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Heroin is a highly addictive drug, and its use is a serious problem in America. Current estimates suggest that nearly 600,000 people need treatment for heroin addiction. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction.
Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and infectious diseases, including HIV/AIDS and hepatitis.
The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system.
Long-term effects of heroin appear after repeated use for some period of time. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration.
In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.
Reports from SAMHSA's 1995 Drug Abuse Warning Network (DAWN), which collects data on drug-related hospital emergency room episodes and drug-related deaths from 21 metropolitan areas, rank heroin second as the most frequently mentioned drug in overall drug-related deaths. From 1990 through 1995, the number of heroin-related episodes doubled. Between 1994 and 1995, there was a 19 percent increase in heroin-related emergency department episodes.
With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.
There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin (or other opiate) use and return to more stable and productive lives.
Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. LAAM, also a synthetic opiate medication for treating heroin addiction, can block the effects of heroin for up to 72 hours. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates. Several other medications for use in heroin treatment programs are also under study.
There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher- based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.
According to the State Alcohol and Drug Abuse Profile,* a survey of state of resources, services, and needs related to alcohol and drug abuse, heroin abuse accounted for the second largest number of all publicly funded drug treatment admissions in 1995. In California, Connecticut, Maryland, Massachusetts, New Jersey, Puerto Rico, Rhode Island, and Washington, heroin was the primary drug of abuse reported in publicly funded drug treatment admissions.
Monitoring the Future Study (MTF)
According to the 1997 MTF, an annual survey of drug use among 8th-, 10th-, and 12th- graders, rates of heroin use remained relatively stable and low since the late 1970s. After 1991, however, use began to rise among 10th- and 12th- graders, and after 1993, among 8th- graders. In 1997, prevalence of heroin use was comparable for all three grade levels. Although the annual prevalence rates for heroin use remained relatively low in 1997, these rates are approximately two to three times higher than those reported in 1991.
Heroin Use by Students, 1997:
Monitoring the Future Study
In December 1996, CEWG reported that the availability of low-priced, high-quality heroin continues to increase, especially in the East and some areas of the Midwest. This increase has also been reported in some cities that previously had escaped the influx of high-quality heroin.
Quantitative indicators and field reports continue to suggest an increasing incidence of new users (snorters) in the younger age groups, often among women. One concern is that young heroin snorters may shift to needle injecting, because of increased tolerance, nasal soreness, or declining or unreliable purity. Injection use would place them at increased risk of contracting HIV/AIDS.
In some areas, such as Boston and San Francisco, the recent initiates increasingly include members of the middle class. In Newark, heroin users are usually found in suburban populations.
The 1996 NHSDA shows a significant increase from 1993 in the estimated number of current (once in the past month) heroin users. The estimates have risen from 68,000 in 1993 to 216,000 in 1996.
Among individuals who had ever used heroin in their lives, the proportion who had ever smoked, sniffed, or snorted heroin increased from 55 percent in 1994 to 82 percent in 1996. During the same period, the proportion of users who injected heroin remained about the same, at about 50 percent.
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