Heroin & Prescription Opiates: What’s the Difference in Treatment?

Tim Sonnet

Medically reviewed by

Tim Sinnott, MFT

June 26, 2019

Article Contents

Heroin Vs Prescription Opiate Treatment

Article Contents

In the United States of America, the drug abuse epidemic is becoming more and more lethal as time progresses. At the center of the epidemic are prescription opioids and heroin. These drugs are related to each other, and therefore have many similarities in effects, addiction symptoms, and drug treatment program options. However, the key difference between the two is the legal status of heroin within the US. Because of its illicit nature, heroin has not only become a popular drug to turn to when prescriptions for legal opioids run out but has also resulted in heroin addiction recovery centers learning how to alter their treatment for heroin addiction. This is due to the different environments in which a person obtains heroin versus prescription opioids.

Prescription Opiates

What are prescription opiates?

Opioids are a type of Schedule II Controlled Substance naturally found within the opium poppy plant. Schedule II Controlled Substances are noted to be highly addictive, while also presenting some medical uses. Prescription opioids are made both using the poppy plant, as well as synthetically within a lab setting to provide medication for those suffering from severe pain. While prescription drug abuse rates continue to increase, these medications are highly regulated due to their addictive nature. Typically ingested orally, the most commonly prescribed opioids include Codeine, Fentanyl, Hydrocodone, Methadone, Morphine, and Oxycodone.

Effects Of Prescription Opiates On The Mind And Body

There are a number of different systems throughout the body which are affected by drug abuse:

  • Kidney damage and at times failure can occur as long-term side effects due to chemicals in the bloodstream poisoning the body’s organs. Dialysis becomes necessary in this situation, and without a transplant kidney failure is fatal.
  • Opioid abuse has the potential to affect the lungs as well. Opioids alter the breathing in a way that increases the potential of developing pneumonia. Fluids can also potentially build up within the lungs, causing further complications.
  • Due to regrowth impairment, those abusing prescription opioids are at a high risk of bone loss. Regrowth impairment is caused by defective nutrient absorption in the gut. Bone loss is responsible for a considerable number of fractures and broken bones among those facing prescription opioid abuse issues.
  • The use of prescription opioids slows the body’s rate of digestion and has the potential to cause leaky gut. Leaky gut is a condition during which the gut’s biome is disrupted, causing pores to open within the intestinal lining, releasing drugs and toxins into the bloodstream. In addition to leaky gut, opioids interfere with receptors in the intestines, most often leading to constipation.
  • The risk for a heart attack is increased among those taking prescription opiates. The vascular system is also affected in those injecting the drugs. Because most prescription opiates are available in pill form, those who inject the drug must crush and dissolve the pill in water before injecting. The resulting concoction can potentially still contain small fragments of solid material. Once injected, these solid particles can cause blockages within the tissues of the body.
  • The purpose of the liver is to process and filter toxins within the body. Acetaminophen, a drug commonly combined with opiates in pain killers, is particularly hard on the liver. Because of the presence of Acetaminophen in prescription opiates, abuse of opiates has the potential to cause liver disease, a fatal ailment.

Addiction to prescription opiates also has the potential to cause mental and emotional side effects. Opioids work by binding to receptors within the central nervous system. This system includes the brain. Once bound to these receptors, opiates mimic pain relievers naturally produced within the body. This can result in the lessening of pain, and even feelings of euphoria, but can also result in nausea, confusion, and drowsiness.

As the use of the drug continues, the body requires more and more of the substance to feel the same state of euphoria. Once dosage size is increased past the recommended amount and addiction sets in, withdrawal symptoms may be felt if more of the drug is not administered. The symptoms of prescription opiate withdrawal include mood swings, anxiety and irritability, vomiting, cramping, and muscle aches.

It is possible for prescription drugs to be abused to the point of an overdose. During a prescription opioid overdose, the rate of breathing is slowed considerably, resulting in oxygen being cut off from the brain. This can result in permanent brain damage and death.


What Is Heroin?

Heroin is a specific type of opioid. The drug is made from morphine, which itself is derived from the opium poppy. Heroin appears all over the world in many different ways. Heroin is typically found in the form of a powder, ranging in color from white to brown. Powdered forms of heroin are typically cut with another powder of similar color and consistency, for example, sugar, starch, or powdered milk. Because of its bitter taste, heroin is typically ingested either through smoking or snorting the powder, though injecting the drug is another form of administration. Black tar heroin has a dark black, sticky, sometimes solid appearance, leading to its name. The color of black tar heroin is a result of impurities left behind throughout the creation of the drug. This form of heroin is most often injected into the body after being diluted down.

Effects Of Heroin Addiction

Because it’s technically an opioid, heroin works much in the same way prescription opioids do. It binds to receptors in the brain, specifically the ones responsible for regulating pain and feelings of euphoria. Once the heroin becomes bound to these receptors, the brain is signaled to release dopamine, resulting in good feelings and reinforcing the behavior. Because the receptors in each person’s body are different, it can be difficult to predict how heroin will affect each person differently.

People using heroin typically feel a ‘rush’ after first consuming the drug. The intensity varies, but the feeling of a ‘rush’ can be accompanied by a dry mouth, heavy hands and feet, and flushed skin. Itching is also known to occur over the entire body. After using heroin, a person will feel exhausted for a number of hours. This exhaustion can be accompanied by depressed breathing and a slowed heart rate.

After continued use, heroin does have an effect on the brain, decreasing the overall amount of white matter present. The loss of this white matter can result in a decrease in cognitive functions such as decision making, behavior regulation, and the ability to respond to stress.

Other organs within the body are also damaged by heroin use. Insomnia and constipation are popular effects of long term heroin use without heroin addiction treatment. The lungs are also affected, as the body is more predisposed to getting pneumonia. Depression and antisocial personality disorder can also develop as a result of heroin use. The hormones in the body are also affected, leading to sexual dysfunction among men and irregular periods among women.

Different forms of administration also come with additional side effects or consequences of use. Those who snort the drug often have problems with their nasal passages. Those injecting the drug are creating scar tissue constantly, meaning they must rotate injection sites. Blown veins, infections of the blood vessels, abscesses, and other skin infections are also potential risks. Blood vessels can also become blocked with the substance being injected. Using dirty needles exposes those dealing with heroin addiction to a myriad of other diseases including hepatitis and HIV. These illnesses can then be passed on to sexual partners and children.

As with prescription opioids, heroin withdrawals begin very quickly if more of the drug is not ingested.  In fact, symptoms can present themselves in as little as a few hours since the last use of heroin. Symptoms of withdrawal peak approximately one to two days after the last use of the drug, and subside after about a week. However, depending on the severity and degree of the addiction, it is possible for withdrawal symptoms to persist for a number of months. Symptoms of withdrawal include restlessness, insomnia, leg movements, nausea, vomiting, diarrhea, and cold flashes.

Furthermore, it has become evident to the medical community that heroin is addictive to an extreme degree, necessitating heroin addiction treatment. Heroin addiction can often result in heroin use disorder. This disease takes place when relapsing occurs to the point where the individual becomes more than physically dependent. This often results in drug-seeking to the extreme, with no regard for any consequences or dangers.

Overdosing on heroin is a strong possibility for those using the drug if treatment for heroin addiction is not received. This is because heroin depresses the respiration of those using the drug, similar to the overdose effects of prescription opioids. Like other opioids, if medical intervention does not occur and there is no heroin addiction treatment, heroin overdoses have the potential to result in death.

The Relationship Between Prescription Opiates And Heroin

  • People who abuse heroin have typically abused prescription opioids prior. Those who have substance abuse problems involving heroin typically started using opioids prior to their heroin use. Research is now showing that prescription opiate abuse may be a steppingstone on the path to heroin use. Heroin is also at times less expensive, as well as easier to come by than prescription opioids. If unable to obtain a prescription, it is likely that a person facing opioid withdrawals would eventually look elsewhere to find a drug that will make their withdrawals dissipate.
  • Heroin used to be prescribed as a painkiller. Here in the United States, from the late 19th century until the early 20th, heroin was prescribed for a number of different ailments, considered to be a cure-all for anything from depression, sluggishness, and colds to tuberculosis and even cancer. By the time 1920 rolled around and the Dangerous Drug Act was enacted by Congress, the market for heroin has already opened up in the states.

Prescription Opiate Treatment Vs Heroin Addiction Treatment

Because Heroin is a specific type of opiate, made from morphine, treatment for heroin addiction and treatment for prescription opiate abuse is very similar. By and large, the difference between treatment for heroin addiction and prescription drug treatment programs is the legality of the substance being abused. Because prescription pain relievers are prescribed by a doctor, they are oftentimes seen as less dangerous than heroin. However, it is important for those in rehabilitation for prescription drug use to learn the truth about the dangers of drug abuse.

In addition, because heroin is an illicit substance in the United States, those obtaining the drug must do so through other means. This oftentimes means getting involved in dangerous situations. Those facing heroin addiction often live in more dangerous areas where they are exposed to people trying to sell them drugs. In a prescription drug abuse setting, the drugs are obtained through a pharmacy initially, and therefore pass through the eyes of passersby more easily. In other words, prescription opioids are often more inconspicuous than heroin. Those facing heroin addiction or attending heroin addiction recovery centers may also fear possible criminal consequences if they seek treatment for heroin addiction, which can deter them from attending a heroin rehab center.

The treatment focus for heroin addiction must be on changing the people, places, and things the person facing addiction previously associated with. This is because they serve as possible triggers on the road to recovery, and have the potential to expose those early in their recovery to situations that may cause a relapse.

All In All

While it is true that treatment for opioids and treatment in heroin addiction recovery centers have many similarities, the fact is that their treatment must be different because of the legal status of prescription opioids. While opioids can be more safely obtained and taken, heroin addiction has the potential to put those facing substance abuse in many dangerous situations. The people, places, and activities a person was associated with during their addiction must be altered within a heroin rehab center if sobriety is going to be successful.

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Tim Sonnet

Medically reviewed by

Tim Sinnott, MFT

June 26, 2019

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