Short-Term Effects of Heroin
Heroin is a drug synthesized from the opium poppy. It is a derivative of morphine also known as diacetylmorphine and converts in the body to morphine and morphine metabolites. Heroin is a widely used recreational drug of abuse. It is also used medically as a pain reliever such as during childbirth and heart attack. In some countries, it is used in Opioid Replacement Therapy and has similar efficacy to methadone replacement treatment. The effects last a few hours, in contrast to short-acting opioids like Vicodin.
Heroin was created in 1874. It is made from opium which has been in use for centuries and it’s derivative morphine which has been used in pure form since Byzantine and medieval times in the form of laudanum. In 2016, 448 million tons of heroin were produced in the world. Most of the world’s heroin comes from opium made in Afghanistan. Heroin is thought to metabolize faster than morphine, but the differences in effects are minimal and possibly subjective. They are both more likely to be abused and produce euphoria than other opioids.
Heroin is converted in the body to morphine. Morphine is an endogenous endorphin (endogenous + morphine) produced in the body from levodopa and dopamine. Morphine is named after Morpheus, the Greek god of dreams. Heroin is the original brand name for Bayer’s diacetylmorphine, it comes from the words hero and heroine. It can be smoked, eaten, snorted, or used as a suppository.
In the short term, the user first gets a sharp rush and mental euphoria. Subsequently, there is flushing, dry mouth, couchlock, nausea, vomiting, itching, reduced heart rate, relaxation, or sometimes motor agitation, and after a few hours slowed breathing, CNS depression, and reduced heart pumping. In overdose, slow breathing also known as respiratory depression can cause brain damage, coma, and death. Mentally, it can cause fogginess, drowsiness, or disinhibited speech or actions.
Heroin is a depressant on the central nervous system. Instead of talking about heroin addict behavior, we will try to use person-first language and call these loved persons, people with heroin addiction. That way we understand that the person is more than their addiction, and addictive behavior and can be removed from them with motivation, help, love, care, and effective treatment protocols.
Heroin and brain damage
Over repeated uses of heroin for many months, the structure of the brain and mind begin to change. Changes in the physical structure of the brain correspond to changes in the mind and in subjective experience. Some changes in neurotransmitters and hormones can take up to two years to reverse and a few of the changes can never be reversed in known ways due to epigenetic changes in gene structure or loss of particular types of neurons. Extinction of some of the brain’s white matter can change behavior, ability to make decisions, and stress responses. As tolerance develops, withdrawal may set in sooner and sooner, sometimes to the point that balance is no longer possible to maintain. The person must experience withdrawals or take an amount that will result in overdose or severe illness. In other words, sometimes the amount you need to avoid withdrawal is the amount that will kill you, so a decision has to be made to get help, go through withdrawal, or risk an overdose.
Injecting can put one at risk of blood infections, hepatitis, HIV, infections of the veins, abscesses, poisoning from various fillers, and damage to the kidneys.
Many long-term persons with heroin addiction experience withdrawal often. They are always on the edge of finding a way to get money for their drug and going through withdrawal. They may resort to prostitution, burglary, stealing from locked cars, armed heists, fraud, or stealing from family members. This can cause a lot of regret, guilt, and inability to face oneself that can lead to further need to self-medicate, in a vicious cycle.
The lifestyle and physical changes can lead to rifts between loved ones, separation from one’s parents, children, friends, and siblings.
Some users cannot face the withdrawal syndrome. The toxic rebound of fear and depression is difficult to bear. There are symptoms such as the following:
- Sensitive genitals
- extra yawning
- old sweats,
- bone aches,
- watery eyes
Basically, the person with addiction may be up for days vomiting and having severe attacks of panic alternating with depression. It may feel like the intense flu, with nearly psychotic episodes of fear, rage, and depression. The person with addiction is not overly afraid of flu-like symptoms but rather the fear, anxiety, and depression are actually attendant with these less harsh medical signs but are independent of them and generally of far greater disability than the severe flu-like symptoms. Therefore, they are not merely being weak in the face of flu-like symptoms and most of them could easily make it through the flu without becoming terribly anxious or depressed. The mental symptoms are independent and of greater substance than the physical symptoms.
The person with addiction’s social life may be upended. They may lose their job. They may start to pawn furniture, lose their house and car or become homeless. All of their relationships may be strained.
How long does it take for heroin to leave your system?
Heroin’s half-life is 30 minutes, which means half the dose is gone from most of the system in that time and should be lost in the urine. The rest of the test can be detectable for up to 7 hours, and it is largely undetectable in the body after 7 days. Traces may remain in the hair for up to 3 months. In long-term users, some heroin can remain in fatty tissues for longer periods of time.
Post-Acute Withdrawal Syndrome
- Anhedonia, lack of ability to feel pleasure
- Autonomic dysfunction, nervous system out of whack
- Emotional lability
- Generalized anxiety disorder (GAD)
- Inability to concentrate
- Brain Fog
- Hyperalgesia increased sensitivity to pain
- Lack of motivation
- Memory impairment
- Inability to multitask
- Panic disorder
- Lack of physical coordination
- Sleep disturbance
- Socially belligerent
- Lack of ability to deal with stress
- Stressful and/or frustrating situations
Also, stress can cause a rebound of acute withdrawal symptoms during this period. This resolves within 6 months to two years.
- Needles, syringes, baggies, insufflation papers, smoking apparatus laying around, spoons, pipes, lighters, tourniquets
- Sneaking out at odd times
- Inability to perform at work
- Losing jobs
- Drowsiness, nodding off, inattentive
- Intolerant speech
- Symptoms of withdrawal as listed above
- Memory loss
- Track marks on arms or clothing to hide track marks
- Withdrawal from friends and family
- Bad health and hygiene
- Medical complications
According to an article published in Anesthesiology in 2016, tolerance to a large dose of heroin can develop in hours. This can make it such that the patient requires more medication to get the same effect. It can also lead to a short hangover period of withdrawal. Normally, it takes a month or more of daily usage for significant tolerance to develop. Once tolerance develops, the withdrawal will set in within hours for short-acting opioids till up to one or two days for long-acting opioids like methadone. Heroin withdrawals will start 6 to 12 hours after the last dose.
Medication-Assisted Treatment for drug abuse
Methadone maintenance is the most well-known form of opioid replacement therapy in mental health. Methadone is well-suited to this use because it is one of the most long-acting opioids and therefore it only has to be dosed about once per day and withdrawal will not set in for 24 to 48 hours or more after dosing. The dose amount varies from 20 to 200 mg. Methadone can be addictive, can cause a high, especially when combined with benzodiazepines, and is a drug of abuse preferred by some persons with opioid addiction. It can also cause respiratory depression and fatal overdose.
Buprenorphine is an opioid that is sometimes considered less addictive than methadone. It is used in opioid replacement therapy. Suboxone is buprenorphine combined with an opioid antagonist called naloxone which is also used to reverse opioid overdoses. This makes it less likely to cause an overdose. However, Subutex is buprenorphine without the opioid antagonist and can be abused and overdose death is possible, though it appears to happen less frequently still than with other opioids. Abuse of buprenorphine is a problem in Europe whereas, in the United States, heroin and fentanyl are more problematic.
Heroin Maintenance therapy for substance abuse is done just like methadone maintenance except heroin is used to replace street heroin and the patient is monitored while dosing. It has similar efficacy for behavioral health to methadone maintenance therapy and is most widely used in countries like Portugal, where drug use has been decriminalized. It is also used in Switzerland and in other places using cutting-edge science and politics to face down the problem of drug addiction.
Many doctors are comfortable prescribing non-scheduled medications to help ease withdrawal symptoms. These include hydroxyzine (antihistamine), gabapentin, and clonidine.
Many patients have weaned themselves off of opioids like heroin using an herb called kratom. This herb is a relative of the coffee plant grown in countries like Thailand and Paupau New Guinea. In the United States, it can be easily ordered online. Just choose a reputable vendor, put about 4 grams in warm water to replace your heroin dose, and up the dose as needed.
The Risk of Relapse
Relapse rates for heroin addiction are very high. Patients with substance abuse issues should not be discouraged after relapse and should try to quickly resume abstinence. Predictors of relapse include: abusing higher amounts of drugs, having a family history of alcohol abuse, and having a tendency to abuse parents or spouses. People with those risk factors should be given additional support to avoid relapse.
If you have a heroin abuse problem, talk to your doctor, therapist, or counselor about getting help. You can do it!
Disclaimer: We are not dispensing medical advice in the place of your doctor. We are not selling medications for any medical condition.
1 “Differential Opioid Tolerance and Opioid-induced … – ASA Publications.” https://pubs.asahq.org/anesthesiology/article/124/2/483/12697/Differential-Opioid-Tolerance-and-Opioid-induced. Accessed 5 Feb. 2021.
2 Buprenorphine: Toxicity and Overdose: Emergency Medicine News.” https://journals.lww.com/em-news/fulltext/2009/01000/buprenorphine__toxicity_and_overdose.6.aspx. Accessed 5 Feb. 2021.
3 Buprenorphine: Toxicity and Overdose: Emergency Medicine News.” https://journals.lww.com/em-news/fulltext/2009/01000/buprenorphine__toxicity_and_overdose.6.aspx. Accessed 5 Feb. 2021.