Heroin, an opioid drug derived from the opium poppy plant, is a highly addictive illicit drug. Classified as a Schedule I drug by the DEA, heroin is considered to have a high potential for abuse and no governmentally accepted medicinal properties. The National Institute on Drug Abuse reports that 23 percent of people who use heroin develop an addiction to the drug.
Heroin changes the way the brain functions by binding to opioid receptors in both the brain and body. Heroin creates a feeling of euphoria and blocks feelings of pain, as well as slowing down some of the autonomic body functions like breathing and blood pressure. Heroin is a central nervous system depressant, and the death rate is increasing, with heroin-related deaths doubling in the two years between 2010 and 2012, according to WebMD. Heroin addiction does not have to be a life sentence, however.
Detox Health Risks
The process of purging drugs from the body is called detox. While not usually life-threatening, heroin withdrawal symptoms can be tough to handle without professional help. They are often flu-like symptoms but much stronger.
Chronic use of heroin can lead to tolerance of the drug. This means that it will take more of the drug each time to create the same desired effect. Over time, a physical and emotional dependence can manifest. After a tolerance is established, withdrawal symptoms can even start before the heroin is completely out of your system. These symptoms include:
- Muscle and bone pain
- Vomiting and diarrhea
- Abdominal cramps
- Insomnia
- Agitation
- Irritability
- Sweating
- Goose bumps
- Cold flashes
Withdrawal symptoms can start as early as a few hours after the last dose of heroin and usually peak in a few days.
While there is no specific timeline, and the detox process can vary from person to person depending on the amount of heroin taken and the severity of the dependence, withdrawal symptoms typically last around a week. During withdrawal, cravings can be very intense, and in order to prevent a return to drug abuse, close monitoring is recommended. Symptoms may also require medical treatment at times. For example, vomiting and diarrhea can lead to dehydration or even aspiration of vomit into the lungs. Around-the-clock medical supervision in a secure environment like a detox facility greatly enhances the chance of success and patient safety.
There are several medications on the market to aid in relieving some of the worst withdrawal symptoms during detox. These medications fall into three main categories: agonists, partial agonists, and antagonists.
Historically, one of the most common heroin addiction treatments was methadone. An opioid agonist, methadone is a slow-acting opioid that doesn’t produce as much of a high as heroin and can counteract some of the withdrawal symptoms. Heroin is considered relatively fast-acting with a single dose remaining in the body for between four and six hours, while methadone is longer acting and can stay in the body for 24 to 36 hours with a single dose. Harvard Health estimates that over 100,000 people in the United States still use methadone as a form of opioid maintenance treatment today. Methadone should only be administered under direct medical supervision, however, as it is still an opioid with risks of abuse and dependence.
Other types of pharmaceuticals used in the detox process include medications like clonidine, a blood pressure medicine, which can help to relieve anxiety, agitation, and some of the physical withdrawal symptoms. Antidepressants and other anti-anxiety medications may also be useful to balance the mood swings that can occur during detox.
Partial opioid agonists include forms of buprenorphine like Subutex and Suboxone. Buprenorphine works to fill opioid receptors, and it is a milder version of the more potent opioid drugs. Buprenorphine still produces some of the same effects of heroin, just at lower levels, therefore reducing withdrawal symptoms.Subutex is a brand name form of buprenorphine, which is generally taken via a tablet dissolved under the tongue once a day. Partial opioid agonists have a much lower chance of abuse since their effectiveness plateaus after a certain point. This means that no matter how much a person takes, they will hit a ceiling after which the drug will cease to create the desired results.
Suboxone is both a partial opioid agonist and an antagonist containing both buprenorphine and naloxone. Naloxone is an opioid antagonist often used to reverse an overdose. Antagonists block opioid receptors, are fast-acting, and are often used to reverse the effects of an overdose. The combination of an agonist and antagonist in one medication can be effective in warding off withdrawal symptoms as well as preventing further substance abuse.
The FDA approved the use of both Suboxone and Subutex as the first narcotic drugs to be prescribed over the counter for opioid dependence under the Drug Abuse Treatment Act (DATA) of 2000. Suboxone is also meant to be taken as a tablet sublingually once daily. As a further aid against misuse, injecting Suboxone will induce withdrawal symptoms. Both of these forms of buprenorphine can be prescribed by a doctor and picked up at a pharmacy, making them more accessible and cost-effective than other opioid addiction medications. They should still be closely monitored and used only as a part of a rehabilitation program as they work to aid in detox and do not manage the psychology of addiction.
Rapid detox programs use opioid antagonists like naloxone or naltrexone to quickly remove opioid drugs like heroin from the brain and body. Depade and ReVia, types of naltrexone, may be used, but on their own, they do not combat withdrawal symptoms, thus necessitating medical direction and supervision. Another form of naltrexone, Vivitrol, is injected once a month and used in heroin and opioid addiction recovery programs. This form stays in the system longer, blocking opioid receptors and is effective for long-term maintenance.
After Detox
Detox is not a cure for addiction, but rather the initial step in a rehabilitation or recovery program. In order to break the vicious cycle of addiction and remain free from drugs, group counseling and individual therapy are necessary tools. Chronic abusers of heroin can experience a suppressed pleasure center in the brain, which can lead to depression. Heroin users are 14 times more likely to successfully commit suicide than their non-using peers, as published by Addiction.
Mental health disorders often co-occur with substance abuse disorders. Both issues can be complex disorders that are often intertwined requiring specialized, simultaneous care. Heroin addicts often report feelings of hopelessness during rehab. Addiction counseling and psychotherapy cognizant of the specific difficulties a heroin addict faces are key components of dual diagnosis treatment. Rehab in a dual diagnosis treatment program focuses on treating both the physical addiction as well as restoring emotional balance.
Foundations Recovery Network professionals are uniquely qualified to offer dual diagnosis treatment in a safe and secure environment. Treatment in dual diagnosis rehab often includes behavioral therapies to modify negative thought and behavior patterns as well as pharmaceutical options, when necessary, to help maintain sobriety and make withdrawal as painless as possible. Alternative therapies to promote emotional and physical well-being include a nutritious diet and exercise plan as well as other holistic methods like yoga and massage to help balance mood. Social and family support groups are encouraged and can be important for long-term success.
Each person is unique and requires a comprehensive evaluation to discover which form of treatment will be best suited for them. Qualified admission counselors are standing by and can answer any further questions that you may have. Hope is only a phone call away.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton