Heroin and Opiate Addiction

Dear Dr. Peg,

I have been addicted to heroin for over six months now. While I have never used the drug intravenously, I still must smoke every day to function normally. I have wanted to quit since school has started but I’m so scared my school work, job and general life will suffer. I have researched multiple treatments but haven’t yet tried using one. As a doctor what would you recommend as a course of action? At the moment I am only engaging in counseling at the student health center. Thank you.

Sincerely,
Anonymous

Dear Anonymous,

You have several things going for you already. You want to quit. You have only been addicted for 6 months. You are already in counseling. Those are three giant steps along your new path, and you are to be commended. I’m going to answer your question, but first I’ll fill in some background for those who don’t know.

Heroin got its name from the fact that users feel powerful and invincible, like a hero. It is one of a class of drugs called opiates, derived from the opium poppy. Some other opiates are prescription narcotic painkillers like oxycodone and hydrocodone, Narcotics are addictive, like heroin, and are sometimes sold on the street and used illegally. Narcotic addiction is a huge and growing problem, with an estimated 2.2 million new non-medical users in 2005.

Ironically, heroin was developed originally as a treatment for morphine addiction. Oops! As soon as it was discovered that heroin was in fact more addictive than morphine, heroin
was made illegal, and remains so.

Of all the opiates, heroin is the most addictive. Called “dope,” “horse,” “smack,” and “tar” on the street, it gets into the brain easily and quickly, resulting in peak levels shortly after injection or inhalation. This is called a “rush.” After the rush, active metabolites stick around in the body for several hours, resulting in a prolonged but less intense “high” than the initial peak, described as a relaxed, contented state.

So what’s not to love, right? Wrong. The problem is, your body gets very attached to those sensations, and it complains when it can’t have them. That’s called addiction and withdrawal. Addiction leads to physical problems, discussed below. Not only that, the more you get high, the less useful you are, to yourself and to others. Eventually the addiction takes over your life, and you spend a huge amount of energy and money feeding it. You might even commit more crimes in this pursuit.

Heroin can be injected in the veins, smoked, or snorted. In the 1960’s, when heroin use was highest, most users injected it. Injection is the most efficient if the heroin is low purity, but can result in nasty skin infections and blood borne diseases like Hepatitis B and C and HIV if needles are shared. Overdose is most likely from injection, partly because the purity of the drug is so variable.

Nowadays, as the heroin supply is generally more pure and the risks of injection are well-known, more people are smoking it and sniffing it. Smoking gets it into the brain fastest. Snorting requires the least equipment but can eat a hole through your nose lining. However you get it into your body, it is highly addictive.

Lest you think you’re the only opiate addict on campus, here are some stats. According to the Office of National Drug Control Policy, in 2003 one percent of college students reported using heroin at least once during their lifetime. Another survey, done by the National Household Survey on Drug Abuse, reported that among users 17-22 years old, the rate of use was higher for college students than for non-students. The rates of prescription narcotic use are higher. Abuse of prescription drugs for non-medical purposes went up by one third in 18 to 25 year olds in just one year from 2000-2001, and most of that increase was due to OxyContin and other painkillers. This is according to the National Survey on Drug Use and Health.

Back to you. It sounds like you are still in the early stages of addiction, where you are still able to manage a job and school. You say you’re worried that your life will suffer if you quit. It is hard to quit: I won’t lie to you. But your life will suffer much more if you don’t quit but stay on what will surely become a downward spiral.

How to quit? The old tried and true is the methadone clinic, which basically replaced one addiction with another, less dangerous one. That is still available, but a new drug called buprenorphine has made narcotic addiction treatment more successful. Buprenorphine is a prescription drug, available only from health providers who have special training. It attaches to the same receptors that opiates do but has a less intense effect. The idea is to avoid withdrawal symptoms while you slowly taper down the dose, meanwhile going through counseling to help you recover from your addiction.

Ask your counselor about "bupe." And hang in there; you can do this!