Matt S

Heroin Overdose Symptoms, Effects & Treatment The use and misuse of opioids has gained a lot of attention in the United States, particularly because of an unfortunate rise in life-threatening overdoses. Dating back to the late 1990s, there has been a staggering increase of over 500% in the number of drug overdose deaths. Opioids are involved in a majority of these overdoses in what has widely been considered an opioid overdose epidemic. The number of overdoses involving opioids like heroin has risen more rapidly in the last decade and has continued to rise in recent years. The effects of this on families and communities can be devastating. Understanding more about what happens during a heroin overdose, the symptoms, and the ways you can help has the potential to save lives. What is a Heroin Overdose? Heroin is a potent opioid with a chemical structure very similar to morphine. As heroin is processed in the body, morphine is among the active metabolites produced. Heroin and its metabolites interact with opioid receptors in the brain producing various effects, including relief of pain, euphoria, and the potential for respiratory depression. Heroin is often injected intravenously, allowing for peak levels in the bloodstream to be reached within minutes. As opioid receptors are flooded, there is a dose-dependent potential for opioid toxicity. When toxicity occurs, respiratory depression becomes the primary concern. The term respiratory depression refers to the body's failure to produce the normally automatic signals to support breathing, which can lead individuals to stop breathing. Respiratory depression is what makes an overdose deadly. How Fentanyl Contributes to Heroin Overdose In recent years the increased availability and practice of lacing or even replacing street drugs with fentanyl has added tremendous risk for individuals using heroin. Fentanyl is one hundred times more potent than morphine, so relatively small doses can be dangerous. This has been a point of frustration — if fentanyl is so deadly, why are dealers using it in their products? Unfortunately, the practice has the potential to continue due to several factors. Because of the smaller quantities of fentanyl needed for effect, it is cheaper to produce and easier to smuggle across borders. In some instances, fentanyl has been used because heroin was in short local supply. These products are also highly addictive. Each of these factors provides incentives to dealers to continue using fentanyl in their products, contributing to the risks of overdose. While fentanyl is available by prescription, and these sources provide a consistent, reliable product, most of the fentanyl incorporated in products sold as heroin is produced illicitly. There are no quality control measures to ensure the correct dose is delivered and no tests to ensure the product is pure. Because of the potency of fentanyl, inadvertently taking a higher dose than intended produces a much higher risk of overdose. Heroin Overdose Statistics The national trends in opioid overdose rates highlight the dangers of fentanyl and synthetic opioid involvement in the illicit market and the impact this has on heroin users. In general, the rates of heroin overdoses in and of themselves are not increasing, but the rates of overdoses involving synthetic opioids are rising sharply. On a national level, the number of overdose fatalities involving heroin peaked in 2016 and 2017. Despite some reductions in recent years, the overall rates involving heroin are still 368% higher than in 1999. The number of overdose deaths involving any opioid continues to rise sharply, with synthetic opioids like fentanyl being a major contributor. These issues are pervasive across all communities in the United States but have a comparatively larger impact in the Midwest and Northeast. Many states in these regions continue to experience disproportionate growth in the involvement of synthetic opioids, with levels often accounting for 70% or more of the reported deaths. Large cities and areas with lower income are affected at higher rates, but ultimately, all communities see these increases in overdoses. Symptoms of Heroin Overdose The symptoms of a heroin overdose align with the standard signs of opioid overdose. Some of these signs include: ● ● ● ● Drowsiness or loss of consciousness Shallow, labored breathing Pinpoint pupils Cyanosis, e.g., fingernails or lips turning blue or white Cyanosis is a result of inadequate oxygen levels in the bloodstream. In the case of heroin or opioid overdose, the body is not receiving enough oxygen because of respiratory depression. The term respiratory depression refers to difficulty breathing. Heroin Overdose Causes and Risk Factors Due to the relatively short half-life of heroin, active use often leads to dosing several times per day and the potential for a more rapid buildup of tolerance. An inherent problem is that the tolerance to euphoric effects may develop more quickly than the tolerance to the effects of respiratory depression. The longer heroin is used, the more likely higher doses are required and the more likely an overdose may occur. The introduction of more synthetic opioids like fentanyl in the market has also produced increased risk. Unfortunately, these products can be consumed without the knowledge of the user. Dosing variability and higher potency introduce a higher risk of accidental overdose. What to Do If Someone Overdoses on Heroin Finding someone you suspect may be overdosing can be a harrowing experience. Taking time to further familiarize yourself with the signs of overdose and formulating a plan ahead of time can help. Your ability to respond can save lives. Here are the steps to follow: ● ● ● Call 911 if any of these are occurring: ○ Face becomes clammy or pale ○ Unresponsive; limp body, unable to awaken or speak ○ Gurgling noises or vomiting ○ Lips or fingernails are blue, white, or purple ○ Breathing is labored or stops ○ Heartbeat has slowed or stops Provide naloxone, if able If you suspect the individual is no longer breathing, or the heart has stopped, perform CPR until paramedics arrive. Naloxone is now available without a prescription as a part of a nationwide effort to increase access to the medication. Similar to someone managing severe allergies carrying an Epipen, having a form of naloxone such as Narcan on hand acts as a safety net and can potentially save the lives of loved ones or community members. The medication is helpful and useful to have on hand regardless of whether an opioid was prescribed or is being used in other capacities. Heroin Overdose Treatment Upon arrival at the emergency department, medical management of a heroin overdose follows the basic tenets of opioid overdose management: ● ● ● ● Maintaining oxygen levels, often with the use of ventilation Identifying and managing any other substances that may also be present, as needed Management of withdrawal symptoms Psychosocial support for the management of withdrawal and opioid addiction Initial care primarily focuses on navigating the effects of respiratory depression and ensuring adequate oxygen levels are maintained. From there, supportive care is provided depending on individual needs. Heroin Addiction Treatment Longer-term psychological and social support in the form of treatment plans utilizing individualized therapy, group settings, and medications becomes the focus after initial overdose treatment. These are also the forms of treatment helpful for individuals who may not have overdosed but are seeking comprehensive help with managing heroin use. With quality, nonjudgmental support, the path to recovery becomes more navigable. Residential programs are available at the Recovery Village Kansas City Drug and Alcohol Rehab facility. If you or a loved one are concerned or struggling with heroin use, recovery advocates are available to help — reach out for more information today! Resources 1. Centers for Disease Control and Prevention. "Understanding the Opioid Overdose Epidemic." August 2023. Accessed September 27, 2023. 2. Milella, Michele Stanislaw; et al. "Heroin and its metabolites: relevance to heroin use disorder." Translational Psychiatry, April 2023. Accessed September 27, 2023. 3. Baldo, Brian A.; Rose, Michael A. "Mechanisms of opioid-induced respiratory depression." Archives of Toxicology, April 2022. Accessed September 27, 2023. 4. Treillet, Erwan; Laurent, Sophie; Hadjiat, Yacine. "Practical management of opioid rotation and equianalgesia." Journal of Pain Research, October 2018. Accessed September 28, 2023. 5. Ciccarone, Daniel. "The Rise of Illicit Fentanyls, Stimulants and the Fourth Wave of the Opioid Overdose Crisis." Current Opinion in Psychiatry, July 2021. Accessed September 28, 2023. 6. Mattson, Christine L.; Tanz, Lauren J.; Quinn, Kelly; Kariisa, Mbabazi; Patel, Priyam; Davis, Nicole L. "Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths --United States,-." Morbidity and Mortality Weekly Report, February 2021. Accessed September 28, 2023. 7. Shiels, Meredith S.; et al. "Premature mortality from all causes and drug poisonings in the USA according to socioeconomic status and rurality: an analysis of death certificate data by county from 2000-15." The Lancet Public Health, February 2019. Accessed September 28, 2023. 8. Parthvi, Rukma; Agrawal, Abhinav; Khanijo, Sameer; Tsegaye, Adey; Talwar, Arunabh. "Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit." American Journal of Therapeutics, May 2019. Accessed September 28, 2023. 9. National Library of Medicine. “Heroin Toxicity.” May 2023. Accessed September 27, 2023. 10. Substance Abuse and Mental Health Services Administration. "Opioid Overdose." March 2023. Accessed September 28, 2023. 11. Substance Abuse and Mental Health Services Administration. "Naloxone." September 2023. Accessed September 28, 2023. 12. Powell, Heather; Peters, Golden L. "Managing Opioid Overdose in the Hospital Setting." U.S. Pharmacist, March 2019. Accessed September 28, 2023.