Heroin, also know as dimorphine among other names, is an opiod most commonly used as a recreational drug for its euphoric effects. It is used medically in several countries to relieve pain or in opoid replacement therapy, it is typically injected usually into the veins but it can also be smoked snorted or inhaled. The onset of effects is usually rapid and lasts for a few hours.
What is Heroin
Heroin is a very addictive drug made from morphine, a psychoactive (mind-altering) substance taken from the resin of the seed pod of the opium poppy plant. Heroin’s color and look depend on how it is made and what else it may be mixed with. It can be white or brown powder, or a black, sticky substance called “black tar heroin.”
Heroin is part of a class of drugs called opioids. Other opioids include some prescription pain relievers, such as codeine, oxycodone (OxyContin), and hydrocodone (e.g. Vicodin).
Heroin use and overdose deaths have dramatically increased over the last decade. This increase is related to the growing number of people misusing prescription opioid pain relievers like OxyContin and Vicodin. Some people who become addicted to those drugs switch to heroin because it produces similar effects but is cheaper and easier to get.
In fact, most people who use heroin report they first misused prescription opioids, but it is a small percentage of people who switch to heroin. The numbers of people misusing prescription drugs is so high, that even a small percentage translates to hundreds of thousands of heroin users. Even so, some research suggests about one-third of heroin users in treatment simply started with heroin. Maybe they were mistakenly told that only one use cannot lead to addiction. Both heroin and opioid pill use can lead to addiction and overdose.
Methods Of Use
Heroin is most often injected intravenously (IV), however, it may also be:
- vaporized (“smoked”)
- sniffed (“snorted”)
- used as a suppository
- orally ingested.
Smoking and sniffing heroin do not produce a “rush” as quickly or as intensely as IV injection. Oral ingestion does not usually lead to a “rush”, but use in suppository form may have intense euphoric effects. Heroin can be addictive by any given route.
Effects Of Heroin Use
Heroin is metabolized to morphine and other metabolites which bind to opioid receptors in the brain.
- After an injection, the user reports feeling a surge of euphoria (the “rush”) accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities.
- Following this initial euphoria, the user experiences an alternately wakeful and drowsy state.
- Mental functioning becomes clouded due to the depression of the central nervous system.
- The short-term effects of abuse appear soon after a single dose and disappear in a few hours.
Other effects can include respiratory depression, constricted (“pinpoint”) pupils and nausea. Effects of overdose may include slow and shallow breathing, hypotension, blue lips and nails, muscle spasms, convulsions, coma, and possible death.
Intravenous use is complicated by other issues such as the sharing of contaminated needles, the spread of HIV/AIDS, hepatitis, and toxic reactions to impurities.
Other medical complications that may arise include:
- collapsed veins
- spontaneous abortion
- endocarditis (inflammation of the heart lining and valves).
What to do in a heroin overdose?
Signs of an opioid overdose include extreme drowsiness, blue lips and fingernails, slow or halted breathing, pinpoint pupils, slow heart rate, coma, death.
Occurring more frequently in the U.S., heroin purchased on the street may be “cut” or contaminated with other dangerous and extremely potent opioids, such as fentanyl or carfentanyl. These agents are often fatal to the user, and deaths have been reported.
For use in the community, naloxone comes as a nasal spray (Narcan Nasal) or as an injectable device with verbal instructions built in (Evzio). If naloxone is available, you can administer it yourself to someone who is overdosing.
In many pharmacies you can now access naloxone without a prescription to keep with you, at home or in your car in case of an overdose emergency. This is recommended especially if you have friends or family members using opioids or undergoing treatment. Ask your pharmacist about access to naloxone in your state. Read the directions on administering the naloxone before an emergency occurs.
- Naloxone (Narcan, Narcan Nasal, Evzio) will usually result in reversal of the opioid-induced respiratory depression within 2 minutes.
- Retreatment with naloxone may be required as the duration of action of naloxone (30 to 120 minutes) may be shorter than the action of the opioid itself.
- Respiratory support, intravenous fluids, and other adjunctive medications may be required, so it is important to call 911 immediately.