Heroin is an opioid drug. It is derived from morphine which is a natural substance extracted from the seed pod of various opium poppy plants that are grown in Colombia, Mexico, as well as Southeast and Southwest Asia.  It is sold to users in a white or brown powder though originates as a black sticky substance which is known as black tar heroin.

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How do people use heroin?

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Heroin can be sniffed, snorted or smoked as well as being injected. When injecting, it is not uncommon for users to mix heroin with crack cocaine. This is known as speed balling.

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What are the effects of heroin?

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Within a very short space of time after being taken, Heroin rapidly enters the brain and will quickly bind to opioid receptors on cells in many different areas of the brain, especially those that regulate feelings of pain and pleasure, as well as regulating heart rate, breathing and sleep.

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Short-Term Effects

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Heroin users will tell you that they feel a surge of pleasure or euphoria (a "rush"). Combined with this there will be some other physiological responses:

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* Dry mouth

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* Nausea

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* Severe itching

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* Heavy feeling in the arms and legs

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* Clouded thinking

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* Flipping from consciousness to unconsciousness

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Injecting drug use

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Those who inject heroin are at heightened risk of contracting blood borne viruses such as HIV and hepatitis through sharing needles

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Consequences of long term use:

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* Chronic insomnia

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* Collapsed veins (when injected)

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* Damage to the nose (when snorted)

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* Infection of the lining of the heart and heart valves

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* Severe constipation and stomach cramping

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* Kidney and liver disease

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* pneumonia and other long term lung conditions

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* depression/personality disorder

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* Impotence (men)

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* Irregular menstrual cycle (women)

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Other potential effects

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Heroin is often mixed with other products such as sugar, starch,powdered milk,etc. These can clog blood vessels which can cause permanent damage to major body organs.

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Overdose

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As heroin is sold illegally, it's contents and purity can not be assured. As such, the same volume of heroin from one supplier could have a significantly high purity ratio than that of another. As such, it is, sadly, all to easy to overdose on heroin.  As an opioid, it will reduce the respiratory effort of the user leading to unconsciousness and death. If someone is given emergency medical aid with the drug Naloxone, this may reverse the effects but brain damage may have already occurred. Furthermore, while films and TV programmes show Naloxone being given with an instant reaction, it quickly wears off and multiple doses may need to be given.

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Is Heroin addictive?

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The answer is Yes: It is highly addictive. The difficulty is that, those who use it, develop what is known as tolerance. This means that they will need increasing amounts to gain the desired effects. This is when someone is diagnosed with a Substance Use Disorder.

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Can someone who uses heroin just stop taking it suddenly?

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This is never something that I would advise. Contrary to popular misconception, it can be fatal.

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Those who do stop suddenly, often referred to as going "cold turkey" can expect to experience the following :

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* Severe muscle and bone pain

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* Uncontrollable diarrhea and severe vomiting

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* cold flushes with cutis anserinus (goose bumps)

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* Very severe cravings

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Fatalities occur due to two reasons: Dehydration caused by loss of bodily fluids through extreme diarrhea and vomiting as well as overdosing when someones cravings lead to excessive use. This is because after a period of not taking opioids tolerance drops.

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How is heroin addiction treated in a treatment center?

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There are a range of medical treatment plans that can address the physical symptoms of withdrawal.  There are two mainstays of treatment in the UK: Methadone and Buprenorphine.

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Methadone is a fully synthetic opioid which is given to someone in withdrawal. It is given in increasing doses until the user feels comfortable. While the optimum treatment is to stay on a therapeutic dose (one that provides a level of cover for which the person feels well over a 24 hour period) for a year before reducing. this would be very cost prohibitive. There are a lot of myths and misinformation about methadone which can be problematic when suggesting it in a consultation. Please see the following link:

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An alternative, which can be used in a more timely fashion, is Buprenorphine . This is also an opioid but has a different method of action. In order for someone to successfully start on Buprenorphine, the user needs to demonstrate clear signs of withdrawal. It could be up to two days, or more, after entering a treatment centre before someone who is going to be taking Buprenorphine can start treatment. Of course, centers will offer adjunctive medication to ameliorate symptoms of withdrawal.

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How long does someone need to be in a residential treatment centre for heroin addiction?

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This depends on multiple factors, namely how long they have been using heroin and how much they are using a day. In any event, a month is usually a good starting point. There are , rare, occasions where someone can complete a treatment plan within a fortnight, but this would be exceptional.

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5 day rapid detox

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This is available but, as a clinician, I would never advise anyone to do this. The process involves high levels of sedation and naloxone. This is, wholly, a medical  treatment  plan a dos not  provide  any therapeutic  input meaning  there is no opportunity to  address underlying causes  for use  or develop  meaningful strategies to aid relapse prevention.

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Therapy

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All centers who provide treatment for opioid addiction provide a fully immersive therapy programme, either along a 12 step approach or a SMART based recovery model.  These run seven days a week and , those in treatment, are obliged to attend all sessions if physically well enough to do so. For new admissions, it can be 24-48 hours , on occasion, before someone is able to take part.

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Sitting alongside this programme, many centers also offer adjunctive treatments and therapies such as:

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* yoga

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* mindfulness

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* art therapy

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* gentle exercise and group walks

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* music therapy

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* individual sessions (for those staying more than a week)

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Clients, before leaving, are linked in with support groups in their local community, be they voluntary or statutory. A psychological tool kit is built up so that clients have a selection of techniques to employ

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How do I arrange admission?

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A comprehensive and holistic assessment with a clinician is the first step to securing the right treatment plan in an appropriate treatment centre. Not all centers provide opioid treatment and selecting   the right centre is a key part of  getting into recovery.

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Same day admissions are sometimes possible, but can usually only be  achieved if the referral is  made very early in the day and there are no complex medical issues.

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Sharing information with the persons GP may be necessary.However, a medical summary can be requested from the surgery without the need to identify what it is  being used for.

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Effective discharge planning starts at the point of pre admission assessment. For free and impartial advice from a clinician, in the field, who prescribes for and treats opioid addiction call Paul, on: 01252 412 064

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