It usually takes a couple weeks to become physically dependent on opioids such as heroin. But the psychological addiction to the euphoria it produces can start sooner than that.
Heroin enters the brain to trigger euphoria and painlessness very quickly, but it also has a short half-life, so it leaves the body very quickly. Heroin can cause a lot of discomfort when it wears off. This means people who try heroin end up cycling through several doses, rapidly becoming addicted.
In the US, many people who struggle with heroin addiction become addicted to prescription opioid painkillers first and then turn to heroin. Help to overcome addiction is available through a combination of Medication-Assisted Treatment (MAT) and behavioral therapy.
Heroin Addiction: A Serious Problem in the US
Heroin is a strong synthetic opioid that is a major cause of addiction and related overdoses and deaths all over the world. It is highly addictive because it is so potent compared to the drugs it is related to, including morphine and opium.
Although heroin is now in Schedule I according to the Drug Enforcement Administration (DEA), it was once considered a “wonder drug,” as it works quickly and is very effective at reducing pain. However, this potent narcotic was soon the cause of a major opioid crisis, leading to some of the first drug legislation in the United States.
Although research has found that 80 percent of people who try heroin do not become addicted to it, more people than ever before in the US are struggling with heroin addiction. This is partially because heroin is abused instead of prescription narcotics, and it is less expensive to get than prescription painkillers.
Heroin’s Strength Makes It Very Addictive
Morphine was the first synthetic narcotic, and heroin was manufactured from morphine. When talking about the potency of narcotics, to understand their addictiveness and effectiveness, morphine is considered the standard. For example, oxycodone (the primary substance in OxyContin) is about 50 percent stronger than morphine, while hydrocodone (the primary substance in Vicodin) has the same potency as morphine. Heroin is between two and five times stronger than morphine, meaning it has a more intense euphoria and analgesia.
When heroin was first used as a prescription medication, it was lauded for its rapid effects, but the drug also leaves the body very quickly, meaning that the person taking it will feel like they need another dose soon. An article on heroin toxicity stated that the half-life of this drug is about 30 minutes, but that can depend on how the drug is consumed (injection, smoking, etc.), the tolerance and dependence of the individual using the drug, biological factors like body weight, and other differences.
Because heroin becomes bioavailable very quickly (binding to the opioid receptors in the brain within minutes after being taken) and is metabolized out of the body very quickly, it’s easy for people to become addicted to the drug. However, many people who currently struggle with heroin addiction turned to heroin after their prescription narcotics, either oxycodone or hydrocodone, were no longer available to them. For many people, the original substance abuse issue did not begin with heroin.
How Quickly Can You Become Addicted to Heroin?
It is commonly said that heroin is so addictive that it only takes one dose to cause a problem. Although this is an exaggeration, opioid drugs lead to dependence, tolerance, and addictive behaviors very quickly, and this includes heroin.
Medical studies suggest that, even with a doctor’s oversight, the body can develop a dependence on opioids after just five days of consistent use. Once you become physically dependent on the drug, you may crave more of it to get the original effects, even if those effects are for pain relief after surgery or an injury. You may begin taking more of the drug than prescribed, which is the first sign of compulsive behaviors associated with addiction.
A recent study examined how the brain processes naturally produced, or endogenous, opioids, which are a normal part of the brain’s response to certain stimuli, including pain. The study found that these natural opioids were released by the brain in certain high-stress scenarios, allowing a sense of connection to other people, a feeling of reward for attempting a stressful task, or the ability to take on a high-risk, high-reward task. Endogenous opioids inhibit fear and reduce sensitivity to adverse stimuli.
Although the study did not examine people who struggled with opioid use disorder, the researchers suggested that opioid misuse could lead to an extreme of these sensations, including an intense feeling of reward and extensive emotional relaxation. Over time, this leads to higher rates of depression while intoxicated as well as anxiety, stress, and insomnia when not taking opioids. The study highlights some ways that opioid addiction can make a person feel good and some emotional ways that they might feel bad when they attempt to quit taking the drug.
Because heroin can make someone feel so relaxed, happy, rewarded, and pain-free so quickly, and then so bad as it wears off, it makes sense that many people can quickly become addicted to this narcotic. Withdrawal symptoms are also so uncomfortable that many people relapse if they attempt to quit “cold turkey,” which increases the risk of overdose death.
Here are some withdrawal symptoms you might experience without help from medical professionals:
- Muscle aches and pains
- Yawning excessively
- Intense anxiety
- Stomach upset and nausea
- Abdominal cramps
- Dilated pupils and possibly blurry vision
- Rapid heartbeat
Withdrawal symptoms are risky because of the risk of relapse and overdose, and also the potential to become sick from dehydration. The right evidence-based treatment program can help you safely detox and change your behavior involving heroin.
Evidence-Based Heroin Addiction Treatment Helps
There are two primary focuses for heroin addiction treatment:
- Medication-Assisted Treatment (MAT): Buprenorphine and methadone are the most common medications prescribed to ease the body off physical dependence on narcotics like heroin. Buprenorphine-based medications can even be prescribed by a physician in an outpatient clinic, which has greatly improved access to addiction treatment.
- Counseling: Both individual and group therapy can help you identify triggers for substance use, feelings that lead to cravings or compulsive behaviors, and ways to manage cravings to reduce your risk of relapse. Cognitive Behavioral Therapy (CBT) is one of the most common approaches to addiction counseling, but other forms of therapy like Contingency Management can also apply.
Evidence-based treatment can be inpatient, outpatient, or a combination of the two. Remaining in treatment for long enough is important, so get help finding the right program near you.
- The Science of Addiction. Johns Hopkins Medicine.
- Drug Scheduling. United States Drug Enforcement Administration (DEA).
- History of Heroin United Nations Office on Drugs and Crime (UNODC).
- Can Using Heroin Once Make You Addicted? Drug Policy Alliance.
- See How Deadly Street Opioids Like “Elephant Tranquilizer” Have Become. (October 2017). Washington Post.
- Heroin Toxicity. (May 2021). StatPearls.
- Understanding the Epidemic. (March 2021). Centers for Disease Control and Prevention (CDC).
- The Neurobiology of Opioid Dependence: Implications for Treatment. (July 2002). Addiction Science & Clinical Practice.
- The Role of Mu-Opioids for Reward and Threat Processing in Humans: Bridging the Gap From Preclinical to Clinical Opioid Drug Studies. (April 2021). Current Addiction Reports.
- Opioid Withdrawal. (May 2021). StatPearls.
- What Are the Treatments for Heroin Use Disorder? (June 2021). National Institute on Drug Abuse (NIDA).