What are Opioids?
Opioids, substances that act on opioid receptors and produce morphine-like effects, come in many forms and often lead to an opioid use disorder (OUD) that many users let direct their lives — and their loved ones’ lives — into a downward spiral. Examples of opioids include heroin, fentanyl, codeine, morphine, and synthetic opioids such as oxycodone and Opana.
Prescription pain medications such as Vicodin, Morphine, Oxycontin, or Codeine that are legally given to patients can lead directly to heroin addiction after their prescription medications are no longer available.
To help a loved one overcome heroin or opioid addiction, it’s very important to understand how opioids hijack your brain. The opioid chemical family interacts with opioid receptors on nerve cells throughout the body and brain [2].
When taken for a short period of time and as prescribed by a doctor, opioid pain relievers are generally safe. However, because they produce a sense of euphoria as well as pain relief, they can be misused.
Even when prescribed by a doctor, opioid pain relievers can lead to dependence, addiction, and death when misused [3]. Misuse can be procuring opioids without a doctor’s prescription, ingesting larger amounts than prescribed, or ingesting in ways and forms not prescribed.
Opioid Use Disorder
Opioid use disorder, otherwise known as OUD, is defined as the sustained use of opioids that causes clinically significant distress or impairment. Opioid use disorders affect over 2.1 million people in the United States, and there are over 120,000 deaths worldwide annually attributed to opioids [4].
Opioid use disorder diagnosis is based on the American Psychiatric Association DSM-5 and is defined as having an innate desire to obtain and take opioids despite social and professional consequences. Opioid use disorder leads to an increased opioid tolerance, and withdrawal syndrome when discontinued.
Withdrawals from opioids can be extremely debilitating and can even present medical complications in some cases. Withdrawals from short-acting opioids such as heroin start within 8-24 hours after use.
These symptoms, which can last anywhere from four to ten days, include [5]:
- Perspiration
- Nausea
- Vomiting
- Muscle cramps
- Diarrhea
- Insomnia
- Hot flashes
Diagnosis of Opioid Use Disorder
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, otherwise known as the DSM-5 provides diagnostic criteria for OUD. This is the same for all substances and based on the presence of at least two of eleven criteria, which can be divided into four clusters [6]:
1. Impaired Control
- Opioid use in larger amounts or over a longer period of time than intended.
- The persistent desire to cut down or multiple unsuccessful attempts at cutting down or stopping use
- A great deal of time spent using the substance or recovering from its effects
- Intense desire to use or craving for the substance
2. Social Impairment
- Substance use resulting in failure to fulfill obligations at work, school, or home
- Substance use causing or exacerbating interpersonal problems
- Giving up on important social, occupational, or recreational activities due to substance use
3. Risky Use
- Recurrent use of the substance in physically hazardous situations
- Continued use despite negative physical or psychological consequences
4. Pharmacologic Dependence
- Tolerance build-up due to the effects of the substance
- Worsening withdrawal symptoms with cessation of substance use
What is Heroin?
Heroin is a dangerous opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in the Middle East, Asia, Mexico, and Colombia.
Heroin can come in many forms. On the east coast, it is usually in a white or brown powder. While on the west coast it is a black sticky substance known as black tar heroin [7]. It can be injected, eaten, snorted, or smoked.
While using heroin is dangerous no matter which way it is administered, it is possible to sustain permanent damage from injecting heroin. Even if you have sanitized the equipment, cleaned the site, and filtered the heroin; it remains extremely dangerous to inject heroin.
Some of the dangers of injecting heroin include the risk of developing infections, heart problems, getting HIV or Hepatitis C, and increasing the chances of an overdose.
In the brain, heroin binds to opioid receptors on cells in many different locations, including those involved in the feeling of pain and pleasure, as well as those involved in the regulation of heart rate, sleeping, and breathing.
Other common and short term side effects of heroin use include:
- Dry mouth
- Flushing of the skin
- Heavy feeling in the arms and legs
- Nausea and vomiting
- Severe itching
- Constipation and stomach cramping
- Clouded mental functioning
- Going “on the nod,” a back-and-forth state of being conscious and semi-conscious
People who use heroin over the long term may develop more serious conditions that can require hospitalization or cause death.
These longer-term complications can include:
- Insomnia
- Collapsed veins for people who inject the drug
- Damaged tissue inside the nose for people who sniff or snort it
- Infection of the heart lining and valves
- Abscesses (swollen tissue filled with pus)
- Liver and kidney disease
- Lung complications, including pneumonia
- Mental disorders such as depression and antisocial personality disorder
- Sexual dysfunction for men
- Irregular menstrual cycles for women
Signs Your Loved One May Have a Heroin or Opioid Addiction
The first step to helping a loved one overcome a heroin addiction is to recognize that they have a problem. However, this may be difficult as many people with OUD hide their drug usage from their loved ones due to shame and an inability to help themselves.
Furthermore, some may be able to operate a somewhat-normal lifestyle despite their usage. In order to help someone you love to diagnose and overcome their condition, be on the lookout for these signs [8].
Signs your loved one may have a heroin addiction:
- Slurred speech
- The inability to control prescription opioid use
- Needle entry points on their skin or “track marks”
- Uncontrollable cravings
- Mood swings
- Consistent drowsiness
- Changes in sleep habits
- Weight loss
- Frequent flu-like symptoms
- Decreased libido
- Lack of hygiene
- Changes in exercise habits
- Isolation from family or friends
- Stealing from family, friends, or businesses
- New financial difficulties
Risk Factors
People with certain risk factors, lifestyles, or conditions may be at further risk for developing OUD. Furthermore, some risk factors increase the likelihood of a person turning to illegal drugs such as heroin. This is due to the low cost and easy availability.
Known risk factors of opioid misuse and addiction include:
- Poverty
- Unemployment
- Family history of substance abuse
- Personal history of substance abuse
- History of criminal activity or legal problems including DUIs
- Regular contact with high-risk people or high-risk environments
- Problems with past employers, family members, and friends
- Mental disorders
- Risk-taking or thrill-seeking behavior
- Heavy tobacco use
- History of severe depression or anxiety
- Stressful circumstances
- Prior drug or alcohol rehabilitation
Potential Exposure to Other Drugs Such as Fentanyl
The synthetic opioid fentanyl is up to 100 times stronger than morphine and 50 times stronger than heroin. It is a major contributor to the opioid overdose epidemic and leads to fatal overdoses.
Because of its extremely high potency, it is often added to other drugs, making them cheaper, more powerful, more addictive, and more dangerous. Many people have died from fentanyl overdoses after unknowingly using heroin containing fentanyl [9].
Carrying Naloxone as an Overdose Countermeasure
Naloxone, an opioid antagonist, is a medicine that can rapidly combat heroin or other opioid overdoses. It quickly attaches to opioid receptors and blocks the furthered absorption of opioids for 30 to 90 minutes [10].
If used, it is important to call 911 because many opioids remain in the body for periods longer than this. Naloxone can quickly restore normal breathing to someone with breathing difficulties due to an opioid overdose. This medicine comes in two different FDA-approved forms – a prepackaged nasal spray and an injectable form.
No matter the form used, it is important to receive training and educate yourself on how and when to use naloxone. Many pharmacies carry naloxone and in some states, naloxone can be provided by a pharmacist without a doctor’s prescription.
There are also community-based programs that provide the medicine free of charge. Here is a website that gives training and helps you find access to Naloxone: getnaloxonenow.org.
Do’s and Don’ts in Helping Someone With a Heroin Addiction
After you’ve identified that someone you know or love has a heroin addiction, it’s important to take measured steps. Here are some tips and methods to help them begin their journey of recovery.
- Do dispose of unused pain medications and opioids in the household
- Do gain a better understanding of their addiction
- Do offer your support
- Do encourage them to recognize their addiction and to get help
- Do stage an intervention with loving friends and family – explain how their use is hurting you and themselves
- Do recognize you need to take care of yourself as well
- Do recognize recovery is an ongoing process – it won’t happen overnight
- Don’t shame or demoralize the user about their addiction – it could happen to anybody
- Don’t enable their behavior by taking over their responsibilities
- Don’t let you or themselves make excuses for their behavior
- Don’t give them money — unless it strictly supports their recovery
- Don’t overburden yourself with their addiction — ultimately it is up to them
Treatment Options
There are many support programs similar to Alcoholics Anonymous that are there to help provide community support from other addicts to those with heroin or other addictions. They use a 12 step program in order to help people with addictions get sober and stay sober.
Search online for your local 12 step groups:
- Heroin Anonymous
- Narcotic Anonymous
- Pills Anonymous
Residential Detox and Medication-Assisted Treatment
Medication-assisted treatment, or MAT, includes medications such as suboxone or methadone. These medications can help diminish cravings, reduce withdrawal symptoms, and can lead to a lower relapse rate for those with OUD [11].
Suboxone is a partial opioid agonist that binds to those same opioid receptors that regular opioids do but activates them in a lesser manner than full agonists [12]. It contains naloxone and buprenorphine. This helps reduce cravings and withdrawal symptoms without making the user feel the “rush” of opioids. This drug can be provided by physicians and is considered to be a less painful way of detoxing.
Methadone is a synthetic opioid that binds to opioid receptors. It also helps eliminate cravings and withdrawal symptoms [13]. The difference here is that because it is such a powerful drug, it is typically only administered in specialized opioid treatment programs [14].
Inpatient Heroin Treatment
Inpatient heroin treatment offers comprehensive support that includes medical care for the physical symptoms of withdrawal, psychological support, and a safe environment [15]. For people with the most severe addictions, as well as those with a history of relapse, inpatient care may be the most effective option.
Outpatient Heroin Treatment
Similar to inpatient care, comprehensive outpatient treatment offers therapy, some medical support, and group support but only for a portion of the day. It’s a good option if you need significant care but cannot commit to 24-hour residential treatment [16].
Therapy
Therapy can help you develop new skills for dealing with stress and cravings. It may also help you identify the emotions that led to your addiction. For example, some people use drugs to manage their depression or past trauma.
Medical Care
In addition to medical detox support, medical care for underlying conditions may help ease recovery. People who began using heroin or other opioids to cope with chronic pain, for example, may need alternative treatment.
The Road to Your Loved One’s Recovery is Closer Than You Think
Opioid use disorder has become a large issue worldwide. The journey your loved one is going to take can be a long and hard one, but thankfully they have you to support them. Identifying the signs, understanding the issue, and supporting your loved one through it to the end are all very important steps that we’ve outlined and will ensure the best chance of success for your loved one.
Please feel free to contact us if you or someone you know needs help. Our staff at Wavelength Recovery is here to support you with breaking the cycle of addiction.
Sources
- National Institute on Drug Abuse. Opioids. Retrieved October 25th, 2021, from https://www.drugabuse.gov/drug-topics/opioids
- National Institute on Drug Abuse. Opioids. Retrieved October 25th, 2021, from https://www.drugabuse.gov/drug-topics/opioids
- Dydek, A. (2021, July 12) Opioid Use Disorder. Retrieved October 25th, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK553166/
- World Health Organization (2009) Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Retrieved October 25th, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK310652/
- Buresh, M. (2021, May 19) Treatment of Opioid Use Disorder in Primary Care. Retrieved October 25th, 2021, from https://www.bmj.com/content/373/bmj.n784
- National Institute on Drug Abuse (2021 June) Heroin Drug Facts. Retrieved October 25th, 2021, from https://www.drugabuse.gov/publications/drugfacts/heroin
- Mayo Clinic (2018, February 16) How Opioid Addiction Occurs. Retrieved October 25th, 2021, from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
- National Institute on Drug Abuse (2021 June) Naloxone Drug Facts. Retrieved October 25th, 2021, from https://www.drugabuse.gov/publications/drugfacts/naloxone
- Villines, Z.Heroin Addiction Treatment: Know Your Options. Retrieved October 25th, 2021, from https://www.webmd.com/connect-to-care/addiction-treatment-recovery/heroin/heroin-addiction-treatment-options
- National Harm Reduction Coalition. Medication for Opioid Use Disorder. Retrieved October 25th, 2021, from https://harmreduction.org/issues/medication-for-opioid-use-disorder/
- Wavelengths Desert Recovery. Understanding Opioid Withdrawal. Retrieved October 25th, 2021, from https://www.wavelengthstreatment.com/addiction-treatments/detoxification/opioid-detox/
- Wavelengths Desert Recovery. Residential Addiction Treatment. Retrieved October 25th, 2021, from https://www.wavelengthstreatment.com/addiction-treatments/in-patient-treatment/
- Wavelengths Desert Recovery. Outpatient Addiction Treatment. Retrieved October 25th, 2021, from https://www.wavelengthstreatment.com/addiction-treatments/outpatient-addiction-treatment/
