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Heroin Addiction and Health Effects

February 21, 2014  |  Falmouth Enterprise

By Dr. Michael Bihari 

The growing epidemic of heroin abuse has received much attention during the past month. Our region of the country has been especially hard hit as noted by the increasing number of heroin overdoses in Falmouth and other towns on and off Cape. An article in the Boston Globe earlier this week reported that beginning of the year, 64 people have overdosed in Taunton, five fatally.

What Is Heroin? 

Heroin is an opioid drug that is made from morphine, a naturally occurring substance taken from the seed pod of the Asian opium poppy plant. Opioids are a class of drugs with powerful pain-relieving properties. 

Heroin in any form is illegal in the United States. Under the Controlled Substances Act heroin is classified as a Schedule I substance meaning that it has a high potential for abuse and no currently accepted medical uses.

Common street names for heroin are smack, dope, brown sugar, junk, H, Mexican black tar, white horse, skag, skunk, and China white.

Heroin is typically sold as a white or brownish powder, or as the black sticky substance, “black tar heroin.” Although purer heroin is becoming more common, some street heroin is “cut” with substances such as sugar, starch, or powdered milk. Recently in the Northeast the powerful opioid medication fentanyl has been added to heroin, a potent and deadly mixture responsible for many heroin-related overdoses and deaths. 

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three routes of administration deliver the drug to the brain very rapidly,

Heroin Addiction

Addiction is a chronic recurring disease caused by changes in the brain that lead to uncontrollable drug-seeking behavior no matter the consequences. 

Heroin enters the brain very quickly, making it particularly addictive. It is  estimated that almost one-fourth of the people who try heroin become addicted.

When heroin enters the brain, it is converted back into morphine, which binds to molecules on cells known as opioid receptors. These receptors are located in many areas of the brain, especially those involved in the perception of pain and in reward. Opioid receptors are also located in the part of the brain which controls some of the functions critical for life, such as blood pressure, arousal, and respiration. Heroin overdoses can suppress breathing, which can be fatal.

After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) along with dry mouth, a warm flushing of the skin, heaviness of the arms and legs, and clouded mental functioning. Following the initial rush, users may go “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same.

Health Effects of Heroin

Heroin abuse is associated with a number of serious health conditions, including fatal overdose and serious infectious diseases. People who inject heroin are at risk of contracting HIV and hepatitis C. This is because these diseases are transmitted through contact with blood or other bodily fluids, which can occur when sharing needles or other injection drug use equipment. In fact, there has been a significant increase in hepatitis C cases in Falmouth and on Cape Cod in the past year.

In addition to the effects of the drug itself, street heroin may contain toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.

Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. Heroin users who reduce or stop using the drug abruptly may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—often include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), and kicking movements (“kicking the habit”). Users also experience severe craving for the drug during withdrawal, which can lead to  continued abuse and/or relapse.

Prescription Pill Abuse and Heroin

Prescription pain medications such as Oxycontin, Vicodin and Percocet have effects similar to heroin when taken in doses or in ways other than prescribed, and aside from marijuana are the most commonly abused drugs in the country. 

Nearly half of young people who inject heroin surveyed in three recent research studies reported abusing prescription painkillers before starting to use heroin. Some individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids. This is probably a factor in the increase in heroin use locally. Prescription pain killers are in shorter supply causing prices to rise. For the cost of several opioid pills, a user can buy week’s supply of heroin

Additionally, many of the young people surveyed also reported that crushing prescription opioid pills to snort or inject the powder provided their initiation into these methods of drug administration.

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