Heroin Addiction Explained

Table of Contents

Heroin is another name for the semi-synthetic opioid diacetylmorphine, which is made by chemically altering morphine. Morphine is a naturally occurring substance derived from the seeds of opium poppies. The modifications made to heroin mean that it crosses the blood-brain barrier faster than morphine. This is what creates the pronounced ‘rush’ described by people who use the drug recreationally. Medically, the drug is used in the United Kingdom to treat severe pain. (1)

The effect that heroin has on the brain is so potent because it hijacks a set of neurotransmitters known as endogenous opioids. The brain naturally produces chemicals that have very similar properties to opiates. Substances such as endorphins, dynorphins, enkephalins and dopamine are impacted by heroin use. They regulate our reaction to painful stimuli and are involved in vital functions such as hunger, thirst, immune response, pleasure, motivation and mood control. (2)

Most people who regularly use heroin administer the drug intravenously, although it can be smoked, snorted or taken rectally. When injecting the drug into a vein, the effects are felt within 10 seconds. The high is characterised by a rush that can last for a few seconds up to several minutes, followed by a period of euphoria, tranquillity and sedation that lasts for up to five hours. (3) The brain is flooded with dopamine, endorphins and other neurotransmitters that cause the high.

The so-called positive effects of the drug are not felt by the drug user for more than a few weeks to a couple of months. Once addiction has taken hold, the brain becomes reliant on the presence of the substance in the brain for any neurotransmitters to be released at all.

These chemical messengers are vital in our daily functioning, and few substances have as profound an impact on them as heroin.

Other Names for Heroin

  • Diamorphine
  • Diacetylmorphine
  • Morphine diacetate

Slang Names for Heroin

  • Dope
  • H
  • Smack
  • Junk
  • Horse
  • Brown

Legal Class of Heroin — Class A

According to The Misuse of Drugs Act 1971, heroin is a Class A controlled substance. This law is intended to prevent certain drugs from being used in a non-medical setting. There are a series of offences that are defined by this law, including unlawful possession, unlawful production and intent to supply, import and export. The categories are Class A, B and C, with A carrying the harshest punishment. Other Class A drugs include LSD, crack, cocaine, MDMA and methamphetamine. (5)

Chemical Formula of Heroin – C21H23NO5

Diacetylmorphine; CAS-561-27-3 is made from crude morphine via the process of acetylation. It weighs 369.4 g/mol and (5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol acetate is the systematic name for the substance.

https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?cid=5462328&t=l (6)

Understanding the chemical components of heroin

Heroin is derived from the opium poppy using a process that includes drying and treating the latex from the seed pod. Calcium hydroxide, ammonium chloride, acetic anhydride and sodium carbonate are used to produce the final product. (7)

Routes of Heroin Administration

Intravenous

This is the most common method of administering heroin due to the potent and fast-acting high it induces. Inherent dangers such as the passage of disease and incorrect usage of a needle are just a couple of the factors that make heroin use so dangerous. (8)

Inhalation

Inhaling heroin induces the effects within around five minutes, which is slower than smoking or injecting. People often start off using the drug in this way, believing it to be safer or less addictive because it doesn’t flood the brain as much as with other methods. Sadly, most people who start off using the drug in this manner go on to crave the intense hit offered by other routes of administration.

Transmucosal

This route of administration covers several methods in which the drug can enter the body across or through a mucus membrane. This avoids first-pass metabolism in the liver and can be achieved by absorbing the liquid form of the drug into the nose, mouth, eyes, rectum or vagina.

Orally

Ingesting heroin orally allows the drug to be metabolised by the liver, meaning it turns into morphine before crossing the blood-brain barrier. The effects of taking the drug orally are the same as they would be when taking morphine via the same route of administration. (9)

Intranasal

Intranasal ingestion of heroin bypasses the metabolising effects of the liver, meaning the drug goes directly into the systemic circulation system. For less pure forms of heroin, snorting the powder may be too harsh on the nose. In these cases, the powder can be made into a liquid and sprayed into the nose.

Rectal

Also known as plugging, this is the practice of taking the drug by inserting it into the anus. The substance is absorbed by the membranes in the rectum and directly into the bloodstream. There is an abundance of veins in the anus, which makes this route particularly fast-acting.

Intramuscular

This is where the drug is injected into a muscle as opposed to into a vein and is most often the result of an injection error. The drug is not passed into the bloodstream as quickly, and the risks of damaging nerves or muscles are high.

Subcutaneous

Subcutaneous administration of heroin is where the drug is injected under the skin and is often the result of an accident. It carries a high risk of skin infection and can cause abscesses to develop. (10)

Intrathecal

Injecting diamorphine intrathecally should only happen in a clinical setting and be performed by a qualified doctor. It involves the injection of the drug directly into the spinal cord.

What Is the Difference Between Heroin, Meth and Xanax?

  • Heroin: This is an opioid drug and the most lethal illegal drug in the United Kingdom. (11, 12) It works by hijacking opioid, dopamine and GABA neurotransmitter receptors in the brain. These chemical messengers modulate pain and regulate pleasure, hunger and wakefulness. Opiates are used medically as painkillers and sedatives.
  • Methamphetamine: Drugs that fall into this category are stimulants. Stimulants cause a surge in the production of dopamine, which causes intense euphoria and makes them highly addictive. The high is similar to that of crack cocaine but lasts much longer. (13)
  • Xanax: Xanax is the brand name for alprazolam. It is a powerful benzodiazepine that is 10 times stronger and much faster-acting than the most commonly prescribed benzodiazepine in the United Kingdom, diazepam. The drug is a sedative-hypnotic that causes the activation of GABA, the neurotransmitter responsible for inhibiting the central nervous system, causing relaxation and sleep. (14)

What Is Heroin Addiction?

While some people can use heroin recreationally without becoming addicted, this is very rare. Heroin’s mechanism of action is highly conducive to substance dependence because it significantly affects the balance of neurotransmitters in the brain. The neurotransmitters it has an impact on are important to daily functioning, such as dopamine and endorphins.

Dopamine works in two ways: It modulates movement and it acts as a tool for motivation. Dopamine is released in the brain just before we carry out an act that it deems is going to be pleasurable. This signals to us that we should carry out the act again.

An influx of dopamine causes a feeling of profound well-being and euphoria. The continued use of heroin causes the brain to rely on the substance in order to release sufficient amounts of dopamine to feel normal.

Endorphins are one of the brain’s naturally occurring opiates, which modulate pain and make us feel good. For instance, endorphins are released naturally during exercise in order to minimise discomfort and encourage us to continue the healthy behaviour. Opiate drugs emulate these types of neurotransmitters and cause analgesia, stress relief and euphoria. Heroin also causes stimulation of the neurotransmitter GABA, which has anxiolytic and sedative effects.

Discontinuing heroin after a prolonged period of use causes the brain to rely on these synthetic opioids instead of creating and releasing its own. This is why people who are addicted to heroin suffer from such debilitating withdrawal symptoms. It is also often one of the main reasons why people continue to use the drug even after it has a serious impact on their well-being. (15)

Heroin addiction potential

Heroin is one of the most addictive substances ever made. This means that those who are at risk of developing addictive behaviour patterns are very likely to develop a substance abuse disorder if they start to use it. People with mental health issues such as bipolar disorder and schizophrenia are at a significantly increased risk of becoming addicted to the drug,

Risk Factors for Addiction

Genetic factors

Genetically inherited psychological risk factors for becoming addicted to heroin include sensation- or reward-seeking behaviours, impulsivity and behavioural disinhibition. A lower expression of dopamine D2 receptors is also linked to developing substance dependencies. This deficiency is linked to higher impulsivity and a state of reward deficiency that causes a person to view the benefits of heroin as more significant than the risks and negative effects.

Personality factors

Sensation-seeking is thought to be an important factor in the development of an addiction in an individual who has previously been prescribed an opiate painkiller. Impulsivity is another personality trait closely linked to developing a dependence on heroin. This factor causes even someone who is cognizant of the harmful nature of heroin to use it. Deficient self-regulation mechanisms are almost universally noted in the onset of substance dependence disorders.

Social and environmental factors

Environmental factors in developing heroin addiction are less consistent than genetic factors. Early-onset antisocial behaviour, academic failure and socioeconomic status can cause young people to seek out illicit substances. A history of abuse, delinquency, anxiety, depression, hyperactivity and familial drug use are also thought to be major risk factors in becoming addicted to opiates.

Family history

Often, those who don’t fall into the same pattern of addiction as their family members have other role models. These people may have given them a better example and the attention they may have lacked from their parent/s who were using drugs. Learning that drug-taking is a viable coping mechanism from watching a parent do it at a young age invariably creates an increased likelihood of becoming addicted. (16)

Mental disorders and dual diagnosis

In co-occurring disorders, the symptoms of drug use and the mental health problem often overlap, and one usually perpetuates the other. It is integral that the drug user identifies any underlying mental health conditions when they seek treatment. Treating the drug problem without addressing the other issues often results in relapse. Relapse is perceived as a failure in the eyes of the sufferer, and this can make the problem more severe and render them unlikely to seek help again. (17)

How Heroin Addiction Develops

Heroin addiction can develop in a number of ways. Some people start to use the drug after developing a dependence on prescribed opiate medications. Others may actively be seeking more and more extreme highs. Some individuals start off by smoking or snorting heroin, believing this to be less harmful. While not quite as intense, taking the drug in this way still carries an extremely high risk of developing an addiction.

The more frequently the drug is used, the more reliant the brain becomes on its effects. As someone uses the drug more, they require increasing amounts in order to achieve the initial effects. This leads to an increase in tolerance as well as an increase in consumption and often leads to addiction.

How heroin addiction affects brain chemistry

The euphoria of the initial high, also known as a rush, is caused by the substance crossing the blood-brain barrier. A surge of neurotransmitters that is far greater than the brain would ever produce itself causes this sensation. It lasts for around five to 15 minutes and wears off as soon as the heroin is metabolised into morphine. Morphine still has a pronounced impact on the body, and this residual high lasts for a further few hours.

Prolonged use of heroin causes changes in the physiology and physical structure of the brain. As the body attempts to adapt to these surges in dopamine, endorphins and GABA, long-term imbalances in the neural and endocrinal systems develop.

These changes make not using heroin extremely difficult and mean recovery is a long process that requires the commitment of the person who is going through it.

Heroin Addiction & Abuse: Signs, Symptoms and Effects

Behavioural signs & symptoms

  • Possession of syringes, needles and other paraphernalia
  • Deceptiveness regarding whereabouts and/or activities
  • Decreased interest in significant activities
  • Using larger and larger quantities of heroin in order to achieve the desired effect
  • Using heroin when it is obviously dangerous to do so
  • Devoting considerable time to acquiring, using and recovering from the abuse of heroin

Physical signs & symptoms

  • Pupillary constriction
  • Depressed respiration
  • Irregular heartbeat
  • Dry mouth
  • Watery eyes and runny nose
  • Scabs, sores, other skin damage due to injection drug use
  • Disrupted sleep patterns
  • Weight loss
  • Fatigue
  • Heaviness in arms and legs

Cognitive signs & symptoms

  • Poor judgment
  • Impaired ability to concentrate or focus
  • Diminished cognition
  • Confusion
  • Disorientation

Psychosocial signs & symptoms

  • Anxiety
  • Agitation
  • Mood swings
  • Social withdrawal
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Simple Ways to Identify a Heroin User

Heroin use has a marked impact on the majority of people who use it. While some may be able to regulate their use or hide it from friends and loved ones, it causes most of its users’ significant problems. As the addiction becomes worse, the condition becomes steadily more obvious and has more and more impact on the daily life of the sufferer. Some signs that a person is using the drug include:

  • Financial issues
  • New friends whose primary focus is drug-taking
  • Track marks
  • Aggressive or violent behaviour
  • Restlessness
  • Poor hygiene
  • Tremors
  • Fluctuations in weight
  • Mood swings
  • Anxiety
  • Fatigue
  • The presence of tin foil, baggies, balloons and/or syringes

What Makes Heroin So Addictive?

The reason why heroin is so addictive is because of the changes it makes to the brain chemistry of people who use it regularly. It specifically has an impact on the way the brain’s motivation and reward system works. An extremely clever function of the brain is that it uses neurotransmitters to signal when an experience causes happiness. It uses a different set of neurotransmitters to signal that we should repeat the experience.

Using opiates causes the release of both sets of neurotransmitters, as well as other ones designed to help us feel pain relief and induce relaxation and sleep. The effect the drug has on these vital functions is what makes it so addictive. The brain tries to adapt to the extreme changes made by the substance. Therefore, when the substance is no longer in the system, the brain needs to try to adapt again.

Teen Heroin Addiction

Young people are at an increased risk of becoming addicted to any substance. This is due to the fact their brains haven’t yet fully developed and they are more impulsive and demonstrate lower self-control. Young people also have pronounced emotions and have more difficulty regulating their emotions due to hormones and the stresses of adolescence. Heroin offers escape from anxiety, pain and stress for the duration of the high.

For some people, young people especially, the benefits of the short-term gain offered by taking an opiate substance outweigh the horrific long-term consequences. (19)

Signs your teen is abusing heroin

Teenagers who are abusing heroin will soon demonstrate a decline in their overall health. Their behaviour will also be affected, and the company they keep is likely to change. The most typical signs to look out for include track marks, cuts and bruises from picking at skin, sudden weight loss, a constant runny nose and wearing long-sleeved clothes. The teen is likely to become more hostile and agitated, and their mood may swing from euphoric to very low.

The Short-Term Side Effects of Heroin Abuse

When injected, heroin binds to receptors in the brain within seconds. When taken via any other route, the feelings are still usually felt within 20 minutes. The high starts with an intense feeling of euphoria and well-being and is usually accompanied by a feeling of heaviness, a dry mouth and an increase in temperature. Those who are new to the drug often describe nausea and vomiting during this stage, and as it wears off, users can start to feel extremely itchy.

After this initial high, the user may experience a feeling known as nodding off. This is characterised by the alternation between consciousness and unconsciousness and can last for up to an hour. For several hours after administration, the user often feels drowsy, breathing and heart rate is decreased and mental function is blurred. Heroin users usually require a dose every six to 12 hours. (20)

The Long-Term Side Effects of Heroin Abuse

Heroin changes the way the brain functions when used in high doses over a prolonged period of time. As well as imbalances in hormones and neurotransmitters, studies have also shown that the drug causes a decrease in white matter. This may affect a person’s ability to regulate their behaviour, make decisions and respond to stressful situations.

Continued chronic use of heroin ends in a serious condition that is unresponsive to treatment and characterised by repeated relapse. In this state, the sufferer uncontrollably seeks out the drug no matter what the consequences may be. (18)

Effects of Heroin Overdose

An overdose on heroin is a serious, life-threatening condition that is thought to affect as many as 70% of people who are addicted to heroin. (21) Opioid substances depress the central nervous system, which can cause the heart and breathing to slow down to dangerously low levels. When heroin is taken in quantities higher than the body is able to metabolise, the body shuts down and oxygen can no longer reach the brain. (22)

There is an antidote for heroin overdose called Naloxone. This binds to the same receptors as opiates but has the opposite mechanism and blocks the effects of the heroin.

Heroin Use and the Central Nervous System

All opiates are synthesised in the central and peripheral nervous system, which affects physiology and psychology. Opioid receptors are spread out all over the body and help with hepatic, renal, intestinal, immunological, memory, learning and nociception functions. Opioid drugs bind to these receptors and cause havoc throughout the human body.

The continued use of heroin is extremely dangerous, as it fundamentally changes the way these systems operate. The brain is fooled into thinking that the way neurotransmitters function when a person is using heroin is the right way. This is what makes detoxification and drug rehabilitation from heroin particularly challenging for those who have to go through it.

Impact of Heroin on Relationships

The impact of addiction on the loved ones of the person going through addiction can be almost as traumatic as it is on the sufferer. People who become addicted to a substance as harmful as heroin are likely to change beyond recognition, especially during times they are craving the drug. They may become a financial burden on people around them and often begin stealing or lying to support their habit.

Drug taking becomes the person’s priority, and they lose sight of the consequences of their actions. This can render loved ones financially worse off and cause them to worry endlessly that the sufferer is going to harm themselves or be put in a vulnerable position while under the influence. A lot of heroin users lose contact with their friends and families, and the social isolation pushes them further into the problem. (23)

Facts and Statistics on Heroin Addiction

  • Heroin addiction is the eighth most common cause for people aged 16-24 in the United Kingdom to attend substance misuse services. Only crack and other opiates have caused more young people to enter treatment.
  • Overall, heroin accounts for 42% of the people who entered treatment facilities in 2017-2018.
  • Heroin is the second most commonly seized Class A drug in the United Kingdom. (24)
  • In 1975, only 5,000 people were thought to be using heroin in England. By 2016-2017, this figure had shot up to approximately 140,000. That is a 2800% increase.
  • There are a recorded 341,576 people in the United Kingdom who qualify as high-risk opioid users.
  • More than half of the opiate death hotspots in the United Kingdom are coastal holiday resorts.
  • Blackpool has the highest death rate from heroin use in England. (25)
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The link between opiate painkillers and heroin abuse

In America, data has shown that heroin initiation is 19 times more likely in someone who has previously been prescribed opiate painkillers than those who haven’t. Some people may become addicted to the euphoric effects of a drug they have been legitimately prescribed. When the prescription runs out, the user turns to street heroin to achieve the high.

One study found that in a study of young people who injected heroin, 86% had previously used opiate painkillers non-medically. Over the last decade, the availability of opiates such as fentanyl and oxycodone has rapidly increased. This has led to an increase in people seeking out the high that is brought on by heroin. (26)

Heroin Treatment Options

The first step towards overcoming a serious addiction such as heroin is accepting that there is a problem and making the decision to stop. Sadly, people cannot be forced into recovery. The desire to get better is the main driving force for anyone who overcomes the illness. If the person has not made a conscious decision to stop, it will be very difficult to effectively treat them.

That is not to say that the desire to stop is all it takes — the road to recovery is very challenging, and people often have setbacks. It is important that people who go through the process build a support network and encourage loved ones to understand what they are going through. Withdrawing from heroin without medical assistance often results in failure that can perpetuate drug use.

Treatment begins with detoxification, which removes the drug from the body and gets the person into a state where rehabilitation is possible. Often, medication is used to help manage withdrawal symptoms that may otherwise be unbearable. Next, inpatient or outpatient rehab takes the service user through therapy, group activities and relapse prevention. Finally, the individual must follow up with long-term treatment to address any underlying issues and prevent relapse.

Medications That May Help Your Heroin Addiction Recovery Efforts

There are several medications that can be used to help someone who is going through the process of recovery. Some people may be given a less potent opiate such as methadone or morphine. Others may be given a combination of the stronger opiate, buprenorphine, in combination with naltrexone. The latter prevents the high feeling associated with opiate use, while the former quells the withdrawal symptoms. Non-opiates such as clonidine can also be used. (27)

Heroin Treatment in Rehab Facilities

Due to how severe heroin addiction is, inpatient rehabilitation is the recommended course of treatment. There are often triggers at home that can make it very difficult to avoid using drugs. Some people find they have gotten stuck in a rut and a change of location is required to change their habits. Also, an individual is far more likely to have access to a drug dealer when they are in a familiar environment.

With a residential rehab centre, the service user has access to care 24 hours a day and has a full team of addiction specialists at their disposal. It can be enlightening for some people to experience a structured lifestyle like the one in rehab. The responsibility of being on time, attending appointments and being organised are also bypassed in inpatient care.

Heroin Rehab Treatment Process

The service user is first given an assessment over the phone, during which they explain how much they use and give information about their medical history. This is followed by a detailed medical assessment upon arrival at the clinic. From this point, the person is in the care of a dedicated group of specialists whose sole aim to help people to recover.

There is a mixture of group and individual therapy, workshops and daily mealtimes, and medication will be administered at the same time every day. In this setting, the service user can build a trusting relationship with the medical staff that is conducive to the level of honesty required for treating addiction. It is imperative that any underlying mental health issues or co-occurring disorders are identified and treated.

Heroin Outpatient Treatment

Outpatient treatment may be effective for people who have very recently developed an addiction to heroin. Their brains may not yet have changed as much as someone who is in the later stages of addiction, and treatment is slightly easier. That said, the temptation inherent with going home every day and spending weekends in a place with access to drugs is dangerous. Inpatient treatment gives the individual the best chance for recovery.

Outpatient treatment is recommended after someone has successfully completed a rehabilitation programme. Like alcoholism, heroin addiction is a lifelong disease, and those who suffer from it should seek treatment for at least two years after their last hit of the drug. This is an integral part of relapse prevention and being able to cope with and move on from relapse if it does occur.

Get the Help You Need

If someone is suffering from an illness as crippling as heroin addiction, they do not have to suffer in silence — there is treatment available. With the right care and a long-term approach to treating the problem, people who have suffered from the disease can go on to live long and rewarding lives. It is usually facing up to the magnitude of the addiction and wanting to make the effort to change that is most difficult.

Find help for heroin addiction

In the United Kingdom, rehabilitation services have come a long way over the last couple of decades. Medical treatment helps to ease withdrawal symptoms, and non-judgmental therapists and support staff help to make the person feel better. The days of punishing people who suffer from addictions are long gone and have been replaced by compassionate, knowledgeable care.

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If you or a loved one is going through the trauma of heroin addiction, UKAT addiction centres can provide the ideal location for recovery. We have a wonderful team of medical professionals who will guide you through the process and support your recovery for years to come. Call us now on 0808 250 2546.

Sources

(1) https://www.ncbi.nlm.nih.gov/pubmed/15785068

(2) https://thebrain.mcgill.ca/flash/i/i_03/i_03_m/i_03_m_par/i_03_m_par_heroine.html

(3) https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/heroin

(4) https://www.verywellmind.com/what-heroin-effects-feel-like-22047

(5) https://www.drugwise.org.uk/what-are-the-uk-drug-laws/

(6) https://pubchem.ncbi.nlm.nih.gov/compound/Heroin#section=Chemical-and-Physical-Properties

(7) http://www.emcdda.europa.eu/publications/drug-profiles/heroin

(8) http://www.cesar.umd.edu/cesar/drugs/heroin.asp

(9) https://www.drugbank.ca/drugs/DB01452

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869685/

(11) https://www.economist.com/graphic-detail/2019/06/25/what-is-the-most-dangerous-drug

(12) https://blog.cansfordlabs.co.uk/what-drugs-kill-most-people-uk

(13) https://www.drugabuse.gov/publications/drugfacts/methamphetamine

(14) https://www.medicalnewstoday.com/articles/263490.php

(15) https://www.verywellmind.com/heroin-4157307

(16) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155832/#R42

(17) https://www.helpguide.org/articles/addictions/substance-abuse-and-mental-health.htm

(18) https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use

(19) https://medlineplus.gov/drugsandyoungpeople.html

(20) https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use

(21) https://www.who.int/substance_abuse/information-sheet/en/

(22) https://www.drugabuse.gov/publications/drugfacts/heroin

(23) https://adfam.org.uk/help-for-families/understanding-the-issues/the-effects

(24) https://files.digital.nhs.uk/14/527824/drug-misu-eng-2018nov-rep.pdf

(25) https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/halfofheroinmorphinemisusedeathhotspotsinenglandandwalesareseasidelocations/2018-04-04

(26) https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

(27) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/586111/PHE_Evidence_review_of_drug_treatment_outcomes.pdf

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