Signs of Heroin Abuse

When heroin is administered, the user feels euphoric and presents with symptoms like dry mouth, a warm flushing of the skin, nausea, constricted pupils, respiratory depression, heavy extremities, and drowsiness. After the euphoric state is over, the individuals can oscillate between hyperactivity and fatigue states.

The effects of heroin consumption manifest quickly with feelings of euphoria, calmness, complacency, diminished hunger and sexual impulses, and the heroin abuser becomes disinhibited and fearless (because they feel protected and immune to the environment).

Heroin is a semi-synthesized morphine derivate. Drugs derived from morphine are called opiates or narcotics. All the active substances in this category are extracted from the opium poppy plant called Papaver somniferum.

The main medical use of opiate drugs is for their analgesic or pain-relieving effects. Opiates have been used for this purpose for centuries and remain the most potent and selective pain relievers known to medicine. Unlike the depressant-type anesthetic drugs, opiate analgesics relieve pain without causing unconsciousness. After receiving moderate doses of opiates, patients remain conscious and are able to report painful sensations but do not suffer from the pain.

Morphine is the prototype opiate analgesic and is the standard by which others are measured and classified. It is used primarily for severe pain. As we have noted, although heroin is more potent than morphine, it is not used medically in the United States because it is a Schedule I drug. Addiction is a risk in using opiate drugs for pain relief, but it should be noted that relatively few patients who use the drugs as directed develop problems. To reduce the risk of addiction, less potent opiates are used whenever possible, and treatment is as brief as possible. When pain is severe and chronic, however, as with terminal cancer patients, tolerance inevitably develops, and higher doses of more potent opiate drugs must follow to relieve the patient’s pain. Ultimately, high doses of opiates may be the only way to relieve the suffering, and eventually, even this may not be enough. In Great Britain, physicians use the potent opiate heroin but, because heroin is a Schedule I drug, doctors in the United States may not administer it.

As we mentioned before, heroin has very powerful analgesic and euphoric properties. Although brief, sharp, localized pain is poorly relieved by opiates, they do effectively relieve duller, more chronic, and less localized pain. As with all opiates, heroin acts chiefly on the central and autonomic nervous systems and, to some extent, directly on smooth muscles. Effects on the central nervous system are primarily depressant, although larger doses may bring out stimulant properties. The depressant actions include analgesia (relief of pain, sedation, freedom from anxiety, muscular relaxation, decreased motor activity), hypnosis (drowsiness and lethargy), and euphoria (a sense of well-being and contentment). Unlike anesthetics, opiates are able to produce marked analgesia without excessive drowsiness, muscular weakness, confusion, or loss of consciousness.

Michael Agar (1973) points out that the heroin user can experience four different effects from administering heroin:
1. The rush. Heroin produces euphoria, referred to as the “rush”. Michael Agar described this state as: “About 10 seconds after the beginning of an injection of heroin the subjects had a typical narcotic ‘rush,’ including a wave of euphoric feelings, visceral sensations, a facial flush and a deepening of the voice”. Heroin and cocaine activate brain systems that are responsible for the reinforcing properties of such natural rewards as food and sex; male and female users describe the euphoric rush produced by heroin and cocaine as similar to, but several times stronger than, sexual orgasm (National Institute of Drug Abuse 1997). Agar (1973) notes that while heroin is believed to have no effect on an addict after his or her tolerance builds up, heroin users actually experience the rush no matter how addicted they are. Addicts frequently describe the rush in sexual terms. Indeed, heroin use substitutes for sex, in which the addict usually has little or no interest. Typically, the onset of heroin using behavior coincides with adolescence, and remission usually occurs, with or without treatment, as the sex drive diminishes with age; there are few heroin addicts among people older than forty years of age.
2. The high. Described by addicts as a feeling of general well-being, the high decreases with increased tolerance; thus, increasing dosages are required to achieve the high. Whereas the rush is experienced over a period of seconds, the high can last for several hours.
3. The nod. This is described by addicts as being “out of it,” in a state of unawareness, oblivious to one’s surroundings, an escape from reality. In 1980’s, a scientist (Dole) described that the nod ranges from a slight dropping of the eyelids and jaw to complete unconsciousness: “they become calm, contented, and detached. They appeared to be quite uninterested in external events” (Dole 1980). Tolerance affects the nod dramatically, and doses greater than that required for the high are needed to sustain the nod.
4. Being straight. This is how addicts describe their condition when they are not sick, that is, not suffering the onset of withdrawal symptoms; that is, when their bodies are homeostatic. Unless tricked into buying a “blank,” addicts will get a rush and get straight, although they will not necessarily experience a high or the nod.

Heroin impairs homeostatic body functions. There is a slight decrease in body temperature, although dilation of blood vessels gives the user a feeling of warmth. The body retains fluids. There is also a reduction in the secretion of digestive fluids, and a depression of bowel activity so the user suffers from constipation. Heroin also causes a constriction of the pupils, which explains why addicts frequently wear sunglasses. At relatively high doses, the sedating effects cause a semi-stuporous, lethargic, and dreamy state (“nodding”), in which there is a feeling of extreme contentment. Unlike alcohol, heroin depresses aggression. It also stimulates the brain area that controls nausea and vomiting, and instead of euphoria, some initial users experience nausea and vomiting. A very dangerous side effect of heroin is that it depresses the respiratory centers in the brain. Thus, an overdose can result in respiratory arrest and death from lack of oxygen to the brain.

Dangers of Heroin Abuse

Long-term heroin use can cause permanent changes in the user’s cognitive function, altering the way they think. If actively using the drug, the user may lose the ability to make good decisions or control their impulses.

Dangers of abuse:
• Respiratory diseases (tuberculosis, pneumonia).
• Liver disease.
• Insomnia.
• Damage to soft nasal tissue.
• Collapsed veins.
• Cardiac valve infection.
• Chronic constipation.
• Intestinal obstruction.
• Important weight loss.
• Sexual dysfunction.
• Irregular menstrual cycles.

Drugs like heroin can also suppress the immune system of the user, making them more likely to catch colds and develop some forms of infection.

Psychological dependence

What is a psychological dependence?
Physical dependence occurs when heroin addicts develop pathological organic needs of using the substance in order to avoid the disorders that may appear as soon as the individual stops administering the drug. This type of dependence is very common among the heroin users.

Of course, the side effects go far beyond the physical ones. Heroin users definitely develop psychological side effects of heroin. It usually starts with rapidly shifting and prioritizing their life differently. The majority of heroin addicts tend to quickly separate the world into two major groups of people: those who use heroin, and those that are not using the substance. This usually alters their relationship with friends and family and how they spend their time. The social impact on heroin addicts is a tremendous one. The individuals may find themselves hanging out with people that they normally would not associate with. This can have negative effects on their behavior as they normalize bad behavior.

The degenerative side effects of heroin abuse on the brain are very pronounced. People that abuse heroin, may quit their jobs, lose their home, and not care that much about these problems because they are often “blinded” by the effects of the drug. When money and their drug supply becomes a problem to maintain, the addicts usually start to engage in illegal activities in order to get more money. They may steal from family, friends, loved ones, or from a business in order to get more money for heroin.

Physical dependence

What is a physical dependence?

The psychological dependence affects the behavior of the user. The individual has a particular mental state that is characterized by an imperious wish of using the drug in order to obtain the drug’s effects. This type of dependence is very common among the heroin users.

The majority of the heroin addicts don’t really notice the effects until they run out of the substance and realize that they cannot get any more of it. When the user gets into this state, withdrawal’s signs and symptoms and sends the individuals into a flu-like stage. This flu-like stage can only be fixed by “feeding the body” with more heroin. The physical dependence manifests by degenerative side effects that can be noticed after a prolonged heroin use. Most of the times, the addicts try to overcome the uncomfortable heroin’s physical side effects by administering the drug repeatedly, making it impossible to escape from this vicious cycle.


Recognizing a Heroin Addiction

Heroin is usually smoked, snorted or injected. Depending on one of the methods of administration mentioned before, there can be found remnants of the drug use left behind.

First, it is very important to recognize the heroin itself. Heroin can be a powdery or crumbly substance, ranging in color all the way from off-white to dark brown. Black tar heroin is nearly black and is sticky instead of powdery. Often, you will find syringes or small glass or metal pipes. A heroin addict may leave dirty spoons and lighters around or a device to cause the veins to enlarge, so there may be belts or rubber tubing found in the area where he or she is using the drug.

Heroin is a fast-acting drug. When it’s injected, there is a surge of euphoria that arrives within seconds. The user can also get a dry mouth, and his or her skin will flush. The addict’s pupils will often be constricted. Heroin users may nod off suddenly, and breathing will be slowed, which is how an overdose kills.

When awake, the addict’s thinking is usually unclear. In the majority of the cases, the users will tend to lose some of their memory, and their decision-making and self-control are likely to deteriorate too.
Other signs of heroin use are itching, nausea and vomiting. Another sign of heroin use is constipation often suffered by opiate abusers. The addict will tend to look for laxatives. They may also experience skin infections, or other kinds of infections, and a lowered immunity to illness.

Signs of a Heroin Overdose

Heroin abusers do not know the actual strength of the drug or its true contents and they are at a high risk of overdose or death. Ingesting heroin that is significantly purer than the user’s level of tolerance leads to overdose reactions that can include respiratory arrest and death. And because heroin is illegal, there is no way for the user to determine the level of purity. Indeed, the “hot shot,” a dose of heroin pure enough to be fatal, is used as a relatively easy way of eliminating addicts who have become police informers. Another danger is that heroin cut for street sale might contain adulterants that can be harmful to the user. Even if the heroin is not adulterated, the user might mix it with other drugs, such as the stimulants cocaine and amphetamine, to enhance the euphoric reaction (potentiating effect); such combinations can be fatal.

Users also face the dangers associated with diseases that are transmitted by shared hypodermic needles, particularly hepatitis and AIDS. In New York City, where there are believed to be about 200,000 heroin addicts, as many as 60 percent of them might be infected with the AIDS virus, and addicts are the leading cause of the spread of AIDS. In addition to transmission by shared needles, infected addicts spread the disease through sexual relations with nonaddicts.

The effects of a heroin overdose are:
• Slow and shallow breathing
• Blue lips and fingernails
• Clammy skin
• Convulsions
• Coma
• Death



H. Abadinsky, “Drug Use and Abuse – A Comprehensive Intro. 7th Edition” (Cengage, 2011), pages 100-101