Heroin has long been the primary drug associated in the American mind with drug abuse, thanks in large part to Hollywood. In fact, it lags far behind marijuana and cocaine as a drug of concern in the United States, but its effects are so devastating that the heroin threat should never be discounted. With nearly a million chronic heroin users in the U.S., it accounts for 11% of emergency room admissions for drug abuse, and 335,000 people were treated for heroin addiction in 2006. There is no good way of estimating how many more did not seek help.

Heroin is an illegal drug with no medical use, derived from morphine and sold on the street. It is available in every state, in nearly every community. Heroin abuse happens every time someone uses it; heroin addiction comes when a user becomes dependent on the drug, which happens very quickly with regular use. Heroin is highly addictive, a synthetic opiate that works upon the central nervous system and the brain in scientifically measurable ways.

Breaking an addiction to heroin is not a matter of simply stopping the drug or even of going through detoxification to get rid of the drug residue in the body. When injected intravenously, heroin binds to the opioid receptors in the brain, creating an intense euphoric “rush” within 7 or 8 seconds. One of the reasons that heroin is so addictive is because it enters the brain so rapidly, and produces such an intense “high.” Unfortunately, however, the high is accompanied by less pleasant effects: drowsiness, impaired mental function, slowed heartbeat and respiration, sometimes fatally so. And because continued heroin abuse leads to the body building up a tolerance to the drug, it takes more and more of it to produce the desired rush, which leads inevitably to a heroin addiction. The National Institute on Drug Abuse (NIDA) has determined that all forms of taking heroin: intravenous and intramuscular injection, sniffing, and smoking, are addictive.

Once addicted to heroin, the user becomes entirely focused upon obtaining and using the drug. There is no other priority to his or her life. Strong and determined intervention is required to convince an addict to seek treatment, and recovery from heroin addiction is a long process. Per a NIDA research report on heroin, “The best documented drug-free treatments are the therapeutic community residential programs lasting 3 to 6 months.” Treatment for heroin abuse and addiction involves detoxification, counseling, and behavior modification to avoid relapse, with long-term continuing emotional support to overcome the powerful psychological dependency that heroin brings with it.

Detoxification alone cannot overcome a heroin addiction. It manages the intense cravings and physical discomfort of withdrawal, but it does not address the emotional craving for the drug. Methadone is commonly used to block heroin’s effects and eliminate withdrawal symptoms, but it is itself a synthetic opiate, and addictive when misused. Buprenorphine, a newer drug with less risk of addiction, is now being used as an alternative to methadone. Doctors and drug treatment facilities using it must be state-certified to do so. People seeking treatment for heroin abuse should start with an evaluation and referral from their doctor to a qualified program.