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Heroin

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Image: images/heroin.jpg Heroin belongs to a group of drugs known as opiates (sometime called narcotic analgesics)

Other opiates include opium, morphine, codeine, pethidine and methadone

History

Although opium cultivation is concentrated in Asia, it is grown widely around the world.

Opium has been used by many cultures for both medical and recreational purposes.

Opium is refined to produce morphine and codeine which are then used to manufacture heroin.

Heroin comes as white to off-white granules or pieces of 'rock' with a bitter taste but no smell.

Heroin is most commonly injected into a vein. It is also smoked (chasing the dragon) or snorted.

Common street names: dope, gear, H, hammer, harry, horse, junk, skag, slow, smack.

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Effects
The effects of any drug, including heroin, vary from person to person.

They are influenced by variables such as:

  • The individuals health status (including height and weight)
  • Mood and emotional well-being
  • Purity of the drug
  • Route of administration
  • The environment in which the drug is taken (alone, social setting, etc)
  • Tolerance
  • Use of other drugs (legal or otherwise)

Both the physical and physiological effects of heroin may last 3-4 hours.

The immediate effects may include:

  • A sense of heightened relaxation;
  • Pain relief;
  • Diminished hunger;
  • Diminished sexual urges;
  • Reduction in blood pressure, heart and respiratory rates;
  • Constriction of the pupils
  • Drying out of the mouth;
  • Drowsiness and/or sleep.
  • Nausea and vomiting

Once an individual's body has adjusted to the use of heroin he or she can become a social user. That is the person's life is not dominated by their heroin use. They can function adequately in relationships, work, study, etc.

The effects of an increase in use of heroin include:

  • Reduced level of concentration;
  • Likelihood of sleep;
  • Shallower and slower breathing;
  • Nausea and vomiting;
  • Sweating and itching on the skin;
  • Constipation;
  • Menstrual irregularity;
  • A reduced sex drive in both men and women
  • Infertility in women.

Longer term and particularly unsafe use causes complications that include, skin, heart and lung infections and diseases such as Hepatitis and Human-Immunodeficiency Virus (HIV) and dependency.

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Tolerance & Dependence

As a person uses heroin more regularly, a tolerance to its effects is developed.

An ongoing user's tolerance means increasing amounts of the drug are required to achieve the desired effects. Eventually the person will use heroin to delay the onset of withdrawal signs and symptoms, rather than for any euphoric effect. In this situation the person is dependent on heroin.

The major indicator of a person's heroin dependence is the existence of the Drug Dependence Syndrome.

The signs and symptoms of drug dependence syndrome have been defined by the World Health Organisation as:

  1. Existence of the Neurodaptation Syndrome indicated by pain and pilo erection (cold turkey) if the user reduces and or ceases their heroin use.
  2. Narrowing of the behavioural repertoire occurs so that the person becomes more dominated by their drug use and pays a reduced amount of attention to, for example positive self care, fitness, work and study.
  3. Salience of drug seeking behaviour evidenced by the increased effort a user will go to in obtaining the drugs.

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Overdose

Overdose of heroin can occur because:

  • Heroin is not quality controlled and may contain other substances such as sugar, cleaning agents, and caffeine. Therefore the user does not always know the precise dose that they are administering.
  • Interaction of the heroin with other drugs and/or alcohol, especially alcohol or benzodiazepines
  • The user's heart and respiratory rates are greatly slowed and the blood pressure reduced, leading to death.

Most overdoses occur as a result of poly-drug use.
Complications of heroin overdose also include: chest infection; accidents such as falls; paraesthesia of nerves and muscles; motor car accidents; amongst others.

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Withdrawal

When a social user of heroin stops using, very mild withdrawal signs and symptoms will be experienced.
More severe withdrawal signs and symptoms will be experienced when a heroin-dependent person stops using.

The signs and symptoms of heroin withdrawal are:

  • craving for heroin;
  • elevated heart rate;
  • emotional depression;
  • goose bumps;
  • leg and stomach cramps;
  • low blood pressure;
  • runny nose;
  • diarrhoea
  • vomiting; and
  • yawning.

Withdrawal symptoms get stronger and usually peak around 2 to 4 days after last use. They begin to get weaker and usually subside after 6 to 7 days.
As a person withdraws, signs and symptoms may begin to emerge that reflect underlying problems that include insomnia, irritability, agitation and an elevated heart rate.
The death of someone who is in withdrawal from heroin is very unlikely unless there are other complicating factors.

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Treatment Options

The range of treatment options in Australia includes:

Abstinence models such as therapeutic communities and outpatient counselling and

Non-abstinence models including the use of pharmacotherapies such as Methadone, Buprenorphine and Naltrexone.

The aims of these non-abstinence models are to provide appropriate medication and encourage a reduction in harm resulting from drug use.

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(Southcity Clinic acknowledges the assistance of the Australian Drug Foundation in compiling this information;Image in the public domain courtesy of prevlink.org)