Major points

  1. Heroin is a highly toxic and addictive drug.
  2. Excessive use can cause symptoms such as drowsiness, hypotension, and respiratory depression, which can be life-threatening.
  3. Discontinuing heroin can lead to withdrawal symptoms.
  4. Assist in establishing family and social support functions to avoid re-medication.

What is Heroin?

“Heroin” is a white powder that is highly toxic and addictive. Currently, heroin is classified as schedule I drugs that is often abused. Excessive use may endanger life.

What are the common symptoms?

  1. Weakened physique, poor appetite, weight loss, slow gastrointestinal motility (constipation, bloating, vomiting), bile duct spasm (abdominal pain), difficulty urinating.
  2. Bronchoconstriction and pulmonary edema.
  3. Pupil narrowing.
  4. Chronic brain lesions, loss of balance, confusion, grumpiness, irritability, and hallucination.
  5. Hypotension, hypoxemia, convulsion, and coma. More severe signs of a heroin poisoning include respiratory arrest, and death.
  6. Infections caused by injection (wound ulcer, phlebitis, endocarditis, destruction of heart valves, infectious diseases such as hepatitis, syphilis, and HIV). 
  7. Heroin could pass the placenta. It not only causes fetus addiction but also increases the rate of still birth and premature birth. Besides, approximately 60 to 90% of newborns will experience withdrawal symptoms (such as grumpiness, irritability, nerve development damage).

What are heroin withdrawal symptoms?

After 1-2 weeks of continuous use of heroin, if suddenly stopped, withdrawal symptoms may occur within 7-8 hours. Common symptoms include yawning, anxiety, runny nose, tears, night sweats, sudden cold and hot flashes, followed by insomnia, increased blood pressure, fever, faster heartbeat and breathing, dilated pupils, nausea, vomiting, abdominal pain, diarrhea, muscle spasms, systemic soreness, fantasies, and delusions, etc. It reaches its peak on 2-3 days and alleviates after 7-8 days, Some symptoms can last for 3 to 7 days or weeks to months, so users often cannot tolerate these symptoms and cannot quit drugs.

What are the common treatments?

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

Principles of care:

  1. Developing a support system: strengthening family support and social support functions and regarding 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 policy: We should continue to advocate for public awareness of the dangers of drugs. Our hospital has set up a poison consultation hotline on 02-28757525-821 and a poison prevention and control consultation center https://www.pcc-vghtpe.tw/tc/ to provide advisory service. Encourage all people to fight against drugs together and stay away from drugs.

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).0050
  2. Ceceli, A. O., King, S. G., McClain, N., Alia-Klein, N., & Goldstein, R. Z. (2022). The neural signature of impaired inhibitory control in individuals with heroin use disorder. The Journal of Neuroscience, 43(1), 173–182. https://doi.org/10.1523/jneurosci.1237-22.2022
  3. 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 
  4. Choi, N. G., Choi, B. Y., DiNitto, D. M., Marti, C. N., & Baker, S. D. (2022). Heroin and fentanyl overdose deaths among cases age 50+ in the National Poison Data System, 2015–2020. Clinical Toxicology, 60(5), 639–646. https://doi.org/10.1080/15563650.2021.2016798
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