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Heroin < Back

By Lindita Djokovic

History

Heroin is an opioid drug, made by chemically modifying morphine from the seed pods of the opium poppy. It was first synthesized in 1874, but became popular after Bayer Pharmaceuticals began commercially synthesizing it and marketing it as a cough suppressant and an over-the-counter, non-addictive substitute for morphine. Despite this early perception, heroin is now known to be highly addictive, and it is classified as a Schedule I drug by the United States. In 2013, over 500,000 people over the age of 18 in the United States were dependent on heroin, including 182,000 young adults below the age of 25. Alarmingly, there has recently been a dramatic increase in the number of people killed by heroin overdoses: in 2010 roughly 3,000 people fatally overdosed on heroin, while in 2015 that figure had risen to nearly 13,000 people.



How It’s Used

Heroin can be combined with water to be injected with a needle into the bloodstream, snorted into the nose, or smoked. All three of these methods result in a rapid and dramatic onset of the drug’s effects. The chemical structure of heroin allows it to enter the brain much more rapidly than morphine, leading to a higher risk of addiction.


How It Works

When heroin is injected, smoked, or snorted, it quickly enters the brain by passing what is known as the blood-brain barrier (a collection of cells slowing entry into the brain). Once there, heroin undergoes a chemical process which changes the drug back into morphine. The opioid then acts directly on mu-opioid receptors located in the brain. Heroin’s binding to the mu-opioid receptors triggers the release of dopamine, the neurotransmitter responsible for pleasure, emotion, and reward. This results in feelings of euphoria and increased likelihood of taking the drug again. Some studies on the effects of heroin have shown that this release of dopamine increases the dopamine in the body over ten times the body’s usual level. Significant dangers can occur when one’s body adapts to receiving opioids from external factors rather than the natural chemicals our body creates. The body becomes dependent on heroin intake, and long-term changes in hormone and neurotransmitter levels occur, which can build a tolerance for the drug. Tolerance refers to the tendency for chronic users of a drug to require larger doses of the drug over time to attain the same effect. Higher doses of the drug can increase an addict’s chances of experiencing dangerous complications, such as collapsed veins, liver or kidney disease, lung complications, or even overdose. Another concern is the risk of contracting infection diseases such as HIV or hepatitis from an infected needle.

Treatment

The opioid epidemic in the United States has spurred many pharmaceutical companies to create drugs that can reduce addictive cravings and dependence on opioid drugs. Some commonly prescribed medications are methadone and buprenorphine (brand name Subutex). Methadone is a long-lasting opioid which can be administered in a controlled setting to manage withdrawal and cravings. Buprenorphine is a weak opioid that activates the same receptors as other opioid drugs, reducing an addict’s drug cravings substantially while also countering typical withdrawal symptoms. In order to decrease the abuse potential of buprenorphine, it can be combined with the opioid blocker naloxone When this combination (called Suboxone) is taken properly, the naloxone is inactive and the buprenorphine has the desired effects of reducing craving and withdrawal symptoms. However, if crushed and injected into the bloodstream, the naloxone will trigger withdrawal symptoms and block the effect of the buprenorphine . The aim is to give patients the medication they need to manage withdrawal and cravings while preventing abuse.


For more successful treatment results, many treatment centers and individuals use medications and therapy simultaneously. Cognitive Behavioral Therapy (CBT) and contingency management can be highly effective. Contingency management is a reward-based system in which patients regularly earn money or points for negative drug tests, which can be exchanged for prizes that encourage a healthy lifestyle. CBT is a type of therapy that encourages an addict to identify and change their thought process, expectations, and behaviors related to drug addiction. CBT aims to equip the patient with skills to cope with daily challenges in a healthier manner — instead of relapsing back into drug-taking. Studies show that the most effective way to treat drug addiction is through a combination of medications and therapy.


Works Cited

Alderks, C.E. Trends in the use of methadone and buprenorphine at substance abuse treatment facilities: 2003 to 2011. The CBHSQ Report: April 23, 2013. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK384659/

Centers for Disease Control and Prevention. (2015, July 7). Today’s heroin epidemic. Retrieved from https://www.cdc.gov/vitalsigns/heroin/index.html

Heroin effects on the brain. Retrieved from http://heroin.net/heroin-effects/heroin-effects-sub-page-1/heroin-effects-on-the-brain/

MedlinePlus. (2016, December 27). Heroin. Retrieved from https://medlineplus.gov/heroin.html

The National Institute on Drug Abuse. (2014, November 13). Heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin