Hazelden Foundation - Get smart about heroin: a Hazelden quick guide

A Hazelden Quick Guide

Hazelden Publishing

Center City, Minnesota 55012

800-328-9000
hazelden.org/bookstore

2013 by Hazelden Foundation

All rights reserved. Published 2013.

No part of this publication may be reproduced in any form or by any means without the express written permission of the publisher. Failure to comply with these terms may expose you to legal action and damages for copyright infringement.

eISBN : 978-1-61649-520-6

Editors notes:

The names, details, and circumstances may have been changed to protect the privacy of those mentioned in this publication.

This publication is not intended as a substitute for the advice of health care professionals.

Alcoholics Anonymous is a registered trademark of Alcoholics Anonymous World Services, Inc.

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Cover design by Theresa Jaeger Gedig

Interior design and typesetting by BookMobile Design & Digital Publisher Services

Developmental editor: Peter Schletty

Production editor: Mindy Keskinen

Hazelden Quick Guides are short, accessible e-books that draw on the original work and best practices of leading experts to help readers address common addiction recovery and emotional health issues. The Get Smart collection describes each of the major drugs its historical, cultural, and legal context, its addictive qualities, and information on prevention and treatment.

Heroin. Fast-acting, powerful, and stronger than ever, it is considered a societal problem of epidemic proportions, as use of the drug has seeped into every conceivable corner of societywith deadly results. Whatever your preconceptions or prejudices about this illegal drug may be, it is difficult and dangerous to ignore reality as more and more people cross a once-unthinkable threshold and become heroin users. Many of these accidental drug users began with prescription painkillers, whether legitimately prescribed or not. In time, when these pills became too expensive or more difficult to procure, heroin served as a substitute. As one addict puts it, No one chooses to use heroin. Everyone who uses it uses it out of desperation.

That same young man, now in recovery, advises loved ones to become informed about heroin, to pull up the shades of denial and seek help before its too late. He says, If youre a parent with a kid who has drug problems, become educated about addiction. If youre going to be a help to your kid, then you have a lot to learn. This e-booklet will provide an overview of heroin, including the drugs history (beginning with the cultivation of the first opium poppy plant), how it works on the body and brain to produce a high, and why users become dependent on it. Well explain how recent restrictions and formulary changes in prescription painkillers has led to an increase in heroin use and describe the most common methods of use today.

The routes to recovery from heroin addiction are varied and numerous; in this guide, well also explore treatment options and discuss prevention measures.

Heroin Addiction or Disorder?

In 2013, the American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) . Behavioral health professionals, such as psychiatrists and psychologists, use this manual as a guide to diagnose people with substance use and mental health disorders. In the latest edition, the terminology used for addiction disorders has changed. Instead of separating such problems into categories such as substance abuse, chemical dependency , or addiction , the guide now uses one term substance use disorder to include the full range of problematic drug use. To be officially diagnosed with a heroin problem, someone would be classified as having an opioid use disorder . Opioids include any natural or pharmacological substance derived from the opium poppy, such as heroin, but also drugs that synthetically re-create the effects of these drugs. The diagnostic manual includes a list of criteria to help behavioral health professionals determine whether a person has a mild, moderate, or severe form of the disorder. In this book, we have continued to use the terms abuse, dependence , and addiction as a convenience to readers, since these are the terms most commonly understood by the general public.

Many readers may not have used heroin themselves, but most have benefitted from the ultimate source of heroin, which is opium. For example, if youve ever had surgery and received pain medication at a hospital or were sent home with a prescription for Tylenol with codeine, you have most likely used an opioid or opium derivative. They are used both in surgery and in long-term pain management. These powerful, effective, pain-relieving medications include hydrocodone (Vicodin), hydromorphone (Dilaudid), and oxycodone (Percocet, and the controlled-release formula, OxyContin). The discovery, use, and abuse of such narcotic medications are all significant to the history of heroin as well as in the crisis we currently face with heroin use.

Indeed, to really understand heroin and its role in society, we need to go back to the cultivation of the first opium plant. When humans learned of the pain-relieving and pleasure-producing effects of using opium, the road was paved for both prescription painkillers and illegal drugs such as heroin, all by-products of the powerful opium poppy plant. For those reasons, well begin by discussing opium and then delve into its derivatives.

The Language of Opium

Here are some terms well be using in this guide:

Poppy: A flowering plant grown all over the world. Though there are more than fifty species of poppies, the primary opium poppy originally comes from Turkey and is called Papaver somniferum .

Opium: The milky sap, or latex, contained in the unripe seed bulbs of the opium poppy.

Opiate: A drug derived from opium.

Opioid: Any substance that acts on the opioid receptors in the body; this includes all opiates (opium alkaloids), as well as semisynthetic opioids, synthetic opioids, and endogenous opioids.

Narcotic: Historically, any substance that dulls the senses, relieves pain, or induces sleep. In the United States, the term has evolved to refer to all opioids, as well as illegal drugs such as cocaine and marijuana.

Opium alkaloids: Morphine, codeine, and thebaine are the three major alkaloids, or chemical compounds, found in opium that are used in drugs and medications.

Semisynthetic opioids: Drugs derived from one of the major alkaloids of opium; since heroin is derived from morphine, it is a semisynthetic opioid.

Synthetic opioids: Opioids created, or synthesized, without the use of opium or one of its major alkaloids; they are designed to produce the same positive effects of opiates without the addictive properties. Examples include meperidine, methadone, and fentanyl.

Endogenous opioids: Chemicals produced naturally in the body that act on opioid receptors; endorphins are an example of an endogenous opioid.