Chapter 3
Consequences of Heroin Addiction

Though the price of street heroin in the United States has never been lower, the ultimate costs of heroin addiction remain extremely high. With heroin addiction comes a wide range of consequences, not only for addicts themselves but also for their friends and families, as well as for the societies in which they live.

The Health Consequences for Addicts

The health consequences for heroin addicts are numerous, and many of them are extremely serious. The most serious threat of all is the ever-present possibility of taking a fatal overdose of the drug. When heroin overdose occurs, the drug's depressant effect on the respiratory system prevents the body from getting a sufficient amount of oxygen, and the user falls into a coma. The user's respiratory system continues to slow to the point where the body simply loses its impulse to breathe. As no oxygen whatsoever reaches the bloodstream, the user goes into cardiac arrest and dies. With the purity level of street heroin currently ranging from zero to 90 percent, it is extremely easy for users to underestimate the strength of a new batch of the drug and overdose on it.

The purity level of a given batch of heroin is dictated by how much "cut" (additive) has been mixed with the drug by dealers who seek to increase their sales profits. Since users have no way of knowing what substances have been added to heroin, additional danger lies in the possibility that poisonous agents are present in the drug. Common heroin additives include relatively harmless substances such as sugar, powdered milk, quinine, and cocoa; however, varying amounts of highly toxic substances such as powdered soap and kitchen cleanser frequently appear in street heroin as well, and can cause death by poisoning. "Heroin," notes the Do It Now Foundation, "is the end product in an intricate chain of manufacture that spans continents and involves dozens of separate operations and uncounted greedy middlemen."¹⁷ Thus, it is virtually impossible to tell how pure street heroin is, or, for that matter, whether the substance contains any heroin at all, simply by looking at it.

Additional risk of overdose lies in the inadvertent purchase of synthetic substances that are passed off as heroin. This so-called designer heroin contains no actual heroin whatsoever, but is in reality either fentanyl or meperidine—both synthetic drugs made in makeshift laboratories. Though indistinguishable from heroin in appearance and taste, fentanyl can be hundreds or even thousands of times stronger than pure heroin. The National Institute on Drug Abuse cautions that some fentanyl purchased on the street is so lethal in strength, "users have been found dead with the needle used to inject the drug still in their arms."¹⁸ In some instances, meperidine has caused brain damage and ultimately paralysis in users.

Physical Addiction

The main concern of heroin addicts, however, isn't to avoid lethal overdose or poisoning. Rather it is to avoid the most obvious and immediate health consequence of addiction: the sickening "withdrawal" symptoms that begin anew every time a heroin dose wears off. Depending on how severe the physical addiction is, a heroin addict in withdrawal will experience flulike symptoms that, among others, include sneezing, running nose and eyes, alternate bouts of profuse sweating and cold flashes, muscle and bone pain, abdominal cramps, diarrhea, vomiting, and muscle spasms. Heroin addicts therefore crave heroin not only to feel its pleasure, but also to avoid the pain and sickness that come with not getting a fix every few hours. This all-consuming nature of heroin addiction is summed up by poet and longtime heroin addict William S. Burroughs: "Junk [heroin] is not . . . a means to increased enjoyment of life. Junk is not a kick. It is a way of life."¹⁹

A person begins to experience withdrawal-related physical symptoms after a few weeks of steady heroin use. Though medical science has long known that heroin addiction and its withdrawal symptoms involve the central nervous system in some way, brain researchers from Johns Hopkins University made a remarkable discovery in 1972 that lent tremendous insight into the nature of physical addiction to heroin and withdrawal from the drug.

These researchers found that the human brain's nerve cells, known as neurons, have receptor sites that seem specifically designed to feel the effects of heroin and other opiate drugs. They found that opium molecules fit into these receptors like a key fits into a lock, and cause the nervous system to relieve pain and create feelings of euphoria. This was a puzzling discovery for these researchers, since it seemed extremely unlikely that nature would provide the human brain with receptors designed for the molecules of a specific type of plant. They suspected that there must be another purpose for these receptor sites.

Endorphin Research

Researchers later discovered that the body naturally manufactures chemicals called endorphins to maintain a general sense of well-being in humans and to regulate certain bodily functions. When the body experiences pain or stress, it releases large quantities of endorphins to kill pain. Additional research revealed that opium and human endorphins are identical to one another in their molecular makeup and, therefore, in their effects on the body. Thus, not only is heroin able to perfectly mimic the effects of endorphins, but since the drug's molecules are usually present in far greater quantities than those of naturally occurring endorphins, its effects on the body are considerably stronger.

Endorphin researchers have also found that as a user's body attempts to adapt to the near-constant presence of heroin, significant chemical and physical changes take place in the brain. The brain senses an overabundance of what it thinks are endorphins, and attempts to restore balance to itself by shutting down its own production of real endorphins. It continues to do so whether or not the addict is currently high on heroin. The addict's body must therefore depend entirely on heroin to regulate the various bodily functions that are no longer regulated by endorphins. When there is no heroin present, these functions cease to operate properly, thereby triggering the wide variety of symptoms associated with withdrawal.

Another way that the heroin addict's body attempts to restore balance to itself is by making its various systems, including the nervous system, resistant to the effects of heroin. This resistance to the drug's effects, known as "tolerance," steadily increases for as long as the addict continues to use the drug without interruption. As an addict's tolerance increases, so does the amount of heroin needed to produce the drug's original effects. The severity of withdrawal symptoms likewise increases. Tolerance to heroin increases extremely quickly and causes the need for dosages that would easily cause lethal overdose in first-time users. For example, while first-time users may need as little as two to five milligrams to get high, long-term addicts typically need hundreds of milligrams a day just to take the edge off their withdrawal symptoms. (An addict never grows immune to overdose, however—some amount of heroin will always prove fatal.)

The Consequences of Long-Term Heroin Use

The Drug Abuse Research Center at the University of California at Los Angeles began a study in 1964 in which 581 male heroin addicts in their early twenties were monitored over the course of thirty years in an effort to determine the survival rate and long-term physical effects of heroin addiction. The results of the study, published on Doctor's Guide Online, were alarming. After thirty years, the study showed that 284 of the original 581 participants—more than half—had died. Of these deceased participants, 22 percent died of overdose, 15 percent died of chronic liver disease, and 20 percent died from homicide or suicide. Many of the remaining 43 percent died of either cancer, cardiovascular diseases, or AIDS. Of the 297 participants who were still alive after thirty years, 43 percent were still using heroin.

Once addiction has progressed to a relatively high point of tolerance, most addicts switch to intravenous heroin injection to get the strongest possible dosage, and this form of drug use exposes them to an enormous array of illnesses. "To know . . . an injecting drug user as a patient," explains Dr. Gabor D. Kelen of Johns Hopkins University School of Medicine, "is to know medicine, because they pretty well get just about every possible medical condition known to man."²⁰

Sharing Hypodermic Needles

One reason that heroin addicts suffer from so many illnesses is that they, like other intravenous drug addicts, share hypodermic needles, thereby spreading infectious diseases. Shared needles transmit disease so easily that an estimated 90 percent of all intravenous drug users in the United States have some type of infectious disease. In 1996 the Centers for Disease Control and Prevention declared that the sharing of drug needles accounted for "about one-third of all new cases of AIDS in the U.S. each year."²¹ A high percentage of addicts who develop AIDS also contract tuberculosis, an infectious disease that can attack lung tissue, lymph glands, or other parts of the body.

Other potentially fatal diseases widely transmitted by the sharing of needles include the hepatitis B virus (HBV) and the hepatitis C virus (HCV), both of which cause serious damage to the liver. "Of those addicts who . . . inject their drugs intravenously with a needle," explains James W. West of the Betty Ford Center, a treatment facility for drug addiction founded by the former First Lady,

about 80 percent have hepatitis B and at least 50 percent also contract hepatitis C. There is a virtual epidemic of this viral liver infection among IV drug users. . . . Some who become infected progress to full-blown chronic active hepatitis with eventual cirrhosis, while others develop a chronic carrier state that makes one prone to cancer of the liver. Most, however, will recover from the condition if they stop re-infecting themselves with dirty needles.²²

Additionally, all sexually transmitted diseases, including gonorrhea, syphilis, and herpes, can be contracted through the sharing of needles. The high incidence of prostitution among the addict community contributes even further to this high infection rate among intravenous drug users.

Chronic Constipation

A particularly unpleasant health condition that virtually all heroin addicts suffer is chronic constipation. Though opium provides relief for an upset stomach, heroin intensifies opium's soothing properties to the point of impairing the efficiency and function of the small intestines, resulting in chronic constipation for heroin addicts. This backup in the small intestines causes severe pain and tenderness in the addict's lower abdomen and colon, and can also cause related physical discomforts such as headache and backache. Additionally, since the bacteria and toxins that should be eliminated remain instead in the lower intestines for a prolonged period of time, some of them are reabsorbed back into the body, which further weakens the immune system and places the organs, particularly the liver, under additional stress. Further, the addict's body does not develop tolerance to this effect of heroin—it is a constant for as long as the physical addiction exists.

The range of infections that intravenous drug users commonly suffer is not limited to those that can be contracted by sharing infected needles, however. "The very act of injecting foreign substances, in particular heroin," notes Dr. Kelen, "depresses the immunity of the patient or user and so they are open to infections."²³ Among those noncontagious infections that intravenous drug users widely experience are skin infections at the site of injection, which can result in skin ulcers, abscesses, fungal infections, botulism, tetanus, stroke, destruction of lung tissue, and infection of the heart valves and linings. Additionally, long-term intravenous drug use often results in collapsed veins, arthritis, and other related illnesses.

Compounding these and all other heroin-related physical illnesses are the poor dietary and sleeping habits that addicts generally practice. Further, the ailments that heroin addicts suffer tend to go untreated, because the drug's pain-relieving properties conceal symptoms of real physical illness. Even when addicts are aware of their ailments, they are often afraid to seek medical help for fear of forced withdrawal and incarceration.

Psychological Addiction to Heroin

Addiction to heroin sets in motion very damaging and complex psychological consequences for the addict, in addition to its harmful physiological consequences. Like many other drug addictions, heroin addiction halts the emotional development of users at whatever developmental stage their addiction began, and diminishes existing emotional coping skills. Since emotional discomfort, as well as physical pain, is relieved by heroin use, the drug can initially make experiences that might otherwise be unpleasant more enjoyable. However, the more often heroin is used for this purpose, the less able the user is to cope with such situations without the drug. One recovering heroin addict states:

[The addict] finds that certain events are not merely better on the drug but cannot be faced without it: a visit to the bank manager, a job interview, a meal with his parents. Each time he surrenders to the temptation, this feeling increases so that the next time it is harder to resist. Even his increasingly brief glimpses of the trap into which he is walking serve, perversely, not to strengthen his resolve but to weaken it: he wants the escapism of heroin to forget what he is doing.²⁴

Additional evidence of psychological addiction lies in the overwhelming depression that accompanies the physical discomfort of withdrawal, as well as in the acute anxiety that stems from the knowledge that heroin, the cure for the sickness, is available, if only some way can be found to obtain it. Obtaining the drug becomes the overriding ambition of the addict's life, and no amount of effort toward this end seems irrational or excessive. Steven Tyler, lead singer of the rock band Aerosmith, recalls the days before he and his bandmates went into recovery for heroin addiction: "We used to spend all day to cop [obtain the drug] and if we got it by the end of the night, we were happy. All of the energy we put out all day long and all of the misery and lies, all of the grief that we put up with to cop those drugs was an insane, intense vim and vigor."²⁵

Antisocial Behavior

As psychological addiction progresses, heroin users find themselves less and less interested in friends and family members who do not share their obsession, and they begin to seek the company of those who do. The relationships between hard-core addicts cannot accurately be described as friendships, however, since they lack the trust and the empathy that characterizes friendship, and are instead more akin to impersonal alliances formed in pursuit of a shared, daily goal. Recovering heroin addict Anthony Kiedis, lead singer of the Red Hot Chili Peppers, notes the antisocial aspect of heroin addiction: "Without you realizing what's happening, heroin sucks the love out of you. . . . It's very deceiving because it'll numb a pain, but it'll numb your love as well."²⁶

Heroin can emotionally desensitize its addicts to the point where many addicts will commit crimes to obtain money necessary for the drug. For the desperate addict, offenses that would have seemed unconscionable before addiction occurred—crimes such as burglary, armed robbery, assault, in some cases even murder—no longer seem abhorrent. As the downward spiral of addiction continues, it becomes increasingly difficult for addicts to face themselves or their actions, and thus, to imagine themselves ever reentering mainstream society.

One Addict's Regrets

In the following passage from Jara A. Krivanek's book, Heroin: Myths and Reality, a former heroin addict tells of some of the consequences of her addiction:

I'm 29 years old. I wish that, by now, my career was all settled for me. That I had friends. You don't learn how to be a friend or what a relationship is when you're just getting high. And when you stop getting high, it's like being a baby and starting all over again from the beginning. When you're high, it's like being a robot. It's euphoric, but you could be anybody. All the people that are out there using drugs, the faces change, but they're all the same, they're all nobodies, because they're never going anywhere, they're never going to make anything of themselves. . . .

The main thing that bothers me is that the years that I lost while I was taking dope I will never get back. And you lose a lot of self-pride because of the things you end up doing, and it takes a long time to get that back. What I should have been doing all that time in my life was going to college, pursuing a career, and going out and doing the socalled normal things. What I was doing was hanging out on the street corner and getting high. And that was my whole life. You don't see a lot of things when you get high. . . . If I hadn't gotten involved with drugs, maybe I would have had a career. Maybe I would have had more confidence in myself at this point in my life, because I don't have it now. I'd have some friends today, which I don't have now because after all those years, I really didn't have any friends left.

Particularly grim evidence of the extent to which heroin addicts can be in denial of the consequences of their actions lies in the many addicted mothers who continue to use the drug during pregnancy. The pregnancies of many heroin-addicted women end in spontaneous abortions triggered by withdrawal symptoms. Full-term babies who are born to these women are as physically addicted to the drug as their mothers, and will begin to experience withdrawal symptoms shortly after birth. Because these infants have no psychological dependence, they are particularly receptive to addiction-curing medical treatment if their addiction is diagnosed. Left untreated, however, the addiction can result in the infant's death. Further, even successfully treated heroin-addicted babies are at greater risk of sudden infant death syndrome (SIDS), and many of them have contracted the HIV virus from their mothers.

Despite a heroin addict's best efforts to maintain emotional oblivion through heroin intoxication, however, feelings of guilt and loss of dignity, as well as an acute awareness of the self-imposed alienation from family, friends, and society, cannot be entirely avoided. "I remember sitting at a table," recalls one recovering addict of the sense of helplessness he felt from his addiction, "in front of me an open packet of heroin, containing, I reckoned, enough to kill myself. I tried to think of a single reason not to do so. I couldn't."²⁷

A well-publicized example of someone whose heroin addiction did ultimately lead to suicide is the rock star Kurt Cobain of the band Nirvana. Cobain, an intravenous heroin addict, killed himself with a shotgun on April 5, 1994. (Coroners also determined, however, that his body contained three times the lethal level of heroin at the time of his death, and that he would soon have died of overdose if he hadn't shot himself.) Cobain had threatened to commit suicide repeatedly in the weeks before his death, and had also overdosed several times during this period but had been revived with emergency medical treatment. In the suicide note that he left his wife, rock star Courtney Love, Cobain stated that their two-year-old daughter, Francis Bean Cobain, would lead a much happier life without him. As with Kurt Cobain, many addicts succumb to their desperation and commit suicide.

The Consequences for Others

Cobain's suicide provides an extreme example of the extent to which the consequences of heroin addiction can extend beyond addicts themselves to include their families and friends. The consequences of heroin addiction are not limited to the relatives of addicts who have died, however, but also affect those who have addicted loved ones who are still living. In addition to feeling powerless to do anything but watch their loved ones inflict ongoing physical and psychological suffering on themselves, for example, they must also contend with the daily fear that the addict might either succumb to despair and commit suicide or die from lethal overdose. Moreover, since many hard-core heroin addicts in withdrawal steal from anyone, including family, to obtain money with which to purchase the drug, relatives often suffer from painful feelings of betrayal.

Society, too, must pay a high price for the heroin addiction in its midst. Law enforcement efforts to control the many illegal activities associated with the heroin trade are extremely costly, as is the incarceration of those convicted of these activities. And, as is true of most illegal drugs in America, heroin dealing increases the amount of street violence. Dr. Kelen explains that next to overdose,

the second or . . . possibly even an equally . . . common cause for [heroin related] death indirectly is shootings. . . . Many of the shootings are related to local disagreements with [drug dealers] and so unfortunately, the ugly side of that reality is the patients come in shot and dead, and not only the drug users or those involved in the trade. We often see very innocent bystanders, including young children, who just happen to get in the way.²⁸

The practice of intravenous heroin use takes an additional toll on society by spreading infectious diseases, as well as by putting the health care workers who provide care to addicts at considerable risk of contracting these illnesses. Further, the combined expenses to the federal, state, and local levels of government for the health care and social services provided to heroin addicts are enormous. In 1995 alone, for example, the cost to the nation for the estimated seventy-six thousand heroin-related emergency room episodes is estimated to be well in excess of $200 million. This figure does not include the cost of publicly funded detox centers and rehabilitation clinics, nor the many other services provided to homeless and destitute hard-core addicts.

The price paid for heroin addiction—in loss of life, suffering, and financial expense—is high indeed for all concerned. The wide range of consequences that accompany heroin addiction points to the tremendous need for effective and practical measures to prevent experimentation with the drug to the greatest extent possible.