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Article Summary

A Guide To Heroin Overdose

Heroin is among the most addictive and powerful narcotics on the face of the planet. If you use this substance, you may become hooked immediately after your first use. After that, you will likely spiral into an ever deepening cycle of intense addiction. Once this happens, the drug will take an immense toll on your mind and body.

People use heroin in a variety of ways, and every method of delivery will allow the drug to drift right into your bloodstream. Most people tend to take it intravenously by injecting themselves with heroin while others smoke or snort the drug. Others still combine heroin with other substances like cocaine to form dangerous cocktails (known on the street as speedballs).

Heroin Abuse In The United States

Over the past couple of years, heroin has become popular in the US. As a direct result, there has been a great surge in its use and abuse. This has led to many deaths from overdose arising from abusing this substance.

A recent TIME Magazine article showed that the use of the drug has been on the rise since 2007. During this time, it grew from close to 373,000 users per year to about 669,000 by 2012. This was according to SAMHSA (the Substance Abuse and Mental Health Services Administration).

Overdose deaths as a result of heroin have also been spiking. They went up by 45 percent from 2006 through to 2010. This was according to data from the DEA (the Drug Enforcement Administration).

Additionally, the geography of heroin users has expanded. Although it was once thought of as a largely urban predicament, public health and law enforcement officials both report spikes in rural and suburban use.

In the same way, SAMHSA reports that heroin use among first timers has been increasing by close to 60% over the past decade - from between 90,000 and 156,000 new users per annum.

In case you are (or a loved one is) in the grips of such an addiction, it is essential that you learn more about heroin overdose and seek treatment as soon as possible. Although you need to get treated at a rehabilitation program that effectively treats heroin addiction before you can break your dependence, you might not understand why such treatment is important until you learn more about the risk of overdose.

Understanding Heroin Overdose

As mentioned above, heroin is the most addictive and lethal of substances on the globe. A derivative of morphine, this drug is usually sold illicitly in the form of brown or white powder or as a sticky black substance commonly known by the street name of black tar heroin.

In the various forms, this drug is smoked or snorted or may be dissolved in water for intravenous injection. All modes of use - shooting up, snorting, and smoking - will deliver the drug quite fast to the brain and provide its potent addictive effects.

Inside the brain, the drug will be converted into its morphine form and bind to the brain's opioid receptors. This molecular interaction often leads to a decrease in the feelings of pain. Through an associated and subsequent increase in the activity of dopamine, heroin will also increase feeling of well-being and pleasure, which are referred to as euphoria. This latter effect provides an explanation behind the addictiveness of the drug.

Most of the dangers of prolonged heroin use - including but not limited to the long term effects it has on the brain - are still unclear. However, others are quite well established. Among these is overdose from heroin.

In the United States, the drug has experienced a resurgence in recent years. In kind, this has resulted in an increase in overdose death. The US National Library of Medicine, for instance, reported that 2014 saw over 10,500 deaths arising from heroin overdose, which was up from over 8,000 in the previous year.

Signs And Symptoms Of Overdose

A heroin overdose is potential fatal and lethal. As such, it usually requires immediate and urgent medical attention. The signs and symptoms of such an overdose tend to vary based on the following factors:

  • If you consumed other mind-altering substances concurrently with the drug
  • The purity and amount of heroin abused
  • The user's weight and age

Common Warning Signs

Overdosing on heroin will affect different parts and systems of the body. Most of these effects are quite obvious while others are not. That said, the common warning signs of an overdose include:

  • Blue color on and around the skin, nail beds, and lips
  • Changed mental state
  • Coma
  • Confusion
  • Delirium
  • Depressed breathing
  • Discolored tongue
  • Disorientation
  • Extreme or severe drowsiness
  • Feeling cold (to the touch)
  • Gasping for air
  • Inability to stay/remain awake
  • Irregular heart rate
  • Labored breathing
  • Lack of muscle tension
  • Low blood pressure
  • Pinpoint pupils
  • Repeated loss of consciousness
  • Rubbery-like muscles
  • Seizures
  • Shallow breaths
  • Spasms
  • Very pale skin
  • Vomiting
  • Weak pulse

The other signs and symptoms might require closer communication with the user as well as a physical inspection of their condition. These include but are not limited to:

  • Constipation
  • Dry mouth
  • Low blood pressure
  • Spasms of the intestines or stomach

Risk Factors for Overdose

A variety of factors, working in concert or independently, may cause you to overdose on heroin. These factors include:

a) Ignorance

A common risk of intravenously using heroin is that you may not know the amount of the drug you are consuming. Therefore, injecting an unknown volume of the drug may increase the risk of an overdose.

b) Polysubstance Use

This is a major risk factor for an overdose. Heroin is an opiate, a class of drugs that depress the CNS (central nervous system). These depressants work by depressing the system. In the process, they slow down your heart rate and breathing.

If you take heroin together with other depressants such as barbiturates, benzodiazepines, and alcohol may compound this depressing effect on your CNS and increase the risk of coma, respiratory failure, and death.

On the other hand, using stimulants such as cocaine with heroin will elicit a physiological response that will oppose the depressing effects of heroin. Cocaine, for instance, is a stimulant while heroin is a CNS depressant. Using both of these drugs will create counteracting effects inside your brain and body. These effects may make you less able to feel an impending overdose.

Still, this combination - which is known as a speedball - is dangerous because you will be more susceptible to the harmful effects of both drugs. Additionally, the combination may make you less aware of the intoxicating depressant effects of heroin. As a result, you might end up taking higher than normal amounts, which will inadvertently increase your risk of an overdose.

c) Relapse

An overdose is additionally highly likely to occur among those who relapse from the drug. Like with any other addictive substance, taking heroin regularly often causes tolerance to the drug. Therefore, you will need more of it to achieve the desired effects.

If you abstain from for a certain period of time, you may experience a decrease in your tolerance levels. This will place you at risk if you relapse and try taking the same volume of heroin that you were used to abusing.

Dealing With Heroin Overdose

Unless it is addressed quickly, a heroin overdose might prove fatal. In case you believe that a close friend, acquaintance, or member of your family has been abusing the drug, you need to prepare yourself to deal with an overdose if it happens.

Proper and speedy action may ensure the safety of the victim or even increase their chances of survival. As always, the first response would be to call 911 immediately. Where possible, you should provide the emergency operator who picks your call with the victim's:

  • Location/Address
  • Estimated time of heroin use
  • Estimated volume of heroin used
  • Respiratory status, such as if they are not breathing

NOTE: Most states have laws in place that are designed to protect people from arrest for using and possessing illicit drugs and their associated paraphernalia if you seek emergency help for an overdose. Therefore, you should not let your fear of legal consequences deter you from seeking help for such an overdose.

After calling for help, you should inspect the victim closely and try to intervene. Start by checking their breathing. If they are not breathing, you should provide rescue breathing if you have been trained to do so.

You should also do the same in case you hear the death rattle. This happens when the victim exhales and the sound that comes out is similar to a distinct labored sound arising from the throat.

In case you have naloxone at hand - which can be purchased in many pharmacies, in some cases without prescription - administer it as you were trained to do. This a pure opioid antagonist that can reverse the effects of most opioids on the body and brain.

You should continue providing the victim with supportive breathing if they are still unable to breathe by themselves or if they have shown signs of labored breathing. If they start breathing on their own, you should continue monitoring them at least until emergency medical assistance arrives.

Typically, naloxone works for about 30 to 90 minutes. As such, it is imperative that you get the victim emergency medical help even if their symptoms alleviate or if they revive. This is because the symptoms of the heroin overdose may resume after the drug naloxone has worn off.

Understanding Heroin As An Epidemic

The recent increase in heroin abuse - particularly in the United States - has prompted politicians and scientists to look for its underlying cause. However, most people already have a clear theory in mind. This is because of a similar epidemic that spread throughout parts of the US, which involved OPRs (prescription opioid pain relievers). Today, the heroin epidemic is closely linked to the abuse of these painkillers.

Although the relationship between heroin and OPR use hasn't been explained fully, the evidence of it is quite overwhelming. Recent data showed that there was a sharp increase in the prescription of these painkillers over the past 20 years.

It is thought that this increase has subsequently made the OPRs more readily available and accessible to those who might want to use them illegally. The illicit use of OPRs and dependence on them has now been linked to an eventual dependence on and addiction to heroin.

The CDC (Centers for Disease Control), for instance, estimates that those who are addicted to such pain relievers are 40 times more likely to eventually become addicted to heroin. The same report shows that 45% of all heroin addicts also suffer from co-occurring disorders, namely addiction to painkillers.

When the pain relief pills are no longer available as prescription or from neighbors, family members, and friends - for whom the drug may have been prescribed - the illicit users will try to buy them from the streets.

However, prescription OPRs tend to be quite expensive particularly in comparison to heroin. It might also be difficult for you to get your hands on them. Since heroin tends to be cheaper and also provides effects that are quite similar to these pain relievers, most users often end up switching over to it at one point or the other. This enables them to maintain their high but at a cheaper price.

Preventing Heroin Overdose

Although heroin - like any other illicit substance - comes with a variety of health risks, none is quite as dangerous or as fatal as an overdose. There are several ways for those who continue using the drug - as well as friends and family members - can prevent such an overdose. These include, but are not limited to:

  • Avoiding using the drug with other substances, particularly benzodiazepines, barbiturates, and alcohol since these drugs may significantly increase your risk of heroin overdose
  • Keeping naloxone at hand in case you (or loved ones) use the drug and an emergency situation arises
  • Seeking treatment for addiction even before an overdose happens

In most cases, the first step in heroin treatment would be to find an effective and safe way to detox the body. Although withdrawing from heroin may not be physically dangerous for you, it might be taxing enough on your mind and body to trigger a relapse. This may eventually increase your risk of overdosing on the drug.

A detoxification center may make the withdrawal process more tolerable. It will, for instance, provide you with a safe environment in which you will receive constant monitoring.

Some detoxification facilities also provide medications - such as naltrexone, buprenorphine, or methadone - to help alleviate the most severe withdrawal symptoms and any cravings that might prompt a relapse.

These centers may additionally work with or as a treatment center. In such a case, you will have a seamless transition from detoxification to post detoxification treatment. The treatment varies greatly depending on the center you check into. However, most will involve medication, therapy, or a combination of the two.

These treatment options include:

a) Inpatient Treatment Centers

An inpatient treatment center will provide you with a safe and immersive environment for treatment, as well as around the clock supervision and monitoring. Government-run treatment facilities and hospitals are some examples of the inpatient care you might receive. They are popular because of the 24 hour care they provide at a relatively affordable cost.

Still, they might not provide the same amenities you would expect from a private rehabilitation program. For instance, if you check into a government-run program, you may not have a private room or such extra therapies as exercise programs and art classes.

b) Residential Treatment

This is a type of inpatient treatment for heroin addiction. It may prevent heroin overdose by providing the same comfort of home. Depending on the treatment center you check into, there might also be such amenities as art and exercise classes.

Although this option is quite expensive, you might get your insurance company to cover some - if not all - of the costs you incur while seeking heroin treatment.

c) Outpatient Rehabilitation

This type of treatment is quite similar to inpatient rehabilitation in the services you will receive - including medication and therapy. However, with outpatient treatment, you will not stay overnight at the treatment facility. Rather, you will attend therapy on set schedules. The hours will mostly depend on you and the intensity of the heroin rehabilitation program.

Although outpatient treatment works effectively and benefits those who are unable to take some time off for rehab or who are only mildly addicted, the fact that you will be living outside the facility means that you might increase your risk of exposure to the drug. Therefore, you will also increase your risk of heroin relapse and overdose.

Dealing With A Heroin Overdose

Heroin is a rapid acting and powerful opioid drug that is commonly sold in its powder or black tar form. After use - through swallowing, smoking, injecting, or snorting - the drug will quickly enter your bloodstream and bind itself to the brain's opioid receptor sites.

This may trigger an increase in dopamine production while simultaneously slowing down GABA (gamma-aminobutyric acid) production according to reports from NIDA (the National Institute on Drug Abuse).

GABA and dopamine are some of the neurotransmitters in the brain charged with the responsibility of relaying messages all through the CNS. Dopamine enhances pleasure while GABA acts as a sort of brake system or inhibitor.

Due to the suppression of GABA neurons and subsequent increase in dopamine levels, you may experience a rush in unchecked euphoria after you take heroin. This accounts for the intense high derived from this drug.

Heroin also works as a CNS depressant. Apart from altering the chemicals in the brain, it acts on the CNS, where it blocks pain sensations and lowers body temperature, blood pressure, and heart rate while also decreasing breathing. This may lead to an overdose.

Some users may also mix heroin with other drugs or use heroin that has been cut using harmful chemicals during its illegal manufacture. This may further increase the risk of an overdose.

Injecting, snorting, or smoking the drug may also send it across the blood - brain barrier at such a high speed that its toxic levels build up quite fast. This buildup may be so dangerous because it often results into a fatal overdose.

That said, the drug tends to take effect quite fast - but also wears off just as quickly. This might encourage you to take it in a binge pattern or in multiple back to back doses if only to prolong or enhance the high. Naturally, this will also add to the risk of an overdose.

In general, a heroin overdose will occur when the drug lowers respiration and lung function to critical levels. At this point, you may stop breathing. According to NIDA, opioid drugs like heroin work on the brain's stem - which effectively controls some of the major bodily functions needed for life, including respiration and heart rate.

Overdosing on heroin may effectively decrease these essential bodily functions to such low levels that your life may be threatened as a direct result. It is for this reason that heroin overdose can quickly turn fatal.

Most often than not, heroin may shut down your respiration when you overdose. It can additionally cause arrhythmia, a condition that involves disturbances to the natural rhythm of the heart.

Arrhythmia is dangerous because it may disrupt the flow of blood to the organs and the body. This condition may also lead to pulmonary edema, which will back up the flow of blood in your veins. This may create drops in blood pressure and cause your heart to fail, lead to a heart attack, or potentially cause kidney failure.

Heroin is so dangerous because anyone can overdose on the drug even the first time they use it, or after several uses. Multiple users often experience an overdose after they develop tolerance to this drug and require more of it to continue feeling its desired effects.

At this point, you may be compelled to increase the dosage, which will raise the risk of an overdose. As you continue using more of the drug and on a regular basis, you will likely develop dependence and/or addiction. This may also increase the risk of suffering a life-threatening heroin overdose.

Luckily, the overdose can be reversed (potentially) through medical intervention. This may involve using Narcan or naloxone. Narcan is a popular opioid antagonist substance that will fill up the opioid receptor sites within the central nervous system. When it does so, it will displace the heroin and potentially stop its toxic effects.

First responders often carry this heroin overdose reversal substance. As a direct result, they are better able to reverse overdoses. Additionally, NIDA has reported that the FDA (Food and Drug Administration) has already approved a take home handheld auto-injector form of this overdose reversal drug (now known as Evzio). Today, even loved ones and family members can use the drug to quickly reverse a heroin overdose before or after calling for medical help.

Helping an Overdose Victim

In case you suspect a heroin overdose, you should first call the AAPCC (American Association of Poison Control Centers) or 911 and seek immediate and urgent medical assistance. After you've called for help, administer the following basic first aid steps even before the medical team arrives:

  • Check if the victim is breathing
  • In case they are not breathing, administer CPR if you are trained to do so
  • Turn the victim on their side (and into the rescue position); this way, they will not choke on their vomit if this happens
  • Loosen any articles of clothing they have on and which might be binding to their body while also ensuring that they are warm
  • Remain calm
  • Try to keep the victim calm
  • Never try forcing the heroin overdose victim to eat or vomit unless you have receive professional advice to this effect
  • Try collecting all and any drugs that they might have taken; list the drugs and show them to the first responders who show up; they will try to reverse the heroin overdose using the right procedures

The Law And Heroin Overdose

Certain protections and rights are afforded to individuals who call for help or witness an overdose from heroin. These protections and rights are written into law to ensure that no legal action will be taken against these individuals.

These laws are now referred to as the Good Samaritan Laws. They are designed to offer protection to anyone who calls for help and medical assistance during a drug overdose. By so doing, they prevent the good Samaritans from getting arrested and/or prosecuted for illicit drug offenses during medical emergencies or when they seek help either for themselves or for others.

In the United States, heroin is classified as an illegal drug. Therefore, fear of law enforcement or police involvement may prevent you from seeking medical attention for a heroin overdose.

According to the NCSL (National Conference on State Legislatures), 22 states - and the District of Columbia - now have Good Samaritan laws. These laws are designed to provide immunity for all low level criminal drug breaches and offences. These include personal possession and use of the drugs, especially if you act in good faith and seek medical help for medical emergencies. You will also not be arrested or prosecuted if you remain on the scene waiting for help to arrive and if you cooperate with medical and law personnel.

Who Is At Risk?

As you probably already know, heroin is a highly addictive and - therefore - dangerous street drug manufactured from opium poppy. Over the past few years, the number of addictions, deaths, and overdoses from the drug has skyrocketed especially because of addiction to prescription killers, which compels some people to move on to heroin after they are unable to obtain these opioid pain relievers.

The CDC reports that the number of overdose deaths arising from heroin abuse has increased by 137%, an alarming number, with opioids leading this dramatic rise. In the same way, there has been a subsequent 200% increase in overdose deaths from opioid abuse due to an increase in addiction to and abuse of both heroin and opioid medication.

Men have historically been the main victims of such an overdose. However, since 2011, the rates of women abusing this drug and overdosing on it have also been on a substantial increase.

That said, the World Health Organization reports that non-fatal overdoses tend to be more common than fatal heroin overdoses. The international medical association has also noted that the groups of people who tend to struggle with heroin and are at a higher risk of an overdose include:

  • Anyone who uses the drug in combination with another illegal or prescription drug - such as alcohol or a depressant
  • Individuals suffering from depression
  • Those suffering from medical conditions affecting the liver, particularly people with HIV, and Hepatitis C or B (conditions that are common among individuals who take the drug intravenously)
  • Those who have reduced their tolerance to the drug, including those who have relapsed after undergoing medical detoxification and rehabilitation
  • Those who inject opioids such as heroin - instead of taking the drug through other methods
  • Those who take relatively high doses of the drug, particularly while making the transition from prescription painkillers to heroin

Even though most people struggling with addiction to heroin tend to be single, the World Health Organization has also noted that these overdoses mostly happen in front of (at least) one witness. The witness may be a friend or a family member.

Regardless of the situation, however, it is important for anyone who witnesses a heroin overdose - or an overdose on any prescription opioid painkiller - to call 911 immediately and get emergency medical assistance as soon as possible. This could make a difference between saving the victim's life and certain death.

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