Heroin Addiction

Heroin is a commonly abused, illegal drug in the United States. A member of the opiate family, it’s derived from the opium poppy plant and made from morphine. Heroin addiction is a rampant disease that claims thousands of lives every year, and it’s only getting worse, as many people use heroin as a last resort drug to feed their prescription painkiller addiction.

In the past few years, nearly 80 percent of people attributed their heroin use to prescription opioid use. Therefore, prescription opioid use is one of the risk factors for heroin use. If you're addicted to heroin or know someone who is, it’s important to seek help as soon as possible. To better understand how this drug can be treated, it’s important to address the following questions: “ What is heroin?” and “ Is heroin addictive?”

In this post, we discuss all you need to know about heroin addiction, including its effects, abuse symptoms and how to seek professional help. If you are suffering from the effects of substance abuse, or want to help someone you know, this information can help you get started with the right course of treatment.

What Is Heroin?

Exactly what is heroin? This is a commonly asked question regarding this substance. Known as dope, smack, horse and junk, heroin can appear as a white or brown powder or a sticky substance called black tar heroin. Heroin is an opiate or natural derivative of the opium poppy plant seed pod, and it elicits feelings of elation and pleasure (a “high”) that people get addicted to. However, the adverse effects of use and abuse are too serious and harmful to ignore. Although heroin is made from morphine, it changes back into morphine after it enters the brain. After binding to opioid receptors, the areas of the brain responsible for pleasure and mood are triggered. Such areas include the brain stem, which is responsible for controlling important autonomic bodily functions such as blood pressure, breathing, and arousal.

Heroin can be ingested by snorting it, smoking it or injecting it subdermally (under the skin), intramuscularly (into the muscle) and intravenously (into a vein). Heroin is such a potent drug that those who use it feel the high relatively quickly. Because of the increase in supply and ease in obtaining it, people from many backgrounds use heroin. Prescription painkillers have become the gateway drug to heroin, so anyone who has been prescribed narcotic medications can be susceptible to heroin use and heroin addiction. Though prescription painkiller addiction and abuse cases are currently much higher than heroin addiction cases, the numbers can shift easily due to the chemical similarity among the opiates. The opioid epidemic has taken the United States by storm, and many people are dying from overdose every day, with a high number related to heroin abuse. Due to the addictive nature of prescription opiates, those who are unable to finance their addiction resort to heroin use because it produces a more distinct high for less money and is readily available.

What Does Heroin Look Like?

When answering the “ What is heroin?” question, another factor to consider is the appearance of this substance. Heroin is available most commonly in a powder form. It can appear white or brown. This color usually varies based on geographic location in the United States. White or off-white powdered heroin is commonly seen in the eastern U.S. The variation in colors denotes the purity level of the drug. The more white it is, the purer and more potent it is in comparison with off-white or brown. Typically, there are more impurities in brownish heroin powder. Conversely, in the Western part of the U.S., heroin is sold as a solid, sticky substance that is typically black in color. Known as black tar or sticky tar, this substance can be hard to the touch. Some powdered heroin may also be found in the West, but it’s typically the more impure, brown variety. The purest forms are odor-free. However, the darker, impure forms of heroin have a slight, pungent smell similar to that of vinegar.

Similarly, black tar heroin also has a smell slightly resembling vinegar. If both black tar and off-white heroin are smoked, the smell will intensify, and the vinegar scent will be even stronger. While pure heroin does exist in the drug marketplace, more often than not, it’s cut with other drugs and substances. This means drug dealers mix in these substances with heroin so they can sell more of the drug and make a more significant profit. While this process does dilute it, it also makes consuming the drug more dangerous, as it can cause a myriad of effects. Some substances heroin is commonly cut with are:

• Baking soda
• Laundry detergent
• Rat poison
• Talcum powder
• Caffeine
• Flour
• White sugar
• Fentanyl

While some of these ingredients are outright dangerous, such as rat poison and laundry detergent, other “safer” materials also threaten a the health of the people using it. For example, caffeine mixed with heroin can mask signs of overdose, causing those who use it to think they should take more. However, this can lead to brain damage or death. Now that many people who use heroin are aware of the price of this drug in comparison to prescription opiates, demand is at all-time high. Consequently, the risks of overdose and death are also at a high as dealers try to meet the demand by cutting heroin with other substances.

History of heroin addiction

Heroin wasn’t always a societal scourge. In fact, the Journal of Postgraduate Medicine stated that heroin got its name for the “heroic capabilities” it seemed to endow users with when it was first discovered centuries ago.

Researchers in the late 1800s and early 1900s believed that heroin could be used to relieve pain, ease suffering and make sick people feel better. Unfortunately, people who used it for relief soon became addicted to the drug. Down the years, heroin became a popular recreational drug, thus solidifying itself as the problem it is today.

Uses of heroin

While morphine is a common choice for relieving mild or severe pains – or sedate patients before an operation – heroin is seldom used for medical reasons. In some countries, it can be administered as an effective analgesic. However, in other countries (like the US), it is banned as a drug of abuse and has no medicinal purpose whatsoever.

Routes of administration

Heroin exists as a white powder or in a sticky form. It is generally administered by injection, inhalation or snorting, depending on the form. Some people even consume it orally. The mode of administration determines how fast the effect is felt. While snorting and inhalation take a while to kick in, the latter brings an instant rush because it quickly permeates the blood-brain barrier.

Adverse effects of heroin

The short-term effects of heroin include relaxation, euphoria, and pleasure. The pleasurable effects are followed by less pleasant feelings, such as dryness of the mouth, heavy limbs, drowsiness, and mental overshadowing. Regular abuse of heroin leads to tolerance and physical dependence on the drug.

Addicts are exposed to the following adverse effects:

• Skin abscesses (if injected)
• Laboured breathing (due to injury in the respiratory system)
• Clogged blood vessels
• Collapsed veins
• Endocarditis
• Organ failure (Kidney and Liver malfunction)

Heroin overdose

Overdosing on heroin is potentially fatal and requires quick medical attention. This occurs when you ingest more heroin than your body can metabolize.

Signs and symptoms of overdose may vary according to:

• The quantity and purity of the heroin used
• Additional substances consumed
• Age and weight of the user

Common warning signs of an overdose include bluish nails or lips, labored breathing, pinpoint pupils, weak pulse, delirium, extreme drowsiness, vomiting, loss of consciousness and coma.

Is Heroin Addictive?

Is heroin addictive? Yes. Is recovery possible? Although it is possible to recover from heroin addiction, it’s not easy. Many people who have tried to beat their addiction have relapsed or returned to it several times after a period of sobriety. Why is overcoming heroin addiction so difficult? Research shows heroin hijacks the brain, “rewiring” it to think heroin is an essential chemical. Referred to as “ the joy plant,” heroin comes from the opium poppy, a flower with seed pods that have highly addictive properties. Many people have reported feeling extremely good and “high” after their first hit, which triggered their heroin addiction. The addicted, hijacked brain is singularly focused on getting high at all costs, so much so that individuals go to extreme measures to get that “high.” Heroin works in the same way as other opioids in that it increases the amount of dopamine released to the limbic reward system, a part of the brain responsible for feeling pleasure. The limbic reward system drives all intense pleasure, such as that related to eating, drinking, and sex. When a person uses heroin, however, the drug takes over the limbic reward system, producing a flush of dopamine and a rush of pleasure and euphoria.

Following this experience, many report feeling like they need to seek out the drug again and again. This repeated use of heroin is what drives heroin dependence very quickly. This is also what contributes to heroin addiction.Detoxing and withdrawing from the heroin addiction can be extremely difficult and potentially harmful to the body if not done under proper guidance. It can be extremely difficult for those who abuse heroin to quit the drug on their own because it affects parts of the brain that control judgment, planning, and organization. Heroin abuse also hijacks the brain’s memory systems and motivational systems. This could easily result in a relentless pursuit of the drug for the next high, at any cost.

Heroin Addiction Defined

Heroin addiction is one of the most dangerous addictions in the world. Although a recent survey reported that the number of young addicts in the USA had reduced by 79% in the past few years, it remains a disturbing problem amongst families with affected people.

Being able to spot a heroin dependency in your family member or friend can save their life. Heroin addiction is simply the inability to perform regular tasks because of total dependence on heroin. Sooner or later, withdrawal sets in, forcing you to abandon all activity and seek the drug.

If you’re addicted, you will have trouble socializing with a new crowd or group of friends. Isolation is a common behavior among most addicts. Before long, personal and legal problems will become a regular feature of the person’s life.

Why is Heroin So Addictive?

Among street drugs, heroin is famous for its powerful addictive properties. People who use the drug recreationally often discover that they rapidly transition to compulsive usage that is almost impossible to control. So, why is it so addictive?

The reason can be traced to the brain. An addiction is characterized by the psychological need for drugs that exceeds your ability to control the intake of drugs. The changes begin in the brain cells and research has shown that heroin affects major areas of the brain, altering the reward pathway and the ways in which we seek instant pleasure.

Heroin is so powerful, its presence in the brain leads to the secretion of large quantities of dopamine (the reason for euphoria). Eventually, this stresses the brain cells. If used continuously, the cells tend to burn out, forcing you to take more heroin to feel the initial ‘euphoric effect’. Over time, tolerance is built and the absence of heroin triggers withdrawal symptoms.

Why Is Heroin Addiction So Hard to Treat?

Overcoming addiction is difficult, but overcoming a heroin addiction is a challenge that can break even the strongest individuals. That said, it is not impossible to beat dependence, but it will take all your will and commitment, along with the right treatment procedures.

Heroin has become famous for the hold it has on its victims. This can be attributed to the physically dependent nature of the drug. Most substances either have physical or psychological withdrawal symptoms attached.

For heroin, withdrawal leads to severe physical effects that make addiction treatment very difficult. When a user stays of the drug (for some hours), the painful effects of withdrawal set in, which leads to them taking the drug for relief.

Physical withdrawal effects include:

• Muscle spasms and joint pain
• Fever
• Nausea and vomiting
• Insomnia
• Increased heart rate and blood pressure
• Stomach cramps

There are also psychological effects of withdrawal, such as anxiety, depression, anger, paranoia, and restlessness.

Famous Heroin Addicts

Heroin is often described as the scourge of poor neighborhoods, because of its popularity in areas with high crime rates. On the contrary, it is also used by the wealthy and educated. Even celebrities have fallen victim to heroin addiction.

Famous heroin addicts include:

• Steven Tyler (Lead vocalist of rock band, Aerosmith)
• Philip Seymour Hoffman (Actor)
• Courtney Love (Singer, Actress)
• Tom Petty (Country singer)
• Janis Joplin (Singer)
• Billie Holliday (Jazz singer)
• Russell Brand (Actor, comedian)
• Corey Feldman (Actor)
• Chris Farley (Actor, comedian)

There is nothing glamorous about heroin. Some of the aforementioned celebrities were able to clean up. However, a few like Janis Joplin and Chris Farley died of an overdose. Spotting the warning signs in time could have prevented their deaths.

Symptoms, Signs and Side Effects of Heroin Abuse and Addiction

You can save yourself or someone you love by identifying signs of heroin abuse. Perhaps you have noticed rapid mood changes or secretive behavior in a family member? If they’ve started lying or staying isolated from colleagues to indulge in their habit, this is a bad sign.

Are they spending time with a suspicious new group of friends? There are common physical signs that reveal heroin addiction, such as:

• Exhaustion
• Mumbled speech
• Severe scratching
• Sexual dysfunction
• Sudden mood swings: excitement to disinterest to depression
• Constricted pupils
• Neglecting responsibilities: school, work and family

Common health signs may include injection scars, regular nosebleeds (from snorting) and frequent respiratory problems.

Immediate Symptoms

These are symptoms that can be observed immediately after taking heroin. At first, the user feels the ‘rush’ of euphoria, which may last for a few hours. When it wears out, a sudden feeling of dread and depression follows. During this time, they will act out or exhibit violent mood swings, irritability and fatigue.

Delayed symptoms

The chronic use of heroin leads to health complications such as cardiac arrest, liver failure, kidney disease, skin abscesses, respiratory tract infection, HIV and so on.

Heroin and Other Drugs

It is not uncommon for people to mix heroin with other drugs to heighten its euphoric effect. One commonly abused combination is heroin and cocaine, otherwise known as a speedball. Although it’s not fully understood why this poly-drug is more popular, users have said that the concurrent cocaine use leads to a rush that serves as a relief for the downing effect of heroin use.

Besides cocaine, heroin is often mixed with substances such as alcohol, meth, MDMA, GHB or opioids. The rate of poly-drug usage has increased due to the following factors:

• ‘Normalization’ of illicit drug abuse
• Prevalence of illicit substances in mainstream channels
• Wilful disbelief of the possible risks

People combine heroin with other drugs for many reasons, but by doing so, they increase their exposure to risk and dependence on other drugs. It also raises the chances of a drug overdose.

Prescription Opioids and Heroin

Opioids are a class of drugs that are derived from opium. Heroin is a common example. However, there are prescription opioids used by physicians to treat pain. Examples of prescription opioids are Oxycodone, Hydrocodone, Morphine, Fentanyl, Methadone and Oxymorphone.

Fentanyl or any other prescription opioid (such as methadone or oxymorphone) is used to amplify the effect of opioid in a person’s system. Like any other poly-drug combination, the consequences can be dangerous.

It can increase the severity of opioid side effects, such as nausea, disorientation, and respiratory collapse. This may cause breathing problems and raise the risk of falling into a coma.

Heroin Abuse Statistics

According to a national statistics report, the number of 18 to 24-year olds in England seeking treatment for Heroin addiction dropped 79% in the last decade. This was attributed to the stigma surrounding the use of heroin and users’ changing preferences for intoxication.

In March 2015, 2,367 people from the same age group presented cases of heroin and opiate addiction at about 900 drug treatment services in England. This pales in comparison to the 11,351 patients in 2005, according to statistics from the National Drug Treatment Monitoring System (NDTMS).

They made up a small fraction of the 149,807 opiate addicts who sought help for treatment during the year – a number that is itself down by 12% from a 170,032 peak in 2009 -2010.

Who is using Heroin?

The figures for heroin consumption appear to be dropping, so who is using it? In the past, people believed that heroin use was confined to a small area of inner cities (so-called poor neighborhoods), but it has transcended those places to the suburbs and even the countryside.

A study revealed the consumption of heroin to be along racial lines. According to the results, about 90% of participants who began using the drug in the past decade were white. Gender-based differences were also observed; while men accounted for 80% of users in the 1960s, the figures for both men and women were approximately equal by 2010.

The report also showed that heroin users are getting older. The average age of heroin users has increased from 16 years old in the 1960s to 23 years old in 2010.

How Do I Find Help for a Heroin Addiction?

Heroin rehab programs provide effective treatment and support for people addicted to heroin. Comprehensive heroin rehab is offered in a number of treatment settings, including both inpatient and outpatient. Many rehabs for heroin or other opioid drugs include a detox program at the start of treatment. Then the patient receives a combination of therapeutic interventions, such as individual therapy, group counseling, family therapy, peer support groups, and more, to help rectify drug-using behaviors and avoid relapse.

Inpatient Rehab Facilities vs. Outpatient Addiction Clinics

When selecting a heroin treatment center, you have the option of choosing between an inpatient facility and an outpatient clinic. Individual treatment needs are naturally going to vary, and there are certain benefits (and drawbacks) to both types of treatment for heroin addiction that may inform the decision for treatment type.

Outpatient facilities can vary widely. Many outpatient rehabs provide treatment in the form of education, group therapy, individual therapy, and in some cases, access to psychiatric care or medication-assisted treatment. Outpatient programs range in levels of intensity and, to some extent, the treatment plan can be tailored to each client, with the number and type of scheduled weekly groups varying based on the individual's needs.

The time commitment can be substantial in an inpatient (residential) rehab setting, and studies suggest that a minimum of 90 days in treatment is essential for successful outcomes and long-term sobriety. Due to the tenacious nature of heroin addiction and the many facets of an individual's life it affects, an inpatient treatment program is commonly sought.

Heroin is highly addictive, both mentally and physically. Those who attempt to quite often suffer from a withdrawal period that can be extremely uncomfortable. A benefit of many inpatient treatment programs is that they commonly include some form of medically supervised detox and around-the-clock support to keep those recovering a safe and comfortable as possible— minimizing relapse risks.

Residential Heroin Treatment

Not everyone who tries heroin will go on to need residential heroin treatment program. It is possible to use any drug recreationally and not become addicted, although, amongst all drugs of abuse, heroin is an exquisitely addictive substance. If heroin abuse is an issue, there are some questions you can ask yourself to help you decide if you or someone you love would benefit from inpatient or residential treatment:

• Do you find that your heroin use makes you more isolated?
• Is your heroin use causing problems at work, home, or school?
• Has your financial standing suffered due to heroin?
• Do you have problems in your relationships because of heroin use?
• Are you unable to stop even though you want to?
• Have you ever stolen money or other items in order to buy heroin?

If you answered "yes" to any of these questions, you might benefit from inpatient or residential rehab for heroin addiction. These are all warning signs of an opioid use disorder, which can be effectively managed if treatment is sought.

Heroin Tolerance vs. Dependence

Tolerance and dependence on heroin are two different things. The body develops a tolerance to the effects of heroin when it is used regularly enough for the brain to adapt to the level of heroin present. The more tolerance the body builds up, the more heroin it will require for the user to feel its effects. Tolerance is generally a warning sign that an individual is developing heroin dependence.

Dependence occurs when heroin users begin to feel that they need the drug to function normally. Heroin-dependent individuals frequently experience uncomfortable physical withdrawal symptoms, including agitation emotional and physical discomfort, which may prompt additional drug-seeking behaviors. The chronic use of heroin seen in those with opioid dependence can also prompt increased tolerance to heroin, requiring the use of ever-increasing amounts of heroin to stave off withdrawal symptoms. It's a tough cycle to break out of, which is why heroin rehab center, for many, offer the best chance of recovery.

Rehab Privacy and Confidentiality

When making the decision to enter a heroin rehab center, it is normal to be concerned about privacy and confidentiality. All inpatient heroin rehab facilities offer a level of privacy and confidentiality as mandated by a federal law known as the Health Insurance Portability and Accountability Act (HIPAA).

Addiction is a medical condition (diagnosed as a substance use disorder), and treatment centers are legally required to respect your privacy and keep your treatment confidential unless you have provided consent to share information or there is a valid, emergent reason to do so.

How Long Does Rehab Last?

The length of time spent at an inpatient heroin rehab center varies by individual. The appropriate length of treatment depends on many factors. A commonly offered treatment duration is the 30-day program. Some heroin treatment facilities also offer 60- and 90-day programs.

Longer programs are available and may provide additional support for those who have completed a 30-day program and relapsed individuals with co-occurring mental or physical health issues, or those who lack a stable home environment. There are also heroin rehab centers that offer inpatient treatment for as long as a year. Deciding which option is right for you is an important step toward starting your recovery.

For more information about treatment length options, please call our confidential hotline.

During Treatment for Heroin Addiction

The treatment process begins with an intake appointment at the heroin rehab center. During the intake, you will sign formal consents for treatment and the program rules will be explained to you.

The intake process also includes questions about your physical and mental health, a substance use history, and sometimes a physical exam, which helps the heroin rehab facility determine the best treatment plan and length of stay for you. Your questions can also be asked at this time.

Heroin Detox

The next step in the heroin rehab is detox from heroin. The main objective of detox is to relieve your withdrawal symptoms while your body adjusts to functioning without the drug. Detox from heroin should be completed under medical supervision.

The type of detox program will depend on the facility chosen. Some facilities choose to ease the detox process through medication-assisted treatment. Providing tapering doses of replacement medications such as Suboxone (buprenorphine and naloxone), buprenorphine, or methadone can reduce the symptoms of withdrawal in a safe, medically monitored setting.

Another type of detox method is abstinence-only or social detox. With this type of detox, there is no replacement drug, and the patient will simply stop using the drug, with no opioid replacement support to minimize the symptoms of withdrawal. Many find this form of detox quite challenging in cases of heroin withdrawal. More recently, medication-assisted detox is becoming an increasingly common method for managing heroin dependence.

Pharmacological Treatment (Medication)

Detoxing from heroin addiction can feel unbearable due to the effects of withdrawal, but if you are in a proper facility with access to qualified physicians, you’ll be treated with medication that can help alleviate the pain.

Each person is different, and your individual needs make it necessary to choose a rehab with access to good medicine. Naturally, the use of medicine begins at the first stage of treatment with other modalities, as the physical effects of withdrawal begin to manifest.

Behavioural Therapies

In rehab, depending on the type of programme, you’ll receive therapy aimed at treating specific problems. The first step is usually to identify the underlying cause of your addiction. What event made you start using the drug? Some people resort to heroin to overcome grief, while others use it to ease physical pain from an injury or accident. When an underlying reason is identified, the addiction therapist helps you to overcome it.

Therapies may also be used to help you fight cravings by initiating certain behavioral changes. Examples of behavioral therapies are:

• Cognitive behavioural therapy
• Cognitive behavioural play therapy
• System desensitisation
• Aversion therapy

Aversion therapy is a form of treatment aimed at helping you develop a strong dislike for the addictive substance. Its application is performed using various techniques.

The Use of Methadone for Heroin Addiction

The use of methadone in treating heroin addiction remains a controversial method. Although methadone is a prescription opiate, the choice to use it as heroin detox medication draws mixed reactions because of its tendency to create a poly-drug-type effect.

The Western Journal of Medicine has defended this approach by stating that methadone is a preferred drug because unlike heroin, it is a long-acting opioid. Therefore, it doesn’t have the immediate sedative effects of heroin, a short-acting opioid.

Rehab Therapy

After you complete detox, you will enter into addiction therapy. There are many different options for therapy at heroin rehab facilities. Most rehab centers provide both individual and group therapy, along with education about addiction. Some facilities will also incorporate family therapy sessions into the treatment process, or provide psychiatric treatment if the individual has an underlying mental health disorder.

Rehab Aftercare

Because every recovery process is as different as the person recovering, heroin rehab centers will carefully plan for ongoing care once the initial treatment duration has ended. To do so, many treatment programs will offer their own aftercare programs or will go to great lengths to plan for or arrange extended treatment or aftercare for all treatment alumni.

People in recovery tend to do best when they have a plan in place for when they check out. During the treatment process, trained counselors will work with you to develop an aftercare plan, which can include outpatient treatment, private therapy, 12-step meetings, long-term residential treatment, and sober-living housing.

Paying for Addiction Rehab

A common question is in regard to what it will cost to complete a heroin addiction rehab program. Costs vary between centers, but there are various options to help pay for treatment, including private insurance, sliding-scale fees, loans, or payment plans.

Rehab Near or Away From Home?

Whether you should travel or check in to a heroin rehab center that is near you is a personal choice. If there are a lot of family members and sober supports within the community, staying close may be a better choice.

Some individuals find that traveling helps them start the new path of recovery and avoid outside stressors or triggers. The most important aspect is that the individual seeking treatment feels sufficiently safe and comfortable to focus on treating the addiction.

About Luxury Rehab and Executive Programs

Many luxury treatment facilities provide cutting-edge treatment, posh amenities, and increased privacy. These allow individuals to recover in a comfortable setting that can include exercise facilities, massage, and other upscale comforts.

Similar to those treatment programs offered in luxury settings, executive treatment facilities can allow individuals to receive the treatment they need while handling important duties. For example, pairing high-quality substance use and behavioral addiction treatments with the flexibility of occasional computer and phone access allows an executive to get sober away from the spotlight.

After Heroin Rehab

The goal of all heroin rehab centers helps patients become sober and stay that way. As touched on earlier, upon completion of treatment, each patient will have an individualized aftercare plan that can include:

• Outpatient substance abuse treatment programs.
• Self-help meetings.
• Private therapy sessions, both in group and individual settings.
• Sober-living housing.

Following an aftercare plan will ensure the best chance at long-term sobriety.

Are You Ready for Rehab?

Knowing when it is time to enter a heroin rehab center can be difficult. If you have decided that it is time to fix the problem, this is a good indication that you are ready to explore your treatment options. Ask yourself if it is time to quit. If the answer is "yes," then seek treatment.

Staging an Intervention for Heroin Abuse

Most people have heard of interventions but may not know exactly what they are. Interventions are conducted with the goal of urging someone into rehab or some other form of treatment. They are often conducted with a trained professional interventionist, as well as supportive family and friends, who express their love and concern while sharing how the individual's addiction has affected them.

Finding the Right Heroin Rehab Program

It's never too late to turn your life around and free yourself from heroin addiction. Recovery is a long and sometimes difficult process, but it allows individuals the opportunity to live a healthy, happy, sober life.

For help finding the right heroin rehab program for you or someone you care about, call our confidential hotline today. Rehab placement specialists are available to answers your questions and connect you with the best rehab for your needs. Know that rehab works and recovery from heroin addiction is achievable.

• Sources

  Former Users Describe the First Time They Tried Heroin https://www.vice.com/en_us/article/kwxkbv/ex-users-describe-the-first-time-they-tried-heroin

  Celebrities who died from painkillers, cocaine and heroin https://edition.cnn.com/2016/06/03/health/gallery/celebrities-who-died-from-opiods

  Heroin: What You Need to Know https://www.webmd.com/mental-health/addiction/heroin-use#1

  Heroin Fast Facts https://www.justice.gov/archive/ndic/pubs3/3843/

  National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd edition).

  National Institute on Drug Abuse. (2014). DrugFacts: Heroin.

  American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

  U.S. Department of Health and Human Services. (2016). Your Rights Under HIPAA.