Dr. Leonard is a Doctor of Medical Science and a clinical anatomist. He achieved his bachelor’s degree in human biology from the University of Miami. He received his Master of Science in anatomy from Barry University’s School of Podiatric Medicine, he then achieved his Master of Medical Science from Nova Southeastern University, and lastly, he achieved his doctor of medical science from Lincoln Memorial University’s DeBusk College of Osteopathic Medicine. He has practiced in both internal and emergency medicine at the University of Florida medical system. He has published several, peer-reviewed scientific articles, as well as a medical book chapter.
Heroin and The Body
If someone has resorted to using illegal Class A drugs, either as the “next step” of their drug abuse or as a replacement for their prescription opioid painkiller dependence, you can guarantee they are not particularly concerned with what a drug like heroin does to the body or does to the face. However, the physical effects that occur to their bodies, their faces, and (let’s not forget) their brains can be devastating and dramatic, as this article will describe and graphically show.
As dramatic as some of the images in this article may be, it is important to remember that recovery from heroin addiction is possible. The following images show Cody Bishop before and after his recovery from heroin addiction, and his story is used with the kind permission of his mother, Jennifer Salfen-Tracy.
Note: Sadly, Cody had a relapse during the current coronavirus pandemic, a situation becoming increasingly common with recovering addicts throughout the U.S. who are unable to access their normal support system, and is currently back in treatment, where we wish him well.
What is Heroin?
Heroin – addictive, harmful and, often, life-devastating – is an opiate drug made from the natural milky, sap-like resin of the humble, yet beautiful opium poppy plant (Latin: Papaver somniferum). This substance, known as opium, is removed from the poppy flower’s pod, and is then refined to produce morphine, which can then be further refined to produce heroin and other opiate-based drugs.
Poppy plants are grown extensively around the world, primarily in southern Asia and South America, specifically for the purpose of morphine and heroin production – to be used either for medicinal purposes, eg. pharmaceutical drugs/medicines, or the illegal drug trade, both of which, unsurprisingly, are hugely profitable.
As an illegal drug, heroin can be either injected, inhaled, aspirated, or smoked. Users will also mix heroin with other substances, known as poly drug use, for an increased, stronger effect. For example, heroin is sometimes mixed with crack cocaine, a practice known as “speedballing” or “fastball,” because the drug synergy (where the sum effect is stronger than what it would be individually) dramatically increases the high. However, the practice of speedballing significantly increases the rate of addiction and its subsequent withdrawal.
Heroin produces its effects of use by binding to opioid receptors in the brain, particularly those for both pleasure and pain, as well as those areas that control heart rate, sleep, and breathing – the main reason that opioid overdoses (often fatal) from heroin, other opiates, and synthetic opioids like fentanyl, are common.
Heroin can come either as a white or brown powder, or as a sticky black substance known as “black tar.” A few of the numerous common street names for heroin are:
- Big H
- Brown Sugar
- Hell dust
- Junk and
A Brief History of Heroin
It may be surprising to learn that heroin was actually used in recent times for medical purposes. In retrospect, though, it may not be so surprising when you consider that it is “medicine,” in the form of prescription opioid painkillers, that has fuelled the still current U.S. opioid epidemic.
However, the earliest use of opium can be found around 3,300 B.C. by a Persian tribe known as the Sumerians. Apart from the discovery of the poppy plant’s strong “recreational” effects, the tribe is better known for the invention of writing. Early writings on clay tablets have shown that the Sumerians used the plant for both medicinal and recreational purposes. They referred to the poppy as the “plant of joy.”
History textbooks are filled with opium’s rise around the world in the centuries that followed, but it was the development of the hypodermic syringe in 1853 by Alexander Wood that led to greater levels of addiction across the U.S. In fact, national surveys between 1878 and 1885 indicated that 56-71% of U.S. opiate addicts were actually middle to upper class white women who purchased the drug legally, and that rate was nearly triple that of opiate addiction here in the mid-1990s.
The True Extent of the Current Opioid Crisis
Around 130 people still die every day from an opioid-related overdose in the U.S., according to the National Institute on Drug Abuse (NIDA). These fatal overdoses emanate from the misuse and abuse of prescription opioid painkillers, eg. OxyContin being just one of these, heroin, and synthetic opioids, which are predominantly illegally manufactured, and often imported.
The Centers for Disease Control and Prevention (CDC) currently estimates that the economic burden nationwide of the misuse of prescription opioids stands at around $78.5 billion a year in total. Here are just a few of the deeply concerning statistics about the extent of the crisis:
- 21-29% of patients prescribed opioids for chronic pain will misuse them
- 8-12% will go on to develop an opioid use disorder (OUD)
- 4 – 6% who misuse such opioids will transition to heroin, and
- Predominantly, it is the young who are the most vulnerable from opioid addiction; however, every U.S. demographic is suffering
The Opioid Crisis & Heroin Addiction in Arizona
Just like every other state in the U.S., Arizona has had its share of the effects of the opioid epidemic plaguing the nation. According to the Arizona Department of Health Services, statistics show that between June 15, 2017 and July 24, 2020:
- There have been about 6,500 suspected opioid deaths.
- There have been close to 47,000 suspected opioid overdoses.
Additionally, the NIDA reports that:
- In 2018, there were 1,106 opioid-overdose deaths reported in Arizona, out of a nationwide total of 14,996.
- 352 of those deaths were heroin overdoses.
Maricopa County, AZ, one of the worst affected counties in the state, reports that:
- Between October 2018 and September 2019, there were nearly 1,400 drug-related overdose deaths, mostly involving alcohol, opioids and/or methamphetamines.
- About 91% of overdose deaths in the county involved poly drug use.
The Transition from Prescription Opioids to Heroin
So why exactly do people transition from prescription opioid painkillers, prescribed by their family physician, onto an illegal Class A drug like heroin, which they have to purchase from a shady-looking drug dealer on a backstreet corner?
According to a review of U.S. survey data about opioid use between 2002 and 2012 by the NIDA, “the incidence of heroin initiation was 19 times higher” among people previously prescribed opioid painkillers than those who had no prescription opioid history. Furthermore, for people entering treatment for heroin addiction who began abusing opioids in the 1960s, 80% started with heroin, whereas in the 2000s, 75% reported that their first opioid was a prescription drug. In fact, when you look at national-level general population heroin data (both those in and not in treatment), nearly 80% of heroin users reported using prescription opioids prior to using heroin.
The reasons for this dramatic increase in heroin use by people previously prescribed opioids is relatively simple to understand, considering the following factors:
- Prescription opioids painkillers are highly addictive, contrary to the way they were marketed (or misbranded) by pharmaceutical companies, such as Purdue Pharma, the manufacturer of OxyContin, among others, at the beginning of the millenia.
- Prescription opioids painkillers are only prescribed for short-term use, meaning the family physician will generally not prescribe them for longer than 3 months (which is still time enough to become addicted).
Heroin is actually cheaper and more readily available.
Heroin & The Brain
Heroin dramatically affects several important areas of the human brain when it is used – not just the euphoric effect associated with all opioids, but also a wide range of physical effects, both short-term and after prolonged use, which, in themselves, are highly dangerous and potentially fatal. For example, heroin users can experience a seriously impacted respiratory function, a condition responsible for the majority of overdoses, because the brain is not consistently sending its normal signals to other parts of the body.
How Heroin Users Achieve Their “High”: The Brain’s Opioid Receptors
Opioid receptors, located in the brain, are receptors that are used to recognize and then deal with pain, and it is these that are initially affected by heroin use, which is why opioids have long been used by the medical profession for pain management in patients. Additionally, opioids will influence brain signals that control a variety of involuntary bodily functions, eg. breathing, heart rate, and sleep cycles.
The brain actually produces its own natural opiates. However, the use of opioid drugs, such as heroin, interfere with this process, thus reducing the brain’s need to generate more. This increases issues with dependency as the brain then requires outside input in order to achieve the same pain-reducing and function-regulating benefits it had previously managed naturally.
How Does Heroin Affect the Brain?
Prolonged heroin abuse has been directly linked with several types of brain damage. For example, types of encephalopathy, which is defined as “any diffuse disease of the brain that alters brain function or structure,” cause the brain to break down at a molecular level. In extreme untreated cases, the heroin user can suffer a total breakdown of the brain’s integrity and the condition can become fatal.
The fastest-growing way of using heroin is by inhalation, known as “chasing the dragon,” where the drug is burnt and the user breathes in the smoke through a pipe; inhaling has led directly to increased cases of brain damage. Researchers believe that the toxicity of the drug is significantly increased by the molecules being burnt before entering the body, which can potentially lead to brain damage and dementia..
One of the most disturbing effects of heroin use on brain function is the ability of the drug to “rewire” or alter the structure of the organ. By this, we mean that the brain starts to form more opioid receptors, and thereby creating a cycle where it takes more of the drug to effect these new receptors, leading to an increased tolerance, and so the increased potential for overdose.
What Are The Short-Term Effects of Heroin?
As soon as heroin is introduced to the user’s bloodstream, its effects are immediate and radical.
However, even before the rush of the euphoria – the “high” – passes, the drug causes short-term effects that are potentially dangerous in themselves. These effects include, but are in no way limited to:
- Slowing of the respiratory function
- Nausea, vomiting, and loss of appetite
- Severe itching
- Runny nose
- Watery eyes
- Warm, flushed skin
- Loss of sex drive
- Risk of overdose
What Are The Long-Term Effects of Heroin?
The long-term effects of heroin use are physically and mentally destructive, and potentially fatal. Additionally, there are the social and economic effects, making heroin an even harder addiction to break.
These are the worst of the long-term effects of heroin use – physically and mentally, as well as socially and economically – and all are destructive and damaging, noticeably changing a heroin user’s appearance, and some are possibly fatal in their own way (for example, both depression and job loss can potentially lead to a suicide attempt):
- Risk of overdose
- Liver disease
- Pulmonary infections
- Collapsed veins, leading to blood clots / stroke
- Kidney disease
- Brain damage
- Skin abscesses
- Heightened exposure to HIV, Hepatitis B, and Hepatitis C (through injection/needle sharing)
- Cognitive function (caused by brain damage)
- Anxiety/Panic attacks
- Social / Economic:
- Destruction of the family unit
- Domestic violence
- Child abuse
- Financial / legal problems
A majority of the world’s poorest drug users (20%) abuse heroin, according to the United Nations Office on Drug and Crime
How Does Heroin Change The Body?
Many of the serious physical effects of drug use are internal ones, such as organ disease, collapsed veins, and brain damage. However, heroin can cause severe and alarming changes to the user’s appearance. These include:
- Gum inflammation
- Bad teeth/deterioration due to a lack of oral hygiene in general
- Facial pustules
- Skin abscesses
- Pockmarked complexion
- Dangerous weight loss
Facial Pustules & Skin Abscesses
Pustules are small bumps on the skin that contain fluid or pus, and heroin users are susceptible to pustules appearing on their face. Similar to pimples, they usually appear as white bumps surrounded by red skin, and, especially given a heroin user’s lack of personal hygiene, are caused when the pores of the skin become clogged with oil and dead skin cells, like acne.
Skin abscesses are tender areas of pink and reddened skin, and are sometimes referred to as “boils.” This bump is filled with pus or translucent fluid, often a sign of an infection. The body’s immune system defends itself by an inflammatory response that sends millions of white blood cells to the infected area. The middle of the abscess will then liquefy, containing the dead cells, bacteria, and other scattered waste and remains.
As heroin users are prone to itchy and irritable skin, these conditions are common, and are subsequently worsened by persistent scratching and rubbing of the infected area.
Long-Term Effects & Body Changes Specific to Women
Although men are statistically more likely to abuse heroin, women experience different effects with the drug, and in addition, to those experienced by men – this happens because of their biological differences and culture-based gender differences.
Female Heroin Users & Mental Health
In a study by the non-profit Caron Foundation, women were both more likely than men to abuse heroin to self-medicate for psychological symptoms, and they reported more occurrences of mental health disorders, ie. depression and anxiety, than men (predominantly, as women are more likely than men in general to suffer mental illness).
In fact, the National Institutes of Health estimates that between 55-99% of all women in for a drug or alcohol addiction treatment have previously been sexually abused, and women sexually abused as a child are 3 times more likely to develop an addiction as an adult than non-abused women. Female heroin addicts are also more likely than men to come from a dysfunctional family.
Lastly, female heroin addicts are likely to engage in high-risk behaviors, particularly prostitution, in order to support their habit, putting them at risk of sexual assault, other violence, and sexually transmitted diseases (STDs).
Female Heroin Users & Pregnancy
Using heroin during pregnancy can cause women to miscarriage, and to suffer premature birth and birth defects in their child. A severe medical condition known as neonatal abstinence syndrome (NAS) is common, sadly, where heroin passes through the placenta to the fetus during pregnancy, causing the baby to become heroin-dependent, putting an already fragile newborn into an extremely compromised state, along with its mother.
Symptoms (a collection of actual withdrawal symptoms) of a child born with NAS include:
- Slow weight gain
- Diarrhea and vomiting
- Excessive crying, and
- Possibly death
Lastly, female heroin users who are pregnant should not be detoxified, since this will also negatively impact a fetus (particularly in the first and third trimester). Instead, pregnant women should be treated with methadone, which will have fewer effects on the unborn baby.
Physical Effects of Heroin Withdrawal
Because heroin is a Class A drug, deemed to be one of the most addictive and strongest of the illegal drugs in circulation, users will experience the onset of withdrawal symptoms within a very short time period (only 6-12 hours) after their last use. As with any substance addiction, it is partly these symptoms that drive an addict to use again. Therefore, the list of withdrawal symptoms given below will begin soon after the last use of an active heroin addict, once the active phase of drug use is over.
The safest way of withdrawing from heroin use is with a professional, medically-assisted detoxification, either within an accredited rehab center or a hospital. Detoxing from heroin without such help, known as “cold turkey,” is inadvisable, with heightened withdrawal symptoms, and will usually result in a swift return to using the drug.
Heroin withdrawal symptoms, which peak around 2-3 days, can include:
- Nausea and vomiting
- Dilated pupils
- Abdominal cramping
- Muscle pain / aches, often severe
The length of heroin withdrawal depends on several factors, which include:
- The total time period of heroin use
- The amount of heroin taken each time
- The frequency of heroin use
- The method used to take heroin, and
- Any underlying medical or mental health issues
Depending on the amount of heroin taken habitually and the total length of use, recovering addicts are likely to suffer a medical condition known as post-acute withdrawal symptoms (PAWS). This condition has a number of symptoms itself, and can actually last around 18-24 months, making abstinence difficult to maintain; the symptoms of PAWS include:
- Increased anxiety and panic attacks
- Irritability and restlessness
- Mood swings
- Memory loss
- Decreased levels of concentration
What Other Drugs are Often Found in Heroin?
One of the drugs that is most commonly found in heroin is Fentanyl. This is a prescription opioid medication that is most often used to treat severe pain. People may take it after they have had surgery, when they are going through cancer treatments, or when other types of pain medication do not work for them. But this drug is also manufactured for sale on the street, and it may be a slightly different formulation than what is typically found in hospital settings.
Even the smallest microdose of Fentanyl can be a big problem when it is added to heroin. A lot of drug dealers will add this drug because it makes their product more potent. It is a potentially deadly combination. Naloxone will work when it is given soon enough to a person who has overdosed on heroin laced with Fentanyl. But a much higher dose might be needed. Sadly, many people who use heroin that has been contaminated with this drug die before they ever receive medical care.
How Quickly do People Form a Tolerance to Heroin?
According to the National Institute on Drug Abuse, taking heroin, “produces profound degrees of tolerance and physical dependence.” A person forms a tolerance to a drug when they have been taking it for a period of time. It stops working as well as it did in the beginning. To compensate, people will usually increase how much they use or add additional drugs into the mix to maximize the effects.
When a person has formed a tolerance, they may begin going through withdrawal if they do not use enough heroin. Symptoms can begin within a few hours and they are very difficult to manage without professional help.
It is difficult to say how long it might take for a person to form a tolerance to heroin because everyone is different. But it may take as little as a few days before they start to feel they need more. It all depends on how much and how often they are using.
What Does the Phrase, “Chasing the Dragon” Mean?
Anyone who has ever used heroin is probably familiar with the phrase, “chasing the dragon.” This refers to the first time a person experiences what it is like to be high on this drug. It is incredibly euphoric (the dragon), and it is something that – no matter how hard they try – they will never be able to replicate (chase).
So many heroin users continue to abuse this drug because they are chasing after that very first high they ever experienced with it. But they soon find out that there is no catching it. It is a chase that can last for the duration of their substance abuse, and it can even end in their deaths.
Do People go Through Withdrawal Once Heroin is Stopped?
Yes, and it does not take long before heroin withdrawal symptoms begin. Some of the common symptoms of heroin withdrawal include:
- Feeling anxious.
- Getting agitated and angry easily.
- Muscle aches and pain in the body.
- Increased eye tearing.
- A runny nose.
- Excessive sweating.
- Excessive yawning.
- Problems sleeping.
- Stomach cramps.
- Dilated pupils.
- Goose bumps
- Nausea and vomiting.
Symptoms may appear as soon as 12 hours after the last dose of heroin. They may persist for as long as two weeks, but there are some people who experience them longer.
Can the Changes From Heroin be Reversed?
It depends. As you have seen, heroin can have a profound effect on the mind and the body. Some of the physical effects from this drug may reverse themselves once the individual is in recovery, but some may be permanent. The same is true for the mental effects.
Everyone is different as far as how they respond when they are in recovery. People who have taken heroin for a much longer period of time, may find that even though they stop, they have done irreversible damage.
How SpringBoard Recovery Can Help
Attempting recovery from heroin in the absence of professional support can be difficult. At Springboard Recovery, we understand that individuals all have different reasons for seeking and using drugs. This is why we make it a point to treat each of our patients as individuals and create treatment plans that will help them on their road to recovery.
The detox process, essential for heroin users, involves a medical team who will help you through the process of getting the drugs out of your system. Springboard Recovery works directly with several detox facilities and will help you determine which one will work best for your particular needs.
If you or someone you love needs support, encouragement or guidance getting clean and maintaining sobriety, we encourage you to contact us here at SpringBoard Recovery. We offer a holistic approach that addresses many of the complex issues surrounding heroin addiction and recovery.
- National Institute on Drug Abuse: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
- The Centers for Disease Control and Prevention: https://www.cdc.gov/
- Arizona Department of Health Services: https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/index.php
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/research-reports/prescription-opioids-heroin/prescription-opioid-use-risk-factor-heroin-use
- JAMA Network: https://jamanetwork.com/journals/jamaneurology/article-abstract/2687229
- UNDCP: https://www.unodc.org/pdf/technical_series_1995-03-01_1.pdf
- National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124962/
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/research-reports/heroin/how-does-heroin-abuse-affect-pregnant-women
- Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone
- Substance Abuse and Mental Health Services Administration: https://store.samhsa.gov/product/protracted-withdrawal/SMA10-4554
- National Institute on Drug Abuse: https://www.drugabuse.gov/drug-topics/fentanyl
- Emergency Medicine News: https://journals.lww.com/em-news/fulltext/2014/04000/InFocus__Fentanyl_Laced_Heroin_A_Deadly.5.aspx
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use
- National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/9246796/