Heroin Abuse

Drug Effects

After a single dose of heroin, the user experiences a surge of euphoria or a “rush,” as well as a warm flushing of the skin. Profound relief of pain, if any is present, takes place. The mouth becomes dry and the extremities begin to feel heavy. Pupils become very small, respiratory rate decreases, and gastrointestinal motility slows, causing constipation. Central nervous system effects include drowsiness and confusion, and in overdose, can progress to unconsciousness, coma, and ultimately, death. Alternating wakeful and drowsy states can also occur, a phenomenon known as being “on the nod.”

Immediate and long-term risks are associated with heroin use. The most important of these is overdose. The practice of injection is also inherently dangerous, because poorly dissolved additives present in street heroin can travel through the blood stream, embolizing in the lungs, liver, kidneys, or brain, causing tissues in these organs to infarct, or die. The veins of repeated injectors can become collapsed, causing the user to seek out other veins, sometimes including those of the neck. There is a high risk of infection associated with injection because sterile needles are not often available, and endocarditis (infection of the heart lining and valves), pneumonia, bone and joint infections, and abscesses of the skin and other organs can occur. Users who share needles with others can acquire and transmit bloodborne viruses such as HIV and the hepatitis viruses B and C, which can cause long-standing liver disease, cirrhosis, and ultimately, liver failure requiring transplantation.

Addiction to heroin is marked by tolerance and withdrawal. Tolerance is achieving less drug effect after taking a dose similar to previous administrations, or stated another way, requiring more drug to experience the same effect as before. Withdrawal is a syndrome of physiological effects that the user experiences after taking heroin for a long period of time, then stopping. It is marked by craving, restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, kicking movements, cold flashes, and goose bumps. It is based on this constellation of effects that the terms “kicking the habit” and “going cold turkey” were coined. Although intensely unpleasurable for the addict, heroin withdrawal, unlike withdrawal from alcohol or barbiturate abuse, is generally not fatal.

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