How to Know If Your Child is Using Heroin?

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According to the National Institute of Drug Abuse, the greatest increase in heroin use is among individuals 18-25 years old. The most common trend leading to heroin use is prescription opiate abuse and addiction. Heroin is relatively cheap compared to the total cost (which often includes co-pays and office visit costs involved in prescription procurement) of supporting prescription drug addiction. When addicts are no longer available to support their preferred choice of drug, they often turn to heroin, which also provides an intense, rapid onset, state of euphoria, commonly known as a “high”. For parents of children with a history of prescription abuse or addiction, extra vigilance to signs of escalating drug use and behaviors is encouraged. Heroin is highly addictive because physical dependency develops quickly; outcomes of chronic heroin use are negative, financially and physically harmful, and possibly fatal.

Immediate Effects of Heroin
Understanding how heroin works is helpful in identifying some of its symptoms. Once heroin reaches the brain, it is converted to an opioid, morphine. The opioid binds to receptors in the brain that typically attract dopamine, the neurotransmitter responsible for pleasurable feelings.  Located in the limbic system, it has effects on hormone release, pain regulation, and one’s general sense of well-being. Histamine is released into the body, causing an overall “itchiness”, which can lead to a common behavior among users of “picking”, which tends to become a preoccupation and lead to scabs and scars, typically along the face and arms. The pain regulation is a result of the morphine opioid blocking pain messages sent through the spinal cord. The most dangerous effect heroin has is its reaction on the brainstem, which controls the autonomic nervous system, responsible for blood pressure, heart rate, and respiratory functions.

The immediate signs and symptoms of use are both physical and behavioral.

Screen Shot 2016-07-12 at 9.16.26 AM Long-Term Use of Heroin
boy-1149957_1920Long-term use of heroin has cumulative effects, meaning that the damage done to the body and the brain add up over time, compounding each other and have deleterious effects on the general health of the user. The constant imbalance of dopamine and the hormonal system of the body can sometimes lead to irreversible damage. In the brain, heroin causes decreases in white matter, the fingerlike extensions of the neuronal cells of the brain, known as dendrites. The dendrites are responsible for decision-making abilities, behavior regulation, and higher processing functions needed for problem solving, which is critical to coping with stress.

Tolerance to heroin develops very quickly; this tolerance leads to increasing consumption of the drug and the search for faster, routes of delivery. Typical users are introduced to heroin as a powdery substance that is “sniffed” or “snorted”, in a similar fashion to cocaine. Most users falsely believe that this route of administration is less damaging or addictive. Heroin is addictive regardless of how it is used. The progression of tolerance is dependency; these factors lead the user to exploring other methods of use, such as smoking and “shooting” into muscles or veins. Overtime, the effects of the quantity of drug and its route of administration have starkly visible physical and behavioral signs.

Screen Shot 2016-07-12 at 9.17.12 AM Drug Seeking Behaviors
Chronic use of heroin leads to various financial, social, and personal situations and changes. Most behaviors can be divided into two main categories: Evasion and Drug Seeking. Evasion behaviors occur before and during use. The user typically evades the company of previous social and personal circles of friends and acquaintances. The behaviors are focused on hiding intended use and intoxication. Users are often quick to defensiveness, especially when conversation is perceived to be accusatory or suspicious.  People, otherwise honest and known as trustworthy, may become suddenly untrustworthy and dishonest. Behaviors directed towards drug procurement are often the most evident and telling.

-Frequent unnecessary car trips

-“Doctor shopping”- having many doctors treating various ailments and pains with narcotic medications and/or antianxiety medications (used during withdrawal episodes to relieve angst)

– Frequent complaints of vague “aches and pains” while asking for prescription medications from others

– Borrowing of money for various reasons

– Selling of personal valuables, including televisions, cell phones, tablets, and jewelry

– Occurrence of sudden, often unsolvable problems ( including those relating to small crimes, such as shoplifting; and resulting in loss of job, deterioration of relationships, etc.)

Heroin use, other than insufflation, usually needs props, often referred to as “gear”.

Screen Shot 2016-07-12 at 9.17.23 AM *It is important to remember the very negative stigma of drug addiction, particularly to heroin. The stigma is apparent in much of the terminologies used when talking about heroin users, especially heavy users; expressions, such as “junkie”, along with negative media images of individuals struggling with heroin addiction increases the user’s shame. It is important, when confronting anyone suspected of using heroin, to remain calm and communicate a nonjudgmental, compassionate and supportive concern for his or her physical and mental well-being and safety. Understanding that most of the behaviors are due to physical tolerance and dependency can help create an empathic perspective. Establishing trust, perhaps by stating that you are not making a personal judgment, is one of the most important ways to encourage honesty and reduce denial. It is reasonable, however, to expect initial denial and dishonesty.

*Heroin use and addiction is a very serious medical problem. Physical dependency causes acute withdrawal symptoms upon sudden cessation. Severe withdrawal effects include nausea, vomiting, fever, profuse sweating, and possible seizures; the overall health of the user is typically compromised and is not able to withstand the additional physical and psychological stress of withdrawal. Seek medical attention right away, if you think your son or daughter is experiencing acute intoxication or withdrawal symptoms.

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