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Abuse of heroin comes with potentially severe medical and social consequences.1 The easily accessible, low-cost illicit drug is highly addictive, and among the leading causes of deadly opioid-related overdoses in the U.S. As its toll continues to climb, heroin testing has become a valuable tool for identifying individuals who abuse the drug and may need treatment to stop.2
Heroin detection time or window of detection for heroin is the range of time that heroin can be detected in a biological sample or matrix, that is:3
Different tests are used to detect heroin and possibly the presence of other illegal or prescription drugs in the system:3
Window of detection depends on the matrix used, as different matrices retain heroin for different lengths of time.3
In addition to maximum detection time, other criteria taken into consideration when choosing a test include:3
In general, the longest windows of detection occur in hair, followed by sweat, urine, oral fluid or saliva, and blood.3
The relationship between concentration of heroin and matrix depends on:3
These factors influence the absorption, distribution, and elimination of the drug and ultimately determine detection time.3
For instance, when heroin is used infrequently such as among individuals who may solely use the drug on the weekends, testing for heroin use should be done within one day as the body may not retain heroin and its metabolites longer than a day. For frequent use, it should be done within one to two days. This short detection time makes it exceedingly difficult to identify recreational opioid use by a random testing protocol.4
Heroin metabolism refers to the process of biotransformation by which heroin is broken down so that it can be eliminated by the body.5
Several factors can extend detection time:6
If a person has already developed physical dependence and the body became adapted to the presence of heroin, withdrawal syndrome can occur rapidly, especially if the intake of the drug is reduced abruptly.1 Withdrawal signs and symptoms vary in severity, time of onset, and duration, depending on the percentage of heroin and other agents used, the duration of use, the daily dose, and the interval between doses.7 Heroin withdrawal typically begins 8 to 12 hours after the last heroin dose and subsides within a period of 3 to 5 days.7
Traditional drug tests are standard practice in determining heroin abuse. The initial test for heroin in a primary care setting is the screening test. If found to be positive, the screening test is followed by a confirmatory test.8
When testing a person for heroin use, accurate metabolite identification is crucial for the purpose of obtaining precise test findings:6
Biochemical laboratory tests can be used to detect the presence or absence of alcohol or another substance of abuse, including heroin.7 These tests may be able to determine the level of present use or quantify cumulative use over the past few weeks.7
The half-life of a drug is defined as the time taken for 50% of the drug to be removed from the body by the person’s metabolism or excretion. After heroin is consumed, it is broken down or metabolised by the body into other chemicals which can be detected through tests after excretion.8
Heroin drug test detection times can be affected by:8
Generally speaking, a urine sample will contain the highest concentration of parent drug and its primary metabolites within 6 hours of administration.8 However, route of administration may affect detection time:8
As drug elimination usually occurs at an exponential rate, a single dose of heroin will be eliminated almost completely within 48 hours. Heroin may also be accumulated in the body as a result of frequent, multiple dosing over extended periods of time, which can lead to significantly extended detection times.8
Abrupt heroin withdrawal is a set of severe signs and symptoms which a person experiences as the body rids itself of heroin without medications. This is what happens when they attempt to quit the drug cold turkey. While generally not life-threatening, abrupt withdrawal causes great distress to the person’s body and mind and may prompt relapse. A preferred alternative to this is a supervised, medication-assisted detoxification which is a set of interventions aimed at managing acute intoxication and ensuring safe withdrawal.7
Due to the rapid metabolism and elimination of heroin and its metabolites, the window period for detecting and quantifying the illicit drug in a person’s body is short, sometimes as short as 1 to 2 days. Other limitations of blood tests are that they are invasive and samples can only be collected by trained staff.2
In contrast, heroin use can be detected in a hair sample even months after the drug was
Drug screening through saliva has advantages over blood and urine:3
However, as mentioned above, the detection period is relatively short:3
Heroin rapidly metabolizes to 6-acetylmorphine and morphine.3 It takes approximately 2 hours after use for heroin to be detected in urine, and the window of detection is typically 1–3 days, although this depends on factors such as fluid intake and urinary pH.3
Heroin and other organic opioids derived from opium can be detected by urine tests. Synthetic opioids, on the other hand, cannot. Illicit drugs such as heroin may contain various adulterants and other mixing agents, including synthetic opioids.7
The key issue associated with urine heroin tests is that they are easily adulterated.2
Hair testing for heroin use has several advantages over other forms of sampling and analysis:9
However, the routine use of hair testing is not appropriate for most addiction treatment settings, partly due to its high cost, especially if repeated tests are needed, and urine testing remains the most commonly used matrix.3
Home use tests for drug abuse indicate the presence in urine of heroin and/or other prescription or illicit drugs. These are qualitative tests which can be done at home and may detect the presence of heroin in the urine, but cannot determine the amount of the drug.10
Neither positive nor negative tests results are 100% accurate:10
During an evaluation prior to detoxification, the person is tested for the presence of heroin in the bloodstream and the concentration of the drug is measured. In the cases of suspected polydrug abuse, the evaluation may also include measuring blood alcohol level and urine drug screening.7
Since this evaluation serves as the basis for the initial heroin addiction treatment plan to be initiated following the withdrawal period, it also includes screening for co-occurring mental and physical conditions and a comprehensive assessment of the patient’s medical and psychological conditions and social situation, such as in the case of veterans with heroin addiction.7
In a treatment setting, testing frequency is tailored to the individual and adjusted as needed.8 Positive test results of recovering individuals can serve as indication that their addiction treatment needs to be adjusted to better serve each individual patients’ needs. Negative drug tests are often used as reward points in treatment approaches such as contingency management to encourage recovering individuals to stay in treatment.1
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