Ashlee Sartori

Heath
10/25/2015
Heroin

What is Heroin?
Heroin (diacetylmorphine) is derived from the morphine alkaloid found in opium and is roughly
2-3 times more potent. A highly addictive drug, heroin exhibits euphoric ("rush"), anxiolytic and
analgesic central nervous system properties. Heroin is classified as a Schedule I drug under the
Controlled Substances Act of 1970 and as such has no acceptable medical use in the United
States. Pure heroin is a white powder with a bitter taste. Most illicit heroin is sold as a white or
brownish powder and is usually "cut" with other drugs or with substances such as sugar, starch,
powdered milk, or quinine. It can also be cut with strychnine or other poisons. Because heroin
abusers do not know the actual strength of the drug or its true contents, they are at risk of
overdose or death. Another form of heroin known as "black tar" may be sticky, like roofing tar,
or hard, like coal. Its color may vary from dark brown to black.
Methods of Heroin Use
Heroin is most often injected, however, it may also be vaporized ("smoked"), sniffed ("snorted"),
used as a suppository, or orally ingested. Smoking and sniffing heroin do not produce a "rush" as
quickly or as intensely as intravenous injection. Oral ingestion does not usually lead to a "rush",
but use of heroin in suppository form may have intense euphoric effects. Heroin can be addictive
by any given route.
Side Effects of Heroin Use
Heroin is metabolized to morphine and other metabolites which bind to opioid receptors in the
brain. The short-term effects of heroin abuse appear soon after a single dose and disappear in a
few hours. After an injection of heroin, the user reports feeling a surge of euphoria (the "rush")
accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this
initial euphoria, the user experiences an alternately wakeful and drowsy state. Mental functioning
becomes clouded due to the depression of the central nervous system . Other effects that heroin
may have on users include respiratory depression, constricted ("pinpoint") pupils and nausea.

Effects of heroin overdose may also include slow and shallow breathing, hypotension, muscle
spasms, convulsions, coma, and possible death.
Intravenous heroin use is complicated by other issues such as the sharing of contaminated
needles, the spread of HIV/AIDS, hepatitis, and toxic reactions to heroin impurities. Other
medical complications that may arise due to heroin use include collapsed veins, abscesses,
spontaneous abortion, and endocarditis (inflammation of the heart lining and valves). Pneumonia
may result from the poor health condition of the abuser, as well as from heroin's depressing
effects on respiration. Heroin addiction can remove an otherwise healthy and contributing
member from society, and may lead to severe disability and eventually death.
Other Health Hazards of Heroin
With regular heroin use, tolerance develops where the abuser must use more heroin to achieve
the same intensity or effect. As higher doses are used over time, physical dependence and
addiction develop. With physical dependence, the body has adapted to the presence of the drug
and withdrawal symptoms may occur if use is reduced or stopped. Withdrawal, which in regular
abusers may occur as early as a few hours after the last administration, produces drug craving,
restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose
bumps ("cold turkey"), kicking movements and other symptoms. Major withdrawal symptoms
peak between 48 and 72 hours after the last dose and subside after about a week. Sudden
withdrawal by heavily dependent users who are in poor health is occasionally fatal, although
heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.
Treatment Options for Heroin Addiction or Overdose
Several medical treatment options exist for heroin addiction. These treatments can be effective
when combined with a medication compliance program and behavioral therapy. Methadone
(Dolophine, Methadose), buprenorphine (Subutex, brand discontinued in U.S), buprenorphine
combined with naloxone (Suboxone) and naltrexone (Depade, ReVia) are approved in the US to
treat opioid dependence. These treatments work by binding fully or partially to opiate receptors
in the brain and work as agonists, antagonists or a combination of the two. Agonists mimic the
action of the opiate, and antagonists block and reverse the action of the opiate. Oral
administration of these drugs may allow for a more gradual withdrawal from opiates. A longacting intramuscular depot formulation of naltrexone (Vivitrol) is also available for use following
opiate detoxification.
Methadone has been used for over a quarter century to treat heroin addiction. The use of
methadone in opiate dependency is highly regulated in the US, and may differ between states.
Oral methadone is approved for opiate detoxification and maintenance only in approved and
certified treatment programs, although certain emergency or inpatient care exceptions exist.
Patients usually need to visit a center daily for treatment and follow-up; however, special
exceptions may be granted for Sunday, State and Federal holidays, and other times as determined
by the Treatment Center Medical Director.1Buprenorphine/naloxone, like methadone, has been
shown in clinical trials to be effective in treating heroin dependence, and may have a lower risk
for withdrawal effects upon discontinuation. Naloxone (a pure opiate antagonist at receptor sites)
is present to help prevent the intravenous abuse of the buprenorphine component.

Buprenorphine/naloxone treatment takes place in an authorized physicians' office, and this may
be more acceptable to patients. Buprenorphine is also available as a single agent and is used
primarily for induction at treatment onset. Patients are usually switched to the combined
buprenorphine/naloxone agent for outpatient maintenance therapy. A 2013 report by the Drug
Abuse Warning Network (DAWN) highlights the fact that buprenorphine has become a popular
drug of abuse itself. Emergency department visits involving buprenorphine increased
substantially from 3,161 in 2005 to 30,135 in 2010.2
Naltrexone, available orally and as an intramuscular depot injection is another treatment option,
but patients must be opioid-free for at least 7 to 10 days prior to treatment. Naltrexone is a pure
opioid antagonist and may result in withdrawal symptoms if the patient is not opioid-free.
Heroin overdose is a medical emergency that requires treatment with naloxone. Intravenous
naloxone will result in reversal of the opioid-induced respiratory depression within 2 minutes.
Retreatment with naloxone may be required as the duration of action of naloxone (30 to 120
minutes) may be shorter than the action of the opioid. Respiratory support, intravenous fluids,
and other adjunctive medications may be required Extent of Heroin Use
Heroin addiction is a treatable condition, but its use is increasing in recent years. According to
the 2011 Survey on Drug Use and Health by the US Substance Abuse and Mental Health
Administration, it is estimated that 607,000 persons per year used heroin in the years 2009-2011,
compared to 374,000 during 2002-2005. Similarly, the estimated number of new heroin users
increased from 109,000 per year during 2002-2005 to 169,000 per year during 2009-2011.3
The increase in initiation is evident among young adults aged 18 to 25 and adults aged 26 and
older. There were 28,000 youth initiates per year in 2002-2005 and 27,000 in 2009-2011. Young
adult initiates increased from 53,000 per year to 89,000 per year, and older adult initiates
increased from 28,000 to 54,000 for these combined time periods. Past year use estimates for
2002-2005 and 2009-2011 showed the same pattern: for youths, estimates were 43,000 and
39,000; for young adults, the estimates were 124,000 and 208,000; and for older adults, the
estimates were 207,000 and 361,000. Monitoring the Future (MTF) data indicates an increase for
young adults aged 19 to 28 and a decrease for 10th graders in rates of past year heroin use
between 2002 and 2011. MTF data did not indicate any changes among 8th and 12th graders
between these 2 years.3
Patients with heroin addiction should seek advice from health care providers who can guide them
with the most appropriate and safe treatment. Combined behavioral and medical therapies may
allow the patient to integrate back into mainstream society and lead a positive and productive life
http://www.drugs.com/illicit/heroin.html

Heroin in Unborn Babies

Unborn children of mothers addicted to heroin are at increased risk for

a premature or stillbirth, in addition to the complications they may face after

their birth. However, mothers addicted to heroin should not attempt to stop
heroin use without consulting a physician. To safely reduce the mother's
dependence on heroin, a physician may use methadone.

Heroin Addiction and Withdrawal After Birth

A baby that is exposed to heroin is at high risk for a number of

afflictions after birth, including hypoglycemia, intracranial hemorrhage,
premature birth, breathing problems and low birth weight. While in
withdrawal from the drug, the baby may experience tremors, seizures,
vomiting, moodiness, achiness, difficulty sleeping, fever and diarrhea.

Methadone Treatment for Mothers on Heroin

Methadone reduces or eliminates an addict's craving for heroin while

blocking the effects, thus allowing the user to transition from heroin
addiction to a drug-free lifestyle with less severe withdrawal symptoms. This
is especially important for pregnant mothers because the symptoms of
withdrawal may cause contractions of the uterus, initiating a premature birth
or even causing the mother to miscarry.

Infants born of mothers who were taking methadone during pregnancy

might experience withdrawal symptoms. These symptoms are similar to the
effects of withdrawal from heroin. They include sleeping problems, lack of
appetite, moodiness and fussiness, vomiting, tremors and fever.

Long Term Effects

It is not precisely known what the long-term effects of heroin and

methadone are on children. Many children born addicted to heroin and
methadone require special education classes in school, and some need to
repeat one or more grades. Whether this is the result of exposure to drugs or
for other reasons is unknown.
http://www.ehow.com/about_5042764_effects-heroin-methadone-unbornbabies.html

In Charleston County, deaths from opioid use, which includes heroin, rose
from 18 in 2013 to 33 in 2014. In Berkeley County, deaths doubled in that
same time frame from 10 to 20, and in Dorchester County, reported numbers
went from five to 11.
Robert Murphy, Drug Enforcement Administration special agent in charge
and senior agent for South Carolina, said most of the heroin in the state is
found in the Lowcountry, but a major concern is that the purity of the drug is
at an all-time high and the people using it are getting younger and younger.
Weve never seen it in this young of kids, Murphy said. And the young
people, they still have a full life ahead of them. When people are addicted to
heroin, theyre going to be addicted to a drug forever.
An undercover narcotics officer at the Charleston Police Department, who
could not give his name due to the nature of his work, said when he first
started about eight years ago, heroin was limited to certain areas of the city.
You used to have to search under the underpasses and you would find it
among the older, transient community, he said. Now its throughout the
city. Heroin use has transitioned into the younger, college-age students.
Theyre young, theyre educated and race doesnt matter.
Dr. Jeffrey Cluver at Medical University Hospital called it the suburban slide.
He said people in the suburbs got used to prescription pain pills but had to
turn somewhere after a nationwide crackdown. Cluver is an associate
professor of psychiatry, associate medical director for the Mental Health
Service Line at the hospital and director of the Psychiatry Hospitalists
Division.

EnlargeJoette Schulte lost her son, Johnny Schulte, due to his accidental heroin overdose.
A photo of him as a child hangs on her wall in her home in West Ashley. He said he felt like
he could conquer the world when he was high, but he never told me why he felt like he
needed to do that because he was so talented and so intelligent, she said. Grace
Beahm/Staff

Joette Schulte lost her son, Johnny Schulte, due to his accidental heroin overdose. A photo of him
as a child hangs on her wall in her home in West Ashley. He said he felt like he could conquer
the world when he was high, but he never told me why he felt like he needed to do that because
he was so talented and so intelligent, she said.

People distributing heroin in the cities recognized that demographic very quickly, he said.
It used to be a small number of heroin users, now its a different population and they are
inexperienced, so the risk for overdose is very high.

To stay competitive, dealers are constantly refining heroin to offer the best
high, Murphy said. Users often dont know what theyre buying, and someone

who has been injecting the same amount for a long period of time can easily
overdose from one batch to the next because the potency is different.
Thats why people are dropping dead with a needle in their arm, Murphy
said. Its very destructive.
Accidental overdose
Joette Schulte isnt afraid to tell people her son died of a heroin overdose.
She may be one of the few willing to speak candidly about her familys
experience, but she is certainly not alone in having to bury a loved one in the
Lowcountry too soon from substance abuse.
Her son, Johnny Schulte epitomized the 21st century heroin user. The 31year-old Mount Pleasant native was described as highly intelligent, and his
family said he excelled at anything he did. But he battled addiction for a long
time. He had been clean and sober for a year before he overdosed in a
Charleston motel March 19. He was supposed to start an internship at the
College of Charleston the next day. His family was left devastated and in
shock.
They described his descent back into drug use as rapid and said they didnt
see it coming because of how well he had been doing
They described his descent back into drug use as rapid and said they didnt
see it coming because of how well he had been doing.
The stigma doesnt bother me as much as the ignorance, his mother said.
Six of my friends came to his service, and I dont think any of them had ever
dealt with drug abuse. I think everything they heard that day from everyone
that spoke made them realize, This isnt what we think it is, and thats what
we want people to hear. I want more people to think our son wasnt a bad,
awful person.

EnlargeJohnny Schulte died of an accidental heroin overdose in March. His family is

trying to start a substance abuse support group for those who have been through similar
losses. Provided

Johnny Schulte died of an accidental heroin overdose in March. His family is trying to start a
substance abuse support group for those who have been through similar losses.

Schultes death was ruled an accidental overdose. Hes one of many who likely didnt realize
what they were getting into when they used for the last time, Murphy said.

A heroin overdose can cause someone to stop breathing and go into cardiac
arrest, which is most often what leads to death.
Murphy and Cluver said dealers are also enhancing heroin with other drugs,
creating a deadly cocktail right off the bat. Almost anything can be mixed
with heroin, but a common drug that officials are seeing is Fentanyl, a
powerful synthetic opiate similar to but more potent than morphine.
http://www.postandcourier.com/article/20151107/PC16/151109733/1177/heroinoverdose-deaths-casting-dark-shadow-on-lowcountry