Long-Term Effects of Heroin
Long-term heroin use can lead to many different negative impacts on a person’s health and mental functioning. It can be difficult to see beyond the immediate high, but it is important to consider what life-changing consequences can happen as a result of extended heroin abuse.
Heroin is a powerful illegal substance in the opiate family of drugs. It is produced via a chemical modification of morphine – a narcotic alkaloid which is extracted from the opium poppy. Opiates are taken for pain relief, and they work by reducing the intensity of pain signals in the central nervous system. They can be highly addictive, leading
some people to persistently abuse the drug in ever-increasing doses. Heroin is classified as a Schedule I substance by the Drug Enforcement Agency (DEA), meaning that it has a high potential for abuse, a high potential for severe psychological or physical dependence and currently does not have any accepted medical use.1
Heroin Addiction and Withdrawal
This growing need and addiction develop due to tolerance, one of the defining characteristics of a substance use disorder.
When a drug is used for an extended period of time, the person using may find that larger and larger doses are needed to achieve the same psychoactive effects. This growing need develops due to tolerance – one of the defining characteristics of a substance use disorder, according to the Diagnostic and Statistical Manual, 5th Edition.2 This phenomenon of tolerance, as well as the increase in drug use behavior that may arise in an attempt to surmount it are both contributory features of a burgeoning addiction.
Heroin tolerance has been well-documented. However, when examining the drug’s pain-diminishing abilities, the body’s buildup of tolerance to heroin evolves a bit differently than how most other drugs build up tolerance in the body. Most other drugs build up tolerance by making the body’s chemical receptors less sensitive to the drug with repeated use over time.
With heroin, however, the body’s chemical receptors (opioid receptors) do not become less sensitive to the drug.3-5 Instead, the receptors remain sensitive to the drug, but the body’s pain sensitivity increases – which means that pain signals will more easily get sent to the brain. This phenomenon essentially diminishes the opioid receptors’ relative magnitude of effect with repeated use of heroin.6-8
Opiates are especially quick to elicit tolerance in those using the drug, with both diminished pain relief as well as less euphoric effects following just one dose.9
The combination of weakened effects and increased pain sensitivity can lead users to feel like they need more and more heroin just to feel normal and get through everyday living – a feeling that can easily pave way to addiction.
Without the drug, users will experience unpleasant withdrawal symptoms10:
- Drug cravings.
- Stomach cramps.
- Watery eyes and runny nose.
- Restlessness and insomnia.
- Fever and chills.
- Muscle spasms, tremors and joint pain.
- Nausea and vomiting.
- Increased heart rate and blood pressure.
Long-term Effects of Heroin on the Brain
Extended abuse of heroin is typically associated with constantly escalating doses. The potential damage that the brain is subjected to at the hands of such a powerful-acting drug can change a person’s everyday functioning.
When a person uses heroin repeatedly, the brain may accumulate several detrimental changes, mainly to functional areas of the brain associated with complex thought, decision-making, controlling one’s own social behavior and long-term memory.11-13 These areas in the brain include the prefrontal cortex and the medial temporal lobe. The cumulative impact to these areas due to heroin use can give rise to a number of behavioral changes14-19:
- Worsened executive functioning.
- Poor task flexibility.
- Poor reasoning.
- Poor problem-solving.
- Poor planning.
- Impaired memory.
- Decreased decision-making
- Impaired emotional processing.
- Impaired behavior regulation.
- Impaired ability to imagine future events and interactions.
The weakened ability to project into the future can have a strong effect on a person’s goal-directed action.
The weakened ability to project into the future may help explain why some heroin users have a difficult time with particular forms of substance abuse therapy. For instance, many relapse prevention strategies involve techniques such as goal setting, role playing, rehearsing drug refusal and considering future consequences of continued use or abstinence.
Long-term Effects of Heroin on the Body
Long-term heroin use can have a detrimental effect not only on the health of your brain, but also on the health of the rest of your body as well.
Chronic users may experience any of the following conditions as a result of long-term heroin use20:
- Sexual dysfunction (both men and women).
- Irregular menstrual cycles or spontaneous abortion (women).
- Kidney diseases.
- Nephrotic syndrome, interstitial nephritis, acute glomerulonephritis, renal amyloidosis and renal pathology secondary to rhabdomyolysis break-down products.
How Method of Heroin Use Can Contribute to Bodily Harm
Alongside the general effects of heroin use on the body, additional types of physiological damage can occur depending on the way a person uses it (i.e., snorting, smoking or injecting).
- Damaged mucous tissues in the nose.
- Sinus problems.
- Nose bleeds.
- Damage to the nasal septum, the thin cartilage wall that separates the two nostrils.
- Septal perforation.
- Septal deviation.
- Lung damage.
- Pulmonary edema.
- Throat cancer.
- Breathing problems.
- Collapsed veins – leading to inadequate blood flow throughout the body.
- Heart infections.
- Pus-filled sores (abscesses).
- Clogged blood vessels (from impure heroin).
- Shared-needle infections.
- Hepatitis B, hepatitis C and HIV/AIDS.20
Some of the most dangerous risks of long-term heroin injection include the contraction of hepatitis B (HBV), hepatitis C (HCV) or HIV. These infectious diseases are life-altering and can eventually prove fatal.
The Dangers of Sharing Needles
Injection drug users are at risk for acquiring hepatitis B, hepatitis C and HIV since these diseases are spread through the blood during needle-sharing. In fact, more than 53% of new HCV infections in the U.S. during 2010 and 9% of new HIV infections in 2009 were due to injection drug use.28,29
In one study, it was found that 45% of injection drug users who tested positive for HIV did not even know that they were infected, making it more likely that these individuals would further spread the infection to other users.30
Due to all these health consequences of long-term use, a heroin user’s life can be shortened by up to 18.3 years before age 65.21 Statistics show that 22.3% of those lost years may be due to overdose, 14% to chronic liver problems and 10.2% to accidents.
Because heroin also affects parts of the brain (the brain stem) related to breathing and other vital life functions, taking too much can cause overdose and even death.
Almost 9% of all drug-related emergency department visits in 2011 were related to heroin use, according to the 2011 Drug Abuse Warning Network (DAWN) report.22
Death from heroin overdose has increased over recent years. From 2001 to 2013, there was a 5-fold increase in the number of heroin overdose deaths in the U.S.23
One Australian study found that 54% of chronic heroin injectors at least experience one non-fatal overdose over the course of their lifetime.24,25
Because tolerance to heroin can build up so quickly, and because the purity of heroin is often times unknown – it can be dangerously easy to overdose. When a person takes too much heroin, the suppressed brain stem functioning leads to breathing problems and precipitous drops in blood pressure. Most people who overdose on heroin die either because they either forget to breathe or because their heart fails.26,27
Additional Effects of Long-term Heroin Use
While the detrimental health effects of heroin use are some of the more straightforward concerns, there can also be hidden risks that come with long-term heroin use. These risks are not due to heroin itself, but to the lifestyle and habits that can surround its use. Poor bodily care and inadequate nutrition, for example, can result in frequent colds, lung problems
and skin infections. The destruction of relationships and finances are additional long-term effects of heroin use. Not only does the purchase of the drug, itself, deplete your money – but the paraphernalia, medical bills, legal fines, job loss and other costs resulting from heroin use can add up to a habit that can totally devastate your finances.
How to Recognize If a Loved One Has Been Using Heroin
While many of heroin’s detrimental effects are not outwardly visible, there are some visible signs of long-term abuse – the most common of which is track marks.
While many of heroin’s detrimental effects are not outwardly visible, there are some visible signs of long-term abuse – the most common of which is track marks (from scarred veins) that result from repeated injections, if injection is the chosen method of heroin use.
Long-term users may show noticeable signs of deteriorating health, including exhaustion (due to insomnia and a general decline in overall health), respiratory problems (chronic coughing or pneumonia) and boils on the skin (“abscesses,” or pus-filled sores). A heroin user may also exhibit other symptoms, depending on how recently heroin has been used31:
- Slowed breathing.
- Slowed heart rate.
- Impaired thought.
- Dry mouth.
- Nausea and vomiting.
- Constricted pupils.
Long-term heroin use presents many risks, but these risks can be prevented or minimized with treatment. It’s never too late to start the process of cutting heroin out of your life.
- Drug Scheduling. DEA.
- Substance-related and Addictive Disorders. American Psychiatric Association.
- Basbaum AI. (1995). Insights into the development of opioid tolerance. Pain, 61. 349–352.
- Collin E. & Cesselin F. (1991). Neurobiological mechanisms of opioid tolerance and dependence. Clinical Neuro-pharmacology, 14. 465–488.
- Stewart J. and Badiani A. (1993) Tolerance and sensitization to the behavioral eVects of drugs. Behavioral Pharmacology, 4. 289–312.
- Laulin JP, Larcher A, Ce ́le`rier E, Le Moal M. & Simonnet G. (1998). Long-lasting increased pain sensitivity in rat following exposure to heroin for the first time. European Journal of Neuroscience, 10. 782–785.
- Laulin, JP, Ce ́le`rier E, Larcher A, Le Moal M, & Simonnet G. (1999). Opiate tolerance to daily heroin administration: an apparent phenomenon associated with enhanced pain sensitivity. Neuroscience, 89 (3). 631-636.
- Chu LF, Angst MS, & Clark D. (2008). “Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations”. Clinical Journal of Pain, 24 (6). 479–496.
- Laulin JP, Larcher A, Ce ́le`rier E, Le Moal M, & Simonnet G. (1998). Acute tolerance associated with a single opiate administration: involvement of N-methyl-D-aspartate-dependent pain facilitatory systems. Neuroscience, 84 (2). 583-589.
- What are the long-term effects of heroin use. National Institute on Drug Abuse.
- Cheng GLF, et al. (2013). Heroin abuse accelerates biological aging: a novel insight from telomerase and brain imaging interaction. Translational Psychiatry, 3. 1–9
- Ersche KD, Clark L, London M, Robbins TW, & Sahakian BJ. (2006). Profile of executive and memory function associated with amphetamine and opiate dependence. Neuropsychopharmacology, 31. 1036–1047
- Liu H, Hao Y, Kaneko Y, Ouyan X, Zhang Y, Xu L, Xue Z, & Liu Z. (2009). Frontal and cingulate gray matter volume reduction in heroin dependence: optimized voxel-based morphometry. Psychiatry Clinical Neuroscience, 63. 563–568
- Curran HV, Kleckham J, Bearn J, Strang J, & Wanigaratne S. (2001). Effects of methadone on cognition, mood and craving in detoxifying opiate addicts: a dose response study. Psychopharmacology, 154. 153–160.
- Friswell J, Phillips C, Holding J, Morgan CJA, Brandner B, & Curran HV (2008). Acute effects of opioids on memory functions on healthy men and women. Psychopharmacology, 198. 243–250.
- Fernández-Serrano MJ, Pérez-García M, & Verdejo-García A. (2011). What are the specific vs. generalized effects of drugs of abuse on neuro-psychological performance? Neuroscience of Biobehavior Review, 35. 377–406
- Fishbein DH, et al. (2007). Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use. Drug and Alcohol Dependence, 90. 25–38.
- Aguilar de Arcos F, et al. (2008). Dysregulation of emotional response in current and abstinent heroin users: negative heightening and positive blunting. Psychopharmacology, 198. 159–166.
- Mercuri K, et. al. (2015). Episodic foresight deficits in long-term opiate users. Psychopharmacology, 232. 1337-1345.
- What are the medical complications of chronic heroin use? National Institute on Drug Abuse.
- Smyth B, Hoffman V, Fan J, & Hser Y-I. (2007). Years of Potential Life Lost among Heroin Addicts 33 Years after Treatment. Preventive medicine, 44 (4). 369-374.
- A day in the life of young adults: Substance abuse facts. The CBHSQ Report. SAMHSA, 10 June 2014.
- Overdose death rates. National Institute on Drug Abuse.
- Hedegaard H, Chen L, Warner M. Drug-poisoning deaths involving heroin: United States, 2000-2013. NCHS Data Brief, No. 190. March 2015.
- Paul Dietze et al. (2001). The Context, Management and Prevention of Heroin Overdose in Victoria, Australia: The Promise of a Diverse Approach. Addiction Research and Theory, 9. 437-458.
- Dettmeyer R, Friedrich K, Schmidt P, Madea B. Heroin-associated myocardial damages—conventional and immunohistochemical investigations. Forensic Sci Int. 2009 May 30;187(1-3):42-6.
- White J & Irvine R. (1999). Mechanisms of fatal opioid overdose. Addiction, 94 (7). 961-972.
- Centers for Disease Control and Prevention. Viral Hepatitis Surveillance – United States, 2010. Atlanta, GA: Centers for Disease Control and Prevention, 2012.
- Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. Plos One 2011;6:e17502.
- HIV Infection and HIV-associated behaviors among injecting drug users – 20 cities, United States, 2009. Morbidity and Mortality Weekly Report, CDC. 2 March 2012.
- Commonly Abused Drug Charts. National Institute on Drug Abuse.
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