What You Don’t Know Unless You’ve Been There: Heroin

You know it as heroin. Chemists know it as diacetylmorphine, an addicting chemical that’s derived from a morphine alkaloid found in the seed pods of the Asian opium poppy plant. When heroin enters the brain it’s converted back to morphine and binds to the opioid receptors Mu, Kappa, and Delta, which are associated with pain and reward.

Heroin doesn’t just make you feel great. People get a euphoric rush when using heroin, says Marci Ouellette, RN, director of nursing at Mountainside, a substance abuse treatment center in Canaan, Connecticut. But the drug also decreases anxiety and pain and gives you a feeling of detachment from the world.

There’s nothing like your first time. There’s a lot to like about how heroin makes you feel, but the trouble is, you can’t get back that initial high. Many try, though, using more of the drug and more often, chasing that feeling. That’s how users become addicted. A key danger, though, says Ouellette, is that a person’s opioid receptors are located in the brain stem, which also controls the autonomic nervous system, responsible for blood pressure, respiration and alertness. High doses of heroin depress these systems and can lead to an overdose which can, of course, kill you. Or leave you with brain damage from a lack of oxygen in the brain if respiration decreases enough.

Heroin is often “cut” or diluted with other substances. These include sugar, starch, powdered milk and other drugs like fentanyl, another painkiller which is 50 times more powerful than morphine. And because the user doesn’t always know what, exactly, they’re taking, it’s much easier to overdose or die. These adulterated versions of heroin are “more dangerous in terms of its overdose potential,” cautions Paul Rinaldi, PhD, director of The Addiction Institute of New York at Mount Sinai Roosevelt and Mount Sinai St. Luke’s, in New York City.

If you want the greatest high, inject it into your veins. This technique, though, brings a second set of risks: that of spreading disease if the needle has been used before by another person. Early in 2015, 150 heroin users in Indiana were diagnosed with HIV; the virus was transmitted through shared needles. Heroin can also be snorted, smoked, ingested orally or used in the form of a suppository, “but the drug is addictive no matter how it is taken,” says Ouellette.

What You Don’t Know Unless You’ve Been There: HeroinWithdrawal from heroin is excruciating. If you abruptly stop you can expect high anxiety, insomnia, muscle and bone achiness, extremely restless legs, feelings or agitation and irritability, as well as GI symptoms such as nausea, vomiting and diarrhea. Suddenly going cold turkey from heroin and other opioids can get so uncomfortable that many times users will just go back to using. That’s why medically monitored detoxification is a more easily tolerated way to come off the drug, Ouellette stresses.

Heroin is a bargain compared to prescription painkillers. “People often progress to heroin because it is much cheaper than prescription opiates, and very pure,” says Dr. Rinaldi.

If you quit and start using again it’s way easier to overdose than it was before. Many people who’ve been addicted to heroin or other opiates often don’t realize that if they go off the drugs in treatment and then relapse, that’s when they’re at the highest risk of dying. Why? Because too often the person will go back to taking the same dose he did before going into recovery, but after detoxing he’s lost the tolerance he built up for that dose, so can more easily overdose and die. Rinaldi says that when people use opiates such as heroin for periods of time, they develop more receptors in the brain for the drugs. These receptors disappear when they stop using. But when someone goes back to heroin after not using for some time and there fewer receptors to receive the drug, the amount can overload the brain, leading to an overdose and, potentially, death.

The risk of relapse can be ever-present. “Last month someone put heroin in my face after I had been clean for a year, and I’m tempted all the time,” says Connie, 38, a former heroin addict who now works for a supermarket chain after spending a year in prison following a drug arrest. Over the past year her weight has gone from 87 pounds to 128 as she has started prioritizing good nutrition and her overall health. Still, Connie struggles against relapse. “When I saw the heroin, I didn’t just wave it away. I had to think about it,” she recalls. “It bothered me that my mind kept racing even a year down the road. It never goes away, it’s always going to be there, but I’ve got to be vigilant and I am. I have a heroin group on Facebook which helps me because I help others.”

Most addicts can’t distinguish one buzz from the next, Connie believes. “If they get an alcohol buzz, they may want to go on to something else that can be more dangerous. It’s never enough for the people I’ve seen. It may be today you just smoke pot or drink alcohol, but you’ll build up to wanting another buzz and when desire meets opportunity you’ll find a way to get what you want.”

Adds Connie, “My friends who have relapsed call me every day. People don’t realize that addicts are human too.”

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