing birds in to the sunset

Overcoming Heroin Addiction

So many people stay addicted to heroin because overcoming the disease is difficult. It causes intense withdrawal symptoms and cravings. The withdrawal is so intense that it’s nearly impossible for people with severe addictions to quit on their own.

“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 without medications makes detox miserable. Most people with heroin use disorders won’t go to rehab because they don’t want to experience detox. The first withdrawal symptoms begin within 12 hours of last use, and the worst withdrawals begin within one to three days.

“The physical withdrawal was fiercely uncomfortable,” Madeleine said. “It would start a nervous tick, such as excessive yawning or sneezing. Symptoms would progress to body aches and stomach pain. After several hours of not using, the constipating effects of heroin would wear off, causing uncontrollable diarrhea.”

Other common symptoms of heroin withdrawal include:

“Hot and cold sweats, restless legs, vomiting, lack of appetite and severe body pains caused insomnia that made the withdrawal even more miserable,” Madeleine said.

Detoxing from heroin addiction can last for several days or weeks depending on the severity of the addiction. Several medications can ease cravings and withdrawal symptoms during the detox process.

Medications for heroin addiction include:

Detox 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 to help the brain gradually adapt to functioning without heroin.

Some treatment centers employ drug tests that encourage abstinence. Urine and blood tests can detect heroin in the body for one to three days.

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.

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