What is Heroin?
“Heroin” is a white powder. It’s no longer used for medical treatment due to the problem of toxicity, addiction and drug resistance, it is a category 1 narcotic that is frequently abused in Taiwan. It is taken by injection or smoking. It takes effect within a few minutes and lasts for about 2 to 4 hours. It can still be detected in urine within 3 to 4 days, and drug exposure residues can be detected in hair.    

Damages caused by heroin abuse:

  1. Weakened physique, poor appetite, and weight loss.
  2. Slow gastrointestinal motility (constipation, bloating, vomiting), bile duct spasm, and urinary retention.
  3. Bronchoconstriction and pulmonary edema.
  4. Pupil narrowing.
  5. Chronic brain lesions, loss of balance, mind wandering, grumpiness, irritability, and hallucination.
  6. Hypotension, inhibition of the respiratory center (low blood oxygen, convulsion, coma, respiratory arrest, and death).
  7. Infections caused by injection (wound ulcer, phlebitis, endocarditis, destruction of heart valves, infectious diseases such as hepatitis, syphilis, and HIV).
  8. Heroin can cross the placenta via mother’s blood. The fetus may become addicted to them. This will increase the risk of stillbirth and premature during pregnancy. Besides, approximately 60 to 90% of newborns will experience withdrawal symptoms (such as grumpiness, irritability, nerve development damage).

Heroin withdrawal symptoms:
Continued use of heroin for 1-2 weeks and sudden quit it can cause the withdrawal symptoms. The withdrawal symptoms start within 7-8 hours of cessation, peak between 2 to 3 days after cessation, and subside about 7-8 days later. The common symptoms include yawning, anxiety, runny nose, tears, night sweats, and chills. More symptoms can also occur such as insomnia, rising blood pressure, fever, rapid heartbeat and breathing, dilated pupils, nausea, vomiting, abdominal pain, diarrhea, muscle spasms, aches and pain all over the body, hallucination, and delusion. Life-threatening can happen if these withdrawal symptoms are not well treated. Some symptoms will last for 3 to 7 days or several weeks to several months. Patients often cannot tolerate the symptoms and take heroin again.

Principles for dealing with heroin poisoning:

  1. Monitoring vital signs and dealing with withdrawal symptoms.
  2. Administering antidotes according to doctor’s order.
  3. Supplementing nutrition (fluid and electrolytes) to maintain optimal function.
  4. Reducing external stimuli, providing a comfortable and safe environment, and reducing injuries to allow patients to have a good rest.
  5. Protecting patients, preventing self-injury or hurting people, and closely observing drug hiding or re-abuse behavior.

Prevention of heroin abuse:

  1. Building a support system: strengthening family support and social support functions and considering substance abuse as an illness, instead of a crime to reduce the social discrimination and stigma against this population.
  2. Psychotherapy: using interdisciplinary care resources, such as psychiatrists, psychotherapists, social workers, religion, and groups, to assist in psychosocial rehabilitation therapy.
  3. School education: advocating narcotics hazard education and adopting diversified narcotics prevention-related courses.
  4. Government’s policies: it is necessary to continuously promote the general knowledge of narcotics hazards to general public. The hospital provide telephone advice line 02-28757525-821 and National Poison Control Center https://www.pcc-vghtpe.tw/tc/index.asp to offer advisory service. Encourage people to fight against drugs and stay away from drugs together.

References

  1. Huang, M. X., & Yang, K. J. (2020). The treatment strategy of heroin addiction. Clinical Medicine, 85(5), 271-275.https://doi.org/10.6666/ClinMed.202005_85(5).005
  2. Chang, K. C., Lee, K. Y., Lu, T. H., Hwang, J. S., Lin, C. N., Ting, S. Y., Chang, C. C., & Wang, J. D. (2019). Opioid agonist treatment reduces losses in quality of life and quality-adjusted life expectancy in heroin users: Evidence from real world data. Drug and Alcohol Dependence, 201, 197-204. https://doi.org/10.1016/j.drugalcdep.2019.05.003
  3. Smyth, B. P., Elmusharaf, K., & Cullen, W. (2018). Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months. Bio Medicine Central Pediatric, 18(1), 151. https://doi.org/10.1186/s12887-018-1137-4
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