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Heroin: Prescription Painkiller’s Evil Twin

By Dr. Karl Benzio MD

Page Overview

Heroin is a street drug that is causing epidemic-sized problems throughout society today. This drug has been around for many years, but has made a resurgence in the past decade. Heroin is a powerful drug, one that often quickly leads to addiction and drug seeking behavior. Although heroin addiction is powerful, progresses rapidly, destroys lives, and frequently kills, treatment for heroin addiction does exist. With the combination of new medications, advances in treatment methods, and effective Christian rehab programs, hope exists for anyone struggling with heroin addiction who is willing to commit to in depth treatment.

How are Heroin and Prescription Painkillers Similar?

Heroin and Prescription Painkillers share many characteristics.

  1. They are both chemically classified in the Opioid family. An opioid is substance acting on special receptors in the brain producing powerful effects. Opioids are broken into 3 categories: Here are some commonly prescribed opiates.
    • Opiates are naturally occurring neuro-active chemicals found in the poppy plant and the 3 main opiates are morphine, codeine, and thebaine.
    • Semi-synthetic opioids are man-made manipulations of one of those opiates. Heroin is produced by a slight chemical alteration to morphine, Other semi-synthetic opioids are oxycodone (Oxycontin), hydrocodone (Vicodin), oxymorphone (Opana).
    • Synthetic opioids are not derived from opiates at all as they are totally created in a laboratory. These include methadone, fentanyl, and buprenorphine.
  2. Because heroin is derived from morphine, when it crosses into the brain, it is converted back into morphine and now is like all the other prescription pain killers.
  3. They both bind opioid receptors in the brain causing powerful pain relief, a feeling of euphoria, and acute anxiety relief while slowing other systems, especially muscular coordination and breathing.
  4. They both are highly addicting, causing the user to physically and psychologically depend on the drug and crave more of it. Heroin is more potent than most (but not all) other opioids.

A significant difference exists between heroin and prescription painkillers; unscrupulous unregulated people manufacture heroin, and regulated pharmaceutical companies manufacture prescription painkillers. Without regulations, major unknowns are both the strength of heroin as well as the other chemicals used to “cut” or dilute the heroin so one bag can become two to double the dealers’ income. Some of the chemicals used to dilute heroin are as dangerous as heroin. This difference is one of the major reasons for the rise in heroin overdoses.

Heroin can be a difficult addiction to overcome, but with the right kind of help and expertise, victory is possible. Finding a program that uses effective therapy models and customizes rehab for the individual is essential.
Dr. Karl Benzio MD

Today’s Heroin User is Different from Past Decades

The typical heroin addict in today’s society is much different from the past, and this has led many families to feel caught off guard by this type of addiction among loved ones. The stereotypical 1970’s heroin user was a young adult living in a big city, wasting their life away on the streets as a “hardcore druggie” who would mainly inject it IV (intravenously). Today’s heroin user looks much different. There has been a rise in recent years in younger, middle class addicts, who are more likely to live in the suburbs than a big city. There are also many more female users, including housewives and soccer moms. Their more common form of intake is snorting it rather than shooting it.

The change in heroin user demographics is largely due to the similarity between heroin and prescription medications and the massive increase in prescription painkiller availability, use and abuse. Individuals are switching from prescription opioids to their evil twin, heroin, because either the doctor has gotten more cautious with how long they prescribe painkillers with the increased awareness and DEA crackdown, or in many cases, heroin is cheaper and easier to get. Because of the widespread use of heroin today, we can no longer say today’s heroin user fits in a certain age range or demographic – it touches so many different lives.

Heroin is Cheaper, More Powerful, More Deadly

When people switch to heroin from prescription painkillers, they find a drug that in many ways affects them in the same way, but is amplified and more potent. This leads to immediate risks as respiratory suppression is the most common cause of overdose death (but also increased heart rate, seizure, and stroke), and it also leads to increased drug cravings and addiction.

Painkillers, when recreationally abused, are taken orally which is the slowest way to get into the blood and the brain, thus missing the rush entirely and not getting high for 20-30 minutes. Heroin on the other hand, has 3 faster ways to get to the brain – snorting, smoking (chasing the dragon), and the fastest is IV (shooting or mainlining) – thus delivering a powerful rush and extreme high when compared to prescription meds.

Not only is heroin today more potent than other opioids and even the heroin of the past, but it is dangerous because it is often cut or contaminated with powerful chemicals. Chalk, caffeine, talcum powder, starch, and fentanyl are added to street heroin to improve its texture, to add filler, and to make it more potent. When we consider that heroin is a drug that is typically injected into the vein, having all these extra contaminants in it becomes deadly very quickly.

Heroin Overdoses Increasing, Narcan Saves Lives

Heroin overdoses have increased drastically in recent years. According to the Centers for Disease Control, there were 10,574 overdose deaths related to heroin in America in 2014, and from 2001 to 2014 there was a 6-fold increase in the total number of heroin deaths (National Institute on Drug Abuse). Opioid overdose is now a leading cause of death worldwide.

For as dangerous as heroin is and how easily a person can overdose on it, there is a medication that can reverse heroin’s effects and save a person from overdose. The medication is called Narcan, and it is an opioid antagonist, blocking or antagonizing the effects of any opioid chemical. If someone overdoses on heroin, first responders, hospitals, and in some states, even friends and family are authorized to give Narcan, reversing the heroin and especially its respiratory effects, saving the person’s life. There is a short window of time after overdose that Narcan can be effectively administered, and it does nothing to help with other kinds of overdose besides opioids such as heroin or painkillers.

Heroin Detox

There are several methods to detoxing from heroin. The drug is an opioid, so withdrawal is similar to prescription painkiller withdrawal. It is not physically/medically dangerous, but it is extremely uncomfortable. Unfortunately, many addicts actually reject rehab because of their fear and unwillingness to endure a week of this extreme discomfort.

  • Nausea and vomiting
  • Teary eyes
  • Runny nose
  • Goose bumps
  • Shaking
  • Yawning or sneezing
  • Aches and pains
  • Diarrhea
  • Involuntary muscle spasms of the limbs (kicking the habit)
  • Abdominal pain
  • Cold sweats
  • Chills
  • Nervousness
  • Depression
  • Cravings for drugs
  • Agitation
  • Anxiety
  • Insomnia
  • Fever
  • Sensitive genitals
  • General Malaise or body heaviness

Even though heroin detox symptoms themselves are not medically dangerous, there are risks associated with it: not sleeping, having constant diarrhea and nausea/vomiting. The person can easily become dehydrated, undernourished, fatigued, and give up. For these reasons, and because there can always be unforeseen complications, detoxing on one’s own at home is not recommended.

Harm Reduction Therapy is a term used to reduce the harm associated with detox.

Supervised detox. The least invasive form of heroin detox is called supervised detox. Nurses are on site while doctors come in each day and are available via phone. Regular nutrition, rest, relaxation, and starting some basic exercises help restore and heal the broken body and brain, while emotional and psychological compassion, therapy, and support bring comfort and guidance. A Christian program will add an overarching recognition of God’s character, love, forgiveness, teachings, and following Jesus’ example delivers encouragement, motivation, and hope, Your spiritual health will be addressed through Bible study and prayer if you are enrolled in a Christian detox program.

Medical detox. A higher level of care than supervised, medical detox helps make the withdrawal easier, and in some cases faster, especially when larger amounts or stronger opioids were being used. Medical detox has more doctor involvement and allows for more intensive use of medications such as methadone, buprenorphine, and naltrexone to reduce the harm of withdrawal symptoms and speed up the withdrawal process.

Rapid detox. Rapid detox rapidly cuts the detox time to about 24 hours and is used in some facilities as another option for opioid detox. During this procedure, patients are admitted into an acute hospital setting and put under general anesthesia. The medical team then uses medications to perform a fast detox while the patient is unconscious. Although more costly due to all the expensive meds, anesthesia, hospital personnel and resources, while incurring more potential complications, this option only takes about 24 hours and can be quite effective if it is done properly with appropriate safety precautions.

Suboxone and Methadone

Two medications have emerged in recent years to aid in the treatment of heroin and opioid addiction. Suboxone is a formulation of buprenorphine (partial opioid agonist) and naloxone (opioid antagonist). When given to someone who has completed opioid withdrawal, the buprenorphine simulates heroin and relieves drug cravings while the naloxone blocks the high. Suboxone does not cause the dangerous side effects of heroin. Suboxone is difficult to abuse because it induces opiate withdrawal symptoms if too much is taken.

Methadone is a slow-acting synthetic opioid agonist. Because it is an agonist, it acts like heroin and lessens the heroin withdrawal symptoms, but because it is so slow acting, it doesn’t cause a high (for most chronic heroin patients). Patients who take this medication use it as a replacement when they have multiple failed attempts to stay off heroin. The ultimate goal is for methadone to be a temporary solution, but then to have the dose slowly decreased over time, to help patients wean off of methadone, thus transitioning from heroin to drug-free over a couple years.

Both suboxone and methadone can be addictive, and a problem arises when individuals begin to depend on these medications over a long period of time. If used, it is important for the treatment team to help patients develop better psychospiritual life coping skills to handle life’s stresses, thus being able to handle and stick to a plan for weaning off of these replacement/transition medications.

Christian Heroin Rehab

The most efficient and safest way to develop a good sobriety foundation for heroin recovery is residential rehab, and a Christian heroin rehab is especially effective for preparing you for not just a life-saving experience, but a life-transforming existence. Faith-based recovery helps you focus on the three spheres – mind, body, and spirit – for a full and lasting recovery. Drawing on the expertise, and compassion of trained staff, and helping you build a Christ-centered Biblical-based foundation for living, a good Christian rehab program will help you dig into the factors leading up and contributing to your addiction, then help you develop meaningful ways to deal with stress, guilt, losses, and hurts in your life. God’s love, forgiveness, peace, and power will then fuel and free you to achieve your God-given potential, regardless of the adversity and temptation that comes your way.

There is Always Hope

Heroin can be a difficult addiction to overcome, but with the right kind of help and expertise, victory is possible. Finding a program that uses effective therapy models and customizes rehab for the individual is essential. Most importantly, a program that incorporates the truth and guidance of God’s word and the peace that comes from His love, forgiveness, and grace can turn everyone and anyone’s life around.