Dependence on opiates

 

Heroin is highly addictive, induces strong cravings and has a high rate of tolerance and dependence, therefore users have to take increasingly larger amounts of the drug to achieve the same effect. However, this tolerance is rapidly lost if the drug is removed for several days, which can result in an increased risk of overdose if a high dose is given after abstinence, particularly if combined with alcohol or other drugs.

 

As the drug can be injected, there is also an increased risk of HIV and Hepatitis C due to sharing needles as well as damage to the blood vessels, including blood clots and abscesses.

 

A distinct opioid withdrawal syndrome is seen after cessation of heroin dosing, however, it is not life threatening in comparison with alcohol withdrawal syndrome. Symptoms include:

• Early symptoms (8-12 hours after last heroin dose): lacrimation, runny nose, yawning and sweating

• Mid symptoms (12-48 hours after last heroin dose): increased restlessness, dilated pupils, bone and joint pain, piloerection, tremor, stomach cramps, irritability and anorexia

• Peak symptoms (48-72 hours after last heroin dose): intensification of previous symptoms, diarrhoea, nausea, depression, insomnia, lack of appetite, violent yawning and sneezing, severe lacrimation, profuse nasal discharge and inflammation of nasal mucous membranes.

 

These physical symptoms disappear within 7-10 days, but psychological symptoms can remain as part of a “Secondary Abstinence Syndrome”. This can last several months and can result in a high rate of relapse. Symptoms include general malaise, fatigue, decreased wellbeing, poor tolerance of stress and cravings for opioids.