Heroin Addiction & Recovery Support Group

Heroin or diacetylmorphine (INN) is a semi-synthetic opioid. It is the 3,6-diacetyl derivative of morphine (hence diacetylmorphine) and is synthesised from it by acetylation. The white crystalline form is commonly the hydrochloride salt, diacetylmorphine hydrochloride. It is highly addictive, and chronic ingestion causes a relatively large tolerance to it when compared to other substances, although occasional use without symptoms of withdrawal has been noted.[1][2] Internationally, Heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs.[3] It is illegal to manufacture, possess, or sell heroin in the United States but, under the name diamorphine, heroin is a legal prescription drug in the United Kingdom. Popular street names for heroin include diesel, smack, scag, heron, black tar, horse, junk, brown, dark and H.

The withdrawal syndrome from heroin (or any other short-acting opioid) can begin within 6 hours of discontinuation of sustained use of the drug: sweating, malaise, anxiety, depression, persistent and intense penile erection in males (priapism), general feeling of heaviness, cramp-like pains in the limbs, yawning and lacrimation, sleep difficulties, cold sweats, chills, severe muscle and bone aches not precipitated by any physical trauma, nausea and vomiting, diarrhea, gooseflesh (hence, the term "cold turkey"), cramps, and fever occur. Many addicts also complain of a painful condition, the so-called "itchy blood", which often results in compulsive scratching that causes bruises and sometimes ruptures the skin leaving scabs. Abrupt termination of heroin use causes muscle spasms in the legs of the user (restless leg syndrome), hence the term "kicking the habit". Users seeking to take the "cold turkey" (without any preparation or accompaniments) approach are generally more likely to experience the negative effects of withdrawal in a more pronounced manner.

Two general approaches are available to ease opioid withdrawal. The first is to substitute a longer-acting opioid such as methadone or buprenorphine for heroin or another short-acting opioid and then slowly taper the dose. The other approach, which can be used alone or in combination, is to relieve withdrawal symptoms with non-opioid medications.

In the second approach, benzodiazepines such as diazepam (Valium) ease the often extreme anxiety of opioid withdrawal. The most common benzodiazepine employed as part of the detox protocol in these situations is oxazepam (Serax). Benzodiazepine use can also lead to a dependence, and many opiate addicts also abuse other central nervous system depressants including benzodiazepines and barbituates. Also, though unpleasant, opiate withdrawal seldom has the potential to be fatal, whereas complications related to withdrawal from benzodiazepines, barbiturates and alcohol (such as seizures, cardiac arrest, and delirium tremens) can prove hazardous and potentially fatal. Many symptoms of opioid withdrawal are due to rebound hyperactivity of the sympathetic nervous system, and this can be suppressed with clonidine (Catapres), a centrally-acting alpha-2 agonist primarily used to treat hypertension.

Buprenorphine is one of the most recent opioid agonist/antagonist used for treating addiction. It develops tolerance much more slowly than heroin or methadone. It also has a withdrawal many times softer than heroin and other opioids. It can be admnistered up to every 24-48 hrs. By itself buprenorphine has low overdose dangers. Buprenorphine is a kappa-opioid receptor antagonist. This gives the drug an anti-depressant effect, increasing physical and intellectual activity. Buprenorphine also acts as a partial agonist at the same μ-receptor illicit opiates such as Heroin initiate from. Due to its effects on this receptor, patients are unable to obtain any "high" from other opiates during buprenorphine treatment.

Researchers at Johns Hopkins University have been testing a sustained-release "depot" form of buprenorphine that can relieve cravings and withdrawal symptoms for up to six weeks. A sustained-release formulation would allow for easier administration and adherance to treatment, and reduce the risk of diversion or misuse.

Methadone is another μ-opioid agonist often used to substitute for heroin in treatment for heroin addiction. Compared to heroin, methadone is well (but slowly) absorbed orally and has a much longer duration of action. Thus methadone maintenance avoids the rapid cycling between intoxication and withdrawal associated with heroin addiction. In this way, methadone has shown some success as a "less harmful substitute"; despite being much more addictive than heroin, and is recommended for those who have repeatedly failed to complete detoxification. As of 2005, the μ-opioid agonist buprenorphine is also being used to manage heroin addiction, being a superior, though still imperfect and not yet widely known alternative to methadone. Methadone, since it is longer-acting, produces withdrawal symptoms that are usually less severe and that appear later than with heroin, but may last longer.

Researchers have discovered two other opioid antagonists: naloxone and the longer-acting naltrexone. These two medications block the effects of heroin, as well as the other opioids at the receptor site. Recent studies have suggested that the addition of naloxone and naltrixone may improve the success rate in treatment programs when combined with the traditional therapy. [citation needed]

The University of Chicago undertook preliminary development of a heroin vaccine in monkeys during the 1970s, but it was abandoned. There were two main reasons for this. Firstly, when immunised monkeys had an increase in dose of x16, their antibodies became saturated and the monkey had the same effect from heroin as non-immunised monkeys. Secondly, until they reached the x16 point immunised monkeys would substitute other drugs to get a heroin-like effect. These factors suggested that immunised human addicts would simply either take massive quantities of heroin, or switch to other hard drugs, which is known as cross-tolerance.

There is also a controversial treatment for heroin addiction based on a plant-derived African psychedelic drug, ibogaine. Many people travel abroad for ibogaine treatments that generally interrupt the addiction for 3 - 6 months or more in up to 80% of patients.[citation needed] Relapse often occurs when the person returns home to their normal environment however, where drug seeking behaviour may return in response to social and environmental cues.[citation needed] Ibogaine treatments are carried out in several countries in South America and in Europe but can be dangerous. Some addicts find the ibogaine therapy most effective when it is given several times over the course of a few months or years, but this can be very expensive if a high price is charged for the treatment.[citation needed] A synthetic derivative of ibogaine, 18-methoxycoronaridine is in phase 2 trials in humans as an anti-addictive drug.