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Opioid Addiction: From Prescription Opiates to Heroin

Table of Contents:

Most people who become addicted [to opioids] like me do so after a prescription for a painkiller following a medical procedure. Once the phenomenon of craving sets in, it is often too late

opioid pills

Opioids vs Opiates

heroin addiction - pictures of different forms of heroin
Picture of powder heroin (top) and black tar heroin (bottom)

Heroin Street Names

Common heroin street names include: dope, diesel, boy, horse, smack, junk, tar, brown, dog food, train, and mud. When buying heroin, depending on the region users may request a specific quantity by asking for a point, cap, bundle, or finger.  

The meteoric rise in deaths from heroin overdoses and prescription opioid overdoses since 2019 has made opioid addiction the focus of lots of attention. In 2020, synthetic opioid overdoses increased by more than 54% compared to the previous year. With all the talk about an opioid addiction epidemic, it is important to understand the difference between opiates and opioids – although they are occasionally (incorrectly) used interchangeably.

Opiates are opium alkaloids that are naturally present in the opium poppy plant. Morphine and codeine are two examples of opiates. Opioids are a broader class of drugs that includes opiates as well as semi-synthetic derivatives and fully synthetic substances that are similar in chemical structure to opiates and have similar analgesic (pain-relieving) properties. Drugs like hydrocodone (Vicodin), hydromorphone (Dilaudid), oxydocone (Oxycontin and Percocet), and buprenorphine (Suboxone and Subutex) are all semi-synthetic opioids. Drugs like fentanyl, methadone, and loperamide are fully synthetic opioids. Tramadol is actually a synthetic opioid as well.

So, what is heroin? Heroin is a semi-synthetic opioid derived from morphine that is highly addictive and is illegal in the United States. When bought on the street, heroin comes as either black tar heroin or powder heroin (known in the 1970’s and 1980’s as China white heroin) depending on the region. Black tar heroin is typically a black or dark brown sticky substance that can sometimes look like coal. It’s consistency makes it difficult to snort, so it is typically used by people who prefer injecting or smoking heroin. Powder heroin is usually a fine white or tan powder that comes in small plastic bags, capsules, or wax bags called stamps.

Opioid Effects

Medical & recreational effects

Opioids are sought after by recreational users mostly for their euphoric effects. Because of their analgesic (pain-killing) and anxiolytic (anti-anxiety) properties they are prescribed by many doctors to alleviate pain. More powerful opioids like fentanyl also have sedating effects which make them useful for anesthesia in a medical/surgical setting. Opioid drugs produce these effects by binding to opioid receptors in the brain that are normally activated by chemicals naturally produced in the body to control pain and reward. Opioids also produce many unwanted side effects though.

Signs of opioid overdose

Signs of overdose include shallow breathing, blue or purple lips or skin, and confusion or unresponsiveness.

Opioid side effects

Opioid side effects include:

  • dizziness
  • drowsiness
  • nausea
  • vomiting
  • constipation
  • physical dependence
  • tolerance
  • itchiness
  • respiratory depression

If you suspect an overdose

If you or a loved one are overdosing on opioids, call an ambulance immediately. If you have Narcan, use it as directed on the packaging.

What does heroin feel like?

Most users describe the experience of using heroin to feel euphoric and sedating. Users experience pleasure, relaxation, reduced anxiety, reduced discomfort, warmth, and a feeling of heaviness or sluggishness. The high varies depending on the amount taken and the route of administration. When snorted, the effects of the drug come on more gradually and peak after 30 minutes. When injected intravenously, an intense rush of euphoria comes on almost immediately and lasts a few minutes. After the rush comes the more sedative effects.

How long does a heroin high last?

The initial rush of a heroin high lasts only a few minutes, but the sedative and analgesic effects last several hours (typically 3-5).

Opioid Withdrawal

Regular use of opioids can result in physical dependence on opioids. Physical dependence means that when a user stops taking opioids they experience withdrawal. Withdrawal symptoms are defined as the unpleasant physical reaction that accompanies the process of ceasing to take an addictive drug. Opioid withdrawal includes both physical symptoms and psychological symptoms, which makes getting off these drugs extremely difficult. These symptoms result from the body adapting to the regular presence of opioids by reducing the production of natural opioids.

How long does opioid withdrawal last? The duration of withdrawal varies by specific opioid. Shorter acting opioids like heroin or fentanyl have a more rapid opioid withdrawal timeline. Withdrawal symptoms usually start to set in within 8-24 hours of the last use, and peak between 48 and 72 hours. The most noticeable physical symptoms of heroin withdrawal typically only last 4-10 days. Longer acting opioids like methadone and buprenorphine have a longer opioid withdrawal timeline, with noticeable symptoms lasting almost a month. For all opioids, psychological symptoms, especially insomnia, can take much longer to completely go away.

Opioid withdrawal symptoms:

Symptoms include: drug cravings, muscle and bone pain, insomnia, restlessness, vomiting, diarrhea, restless leg syndrome and involuntary kicking movements, depression, anxiety, increased heart rate, goosebumps and chills, dilated pupils, watery eyes, sweating, excessive yawning, tremors.

Signs of Heroin Use

constricted pinpoint pupils from opioid use compared to normal sized pupils
pinpoint pupils on the left, normal pupils on the right
bruising on the inside of the elbow lining two major veins used for injection - heroin track mark
Track marks from injecting heroin

If you are concerned that a loved one is using heroin or other opioids without a prescription, there are a several signs you can look for. All opioids, including heroin, have a noticeable effect on the eyes causing pupil constriction. Pinpoint pupils are a strong indicator that somebody is using heroin or other opioids. There are some behavioral signs of opioid use as well. If a loved one who is normally social and outgoing begins to isolate more often and avoid family and friends, it may be a sign of opioid use. Sudden financial issues are also common as maintaining a drug habit becomes very expensive. Drug users will often come up with believable excuses for why they are suddenly struggling financially, but consistent money problems are a sign of potential drug use. When addicts have exhausted other avenues, it is common for them to begin pawning jewelry and other expensive items. Unusual sleep patterns may be another indicator a loved one is abusing opioids. When a person is high on heroin or other opioids, it is common for them to nod off (drift in and out of sleep), sleep more than usual, and be harder to wake from sleep.

If someone is using a needle to inject heroin, there are some obvious physical signs. Most users who inject will have visible bruising and needle marks (known as track marks) on their arms. Though drugs can be injected in any vein, a heroin addict’s arm is the first place to look for signs of heroin use.

Though these obvious physical signs are common, their absence does not mean that somebody is definitely not using opioids. Contrary to popular belief, high functioning heroin addicts do exist. In other words, some opioid addicts maintain stable jobs, attend social events, stay afloat financially, and do well to hide physical signs of use. The only sure way to know if somebody is using opioids is by giving them a drug test. According to Mayo Clinic laboratories the most commonly abused opioids can be detected in urine up to 3 days after use. However, factors like how long a person has been using and their general health can effect how long opiates stay in their urine.

If you suspect a loved one is using heroin

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Signs of Opioid Addiction or Dependence

When a loved one is prescribed opioids for legitimate medical reasons, it can be harder to tell when they have developed an opioid addiction. One sign of opioid addiction in this case is running out of medication before the prescription should be refilled. If a loved one is taking more than they are prescribed and running out of their opioid medications before they should, it could be a sign of a developing opioid addiction. This sign becomes even more clear when the user begins buying additional opioids off the street because they are no longer satisfied with the prescribed amount. Another sign is anxiety about and abnormal attention to the next dose. If you find yourself watching the clock waiting for it to be time for your next dose, this could be a sign of an increasing opioid dependence.

Opioid Detox

As discussed earlier, different opioids have different detox timelines. For this reason, heroin detox compared to other opiates can be shorter but more intense. Many opioid users will try to detox themselves using home remedies for opiate withdrawal. One common way people will try to detox from opioids is by consuming large quantities of the non-psychoactive opioid loperamide, which is sold over the counter as a diarrhea medication. Others will turn to legal opioids like kratom for opiate withdrawal. While kratom may help with the discomfort of opioid withdrawal, it doesn’t help for opioid addiction as it is simply replacing one addictive substance with another.

In a medically-supervised opioid detox center, medical professionals treat opioid withdrawal symptoms with opioid antagonists like naloxone and partial agonists like buprenorphine. Drugs like suboxone that combine these two classes help to control withdrawal symptoms while blocking opiates from producing a high. These drugs help to control cravings and when administered properly, help wean opioid dependent patients down safely and comfortably. Suboxone will only block opiates for several hours to several days depending on the amount accumulated in the body, so without the structure and support of a medical detox center, relapse is likely. Many opioid addicts will purchase these drugs on the street to try to detox from heroin at home, but this method rarely produces any kind of long-term recovery.

At an inpatient heroin detox, patients not only receive opioid replacement medication like Suboxone, but also receive non-narcotic medications to minimize remaining withdrawal symptoms. They will also sometimes be put on short-term or long-term psychiatric medication to help ease the transition back to a healthy normal life.

Opioid Addiction Treatment

Once a person has finished detoxing from opioids, they still need help for addiction. Fads like taking ibogaine for opiate addiction are not sustainable – there is no magic bullet. Relapse rates among opioid addicts are higher than relapse rates for any other drug addictions, including alcohol. One particularly grim study suggested that opiate addiction recovery statistics show less than 1 in 10 recovering opioid addicts will stay sober for more than a year with more than half relapsing within 1 week.

However, studies have also shown that completing an inpatient addiction treatment program do reduce the chance of relapse, with longer stays in treatment providing better results. This isn’t surprising when you consider all of the therapeutic benefits of opioid addiction treatment. Patients in a treatment program receive individual therapy, group therapy, reprogramming efforts like cognitive behavioral therapy and dialectical behavioral therapy, and adjustment to psychiatric medications for things like depression, anxiety, and bipolar disorder. Many addiction treatment programs now also offer long-term buprenorphine treatment for opioid addiction. For patients who have relapsed many times before, this kind of opioid replacement therapy can be very effective. If you or a loved one need heroin addiction help or opioid addiction help, 1 Solution Detox is available to answer any questions and assist in the start to addiction recovery.

Give us a call to learn more about our opioid detox center in Palm Beach