Heroin: Encyclopedia II - Heroin

The withdrawal syndrome from heroin (or any other short-acting opioid) can begin within 6 hours of discontinuation of sustained use of the drug: sweating, malaise, anxiety, depression, persistent and intense penile erection in males (priapism), general feeling of heaviness, cramp-like pains in the limbs, yawning and lachrymation, sleep difficulties, cold sweats, chills, severe muscle and bone aches not precipitated by any physical trauma, nausea and vomiting, diarrhea, gooseflesh (hence, the term "cold turkey"), cramps, and fever occur. Many addicts also complain of a painful condition, the so-called "itchy blood", which often results in compulsive scratching that causes bruises and sometimes ruptures the skin leaving scabs. Abrupt termination of heroin use causes muscle spasms in the legs of the user (restless leg syndrome), hence the term "kicking the habit". However, it must be noted that each person's symptoms can be unique. Users seeking to take the "cold turkey" (without any preparation or accompaniments) approach are generally more likely to experience the negative effects of withdrawal in a more pronounced manner.

Two general approaches are available to ease opioid withdrawal. The first is to substitute a longer-acting opioid such as methadone or buprenorphine for heroin or another short-acting opioid and then slowly taper the dose. The other approach, which can be used alone or in combination, is to relieve withdrawal symptoms with non-opioid medications.

In the second approach, benzodiazepines such as diazepam (Valium) ease the often extreme anxiety of opioid withdrawal. The most common benzodiazepine employed as part of the detox protocol in these situations is oxazepam (Serax). However, it is important to note that benzodiazepine use may also lead to a dependence, and many opiate addicts also abuse other central nervous system depressants including benzodiazepines and barbituates. Also, though unpleasant, opiate withdrawal seldom has potential to become fatal, whereas complications related to withdrawal from benzodiazepines, barbiturates and alcohol (such as seizures, cardiac arrest, and delirium tremens) can prove hazardous and potentially fatal. Many symptoms of opioid withdrawal are due to rebound hyperactivity of the sympathetic nervous system, and this can be suppressed with clonidine (Catapres), a centrally-acting alpha-2 agonist primarily used to treat hypertension.

Buprenorphine is one of the most recent opioid agonist/antagonist using for treat addiction. It develops tolerance a lot slower than heroin or methadone. And it has a withdrawal many times softer than heroin and other opioids. It can be admnistered up to every 24-48 hrs. And by itself has low overdose dangers. Buprenorphine is a kappa-opioid receptor antagonist too. That gives an anti-depressant effect, increasing physical and intellectual activity too.

Methadone is another μ-opioid agonist often used to substitute for heroin in treatment for heroin addiction. Compared to heroin, methadone is well (but slowly) absorbed orally and has a much longer duration of action. Thus methadone maintenance avoids the rapid cycling between intoxication and withdrawal associated with heroin addiction. In this way, methadone has shown some success as a "less harmful substitute"; despite being much more addictive than heroin, and is recommended for those who have repeatedly failed complete detoxification. As of 2005, the μ-opioid agonist buprenorphine is also being used to manage heroin addiction, being a superior, though still imperfect and not yet widely known alternative to methadone. Note that methadone, since it is longer-acting, produces withdrawal symptoms that are usually less severe and that appear later than with heroin, but may last longer.

Researchers have discovered two types of opioid antagonists: naloxone and the longer-acting naltrexone. These two medications block the effects of heroin, as well as the other opioids at the receptor site. Recent studies have suggested that the addition of naloxone and naltrixone may improve the success rate in treatment programs when combined with the traditional therapy.

The University of Chicago undertook preliminary development of a heroin vaccine in monkeys during the 1970s, but it was abandoned. There were two main reasons for this. Firstly, when immunised monkeys had an increase in dose of x16, their antibodies became saturated and the monkey had the same effect from heroin as non-immunised monkeys. Secondly, until they reached the x16 point immunised monkeys would substitute other drugs to get a heroin-like effect. These factors suggested that immunised human addicts would simply either take massive quantities of heroin, or switch to other hard drugs, which is known as cross-tolerance.

There also is a controvertial treatment for Heroine addiction based on an African drug called ibogaine. Many people travel abroad for ibogaine treatments that generally stop the addiction for 3 months or more.