Heroin Toxicity - Causes and Symptoms

Introduction

Heroin is a pain reliever made from morphine. It is highly addictive and is known to produce severe withdrawal symptoms. Since 1924, it has been forbidden in the United States. It belongs to the opioid drug subclass. From 2006 to 2015, there was a sharp increase in heroin overdose deaths in the US. However, since 2016, there has been a trend toward a decrease. In 2019, there were reported 14,019 heroin-related deaths, of which 4,000 were attributable to heroin alone and 10,000 to heroin combined with another drug. It may be occasionally combined with other harmful or poisonous substances, such as fentanyl.

From 1999 to 2019, most overdose deaths in the US occurred in people between the ages of 35 and 54. Many heroin users also abuse other drugs, including prescription pain relievers. Alcohol abuse is another possibility. These chemical mixtures carry a high risk of harm.

Heroin use can result from prescription opioid painkiller addiction. This is because heroin is frequently more affordable on the black market than prescription opioids.

What Causes Heroin Toxicity?

Heroin is typically used as an illegal substance. However, doctors occasionally prescribe heroin to treat pain in certain circumstances. Intramuscular injection of heroin has about twice the pain-relieving effect. While doctors are not permitted to prescribe heroin in the United States, prescription heroin is occasionally available elsewhere. Heroin typically has a three-minute half-life in blood following intravenous administration, whereas 6-acetyl morphine has a 30-minute half-life in humans. The blood level of heroin reaches its peak after five minutes of either intravenous or intranasal use, but its potency after intranasal use is only about half that after intravenous use.

The most recent classification system divides opioid receptors into three major classes and many minor classes. The mu, kappa, and delta receptors are the three opioid receptors that are most clinically significant. Euphoria, supraspinal and peripheral analgesia, and respiratory depression are all brought on by stimulating central mu receptors. Besides having strong analgesic effects, kappa, and delta-opioid receptors are also known to cause disassociation, hallucinations, and dysphoria. Delta receptors are thought to affect mood and modulate mu receptors. The opioid receptors, particularly the mu receptor, are affected by heroin. The kappa and delta receptors are also affected. A growing body of research shows that patients' responses to heroin and other opioids can differ greatly in intensity and quality and that these responses may not always be related to tolerance.

The following are the scenarios for a significant heroin overdose that occur most frequently:

• Using a stronger dose than usual.

• Injection of a highly concentrated solution unintentionally by a careless user.

• Heroin use following a prolonged period of abstinence.

• Intentional overdose—suicidal in nature (rare).

• Body stuffing and packing.

What Are the Signs and Symptoms of Heroin Toxicity?

Due to its effects of fleeting euphoria (excitement) and contented apathy, heroin is commonly used to get high. However, if they take too much of it, they become drowsy, possibly losing consciousness and stopping breathing. Lack of oxygen is the primary cause of heroin-related deaths.

The following are the most typical signs of a heroin overdose:

• Shallow breathing (even gasping).

• Pale skin.

• Blue tint on lips and fingertips.

The signs of a heroin overdose in various body parts are listed below.

1. Airways and Lungs

• No breathing.

• Shallow breathing.

• Slow and difficult breathing.

2. Eyes, Ears, Nose, and Throat

• Dry mouth.

• Pupils are incredibly small, sometimes smaller than a pinhead (pinpoint pupils).

• Discolored tongue.

3. Heart and Blood

• Low blood pressure.

• Weak pulse.

4. Skin

• Bluish-colored nails and lips.

5. Stomach and Intestines

• Constipation.

• Spasms of the stomach and intestines.

6. Nervous System

• Coma (lack of responsiveness).

• Delirium (confusion).

• Disorientation.

• Drowsiness.

• Uncontrolled twitches of the muscles.

How Is Heroin Toxicity Managed?

• Naloxone works quickly to reverse the direct effects of heroin on the central nervous system (CNS). Naloxone can be administered intravenously, intramuscularly, subcutaneously, or through an endotracheal tube, but rescue breathing and airway control are performed first. The more recent intranasal formulation has proven useful for laypeople and first responders.

• While other rescuers assess the available Naloxone administration options, the primary rescuer should begin bag valve mask ventilation or a similar intervention right away to restore oxygen supply to vital organs. Until additional rescuers are available, one rescuer should focus on giving oxygen to the overdose victim. When resuscitating a heroin overdose, basic life support and advanced cardiac life support guidelines should be followed.

• To administer enough fluids and medications, adequate intravenous access is required. If the overdose is pure heroin and not tainted by carfentanyl or similar drugs, an initial intravenous dose of 0.4 to 0.8 mg of Naloxone will typically quickly reverse neurologic and cardiorespiratory symptoms.

• Frequent monitoring of vital signs and cardiorespiratory status is required to ensure that heroin is removed from the patient's system. If the patient's vital signs and mental state are normal after receiving Naloxone treatment for a heroin overdose, they can be released without being taken to the hospital or emergency room. Rebound heroin toxicity poses a very low risk of death without co-intoxicants and further opioid use.

What Is the Prognosis of Heroin Toxicity?

An acute overdose can be recovered within 24 to 48 hours if an antidote can be administered. Heroin is usually mixed with adulterants. These may harm organs and result in additional symptoms. There could be a need for hospitalization.

The individual may breathe fluids into their lungs if their breathing has been compromised for a considerable time. This may result in pneumonia and other lung problems. People who become unconscious for long periods and lie on hard surfaces may have crush injuries to the skin and the tissue beneath. Deep scarring, infection, and skin ulceration could result from this. As heroin is frequently injected into a vein, a user may experience issues with other users' needle sharing. HIV (human immunodeficiency virus) infection and hepatitis can result from sharing needles.

Conclusion

Heroin is a pain reliever made from morphine. An acute overdose can cause shallow breathing, pale skin, and withdrawal symptoms. It can be recovered within 24 to 48 hours if an antidote can be administered. However, these may harm organs and result in additional symptoms. As a result, there might be a need for hospitalization. Frequent monitoring of vital signs and cardiorespiratory status is required to ensure that heroin is removed from the patient's system.