Your body on heroin: Drug causes feelings of pleasure strong enough to be described as “euphoric” by users
The first time Matthew Staglibeni shot heroin, he expected the high to be “revolutionary,” but his body systems had been so dramatically altered by the drug that all he could do was vomit.
He was 15.
The rest of his night involved little more than throwing up — on his new shoes, in a bus aisle on his way back to his grandmother’s house and into his school bag which rested on the side of bed.
That’s because on entering the brain, heroin attaches to the nerve ends of opioid receptors. This is the part of the brain where the body sends natural endorphins that relieve stress and pain and is associated with feelings of pleasure.
Psychologist and professor of addictive behaviors at Arizona State University Dr. Elias Robles says that the brain responds to opiates the same way it responds to the natural chemicals bodies produce, and it doesn’t realize that the drug is highly concentrated and extremely potent.
“I usually threw up,” says Brian Hughes, a recovering heroin and meth addict who got into heroin at the age of 20.
“It was such a good throw up,” he says, “and then everything is ok.”
What’s the next step?
Hughes, now 30, nonchalantly describes the side-effect as if he were discussing drowsiness from a cold medicine.
“You just throw up and then you lose all concern and regard for anything around you. You are just you, in your shell, and everything is ok,” says Hughes.
Although heroin blocks endorphins from reaching the brain, the drug will drive up dopamine levels and induce feelings of pleasure strong enough to be continually described as “euphoric” by users.
This euphoric high is more powerful than any relief brought on by endorphins because people cannot control endorphin release, but they can control their heroin dosages.
“They are like orders of magnitude above in intensity from what we would get naturally out of just regular pleasurable things in life; drinking a glass of water when you are thirsty or having chocolate or sex,” Robles said.
This is also how prescription painkillers, which are also opioids, relieve pain. In cases where the body undergoes substantial damage and is in the process of recovery, its natural endorphins aren’t enough to mask the pain.
Long-term users of opiates eventually build a tolerance to the feel-good drug and require a higher dosage to feel its effects. Heroin often replaces prescription pills in the lives of addicts because it is cheaper and stronger.
“We were spending almost 200 dollars a day on Percocet 30s,” Hughes said. “I told my girlfriend we couldn’t keep doing that, so I turned us on to heroin.”
Dr. Frank LoVecchio, the Co-Medical Director of the Banner Good Samaritan Poison and Drug Control Center, says that, in general terms, one hit of heroin is about the equivalent of taking one Oxycodone, only the heroin is often easier to acquire.
“Now it’s the cheapest and purest it’s been in our country relative to the dollar,” LoVecchio said.
Heroin also has become more potent. Historically, heroin pure enough to smoke or snort would have been extremely costly, according to Robles. Now, people can do heroin without injecting it, which appeals to young people who don’t want to stick a needle in their arm.
However, the next step is injection and “because it provides the bigger bang for the buck,” Robles said. “It leads to the biggest high for whatever the amount of dollars is spent on it. Eventually people who become dependent on opiates, most of them will evolve into injection because it’s more effective and cheaper.”
LoVecchio said one of the attractions of heroin is that the onset of the high is much quicker because it can be injected.
“If you shoot an IV, within seconds it’s in your brain,” he says.
Opiate pills have also become harder to abuse as certain prescription drugs have been reformulated with deterrents that keep them from being able to be injected. Oxycodone pills do not contain a deterrent, however.
While Hughes enjoyed his first heroin high after abusing opiate pills, Staglibeni’s experience kept him from trying it again for about 6 months before using for the second time.
Staglibeni has been addicted to heroin now for 15 years.
Kyle Garrett, a recovering addict living in Phoenix, agreed to check in to rehabilitation after a “night of realization,” or the night he overdosed on heroin.
“My roommate had gone out to score, just like any other night, and when he got back with a little extra from our dealer we decided that we would save that amount for the morning,” Garrett said.
Their extra “gift,” Garrett says, was a sample of their dealer’s newest batch. The two then injected the same amount they had been doing for weeks.
“Any other night, the amount we started with would’ve been just fine. It was the fact that there was more stuff on the table and it was new,” he said. “It was too easy after a couple of hours being high and knowing that there was more to do, to just do it.”
Garrett let his roommate try it first.
“There wasn’t much thought behind it,” he said. “He just shot the rest and went to his room. I still had my half to do so I decided to give it a minute and shoot it in another hour or two. I was feeling good so I wasn’t in a rush, I just wanted to try it, especially since he just did.”
He later found his friend on the floor.
“When I saw him, I felt a little half-panic that he might be dead,” he said. “He finally woke up when I dumped a bowl of ice water on his head.
“After thinking you just found your friend dead, you want to do more heroin,” he added. “All I wanted to do at that point was shoot the heroin that had almost just killed my friend.”
Garrett remembers shooting it, then waking up in a hospital bed
When heroin enters the body, the respiratory system slows. But as a user’s pleasure receptors build a tolerance to higher doses, the breathing receptors do not.
As Garrett upped his doses to feel more high, his breathing became more and more suppressed.
Until it stopped.
“One of the side effects is that you get really sleepy and it decreases your respiratory drive,” says LoVecchio.
Too much Heroin or opioids can cause depression of the central nervous system which can lead to slower breathing and heart rates, potentially resulting in hypoxia (low oxygen) or elevated carbon dioxide levels. This can be fatal.
Overdose antidotes like Naloxone, commonly known as Narcan, which are used by emergency first responders and doctors treating opioid overdoses, knock the opioids off of the receptors they have binded to. This allows the central nervous system to begin breathing again.
As Narcan usually requires administration via syringe, access in Arizona has been limited to trained first responders in Arizona until April of this year when the FDA approved a Naloxone auto-injector called EVZIO.
The take-home Naloxone injector, which comes fitted with directions on how to administer it, is now available for prescription use to families and caretakers of people at risk. The cost, however, is steep, at about 600 dollars for two injectors.
“The problem with it, of course, is the cost. If it was cheaper I would prescribe it.,” says LoVecchio. “Most primary care doctors don’t do it. We know we can’t force people or insurance companies to fill it.”
But once the person receives a dose, the opiate high is immediately reversed and when that person wakes up, the mind and body will be asking for its opiate fix.
“One of the negatives with narcan is that addicts who have been addicted for a while and really need their opiates will go into withdrawal,” says LoVecchio. “I think people continue to take the drug to stay out of withdrawal.”
Symptoms of opiate withdrawal include sweating, fatigue, goosebumps, diarrhea, and vomiting, says LoVecchio, and can only be remedied by another opiate or “waiting it out.”
One method used to assist in the detoxing process is “substituting one opiate for another,” says LoVecchio, such as methadone or Buprenorphine (suboxone).
“It is supposed to be a deterrent in that sense and it should knock out your cravings without sending you into withdrawal,” LoVecchio said.
But these drugs can be harder to quit than heroin.
“I’ve been on suboxone twice and methadone once,” Staglibeni said. “I stopped the methadone cold turkey, which was harder than stopping heroin.”
Staglibeni describes the process of “kicking” the drug without the aid of methadone or suboxone:
“I’m getting sick just thinking about it. If you’re a smoker, all the phlegm, all the bile, all starts coming up. All you want to do is sleep but you can’t. You get some hours in, but then at night, you can’t get comfortable, your whole body aches, your back, your joints everything hurts. It’s just complete, horrible discomfort.
“On the second or third day, you get a little bit of your strength back, you start eating food again. The last time I kicked, I literally didn’t eat for almost 72 hours.”
Avoiding withdrawal is a reason many addicts never recover.
“You have this desire to get right back into it again,” Staglibeni said. “You have to fight it off. Not a lot of people can’t do that.”
Life-threatening also diseases can be transmitted when users share needles to inject the drug, such as Hepatitis C or HIV. Users are also susceptible to bacteria from contaminated heroin, according to LoVecchio, that could infect the heart, brain, and almost every organ in the body.
Another danger comes with not knowing the potency of the drug they are taking or what the drug has been mixed with. Heroin is often cut with Fentanyl, an opiate much more potent than heroin that is administered as a painkiller or anesthetic.
“That’s one reason I always do a small dose when I use,” Staglibeni said. “Always test the product.”