Health Affects
"Heroin
can be injected, smoked, or snorted. Intravenous injection produces the
greatest intensity and most rapid onset of euphoria. Effects are felt in 7 to
8 seconds. Even though effects for sniffing or smoking develop more slowly,
beginning in 10 to 15 minutes, sniffing or smoking heroin has increased in
popularity because of the availability of high-purity heroin and the fear of
sharing needles. Also, users tend to
mistakenly believe that sniffing or
smoking heroin will not lead to addiction. '
'After ingestion, heroin crosses
the blood-brain barrier. While in the brain, heroin converts to morphine and
binds rapidly to opioid receptors. Users tend to report feeling a “rush”
or a surge of pleasurable sensations. The feeling varies in intensity
depending on how much of the drug was ingested and how rapidly the drug enters
the brain and binds to the natural opioid receptors. The rush is usually
accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in
the user’s arms and legs. The user may also experience nausea, vomiting, and
severe itching. Following the initial effects, the user will be drowsy for
several hours with clouded mental function and slow cardiac function.
Breathing is slowed, possibly to the point of death.'
"Repeated heroin use produces
tolerance and physical dependence. Physical dependence causes the user’s
body to adapt to the presence of the drug and withdrawal symptoms occur if use
is reduced. Withdrawal symptoms begin within a few hours of last use and can
include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold
flashes with goose bumps, and involuntary leg movements. These symptoms peak
between 24 and 48 hours after the last dose and subside after about a week,
but may persist for up to a month."
http://www.whitehousedrugpolicy.gov/publications/factsht/heroin/#street
Tolerance, Addiction, and Withdrawal

"With regular heroin
use, tolerance develops. This means the abuser must use more heroin to achieve
the same intensity of effect. As higher doses are used over time, physical
dependence and addiction develop. With physical dependence, the body has
adapted to the presence of the drug and withdrawal symptoms may occur if use
is reduced or stopped. Withdrawal, which in regular abusers may
occur as
early as a few hours after the last administration, produces drug craving,
restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold
flashes with goose bumps ("cold turkey"), kicking movements
("kicking the habit"), and other symptoms. Major withdrawal symptoms
peak between 48 and 72 hours after the last dose and subside after about a
week. Sudden withdrawal by heavily dependent users who are in poor health is
occasionally fatal, although heroin withdrawal is considered less dangerous
than alcohol or barbiturate withdrawal."
http://www.nida.nih.gov/index.html
Treatment
"There is a broad range of
treatment options for heroin addiction, including medications as well as
behavioral therapies. Science has taught us that when medication treatment is
integrated with other supportive services, patients are often able to stop
heroin (or other opiate) use and return to more stable and productive
lives. In November 1997, the National Institutes of Health (NIH)
convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction.
The panel of national experts concluded that opiate drug addictions are
diseases of the brain and medical disorders that indeed can be treated
effectively. The panel strongly recommended (1) broader access to methadone
maintenance treatment programs for people who are addicted to heroin or other
opiate drugs; and (2) the Federal and State regulations and other barriers
impeding this access be eliminated. This panel also stressed the importance of
providing substance abuse counseling, psychosocial therapies, and other
supportive services to enhance retention and successful outcomes in methadone
maintenance treatment programs. The panel’s full consensus statement is
available by calling 1-888-NIH-CONSENSUS (1-888-644-2667) or by visiting the
NIH Consensus Development Program Web site at consensus.nih.gov.
Methadone, a synthetic opiate medication that blocks the effects of heroin for
about 24 hours, has a proven record of success when prescribed at a high
enough dosage level for people addicted to heroin. Other approved medications
are naloxone, which is used to treat cases of overdose, and naltrexone, both
of which block the effects of morphine, heroin, and other opiates. For
the pregnant heroin abuser, methadone maintenance combined with prenatal care
and a comprehensive drug treatment program can improve many of the detrimental
maternal and neonatal outcomes associated with untreated heroin abuse. There
is preliminary evidence that buprenorphine also is safe and effective in
treating heroin dependence during pregnancy, although infants exposed to
methadone or buprenorphine during pregnancy typically require treatment for
withdrawal symptoms. For women who do not want or are not able to receive
pharmacotherapy for their heroin addiction, detoxification from opiates during
pregnancy can be accomplished with relative safety, although the likelihood of
relapse to heroin use should be considered. Buprenorphine is a recent
addition to the array of medications now available for treating addiction to
heroin and other opiates. This medication is different from methadone in that
it offers less risk of addiction and can be dispensed in the privacy of a
doctor’s office. Several other medications for use in heroin treatment
programs are also under study. There are many effective behavioral
treatments available for heroin addiction. These can include residential and
outpatient approaches. Several new behavioral therapies are showing particular
promise for heroin addiction. Contingency management therapy uses a
voucher-based system, where patients earn "points" based on negative
drug tests, which they can exchange for items that encourage healthful living.
Cognitive-behavioral interventions are designed to help modify the patient’s
thinking, expectancies, and behaviors and to increase skills in coping with
various life stressors."
http://www.nida.nih.gov/index.html