Category Archives: rehab

Medications to Reverse Heroin Overdose

Heroin is a highly addictive illegal opioid derived from morphine. Used to produce feelings of euphoria, the drug takes a toll on individuals, their families, and society. It contributes to crime and violence, and it creates problems in work and educational settings. One study estimates that heroin use costs at least $51,000 for each user annually, which equates to $51 billion for the entire United States.

The Centers for Disease Control and Prevention says almost 500,000 people in the U.S. reported using heroin in 2017. That same year, 15,000 people died from drug overdoses involving heroin, a death rate that was five times higher in 2017 than in 2010. The states with the highest percentages of heroin deaths were California, Illinois, and Virginia.

There are medications that can help those struggling with both heroin use and overdose.

How Is a Heroin Overdose Treated?

Heroin can be deadly. A large dosage depresses breathing and heart rate so much that a person cannot survive without medical intervention. When help arrives in time, there are medical treatments that can reverse or stop an overdose. They include:

Polyethylene glycol can sometimes be used to flush an overdose of heroin from the body. Although it is usually prescribed as a laxative for severe constipation, it can also flush opioids that have not been metabolized from the system. It may not work in large doses, however.

Naloxone is an old medication that has become more popular in recent years because of the opioid and heroin addiction crisis. It is a mainstay in emergency rooms where it is used to stop a heroin overdose. It is also given to first responders and police officers to give to people who have taken too much heroin. Individuals and families are also trained to administer the medication if a loved one takes an overdose.

Naloxone works by binding to the same receptors in the brain as opioids. Because it binds more quickly than heroin, it stops the body from reacting to the heroin, ending the deadly effects of the overdose. It may not work when an individual has taken a massive amount of heroin.

It also leaves the body faster than heroin, meaning the heroin can stay in the system after the naloxone is metabolized. If this happens, the overdose may return. That is why it is important to call for emergency medical help after administering the naloxone.

Studies are being done to see if naloxone can also be used to treat heroin abuse and addiction. Although more research is needed, it may be helpful as a therapy for tapering people off an opioid addiction. Its ability to stop heroin’s effects in the brain could potentially help with withdrawal symptoms and cravings.

Nalmefene is routinely used to stop or reverse the effects of alcohol poisoning. Because it binds to the same receptors in the brain that heroin does, it can treat heroin overdoses. Studies suggest that it can also quickly reverse the effects of heroin overdose. It may, in fact, be more effective for treating overdoses than naloxone, but it has only been approved for use in hospitals. It does not work for symptoms of cocaine withdrawal.

Buprenorphine, known by its brand name as Suboxone, is prescribed to help with withdrawal symptoms and cravings. Patients can take the drug at home to decrease the risk of a heroin overdose.

Are There Safe Natural Alternatives?

A controversial alternative called kratom is an herbal supplement derived from the same botanical family as coffee and gardenia. It comes from tropical evergreen trees in Southeast Asia. Its leaves can be smoked, chewed, as well as made into a tea, extract, or capsule. Its effects can be felt at low doses, and euphoria occurs at higher doses. Kratom has been used for hundreds of years but has been made illegal in some Asian countries. It is also illegal in some states in the U.S.

In the past, kratom has been used in the U.S. to relieve pain and reduce opiate withdrawal, but its effectiveness and safety have been questioned. In 2018, the FDA said that it has no scientific evidence of its use for medical reasons. The FDA also says that kratom should not be used as an alternative treatment for opioid addiction.

In 2018, the U.S. Centers for Disease Control and Prevention (CDC) reported an outbreak of kratom-linked salmonella infections in 20 states. No deaths were reported, but 11 people were hospitalized. The supplement had been consumed in teas, pills, and powder. Officials were not able to find the source of the tainted kratom. The supplement may also have dangerous pesticide residue and unsafe additives.

How Is Heroin Addiction Treated?

Substance use disorder is a chronic condition, but medications can be prescribed to reduce cravings and withdrawal symptoms, making it easier for users to stay sober. Each person’s treatment is tailored to individual needs and takes into consideration other illnesses and health issues that occur at the same time as the addiction. Treatments for heroin use disorder may include medications, behavioral therapy, or a combination of the two.

Studies show that treating heroin use disorder with medication helps to keep people in a treatment program. It also helps to decrease drug use, reduce criminal activity, and lessen the risk of transmitting infectious diseases like hepatitis and HIV.

People who give up heroin often have severe withdrawal symptoms that include nausea, diarrhea, and vomiting. Medications can ease the detox process and make relapse less likely.

Behavioral therapy may take place in outpatient or residential environments. To reinforce and encourage sobriety, treatments may rely on reward systems or cognitive-behavioral therapy, which teaches ways of coping with stress and dealing with relapse.

Some programs also use the 12-step system or other kinds of support groups to encourage patients and give them an opportunity to share their feelings. Every treatment should be tailored to fit the specific needs of an individual patient.

What Drugs Are Used to Treat Heroin Addiction?

Medications used to treat heroin and other opioid use disorders use the same opioid receptors as the drug that causes the addiction, but they are safer and less likely to lead to behavioral problems than the opioid. Three kinds of medications are used to treat addictions. They include:

  • Agonists

Agonists activate opioid receptors.

  • Partial agonists

Partial agonists activate opioid receptors, but they create a smaller response.

  • Antagonists

Antagonists block the opioid receptors, but they also change the reward effects of the addictive drug.

The type of medication used to treat a specific patient depends on their individual needs. Treatment centers use three types of drugs:

Methadone

Methadone is sold under the brand names Dolophine or Methadose. It is an opioid agonist that is taken by mouth so that it reaches the brain slowly to lower the risk of a high. It has been used since the 1960s to treat heroin addicts, and it can be effective for individuals not helped by other medications. Methadone must be administered through an approved daily treatment plan.

Methadone also has the following benefits:

  • It is not likely to cause an overdose.
  • Methadone maintenance gives the patient an opportunity to stay stable long enough to make constructive changes.
  • Doses are only required once a day or less.
  • It cuts down on health problems, such as injection-related infections and vein problems.
  • Methadone is more affordable than heroin.

The Alcohol and Drug Abuse Foundation says that methadone treatment is more effective if it is part of a comprehensive program. These types of programs combine methadone maintenance with counseling, support groups, and alternative therapies.

Buprenorphine

Buprenorphine is sold under the brand name Subutex. Buprenorphine helps to relieve heroin cravings but does not produce the highs or side effects of other opioids. It is taken sublingually, or orally, and contains an antagonist called naloxone that keeps an addict from getting high if they inject the buprenorphine. If a heroin user injects Subutex, the naloxone causes withdrawal symptoms not caused when the drug is taken by mouth.

Buprenorphine has the following benefits:

  • It is less likely to cause physical dependence or euphoria.
  • It has a mild withdrawal when compared to heroin.
  • It lessens cravings and has a lower risk of abuse.
  • It suppresses opioid withdrawal symptoms.
  • It cuts down on illegal opioid use.
  • It blocks the effects of other opioids.

Buprenorphine, approved by the FDA in 2002, was the first drug that could be prescribed by certified doctors through the Drug Addiction Treatment Act. This made it possible for patients to take medication without visiting a treatment center. Buprenorphine availability has given many people the opportunity to get the treatment they need.

In 2016, the law was expanded with the Comprehensive Addiction and Recovery Act, or CARA, to include eligible physician assistants and nurse practitioners. There are two FDA-approved generic forms of the drug, making it more affordable and more widely available for the people who need it. In 2016, the FDA approved a buprenorphine implant that lasts six months and an injection that is taken once a month.

Naltrexone

Naltrexone is an opioid antagonist licensed under the brand name Vivitrol. It prevents the effects of heroin, does not sedate, is not addictive, and does not cause physical dependence. However, it is sometimes not effective because patients have trouble following the treatment. An injectable long-acting version of the medication came out in 2010, allowing patients to be treated monthly rather than through daily doses.

Naltrexone has the following benefits:

  • It can be prescribed by any health care provider with a license to write prescriptions.
  • It reduces cravings.
  • It decreases reaction to drug-conditioned cues.
  • There is less risk of withdrawal than with opioids.

What Happens After Treatment for Addiction or Overdose?

Individuals who have a long-term problem with heroin, or those who overdose on the drug, recover more quickly and experience fewer relapses when they undergo treatment in a residential facility. Trained caregivers and medical professionals can monitor the use of prescribed medications and daily activities, but the stay also gives people a chance to take a break from the stress and temptations they face in their daily lives. Therapy usually includes medication, counseling, and information that offer support, encouragement, and skills for avoiding relapse and returning to a normal lifestyle.

If you or someone you love has a problem with heroin, there is help available. Heroin addiction is a chronic condition that requires lifetime maintenance, but the rate of relapse is similar to that of medical conditions like type 2 diabetes. Recovery requires commitment and lifestyle changes, but it is worth the effort.

America’s Heroin Epidemic

How does taking opioids make someone feel? We usually avoid asking this question when discussing recreational drug use because nobody wants to encourage drug experimentation, let alone drug addiction. When the topic is addressed, it’s easy for people to assume that only weak-minded, reckless people turn to drugs.

Sadly, not many people are prepared to understand that drug addiction, particularly heroin and opioid addiction, has risen to epidemic proportions. America’s heroin epidemic affects all of us. It could be your significant other, your neighbor or even your child. No one ever thinks that it can happen to them or someone they love. However, heroin addiction doesn’t discriminate.

Dating back to the 1990s, pharmaceutical companies claimed that patients taking certain opioid medications would not become addicted. As such, health care providers began prescribing opioids for everything from sprained ankles to post-partum pain control. With this increased rate of opioid prescriptions, it slowly became clear that these types of medications were highly addictive and often led to substance abuse issues. As addiction levels rise, so does the need to understand that opioids, legally or illegally, led the U.S. to its current heroin epidemic.

The U.S. Centers for Disease Control and Prevention, or CDC, estimates that the economic burden brought about by prescription opioid and heroin use comes in at $78.5 billion. This figure includes addiction treatment, the cost of health care, legal expenses and lost productivity.

Understanding the Epidemic

The opioid epidemic has been described as the deadliest drug crisis in American history. According to the CDC, more than 115 people die from opioid overdoses every day.

People used to think that only unemployed people from broken homes turned to heroin to escape reality. No longer is opioid use limited to low-income areas; it has transcended into all geographic areas, affecting people of all ages and ethnicities. Now, the faces of heroin addiction include veterans who cannot find work after leaving the military, moms who needed pain relief after giving birth and even people who had oral surgery.

Many people who become addicted to heroin do not have a prior history of substance misuse. Substance use disorder is not linear or predictable. Some people who were introduced to drugs through prescription pain relievers end up on heroin. Health care officials say that the ever-increasing abuse of prescribed painkillers leads users to the street when they no longer can obtain the drug legally. Unfortunately, because heroin is so addictive, it leads to increased drug-seeking behavior.

Those who misuse the drug and become addicted look for a stronger and possibly cheaper high. Heroin is both, but it is also deadly. It can be laced with other drugs that cause death. Deaths from heroin overdose doubled between 2010 and 2012. The death toll also increased dramatically in 2014 when heroin mixed with fentanyl became more common. Fentanyl, when combined with heroin, is lethal. Users can die within seconds of ingestion.

Although the issue is multifaceted, drug makers and physicians play a key role in this epidemic. After all, if there were no pharmaceutical opioids, physicians wouldn’t be able to prescribe them. That is not to say that they are responsible for another person’s substance use disorder, but the snowballing effect of prescription drug use and not being able to gain access to them has led many Americans to heroin.

Veterans and Heroin Use

Veterans have also been affected by America’s opioid epidemic. Untreated chronic pain has led many veterans to seek out pain relief on the street. After being discharged from their service, some veterans find themselves unemployed and homeless. Depression and the need to escape create the perfect backdrop for substance use disorders. According to the VA, it is estimated that 68,000 veterans are currently struggling with opioid use disorders, and when they can no longer gain access to prescription pain medication legally, they may turn to heroin.

Heroin’s Effects

Heroin can be snorted, injected or swallowed. The speed at which heroin reaches the brain depends on the method taken. Users who inject heroin can feel its high within seven to eight seconds. Astonishingly, not all first-time users experience the feeling of euphoria we hear about. Since heroin slows down the digestive tract, some users may become nauseated and vomit.

Many users report that the high they experience is similar to the feeling after a satisfying sexual encounter, only much more intense. It is this sensation that drives users back to the drug. The brain cells that are affected by heroin eventually become damaged, causing the inability to feel pleasure without heroin. In turn, these cells create the intense craving heroin users have. Unfortunately, the more that individuals take the drug, the larger amounts they need to achieve a high. Often, users become convinced that they can’t function normally without the drug.

Symptoms of Heroin Addiction

It is not surprising that an estimated 23 percent of all people who try heroin will become dependent. The brain’s receptors change almost immediately upon use, leading to an inexplicable high within minutes. Since heroin produces a downer effect, using it produces an almost instantaneous feeling of relaxation and euphoria. Similar to other kinds of opiates, heroin prohibits the brain’s ability to feel pain.

Initially, heroin users can hide the signs of their habit. Over time, family members and co-workers may start to notice the signs of drug use, which include cycles of alertness followed by falling asleep, constricted pupils, rapid behavioral changes and shortness of breath.

The above red flags are not unique to heroin. There are more definitive signs that a heroin user exhibits and these typically include possession of paraphernalia used to prepare the drug. In addition, behavioral changes become more evident as drug users sink further into the substance abuse cycle. Individuals may lie to cover up their addiction and avoid making eye contact. Speech may be incoherent. Performance at work and school may decline, resulting in unemployment or expulsion.

Long-Term Effects of Heroin Use

When someone continues to use heroin despite the deadly consequences, they can develop all kinds of health issues as follows:

Central nervous system

Heroin’s impact on a user’s brain is profound. The receptors that produce chemical signals for happiness and pleasure shrink. People who use heroin for long periods of time also show deterioration of white matter on CT scans of the brain. As such, their ability to make sound decisions and regulate their behavior is altered.

Respiratory system

Like other opiates, heroin slows respiratory function. People who use heroin may breathe much slower and shallower when they are high. If someone uses too much, they may stop breathing. The risk of cardiac arrest is one of the major health risks of heroin. Although it can occur the first time someone uses heroin, chronic users usually need to take higher doses to feel the same effect, which increases the risk of respiratory failure.

Cardiovascular system

Large doses of heroin can cause sudden death. Long-term heroin users also face a slew of other cardiovascular issues including vein damage. With each injection, the damage is done to the veins and arteries that lead to the heart. In turn, infection and abscesses can occur. According to the CDC, approximately 32 percent of heroin users in New York City suffer from a drug-induced abscess.

Digestive system

Heroin can also negatively impact the user’s digestive tract. Its sedative properties slow the movement of food and water, causing constipation and bloating. Users may not disclose these symptoms nor seek treatment, putting them at greater risk for developing intestinal blockages.

What’s Being Done

The FDA believes a multidisciplinary approach to treatment would help bridge the gap between substance use disorders and treatment. Stricter limitation of the frequency and the number of opioid prescriptions would force people to look for alternative ways of pain management, including cognitive therapy, occupational therapy, and physical therapy.

The CDC has also partnered with many states to combat both opioid addiction and heroin use. By educating the public and setting up safe zones for those who are suffering from addiction, the hope is that users will go to those safe zones to inject or use as opposed to getting high on the street.

The Opioid Crisis Response Act of 2018 marks a breakthrough in the fight against the heroin epidemic in the U.S. Federal action is intended to make people more aware of the crisis and provide resources for those who want to get clean. However, one the largest hindrances to this bill being passed are funding. If the legislation is successful, some pharmaceutical companies could be bankrupt, thus making treatment of other chronic medical conditions more difficult.

Getting Treatment

Behavioral and pharmacological treatment can be effective for heroin users. Comprehensive treatment allows users to remain abstinent and restore a level of normalcy into their lives.

Heroin users must complete a detoxification program prior to entering a long-term treatment program. During detoxification, patients may be given medications to reduce the intensity of withdrawal symptoms, which can include pain, diarrhea, nausea, and vomiting. Even though the detoxification period is not a treatment for the addiction itself, it is an effective first step.

After detox, many users manage their cravings with medication. Several medications have been approved for the treatment of heroin addiction. Since they work on the same receptors as heroin in the brain, they are considered safe and effective. They satisfy cravings while blocking opioid receptors in the brain; even if a user relapses and takes heroin, they would not experience a high, which can help them on their road to recovery.

The most common medication used for recovery is methadone. Taken orally, it is slow-acting and prevents withdrawal symptoms. If the user is not at an inpatient facility, the medication is usually dispensed through an approved outpatient treatment center on a daily basis.

Buprenorphine has also been approved for the treatment of heroin addiction. This medication is only available through certified physicians. However, it also eliminates the need for daily trips to a methadone clinic. Generic options are available, making it a more affordable treatment option.

Getting treatment for any substance use disorder may be frightening and, for some, embarrassing. People with long-standing emotional problems or chronic pain are usually at a higher risk of developing substance use disorders. However, that should never dissuade anyone from asking for help. The good news is that heroin addiction is treatable. The first step is asking for help and admitting that there is a problem. Both inpatient and intensive outpatient treatments are available for those in need.