Why is heroin so addictive?
There are a lot of opioids out there. The majority of available opioids and the ones that get abused most often are pain pills. There was a time when Vicodin was the number one prescribed medication. And, it was the number one prescription drug of abuse. Was Vicodin abused so much because it was more addicting? No. People took Vicodin to get high because it was easier to get ahold of compared to other drugs. Drug seekers could find it in medicine cabinets, and they could get doctors to prescribe it.
Yet, if you walk into a Narcotics Anonymous meeting and sit for an hour to listen, you will not hear many Vicodin addicts sharing their stories. Instead, you will hear a lot about heroin use. Why is it that so many people in recovery ended up addicted to heroin? One of the main reasons is that heroin is so addicting. While quitting a Vicodin or Codeine addiction is not easy, getting off of heroin is significantly more difficult. But why is heroin so addicting? What does it mean for it to be highly addictive?
Why is heroin so addictive, biologically?
There is an area of the brain called the nucleus accumbens. The nucleus accumbens is the reward center of the brain, also known as the pleasure center. In this small region of the basal forebrain, a complex interaction of dopamine, neurons, endorphins, and opioid receptors make this small section of the brain very powerful. Learning new habits, remembering impactful events, and even getting to sleep are some of the jobs of the nucleus accumbens. Motivation starts here, as well. Imagine the experiments of Ivan Pavlov, ringing a bell with dinner to train dogs to salivate. Pavlovian reinforcement and learning a habit, good or bad, occurs in this part of the brain. Opioid use disorder and the pattern of heroin addiction start here as well. Heroin and other opioids short circuit the system, lighting up opioid receptors and causing copious amounts of dopamine to pour out, soaking the surrounding neurons, stimulating feelings of well-being and pleasure. Street heroin has an extra kick above what most opioids can do here. Heroin has a metabolite called 6-MAM (6-monoacetylmorphine) that is super addictive. In some of the more potent heroin, pure 6-MAM is already in the mix before it enters the human body. There is even a rare form of heroin out there known as “black tar heroin,” which is nearly pure 6-MAM. As you can imagine, the pleasurable high that a drug user gets from black tar heroin is beyond what drug users get from their run-of-the-mill pain pill. Why is heroin so addictive, biologically? It is, in part, due to 6-MAM.
Is the way people use heroin part of what makes it more addictive?
In addition to the unique effects on brain chemistry, heroin is also more addicting because of how people use it. When a drug is delivered to the brain faster, the user gets high more quickly. It is like a car going from zero to sixty in three seconds. One moment, you are in a healthy state of mind, and a few seconds later, you feel a rush of intense high that takes over your entire world. This heroin rush is a big part of what makes it so addicting. If you inject heroin in a vein, it gets to the brain quickly, crossing over the blood-brain-barrier in seconds. Shooting up gets people high fast. Snorting powdered heroin also works reasonably quickly. Another way that people use heroin is to smoke it off of a piece of foil. Smoking heroin with a plastic straw, aluminum foil, and a lighter is known as “chasing the dragon.” It got this name because of the thick smoke appearing to be like a dragon’s fiery breath. Additionally, skin popping and even suppository use occur, which means people insert heroin into their rectum to get high. Inserting heroin into the anus is also known as “plugging heroin” or boofing, and it shows the lengths people will go to to get high when they are addicted to heroin.
Does heroin come from bagel poppy seeds?
Heroin does indeed originate in the poppy. Poppies are beautiful flowers that fill fields with color. The seeds, toasted on the surface of a bagel, add flavor to a delicious breakfast. However, poppy seeds are also the source of opium, a drug used for thousands of years. Opium is the original opioid, or to be precise in older terminology, the original opiate. If you eat a lot of poppy seeds from a bagel, you might test positive for heroin. To be safe, you may want to avoid eating a poppy seed bagel before going in for a drug test! Yet, you will not get high from eating a bagel, other than the good feeling of eating the starchy refined carbs that make up a delicious bagel. Why is heroin addictive, and the poppy seed itself is not? It takes a lot of poppies and refining the components of the opium extracted from them to make heroin.
What about fentanyl? Is fentanyl more addicting than heroin?
You may have heard a lot about fentanyl in the news. Until the COVID-19, coronavirus pandemic broke out; fentanyl was one of the biggest headline news stories. Fentanyl is a highly potent synthetic opioid. It has a potency that is about 80 to 100 times the potency of morphine. Compare this to heroin that is only four times as potent as morphine! Of course, drug dealers do not merely replace heroin with fentanyl, milligram for milligram so that they can get 20 times higher. It doesn’t work that way. If a drug user takes too much of an opioid, including heroin or fentanyl, they can quickly go into a state of respiratory depression. What this means is that their breathing slows down and can even stop. Respiratory depression is the mechanism of death from heroin or fentanyl overdose. So, is fentanyl more addicting or less addicting compared to pure heroin? It’s hard to say. It may even depend on the individual drug user. Currently, there is little, if any, pure heroin out on the streets in the US. Nearly all heroin contains fentanyl. Many heroin supplies turn out to be pure fentanyl. Because of the high potency of fentanyl, drug dealers have more difficulty working with it in clandestine drug labs. As a result, drug batches can have uneven distributions. When a drug user shoots up or snorts fentanyl-tainted heroin, if the potency is higher than what they are used to, they can easily overdose.
Does fentanyl come from hospitals?
You may have overheard doctors or nurses talking about using fentanyl as part of your anesthesia if you have had surgery. Hospitals use fentanyl regularly as a potent injectable opioid for controlling severe pain that can occur during operations. Fentanyl is also an ingredient in pain patches (Duragesic) and pain lollipops (Actiq). These are typically known as cancer pain products. While a drug user can get high from pharmaceutical fentanyl, hospitals are not the source of fentanyl on the streets. Drug dealers are certainly not breaking in and robbing neighborhood hospitals to get the cheap fentanyl that they are mixing into their heroin to save money. The fentanyl on the streets, sold as heroin, comes from much further away. A variety of synthetic fentanyl analogs, meaning drugs that are not chemically the same as FDA-approved fentanyl, are being shipped in from China. Drug dealers are using the US postal service to receive packages of Chinese fentanyl. While there is also Mexican fentanyl, it may ultimately come from China.
Is Chinese fentanyl a form of chemical warfare?
Interestingly, there is evidence that much of the fentanyl from China originates from in or around Wuhan. As you know, it is the same place where COVID-19 originated. You might almost conclude from the recent events that China, or at least Wuhan, is at war with the US, attacking us with viruses and drugs. Is China engaging in chemical and biological warfare with the US and the world? Probably not, but it does sometimes seem that way from the news headlines.
What makes heroin addictive to creative, intelligent people?
You may or may not have noticed; many heroin addicts are highly creative and intelligent individuals. How many times have we read another headline about a celebrity overdosing on heroin? We shake our heads, sad over the lost potential of another creative genius. Why is heroin so addictive to creative people? I find this to be one of the fascinating subjects when it comes to opioid addiction and addiction in general. Are smart people drawn to heroin and other drugs, like flies attracted to bright light? It is more likely that heroin and creative geniuses interact like flies on flypaper. Many people try drugs in modern society. Drug experimentation is rampant.
What makes heroin addictive to rats more so than humans?
Fortunately, most people who experiment with heroin don’t like it much. They might get high and enjoy it, but they eventually move on and put the heroin aside. Addiction is a complex chemical, biological, learned behavior that starts in the nucleus accumbens, as we were discussing above. The reward center of the brain is short-circuited and made to believe that heroin is a good thing and necessary for survival. When rats get shot up with heroin in lab experiments, they cannot stop going back for more. While rats are intelligent creatures that dream and have emotions, they do not have the facilities to fight addiction. However, the human brain is far more powerful. A person who starts to get caught up in heroin addiction can take a step back and say, “this is not a good habit. I’m going to need to fight this one and get back on track.” For many people, this works out fine with little intervention. So going from the simple rat brain to the highly complex human brain, high-level reasoning and planning can make all of the difference. Yet, when the human brain crosses the threshold into creative genius, something else happens.
Why is heroin so addictive to people who have the highest potential for success in life?
Addiction uses our best resources against us. It gets behind our usual psychological defenses and speaks to us in our heads with our voice. When it comes to a smart, creative person, the resources that addiction can use against them are significant. Such a person can convince themselves that heroin use is an excellent choice for them, even when it is not. Heroin addiction is a trap that catches intelligent and creative people in tragic addiction-fueled lives. For those people who can overcome their addiction, they have the potential to have successful lives. They can use their creative abilities to make their lives and the lives of others far better.
Is it possible to overcome heroin addiction?
The best treatment for heroin addiction in the US at this time in history is medication-assisted treatment or MAT. MAT uses one of three drugs, methadone, buprenorphine, or naltrexone. While these drugs have many differences, we can simplify it down to when the patient can safely start the treatment drug. For methadone, treatment begins right away, even the same day the user quits heroin. Buprenorphine, or Suboxone, usually will start within 24 hours of the last opioid use. Naltrexone treatment begins in about a week after the final opioid use. Naltrexone can treat alcohol addiction, as well. Because of the timing, naltrexone is ideal for use in a residential rehab setting. All three treatment medications have a role to play in opioid addiction treatment for different patients. In addition to medication, therapy is an essential component of treatment.
Is heroin the most addictive drug on earth?
Interestingly, heroin is not the most addicting drug. Nicotine, the drug found in cigarettes, is known to be the most addicting drugs to humans. Methamphetamine is likely the second on the list. Heroin is up there in the top five, but it is not the most addicting drug. So, why are we so concerned about heroin and opioid addiction? In recent years, heroin and fentanyl overdoses have increased dramatically. That is why they call it an opioid epidemic. While we all go about our daily lives, thousands of heroin users are losing their lives in their homes, in their cars, and back alleys. These are not expendable people. These are real people who are no different from any of us, other than in their effort to cope with life; they found themselves addicted to heroin.
What is the path to heroin addiction?
How does someone find heroin? How does someone end up addicted to heroin in the first place? One way is through an acute or chronic pain issue. When people take prescribed pain medication, there is a small percentage of people who will get addicted and dependent on it. Many of these people predisposed to addiction fall into the highly creative and intelligent category I described earlier. People who become addicted, when they can no longer get the pills from their doctor, may turn to street dealers for their supply. Pain pills have a high price tag on the black market. When an opioid user buys pills from a drug dealer, at some point, the dealer may offer heroin as an alternative. It might be cheaper, or it might be all that is available at the time. Why can’t the person just say no to heroin? When a person takes opioids and runs out, they can get severely ill with opioid withdrawal symptoms. When a person is in withdrawal, they may not think clearly about consequences; they just want to feel better. And, the dealer will explain that they can snort heroin powder rather than injecting it. Many people think that snorting is not as bad. It seems safer and more respectable compared to shooting up with a needle. So, now you can see the pathway from a patient prescribed Percocet to a heroin addict on the streets.
Why is heroin so addictive and hard to overcome? Front door delivery has made things even more difficult.
It is not so far-fetched to imagine regular people getting hooked on heroin. And, heroin dealing has changed a lot in recent decades. You used to have to go into a dangerous neighborhood or meet your dealer on the side of a highway to get heroin. Now, heroin dealers show up at your front door with just a simple text message. Heroin dealers are on Facebook, Instagram, Snapchat, and of course, on the Dark Web. Heroin dealers even use Uber to deliver drugs to customers.
What is the first step in overcoming heroin addiction?
While heroin is highly addictive and dangerous, it is not as hard to get off of it as you may think. MAT works very well. People transition to feeling better and functioning normally in a short time. You might be surprised how easy it can be to put heroin behind you for good. So, the first step in overcoming heroin addiction may be as easy as making an appointment with your doctor. Or, you could even go straight to the ER. ER doctors are now training to start patients on Suboxone during a visit to the hospital. They then refer them to a local doctor to continue treatment. Some hospitals have complete programs to maintain care long-term. If you are ready to quit heroin, it is possible to take the first step to get help right now.