Heroin is a synthetic drug of the opiate family. Heroin is made by a chemical process that adds two acetyl groups to the alkaloid, morphine, found in opium—hence its scientific name, diacetylmorphine. Opium is obtained from poppy plants grown in Mexico, South America and Asia.
Opioid drugs suppress certain activities of the nervous system, and are used for medical purposes, such as analgesia (pain relief) and muscle relaxation. Other substances in the opiate family are morphine, codeine, methadone and oxycodone.
Heroin can be smoked or sniffed, but the drug is most commonly used intravenously.
Heroin reaches the brain quickly, where it binds to opioid receptors. Thus, the drug affects the brain’s pain, pleasure and reward pathways, but also impacts heart rate, sleep and breathing.
Heroin induces feelings of euphoria, joy, ecstasy, and release from stress, which is sometimes described as a dream-like state. The effect of heroin is immediate, beginning a few minutes after intake and lasting for several hours, during which the drug causes a slowdown in reactions and basic functions, such as walking and thinking.
A bit of history
The first evidence of the use of poppy seed resin was found in archaeological finds attributed to the Sumerian kingdom (in current day Iraq), dating back to about 2,000 BCE. In ancient Greece and Rome, opium was known as a painkiller, and over the years was used throughout Europe before amputation surgeries and as a miracle cure for many ailments. Heroin was first synthesized from morphine by a chemist at St. Mary’s Hospital in London in 1874, and was tested on animals. Two decades later, researchers at the German pharmaceutical company Bayer noticed that the compound had medical potential. Bayer began to market the substance as a medicine and named it “heroin,” from the German word heroisch, which means heroic. Although Bayer could not patent the drug, it distributed and marketed the drug in 23 countries as a treatment for respiratory diseases, pain relief during childbirth, and mental disorders, and as a non-addictive alternative to morphine and codeine. At the beginning of the 20th century, the use of heroin increased, alongside reports in the medical literature about users developing tolerance, needing increased doses and experiencing withdrawal symptoms after discontinuation. In the first decade of the 20th century, it became clear that heroin was an addictive drug and Bayer stopped making it. At the same time, the United States government passed the first law restricting heroin to medical uses only, and prohibited its sale without a license. In 1924, the US Congress banned the import of opium for the production of heroin and any use of heroin, even for medical purposes, and determined that heroin addiction was a criminal offense.
Why do people use heroin?
Heroin impacts the pain, pleasure and reward pathways in the brain very rapidly. Today, about 80% of heroin users in the United States report that they began using the drug after becoming addicted to prescription opioid medications, because heroin is cheaper, easily accessible and easy to consume by smoking or snorting, and its effect is more powerful compared to prescription drugs. While the US Drug Enforcement Administration (DEA) concurs that the easy availability and low price of heroin contribute to its increased popularity, it is not clear whether the widespread availability increases use or is the result of increased use. The US authorities report that the number of heroin users is rising steadily and consistently from year to year, especially among young people aged 18 to 25. At the same time, the number of heroin addicts who need diagnosis and medical treatment continues to rise, as does the number of heroin-related deaths. In the United States, the rise in heroin use is considered an epidemic, linked to policy changes that were put in place in order to stop another epidemic: addiction to prescription pain medications.
What are the adverse health effects of heroin?
When it reaches the brain, heroin turns into morphine and binds quickly to opioid receptors. The rapid and immediate response is a burst of joy, excitement and arousal, whose intensity depends on the dose and how quickly it reaches the brain. Other effects include dry mouth and a feeling of heaviness, and sometimes also itchiness, nausea and vomiting. The heaviness and drowsiness can persist even a few hours after intake, and can induce a slowdown in breathing and cardiac function, as well as life-threatening comas and brain damage. Recurrent use of heroin causes changes in brain structure, as well as neural and hormonal imbalances. Various studies have shown that recurrent use diminishes the white matter in the brain, which can affect decision-making and the regulation of reactions, especially in situations marked by stress and anxiety. Heroin is considered a highly addictive drug that induces great dependence and tolerance. Heroin addiction is a chronic disorder characterized by periods of relapse and remission, uncontrollable urges for the drug, adaptation and the need for higher and higher doses. Discontinuation causes severe withdrawal symptoms, which can appear a few hours after the last use. Withdrawal symptoms include restlessness, pain, trouble sleeping, diarrhea, vomiting, chills and involuntary movements. For injecting heroin users, another issue is the increased risk of contracting infectious diseases, such as HIV and Hepatitis B and C. Injecting heroin into veins has additional health consequences, including the scarring and destruction of veins, vascular infections and blockage, as well as arthritis and rheumatologic conditions. Heroin use is linked to various lung diseases, including TB, and to sleep disturbances and constipation. The drug affects users’ mental state, and many heroin users suffer from depression, personality disorders, and other mental health disorders. Heroin addiction exposes users to the risk of overdose, which can be fatal, because the drug slows down the heart rate and breathing.
How can we treat heroin addiction?
Heroin is a highly addictive drug. There are a number of effective treatments for heroin addiction, including psychotherapy and pharmacotherapy. Combining both types of treatment is considered the most effective approach. As noted, the discontinuation of heroin causes difficult and severe withdrawal symptoms. The medications used for heroin withdrawal are safe and help patients overcome their cravings and the physical symptoms of withdrawal.