Heroin: Physiological effects

Last modified: Sunday, 31. May 2009 - 4:11 pm

Heroin is a central nervous system depressant. The drug slows heart and breathing rates dramatically. During the “nod off phase, consciousness may be lost. Any one of these effects is dangerous to the user; in combination, they are potentially life-threatening. Given the high incidence of nausea and vomiting associated with heroin use, for example, users who lose consciousness and then become sick are at risk of choking to death.
As is the case with other opiates, regular ingestion of heroin creates rapid tolerance in the user. Even over a relatively short period, weekend users may find themselves taking larger doses of the drug to achieve the same high. As many recovering addicts will attest, this is the often the first addictive hook heroin gets into recreational users.
The mechanics of tolerance are still not fully understood. One hypothesis suggests that when habitual heroin ingestion upsets the body’s natural chemical equilibrium, the body attempts to compensate for it. More of the drug is then needed to overwhelm the body’s attempt to suppress the drug’s influence. This kind of tolerance is found with regular use of nearly all psychoactive substances.
Tolerance to heroin can vary greatly among individuals. A “regular” or “safe” dose for an experienced user can kill someone who has never tried it before. Even occasional users who build up some tolerance and take several weeks off from the drug can suffer an overdose from their “usual” dose.
Depending on tolerance, and the amount and purity of the drug consumed, a lethal dose of heroin can range anywhere from 200 to 500 mg. Hardened addicts have survived doses three times that high.
The growing purity level of street heroin sold in American cities and suburbs is one of the most worrisome aspects of the drug’s resurgence. Users accustomed to 25% purity can easily overdose if they use the same amount of the drug that is 50% or 70% pure.
A 2001 study conducted by the ONDCP found that Colombian heroin purity ranges from as low as 7% to as high as 95%. Purity of Mexican black heroin sold in South and West ranged from 14% to 58% — with both extremes reported in Seattle. These kinds of fluctuations can have deadly consequences for the user.
Harmful side effects
Heroin use can cause tragic complications during pregnancy, greatly increasing the chances of spontaneous miscarriage, breech deliveries, premature birth, or stillbirth. Research conducted by NIDA suggests that babies born to heroin-addicted mothers are at higher risk for sudden infant death syndrome (SIDS). Infants who do survive the pregnancy are often born addicted to heroin and exhibit severe withdrawal symptoms for a period of weeks and even months.
Heroin addicts are at a much higher risk for contracting HIV, hepatitis C, and bloodborne pathogens through the sharing and reuse of hypodermic syringes and other “works” associated with injection drug use. Government studies suggest that one-third of all HIV and more than half of all hepatitis C cases are the result of injection drug use.
Long-term health effects
Of course, one of the most debilitating effects of heroin use is dependence and addiction. Dependence follows the same trajectory as tolerance.
Eight to twelve hours after the addict’s last dose, the user begins to experience the onset of flu-like symptoms: watery eyes, sneezing, muscle aches, weakness, and vomiting. The symptoms increase in severity over the next two to three days and include shivering, muscle spasms, paranoia, fear, hallucinations, and debilitating cramps in the stomach and extremities. Within a week, the body has corrected the imbalance created by the regular ingestion of heroin, and the symptoms subside. However, intense cravings for the drug last for a much longer period of time and often contribute to relapse.
Health consequences of chronic heroin abuse include scarred and collapsed veins, bacterial infections of the blood vessels and heart valves, boils, a variety of soft-tissue infections, kidney problems, and liver disease. Pneumonia, tuberculosis, and other lung diseases are also common among long-term users, which can be attributed to either poor nutrition and depressed respiratory function or both. Many of the additives heroin is cut with do not dissolve in the body and can block blood vessels, translating into higher risk of sudden death from stroke or heart attack.
Recovering heroin addicts often endure years of corrective dental work due to neglect and the side effects of regular drug use. Heroin addicts often have cavities along the gum-line and gum disease, because the drug causes a marked decrease in the production of saliva. Saliva protects the mouth by neutralizing acids that cause cavities and providing lubrication that reduces the retention of food debris.
A NIDA-supported study conducted by the University of Southern California Los Angeles examined the lives of some 587 heroin addicts admitted to criminals’ addiction programs in the early 1960s. The researchers found their lives were marked by cycles of abstinence, relapse, crime, incarceration, chronic disease, and early death. By 1997, nearly half of the group had died. A full 40% of the survivors were still struggling with their addiction and reported using heroin in the last year. Fewer then 10% were in a working addiction program.

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