Can You Get Addicted to Heroin After One Use?

Can You Get Addicted to Heroin After One Use?

Heroin is an extremely potent and highly addictive opioid drug, produced by criminal drug trafficking organizations for the illicit drug market; however, regardless of its high potency and high addiction potential, it is doubtful that anyone who uses heroin for the very first time will become instantly addicted or “hooked.”

In fact, any first-time heroin user is considerably more at risk of something far worse than addiction – the risk of death.

The record total number of fatal opioid overdoses reported for 2020, as the coronavirus pandemic and the national opioid crisis literally collided, has never been higher across the U.S., just like many other drug-related accidental deaths seen last year. 

Drug addiction can be defined as “a clinical disease with both a physical component and a psychological component that interact powerfully, and whose primary symptom is an individual’s compulsive engagement in the use of a specific substance” – such as heroin.

The body will take time to become physically addicted to a drug, but a first-time heroin user can still experience strong psychological cravings for the drug after their first hit, with a strong compulsive desire to revisit the euphoric high again.

How Long Does It Take to Get Addicted to Heroin?

Although it is highly unlikely that anyone can become addicted to heroin after just their first time using the drug, repeated and regular use of the substance will significantly increase the possibility of the development of chronic heroin addiction (medically described as opioid use disorder or OUD) in only a matter of weeks.

The actual time it takes for this to happen is dependent upon the amount of heroin used each time, the frequency of the use, how the heroin is used, eg. smoking or injecting, and the individual themselves.

The Previous Misuse of Opioid Prescriptions

Another contributing factor to the time taken for an addiction to form is the individual’s previous history of substance use.

Did you know that 4 out of 5 new heroin users in the U.S. started out misusing their prescription opioid painkillers, such as OxyContin® and Vicodin®? If they are now using heroin simply because they are already clinically addicted to prescription opioids, then there is no crossover and no development – the opioid use disorder (in this case, heroin addiction) already exists.

A research study published by the Centers for Disease Control and Prevention (CDC) revealed that 1 in 5 patients given a 10-day course of opioid medication become long-term users. As the length of time a patient takes opioids increases, so does the patient’s risk of becoming addicted.

Why is Heroin So Addictive?

Heroin is considered highly addictive because, as a chemical substance, it is exceptionally effective at releasing a rapid flood of dopamine (our natural “feel-good” chemical) into the brain when it is used, making the level of euphoria – the “high” – experienced by the user far more powerful than anything they may have felt before.

It does this by binding to the brain’s opioid receptors, completely numbing them, and creating the sensation of a complete lack of pain [see below for more detail on the brain’s opioid receptors: Hooked on Heroin].

Additionally, heroin, like other opioids, numbs the region of the brain responsible for switching off the release of dopamine. By doing this, huge quantities of the feel-good chemical can be released continuously.

Its addictive potency is further heightened by a severe withdrawal should the user stop using, and the user’s craving for its psychoactive and “self-medicating” qualities.

Heroin & Dopamine

Dopamine is a neurotransmitter associated with pleasure. A substance use disorder can develop because, over time, the brain builds a tolerance to the effects of the substance and will demand more of the drug to produce a similar level of euphoria.

The user gradually finds it more difficult to simply function without the drug in their system.

From opioid use disorder to alcoholism and everything in between, every substance use disorder or addiction will begin in the user’s brain, where the drug directly induces the rapid release of large quantities of the brain chemical dopamine from the brain’s “reward center” – the area of the brain that produces pleasurable feelings, which results in the “high” (the state of euphoria) that drug users seek to achieve. 

Medical researchers studying the long-term effects of opioid addiction on the brain have found that extended regular use of the drug results in the loss in size of the brain’s “white matter” which can subsequently affect decision-making, behavior control, and responses to stressful situations.

Heroin & Withdrawal

Heroin is also highly addictive because any abrupt cessation of its regular use will result in the user experiencing severe withdrawal symptoms, such as painful muscle aches, gastrointestinal problems, and other uncomfortable flu-like symptoms.

Heroin users who are attempting to quit the drug often end up using again simply to alleviate the painful and uncomfortable withdrawal symptoms they are experiencing.

Heroin & Psychological Cravings

Furthermore, in addition to the physical symptomatic side of withdrawal, regular heroin use creates powerful psychological cravings for its psychoactive effects, which enables users to “self-medicate” and escape from any emotional pain.

Hooked on Heroin: Opioids & The Brain’s Opioid Receptors

Heroin, like all other opioid substances, produces its rapid and highly euphoric effects by binding to the existing opioid receptors in the brain (found at the end of nerves), and blocking (or stopping) these receptors from feeling any sensations of pain – one of several reasons it’s relatively easy for heroin users to quickly become hooked, and to become heroin addicts.

Our bodies actually produce their own opioid chemicals naturally, known as endorphins.

When we experience physical pain, our nerves are quietened by the release of these endorphins, which attach themselves to the opioid receptors and temporarily block many of them, minimizing the level of pain felt.

This natural system can be severely disrupted when another source of opioids is introduced into our brains, such as an injection of heroin via the bloodstream.

Heroin & The Mu Receptor

Whether the source of the opioid is heroin, a prescription opioid pain-killing tablet like OxyContin®, or our own natural endorphins, they all do the same thing. They bind to these opioid receptors, and block any neurotransmitters  (our chemical messengers) from activating the nerve cells, which in turn stops any electrical pulses from these cells delivering the message to our brain.

To do this, opioids bind to any of 3 major receptors in the brain, called Mu, Kappa and Delta (named after letters in the Greek alphabet). However, it’s the Mu receptor that is responsible for the major effects of all opiates.

Other Cerebral Effects of Heroin & Other Opioid Use

In fact, it’s not just the pain pathways that are affected. Opioid receptors trigger more widespread effects in the brain, such as part of the brainstem called the locus coeruleus, where the receptors there can slow down respiration, cause constipation, lower blood pressure and decrease alertness in the opioid user.

Opioid receptors also “switch off” an area of nerve cells called GABAergic neurons, which themselves are an off-switch for the brain’s euphoria and pleasure networks.

So, when using opioids, this GABAergic off-switch is itself turned off, allowing for the pleasure circuits to literally fill with dopamine.

Stress-Free Euphoria

At one particular stop on this “pleasure highway” – an area of the brain called the “nucleus accumbens” – the dopamine triggers a surge of happy euphoria.

When the dopamine reaches the amygdala, the brain’s “fear center,” it relieves any feelings of anxiety and stress.

Both of these chemical events reinforce the brain’s perception that opioids are a reward – a powerful concept for the development of any substance addiction.

Decision-Making Driven by Cravings

The  areas described above are in full-time communication with the brain’s decision-making region, known as the prefrontal cortex, which is responsible for forming our judgments, like what is considered to be good for us, and what is considered to be bad.

These pleasurable effects magnify our judgments that these sensations are good, which is why the mind begins to form habits and cravings.

Within a relatively short time – a matter of mere weeks –  the decision to seek out the drug, rather than participate in other life activities, becomes automatic.

As you can see, heroin affects the brain and its functions on many levels, such as removing pain, stress and anxiety, and creating happiness and pleasure, even euphoria.

The psychological cravings for more of the substance is a clear sign of opioid addiction/opioid use disorder (OUD).

What is Heroin?

Heroin is a powerful, rapidly-acting and highly addictive drug made from morphine, a natural substance taken from the seed pod of various opium poppy plants grown around the world, but predominantly in Southeast Asia (Thailand / Laos / Myanmar), Southwest Asia (Afghanistan / Pakistan), Mexico, and South America (Bolivia / Colombia). 

In appearance, heroin can be a white (the purest form) or a brown powder, or a black, sticky substance known as “black tar heroin.”

The difference in color comes from any additives used to dilute the product, which can include sugar, caffeine or other substances. Street heroin is sometimes “cut” with strychnine or other poisons.

Many of these various additives do not fully dissolve, and when injected into the body, they can clog the blood vessels that lead to the lungs, kidneys or brain, leading to the infection and physical damage of vital organs.

It is classed as a Schedule I substance in the U.S. under the Controlled Substances Act, meaning that it has “a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.

Heroin users either inject, sniff, snort, or smoke heroin, and some users mix their heroin with crack cocaine, an even more dangerous practice known as “speedballing.”

It works so effectively in the brain because it binds to our natural opioid receptors [as described in detail above].

Obviously, when a drug user buys their heroin from a drug dealer in the street, they have little or no idea what the actual substance contains, or its actual strength, leaving many users constantly at risk of a potentially fatal overdose.

Street nicknames for heroin include Big H, H, Junk, Skag, Horse, Smack, Thunder, Hell Dust and Nose Drops.

Source: Centers for Disease Control & Prevention (CDC)

Prescription Opioids: A Gateway to Heroin Use

Prescription opioid medications, such as OxyContin® and Vicodin®, have similar effects to heroin on reaching the brain and its opioid receptors.

Research over the last decade or so has suggested that the misuse of these prescriptions can open the door to heroin use at some point in the future.

In fact, data from 2011 showed that an estimated 4-6% of those who misused prescription opioids did indeed switch to heroin, and around 80% of those who are now heroin users began by misusing prescription opioids.

The Dramatic & Extensive Damage Caused by Heroin

Whether heroin use begins as a recreational experiment or an extension of an opioid use disorder (OUD) that began with abusing prescription opioid medications, the end result remains the same if the use becomes  long-term – dramatic and extensive damage caused to both the user’s physical and mental health. 

The Physical & Mental Effects of Heroin Use & Addiction

Clearly, the most obvious effect of heroin use is the addictive, euphoric high experienced by users; however, it is not the only rapid and short-term effect of the drug. Other common effects of heroin use include:

• Dry mouth
• Warm flushing of the skin
• Heavy feeling in the limbs
• Nausea and vomiting
• Severe itching
• Decreased mental function, and
• Back-and-forth state moving between consciousness and semi-consciousness, experienced by users who call the condition going “on the nod”

After these initial effects have worn off, the user usually will become drowsy for the next few hours, their mental function remains reduced, their heart function slows, and breathing (the respiratory system) is severely slowed.

It is this decrease in respiratory system function that can lead to signs of an opioid overdose, including coma, permanent brain damage, and death.

Source: Centers for Disease Control & Prevention (CDC)

The long-term effects of heroin use can be both life-changing and life-threatening:

• Insomnia

• Abscesses (pus-filled skin tissue)

• Collapsed veins (from injecting)

• Severe constipation

• Sexual dysfunction for men

• Stomach cramps

• Irregular menstrual cycles for women

• Kidney disease

• Liver disease

• Infection of the heart lining and valves

• Damaged nasal tissue (from sniffing or snorting)

• Severe lung complications and infections, including pneumonia

• Major depressive disorder

• Antisocial personality disorder

HIV & Hepatitis C

Heroin users who inject the drug are also at a high risk of contracting HIV and the hepatitis C (HCV) virus.

Both diseases are transmitted through contact with blood or other bodily fluids, which can happen when users share needles or other injection drug use equipment.

HCV is actually the most common bloodborne infection in the U.S. HIV, and to a lesser extent HCV, can also both be transmitted through unprotected sex, which is more likely with drug use.

Lastly, heroin often contains additives, such as sugar, starch, or powdered milk, that can clog the user’s blood vessels, and lead to damage within the lungs, liver, and kidneys. There is also the risk of permanent brain damage.

“Heroin took my dreams, and everything else I had. Within weeks of my first fix, I had gone from the person I could have been to being a total stranger – unrecognizable to myself. I told lies. I stole. I would do anything for a fix. Often, my junk addiction meant I did.” – Jonathan*: Heroin addict, aged 24, Arizona Department of Corrections, Tucson, AZ *name changed

Heroin: Signs & Symptoms of Withdrawal

Those who are addicted to heroin not only become physically dependent, but are also fearful of the harsh withdrawal symptoms they are likely to experience when they do stop.

This is the primary reason why, with any withdrawal process from extensive opioid use, it is conducted by a professional medically-assisted detox at an accredited treatment facility.

Withdrawal symptoms from heroin can develop as soon as a few hours after sustained use.

Apart from the harsh symptoms, someone who is withdrawing from long-term heroin use is further at risk of serious medical complications developing.

Signs and symptoms of heroin withdrawal include: 

• Intense cravings

• Extreme sweating

• Nausea

• Cramping in the limbs

• Muscular aches and pains

• Insomnia

• Extreme pain in muscles and bones

• Runny nose

• Cold sweats

• Vomiting

• Diarrhea

• Fever

In cases where the individual has pre-existing medical conditions, these can be severely worsened by the withdrawal process, and can lead to death.

Can You Overdose on Heroin?

Yes, a person can definitely overdose on a powerful drug such as heroin, particularly if the drug has been laced with a stronger opioid, like fentanyl, or the heroin is purer or stronger than normal.

In medical terms, a heroin overdose can occur when there is enough of the drug present to produce a life-threatening reaction or death. 

When someone overdoses on heroin, as with any opioid overdose, their breathing becomes much slower, and can even stop entirely; this is known as respiratory system depression.

This decreases the amount of oxygen that reaches the brain, a medical condition called hypoxia. Hypoxia can have both short- and long-term effects, which can include coma and permanent brain damage.

If you suspect someone is suffering from a heroin overdose, call 911 immediately for emergency medical attention.

If the person is in possession of the opioid overdose reversal medication Naloxone, administer as directed, and wait for the emergency services to arrive.

Facts & Stats

Even though the U.S. national opioid epidemic is the direct result of millions upon millions of opioid prescriptions written out by our trusted family doctors, any opioid drug – from prescription OxyContin® to illicit black market heroin – can be highly dangerous when it is misused, with high rates for both overdose and addiction.

To further compound the issue, and leading directly to the record numbers of drug overdose mortality seen during 2020, the illicit drug supply in the U.S. has become more and more “contaminated” with one opioid in particular – fentanyl, a synthetic (or man-made) opioid.

Fentanyl, which is cheap and easy to produce and traffick, is many times more powerful than heroin, and, over the last few years, has been systematically added to virtually every illicit drug available on the U.S. black market – from the drugs sold on downtown street corners to those drugs sold online, including on the dark web.

This practice of contaminating other drugs with fentanyl has been done predominantly by the Mexican drug cartels, who are always keen to boost their illegal profits.

The U.S. Opioid Crisis in Numbers

• Around 130 Americans die every day from an opioid overdose
• Since 1999, the sale of opioid painkillers has skyrocketed by 300%
• About 20-30% of people who take prescription opioids will misuse them
• 2 million Americans are estimated to have misused prescription opioids for the first time in 2017
• About 10% of people who misuse prescription opioids become addicted, and develop opioid use disorder, which equates to around 2.1 million Americans with OUD
• About 5% of people with OUD will move onto heroin.

U.S. Heroin Use & Addiction in Numbers

According to the publication “Opioid Addiction 2016 Facts and Figures,” produced by the American Society of Addiction Medicine (ASAM), heroin, especially when it is mixed with fentanyl, has been a major contributor to the U.S. national opioid epidemic; for example:

• About 494,000 Americans over the age of 12 regularly use heroin
• In 2017, 886,000 Americans had used heroin at least once
• About 25% of people who try heroin will become addicted
• Over 15,000 Americans died from a heroin overdose in 2017

Am I Really Addicted to Heroin?

If you are even asking yourself the question “Am I really addicted to heroin?” the chances are reasonably high that you already have an issue with drug use that requires professional addiction treatment.

Often with a substance use disorder of any kind, the sufferer themselves is less likely to see the evidence than those around them – loved ones, family, friends, co-corkers, and so on.

For example, physical signs of a heroin addiction can include weight loss, poor skin and constricted pupils, which you may not be fully aware of.

Obviously, physical signs of needle marks and facial sores are a clear sign, and many early-stage heroin users will make efforts to regularly hide these with make-up and clothing.

Remember, heroin is not a drug that can be used on weekends, without experiencing intense psychological cravings for another fix during the week…

If you are in any doubt about your use of heroin, please contact either your family physician or a professional addiction treatment expert, and arrange a full appointment.

Alternatively, you can call Modern Recovery, where our substance advice team can discuss these issues with you in full confidence.

Frequently Asked Questions

What is Heroin?

Heroin is an illegal, powerful and highly addictive opioid drug sold by criminal drug dealers, originating from the seed pod of the opium poppy plant. These plants are typically grown in countries in either southern Asia, like Afghanistan and Thailand, South America and Mexico.

Heroin is made from the extracted morphine of the plant, and the resulting product can be either a white or brown powder, or a black, sticky substance, known as “black tar heroin.”

Was Heroin Legal at One Time?

Yes, heroin was once legal to buy and use in the U.S.

It was first produced by C.R. Alder Wright way back in 1874; he worked for St. Mary’s Hospital Medical School in London, and had been experimenting with combining morphine with various types of acids.

The drug was independently re-synthesized many years later by Felix Hoffmann, who was working at Bayer Pharmaceutical Company. Bayer marketed the product (diacetylmorphine) under the trade name of Heroin in 1895.

It was developed as a morphine substitute for cough medicine, and was actually available over the counter.

In 1914, the United States passed the Harrison Narcotics Tax Act to control the sale of heroin and other opioid drugs. At that time, it was reclassified, and could only be gotten by prescription.

A decade later, in 1924, once its highly addictive nature was confirmed, it was formerly banned in the U.S.

Why are Heroin Addicts Called “Junkies”?

Initially, the term “junkie” arose from one of the nicknames for heroin – “Junk.”

It was considered a disparaging slang word for describing someone addicted to heroin, and later, other illegal drugs.

Since it became more commonly used, it is now used to describe those with an apparent addictive behavior (either real or false, such as simply being highly interested in something); for example a chocolate junkie or a baseball junkie.

What Does “Chasing the Dragon” Mean?

The first heroin smoking originated in Shanghai in the 1920s. 

It involved the use of porcelain bowls and bamboo tubes to inhale the smoke.

“Chasing the dragon” was a later refinement of this form of heroin smoking, meaning inhaling the vapours which result when the drug is heated-typically on tin-foil above a flame.

The use of the word “chasing” has additional significance because users are always trying to repeat their very first euphoric high, which, in reality, is impossible to achieve.

How do People Get Addicted to Heroin?

When a person uses heroin, they experience a huge surge of dopamine, the brain’s feel-good chemical that reinforces “reward” or positive behaviors.

Because heroin does this so effectively, by binding to specific opioid receptors in the brain which nullify the sensation of pain, it creates a powerful state of euphoria or “high,” and the psychological craving to revisit the same high drives the user to use the drug again.

After a period of continued use (a matter of weeks or a few months), the brain, which is constantly trying to return itself to its normal state, builds up a tolerance to the drug, making the user increase their dose and how often they use.

Before long, they become addicted to the drug just to feel normal.

Why Do Many Heroin Users Contract HIV and Hep C (HCV)?

HIV and viral hepatitis (hepatitis C/HCV) can be transmitted through the use of shared needles and through unprotected sexual contact, which is why heroin users who inject the drug are at a high risk of either virus.

In fact, people who inject drugs (PWIDs) are the highest-risk group for acquiring HCV infection, and they continue to drive the now escalating HCV epidemic.

According to research data, each PWID infected with HCV is likely to infect 20 other people.

Do Prescription Opioids Lead to Heroin Abuse and Addiction?

Yes, prescription opioids – specifically when misused – can lead to a future opioid use disorder (OUD).

According to the National Institute on Drug Abuse, prescription opioids are a risk factor for heroin use and addiction, among many others, as their data indicates:

• People who misuse prescription painkillers generally are 19 times more likely to eventually use heroin.
• 86% of heroin users report having used Oxycodone and Vicodin prescription opioids prior to using heroin.

How Can Recover from Heroin Addiction?

Anyone who is addicted to heroin (medically known as opioid use disorder) should consider entering a program of professional addiction treatment.

They should not attempt to stop using heroin on their own ( a process known as “cold turkey”), because of the severity of withdrawal symptoms, which normally results in the user using heroin again to stop the withdrawal.

Professional treatment involves both a medically-supervised detox and a period of addiction rehabilitation (or rehab).

This combination addresses both the physical withdrawal symptoms as well as their psychological addiction to the drug.

Heroin addiction is extremely hard to overcome, but it is definitely possible with the right support and treatment.

Modern Recovery Treats Opioid Use Disorder

At Modern Recovery, we understand that individuals all have different reasons for seeking and using drugs.

This is why we make it a point to treat each of our patients as individuals and create treatment plans that will get them on the road to recovery and a substance-free future.

We offer a holistic approach that addresses the complex issues surrounding heroin addiction and recovery.

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