2.6ii Types of substances: Opiates

A Family Guide to Concurrent Disorders - Part I: What are concurrent disorders?

Opiates include heroin, codeine and morphine. They may be prescribed by a doctor for severe pain. Under medical supervision, these strong painkillers are safe in the short term.

Opiates not only relieve pain, but in excess amounts can cause intoxication, giving them a high addictive potential. Opiate use is a problem when the person who is using them either has no medical reason to use them, or is using the drug in larger amounts than needed to manage pain. People who are dependent become extremely tolerant to the drug (they need to increase the amount to get the same level of intoxication) and will undergo withdrawal if they stop using abruptly.

Opiate drugs are often bought illegally. People may fake or exaggerate medical problems when talking to doctors to get prescriptions they don't need, or they may get several prescriptions from different doctors. Sometimes these drugs end up on the streets in the hands of drug dealers.

Heroin

Heroin is a dangerous and illegal drug with high addictive potential.

How does heroin make you feel?

The way heroin, or any drug, affects you depends on many factors, including:

• your age
• how much you take
• how often you take it
• how long you've been taking it
• the method you use to take the drug
• whether you've taken any alcohol or other drugs (illegal, prescription, over-the-counter or herbal)
• whether you have certain pre-existing medical or psychiatric conditions.

When heroin is injected into a vein, it produces a surge of euphoria, or a “rush.” This effect is felt in seven to eight seconds, and lasts from 45 seconds to a few minutes. The initial effect with snorting or smoking is not as intense. Following the rush comes a period of sedation and tranquility known as being “on the nod,” which may last up to an hour. When heroin is injected under the skin or into a muscle, the effect comes on more slowly, within five to eight minutes.

New users often experience nausea and vomiting. The desired effects include detachment from physical and emotional pain and a feeling of well-being. Other effects include slowed breathing, pinpoint pupils, itchiness and sweating. Regular use results in constipation, loss of sexual interest and libido, and an irregular or a stopped menstrual cycle in women.

Heroin use causes changes in mood and behaviour. People who are dependent on heroin may be docile and compliant after taking heroin, and irritable and aggressive during withdrawal.

How long does the feeling last?

Regardless of how it is taken, the effects of heroin generally last for three to five hours, depending on the dose.

People who are dependent on heroin must use every six to 12 hours to avoid symptoms of withdrawal. The initial symptoms are intense, and include runny nose, sneezing, diarrhea, vomiting, restlessness and a persistent craving for the drug. Also associated with withdrawal are goosebumps and involuntary leg movements, leading to the expressions “cold turkey” and “kicking the habit.” Withdrawal symptoms peak within a couple of days, and usually fade within five to 10 days. Other symptoms, such as insomnia, anxiety and craving may continue for some time. Heroin withdrawal is not life-threatening, but can be extremely uncomfortable.

Is heroin dangerous?

Yes. Overdose is the most immediate danger of heroin use. Heroin depresses the part of the brain that controls breathing. In an overdose, breathing slows, and may stop completely. A person who has overdosed is unconscious and cannot be roused, and has cold, moist and bluish skin. A heroin overdose can be treated at a hospital emergency room with drugs, such as naloxone, which block heroin's depressant effects.

The risk of overdose is increased by:

• the unknown purity of the drug, which makes it difficult to determine the correct dose, and harder to protect from overdose (ironically, many overdoses are due to increases in the quality of the drug sold on the street)
• injection, because the drug reaches the brain more quickly than by other ways of taking the drug, and because the dose is taken all at once
• combining heroin with other sedating drugs, such as alcohol, benzodiazepines and methadone.

Other dangers associated with heroin use include the following:

• Consequences of injection: Injection drug use puts the user at high risk not only of overdose, but also of bacterial infection, blood poisoning, abscesses, endocarditis (an infection of the lining of the heart) and collapsed veins. Sharing needles greatly increases the risk of becoming infected with, or spreading, HIV and hepatitis B or C.
• Unknown content of the drug: For example, heroin is often cut with additives that may be poisonous, such as strychnine, or that do not dissolve and can clog blood vessels, such as chalk.
• Combining heroin with other drugs: Taking heroin with another drug such as cocaine (speedballs) results in unpredictable, and sometimes deadly, drug interactions in the body.
• Dependence: The constant need to obtain heroin, and the repeated use of the drug, can result in criminal involvement or other high-risk behaviour, breakdown of family life, loss of employment and poor health.
• Pregnancy: Women who use heroin regularly often miss their periods; some mistakenly think that they are infertile, and become pregnant. Continued use of heroin during pregnancy is very risky for the baby.

Is heroin addictive?

Yes. Regular use of heroin, whether it is injected, snorted or smoked, can lead to physical and psychological dependence within two to three weeks.

Not all people who experiment with heroin become dependent. Some use the drug only on occasion, such as on weekends, without increasing the dose. With regular use however, tolerance to the effects of the drug develops, and more and more heroin is needed to achieve the desired effect. Continuous use of increasing amounts of the drug inevitably leads to dependence.

Once dependence is established, stopping use can be extremely difficult. People who have used heroin for a long time often report that they no longer get any pleasure from the drug. They continue to use heroin to avoid the symptoms of withdrawal, and to control the powerful craving for the drug, which is often described as a “need.” Cravings may persist long after the drug is discontinued, making relapse (beginning to use again) difficult to avoid.

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