Heroin Addiction

Heroin is a powerful Class A drug that has a complicated role in the history of addiction. Heroin has developed a notorious status as one of the most dangerous drugs available on the illicit market. But what makes heroin so threatening? Is it possible to recover from a heroin addiction? What are the risks associated with the opiate? Why is it so addictive, and where does it come from?

Heroin addiction: Statistics

Between April 2021 and March 2022, there were a total of 289,215 adults in England in active treatment for addiction. 49% of these were specifically seeking support for opiate use. This positions opiates as the ‘largest substance group’ associated with misuse and addiction in England.

Of this treatment population,

• 72.4% were men (101,822)
• 27.6% were women (378,736)

This means a total of 140,558 adults were in active support for opiate addiction alone.

This trend is consistent with previous datasets, which typically position users of heroin as the largest treatment group in addiction settings. However, the 2021-22 year records the lowest entrants to addiction for opiates since 2014.
The report also identified that:

• 17% (5,347) of the individuals accessing treatment for heroin addiction reported having a housing problem
• 66% of people in treatment for opiate use had a co-occuring mental health issue
• 1.3% of those receiving addictive intervention between April 2021 and March 2021 died during treatment. 65% of those deaths were individuals accessing support for opiate use.

Heroin: How does it work?

Heroin is a painkiller, making it’s primary mechanism of action the management and relieving of aches, pain and discomfort. It does this by inhibiting specific cells in the brain to quell the perception and response to pain.

Chemistry of heroin

Heroin derives from the seeds of the opium poppy. However, that does not mean that the heroin purchased through non-legal channels occurs naturally. The heroin used recreationally is treated in various ways in order to produce a substance capable of providing enhanced opiate effects.

Heroin can be made through the chemical treatment of morphine, which is the ‘major alkaloid present in the opium poppy.’ Morphine itself has painkilling and sedative properties and can also be addictive. When heroin is taken, it is ‘converted’ back to morphine. It then binds to specific receptors in the brain. This binding facilitates the short-term effects of heroin.

Short-term effects of heroin

As is the case with many drugs, the initial effect of heroin is typically ‘euphoria.’ Euphoria is a surge of positive feelings and energy. Some people describe it as a rush, and this early effect is often the driving factor for repeat use of a drug.
Alongside euphoria, heroin catalyses a range of feelings and sensations in the body, including:

• nausea and sickness
• ‘flushed’ skin
• itchy skin
• dry mouth
• heaviness or aching in the limbs
• feeling tired or drowsy; falling asleep easily
• feeling confused, clouded or distant
• slower breathing
• slower heart rate

Whilst it provokes a range of symptoms during use, sustained heroin use can also lead to the development of long-term side effects. These side effects can profoundly alter the functioning of both the body and the brain.

The effect of heroin on the body

When we think of addiction, we typically consider it as a kind of mental health issue. Whilst this is partially true, it is also important to remember that the risks of heroin addiction can also have embodied potential.

Individuals using heroin frequently are vulnerable to the following physical health issues:

• risk of sharps injuries
• risk of infection (at injection site as well as in heart tissue)
• risk of bloodborne viruses
• dental complications
• reduced appetite, leading to severe weight loss
• sexual dysfunction
• change to menstrual patterns
• sleep issues (including insomnia)
• difficulty with bowel movements
• physical dependence on heroin develops
• withdrawal symptoms
• overdose risk

The effect of heroin on the brain

Heroin’s opiate nature means that its primary action is upon the central nervous system. The central nervous system is made up of the brain and the spine. These two parts of the body are responsible for running a series of complex networks that help our bodies function. The central nervous system is responsible for perceiving the world, judging, thinking, feeling, and responding to pain.

Heroin’s impact on the central nervous system can be wide-ranging. It can lead to a deterioration of function in varying areas, including:

• changes to the functioning of the opioid receptor system (impacting perception and response to pain)
• deterioration of white matter in the brain
• development of anxiety, depression or other mood disorders
• development of paranoia

Addiction and ‘rewiring’ the brain

Heroin, as an opiate, acts on the reward systems in the brain. There are cells in our brains that are especially sensitive to opiates. These are known as mu opioid receptors.

Heroin attaches to these cells when it arrives in the brain. This docking of heroin into the receptor site leads to the release of neurotransmitters that are associated with pleasure, such as dopamine. Dopamine is also heavily linked to feelings of reward.

The brain then makes ‘conditioned associations’ between the use of heroin and feeling good in specific contexts. The building of this association feeds into the development of addiction, leading to ‘the craving for drugs when the abuser recounts those persons, places, or things’ associated with previous use that can then act to ‘drive abusers to seek out more drugs.’
This effectively functions as a partial rewiring of the brain’s mesolimbic reward system.

Changes to Brain Matter

Studies indicate that heavy users of heroin experience reduction in both the grey and white matter of specific areas in the brain, including in the:

• striatum
• fronto-cortical cingulate regions
• amygdala
• and insula

These can be linked to a range of cognitive deficits depending on the area of the brain affected. This is because the brain works through localisation of function, meaning certain parts of the brain are linked to executing specific roles and processes.

The striatum is linked to decision-making functions, the fronto-cortical cingulate to behaviour regulation, the amygdala to emotional processing and fear response, and the insula to pain and emotions. Reduction in the brain matter of any of these four areas could lead to decreased ability in these key functions.

Some studies suggest that the brain matter can be ‘restored’ following recovery from heroin addiction; however, the evidence on this is not fully conclusive.

Withdrawal from heroin

Heroin is well known for having withdrawal symptoms that can be particularly difficult to manage. They can cause significant discomfort and, in some very rare instances, be potentially life-threatening. In today’s world, heroin withdrawals can be managed with the help of clinical professionals, but unpleasant symptoms are still likely to occur.
Withdrawal symptoms:

• anxiety
• low mood
• headaches and cramps
• aches that appear to be located in the muscle, bone and joints
• intense heroin cravings
• feeling very tired
• struggling to sleep
• tremors, shaking or involuntary muscle movements
• difficulties with homeostasis
• feeling (or being) sick
• diarrhoea
• goosebumps
• aggressiveness of agitation
• disorientation

In serious cases, heroin withdrawal can also mimic psychotic symptoms such as hallucinations, paranoia and delirium.

Withdrawal symptoms can begin anywhere between 8 to 24 hours since the last heroin high. These symptoms can last for between 4 and 10 days.

Does heroin immediately make you addicted?

We know how severely heroin can impact our bodies and start to change the way our brains function. But how long does it take for this to happen?

We know that addiction is a process. Using something one time does not mean you are addicted. Addiction, by nature, is the need and drive that results in repeat use.

The short answer is that it is not possible to identify when drug use turns into drug addiction concretely. The turning point will be different for every person due to a range of factors, including frequency of use, dosage, strength of drug, general health and even your metabolism. This means that it is impossible to know for sure if or when heroin addiction will set in.

All we can say with certainty is that heroin is a very addictive substance, and if you are using it, it is more than likely that you will develop a dependence on opioids. This is why there is no safe level of use for Class A substances such as heroin; it would be impossible to recommend use patterns without there being any risk attached.

Treating heroin addiction

There may be a large unmet treatment need for heroin addiction. But that does not mean that support for addiction to opiates does not exist. Addiction treatment is a specialist type of care provided by industry experts.

Treatment for heroin typically comes in two different forms: maintenance therapy and psychological therapy.

Maintenance therapy

In order to start tackling heroin addiction, it is necessary to detox. Heroin detox can be difficult and uncomfortable. It is not without medical risk. In order to manage that risk, pharmacological interventions have been introduced into addiction support.

One such intervention is maintenance therapy. Maintenance therapy typically involves the use of methadone. Methadone will be prescribed (and taken daily) in order to relieve withdrawals and cravings. This works because methadone acts in a similar manner to heroin, meaning the presence of methadone in the body can temporarily quell the symptoms of heroin withdrawal.

Psychological therapy

Once cravings have been managed, treatment can begin to address the psychological side of addiction. For some people, mental health issues lead them to use substances. For others, addiction is the catalyst for psychological distress.

Regardless of which comes first, mental health difficulties and addiction are frequently correlated. For that reason, therapy is an essential component of addiction treatment.

Various forms of therapy are available. These may vary depending on the provider you use. You may also be asked if you have engaged with therapy before in order to gauge what may be the most helpful for you.

Therapeutic interventions typically include:

• Cognitive behavioural therapy (CBT)
• Dialectical Behavioural Therapy (DBT)
• Experiential Therapy
• Group Therapy
• Individual Therapy
• Psychodynamic Therapy
• Psychotherapy
• Twelve Step Facilitation Therapy (TSF)
• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)

Therapies such as these are available in a range of forms; as part of inpatient rehab or in an outpatient context, as short-term aids or more sustained interventions over a number of months and years.

If you’re ready to take the first step at battling your heroin addiction, reach out to an addiction specialist or GP to begin your journey to sobriety.