Rates of heroin use have skyrocketed in recent years. The drug — also known as black tar, smack, horse and skag — claims thousands of lives each year. In 2015, nearly 13,000 people died from heroin overdose. A nationwide effort by researchers and nonprofits seeks to curtail this epidemic.
With a history dating back thousands of years, heroin has ingrained itself in our world consciousness. The most recent epidemic has taken lives in every state, especially in communities that are poor and underserved. According to the 2015 National Survey on Drug Use and Health, more than 1.5 million people aged 12 and older reported using heroin at least once. This must stop. Through education, prevention and treatment, it is possible to make heroin abuse a thing of the past.
Heroin-related deaths skyrocketed 39 percent between 2012 and 2013, according to the CDC. In the longer term, heroin overdose deaths almost quadrupled in the 11 years between 2002 and 2013.
Heroin’s foothold in the United States began in the late 1800s, when it was incorrectly thought to be less addictive than morphine for treating pain. By the time that myth was debunked, hundreds of soldiers and hospital patients were addicted to heroin.
The United States has experienced three heroin epidemics: post-World War II, during the 1960s and ’70s, and from the mid-2000s to today.
Most of the heroin found in the United States today comes from Mexico, Latin America, Southeast Asia or Southwest Asia. In its most common street form, it’s sold as a brownish or white powder or as a sticky, black substance known as “black tar” heroin.
Generally, heroin is cut and diluted. Pure heroin is rare, but it can be found if searched for. Producers may add talc, sugar, starches, powdered milk, baking soda, caffeine, cocaine or quinine to their supply. Heroin mixed with crack cocaine is called “speedball.” Unfortunately, heroin cut with extremely dangerous substances, such as fentanyl and carfentanil, has caused dozens of recent overdoses.
Who is getting addicted to heroin? While no particular profile matches directly with all heroin users, certain areas of the country are being affected disproportionately.
Research from the CDC shows heroin use or dependence is more likely among people who are:
According to the Centers for Disease Control and Prevention, the 2011-2013 National Survey on Drug Use and Health found nearly everyone who reported using heroin also reported using at least one other drug.
The survey also calculated the likelihood that individuals addicted to other substances would be also addicted to heroin.
People with an addiction are more likely to become addicted to heroin:
However, a 2015 study published in the Morbidity and Mortality Weekly Report showed increased heroin usage in males between 18 and 25 years old, people who are uninsured and people living in urban areas. The study found that past-year heroin usage among women had doubled between 2002-2004 and 2011-2013.
This tells us that heroin does not discriminate. There is no archetype for those who are heroin addicts, and that’s because our brains react to drugs in similar ways. Heroin usage will continue to spread without education and prevention.
While heroin use can rapidly lead to addiction, several studies cited by the National Institute on Drug Abuse found that nearly 80 percent of American heroin users — even those in treatment — became addicted by first misusing prescription opioids. Recent legislation and actions by drug companies have raised the price and lowered the availability of prescription painkillers such as Vicodin and OxyContin, so many who were previously addicted to those substances have turned to heroin to achieve the same kind of high.
But why is heroin so addictive? The primary reason involves how the drug is absorbed by the brain. Heroin is so easily received by opioid receptors in the brain that people get a nearly instant high when injecting the drug.
The surge of dopamine from the high is so powerful and long lasting that the brain learns that the only way to keep this feeling going is from the drug — more and more of it, in fact, as tolerance quickly grows.
When an individual injects heroin, the feeling of euphoria is incredibly strong. Heroin users feel a profound sense of calm and satisfaction. They also report a “melting away” of stresses and cares from daily living.
Here’s how heroin works in the body:
The brain adapts to these feelings, and when heroin isn’t present, the brain and nervous system start to go into withdrawal. The only thing that relieves these withdrawal symptoms besides rehab treatment is taking more heroin.
Other symptoms of heroin use include:
One of the main risks associated with heroin use is the contraction of intravenously acquired diseases such as HIV and hepatitis. Sharing drug injection equipment without sterilizing in between uses, as well as impaired judgement from drug use, increases these risks.
Untreated hepatitis B and C can lead to decreased liver function and eventual liver failure. HIV can turn into AIDS. Snorting or smoking heroin doesn’t decrease these risks because heroin’s effect on judgement can lead to unprotected sexual contact with infected individuals.
Heroin use has major effects on the brain and body in the long term as well. The dangers of the drug are linked to opioid receptors, located in the brain stem, which controls main body functions, including:
These functions are impaired while the drug is in the bloodstream. Long-term physical impairments that may take hold include:
In addition, street heroin often contains dangerous chemicals that can clog blood vessels leading to the lungs, liver, kidneys and brain, sometimes causing permanent damage to these essential organs.
When an individual stops taking a drug, the body starts to exhibit unpleasant, sometimes dangerous, symptoms. The body needs time to recover and return to its natural, healthy state. How long it takes to come down from these symptoms depends on the person and on the method of detox.
Early withdrawal symptoms include:
Later symptoms of withdrawal from heroin include:
Generally, these symptoms take hold within 12 hours of the last heroin usage. Because some of these withdrawal symptoms can lead to greater problems, such as dehydration, persons addicted to heroin should not attempt to detox from the drug at home. Medically supervised detox is the only way to safely come down from heroin.
As a person uses more and more heroin, tolerance to the drug builds. Tolerance develops when the brain needs more of the drug to achieve the same repeated effect or to relieve withdrawal symptoms. Tolerance is the biological mechanism behind cravings and addiction.
Besides tolerance, there are other behavioral warning signs of heroin addiction, including:
Psychological warning signs can also indicate heroin addiction:
Heroin use has also been linked to the deterioration of white matter in the brain, which may affect decision-making abilities, behavioral regulation and stress response.
One of the most dangerous side effects of heroin use is hypoxia, a condition where the brain doesn’t get enough oxygen. When the part of the brain that controls breathing and respiration is affected by opioids such as heroin, it can deprive the brain of oxygen, leading to coma or permanent brain damage. This is just one sign of heroin overdose.
Because heroin affects the brain stem, which controls many essential bodily functions, overdose can affect those processes as well.
Signs of heroin overdose include:
In 2015, the Food and Drug Administration moved quickly to approve a drug called Narcan, a nasal spray form of the injectable drug naloxone, which had been used to reverse opioid overdoses since the 1970s. Narcan has been instrumental in saving thousands of victims of heroin overdose. It is now available over the counter at CVS pharmacies in more than 40 states.
If you believe a friend or family member might be addicted to heroin, resources exist to help you know what to do next. You can receive guidance, information and advice from these nonprofit and government organizations. Reputation is everything, so seek these and other resources that can help you proceed in finding treatment for your loved one.
National Council on Alcoholism and Drug Dependence
Partnership for Drug-Free Kids
Substance Abuse and Mental Health Services Administration
Faces & Voices of Recovery