Heroin &
Other Opioids

What are opioids?

Opioids include the illegal drug heroin, man-made drugs such as fentanyl, and prescription pain relievers.

Heroin is an opioid drug made from morphine. It enters the brain quickly and connects to cells in the brain and spinal cord that are involved in pain, pleasure, heart rate, sleep and breathing. Heroin is an illegal narcotic with dangerous side effects including addiction.

Prescribed opioid medications that treat pain include codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, paregoric, sufentanil, and tramadol.

They work in three ways:

1. by lowering the number of pain signals your body sends to your brain
2. by changing how your brain responds to pain
3. by producing feelings of pleasure and connection

Prescription opioids work best for short-term pain of three days or less. Doctors most often use them to relieve pain from surgeries, injuries, and dental procedures.

If you are living with chronic long-lasting pain, many other treatments are available. These include other safer medications and non-drug therapies such as acupuncture, physical therapy, meditation, massage, guided imagery, manual therapies like chiropractic, and gentle exercise such as swimming and tai chi. Even eating a healthy diet and taking certain supplements can improve your brain chemistry and reduce your experience of pain.

See the PAIN MEDICATION section below for detailed information.

Opioid addiction risk factors

Many factors increase the risk of becoming addicted to opioids.

1. Taking them longer than 3-4 days
2. Taking opioids in ways that are different from how they were prescribed, such as crushing a pill so that it can be snorted or injected
3. Taking more than your prescribed dose or taking it more often than prescribed
4. Having a personal or family history of substance abuse
5. Factors such as unemployment, heavy life stress, depression or anxiety

Why are opioids so addictive?

Natural chemicals in the brain (called endorphins) relieve pain, create feelings of pleasure, reduce stress, and help you feel connected to others. Taking opioid drugs changes your brain by creating artificial rather than natural endorphins. These can block pain and also produce a “high” that makes you feel good.

But too much opioid use can cause your brain to need the artificial endorphins to feel good. Once this happens, your brain can even stop making its own. The longer you use opioids, the more likely this is to happen.

Immediate effects

Opioids change how your body feels, your emotions and what actions you take. You may feel sleepy or have shallow breathing, slurred speech, constipation, or nausea and vomiting. Emotionally you may feel anxious, irritable, or have mood swings from sad to very happy. You may be sleeping more or less than normal or making poor choices in your life. Overall, you may feel less able to handle your daily life and responsibilities.

Long term effects: drug tolerance and drug dependence

Increasing the dosage of opioids over time changes the brain so that it only works more or less normally when the drugs are taken - and abnormally when they are not. Two results of this change are opioid tolerance and opioid dependence.

What is opioid tolerance?

After taking an opioid for just a month, it changes the way your brain and body work. If you develop tolerance to the drug you need higher and higher doses to reach the same effect.

What is opioid dependence?

Opioid dependence means that when you try to stop using the drug you have symptoms of withdrawal that can start in a few hours. These include muscle and bone pain, restlessness, problems sleeping, diarrhea, vomiting and severe cravings. This can lead to daily drug use just to avoid these uncomfortable symptoms.

To stop using an opioid and avoid withdrawal symptoms gradually lower the dose you take over time. Your doctor can help you do this in the right way. Your doctor can also prescribe certain medicines to help reduce withdrawal symptoms and control your cravings. These include methadone, buprenorphine, naltrexone, and others.

Symptoms of opioid overdose

An opioid overdose is a medical emergency and you should immediately call 911.

Symptoms include passing out, slow irregular breathing or not breathing at all, slow or no pulse, vomiting, and constricted pupils in the eyes.

Clear signs of opioid addiction include:

• Intense cravings for the drug
• Being unable to stop or cut down on how much you take and how often
• Spending a lot of time getting, using, or recovering from the drug
• Taking the drug even when it is causing problems in your relationships, health, school, work, or trouble with the law
• Taking it in larger amounts for a longer period of time than intended
• Giving up other important activities because of heroin use
• Developing tolerance - either needing to take more heroin to reach the effect you want or experiencing less effect using the same amount
• Having withdrawal symptoms or taking similar substances to relieve or avoid withdrawal symptoms

These screening tools can help you see if your drug use is harming your health and your life. You can take them in the privacy of your home or wherever you feel comfortable. They are confidential and give you immediate online feedback on your drug use.

There are many stages of the recovery process. The first steps are accepting that you are addicted to opioids, are not able to manage them, and it is harming your health and your life. When you are ready and willing to get treatment, it is time to plan your recovery.

Learning about the different approaches can help you get the support you need to stop using opioids, stay drug-free, and create the life you want to live.

Opioid Detox

Opioid Detox is a medically supervised withdrawal process. When you use opioids your body becomes physically dependent on them over time and stopping them can cause intense withdrawal symptoms. Detox treats the immediate physical effects of withdrawal and removes toxins left in the body as a result of the chemicals found in opioids.

See the TYPES OF TREATMENT section for a full description of the types of Opioid Detoxification.

Medications that Treat Heroin Addiction

Medications can be an important part of your recovery. They work best when combined with a strong support system such as a 12-step or other peer-based recovery program, individual or group counseling, or psychological therapy.

How Medications Help:

• Lessen Withdrawal Symptoms: One reason people keep taking opioids is to avoid the intense symptoms of withdrawal. Medications help reduce these symptoms when you start the detox process. But detox is only the first step in stopping opioid use. [bold this and put in italics] If you do not get treatment after detox you are much more likely to start using the drug again.

• Prevent relapse:  Medications can be used to decrease cravings and help your brain and body return to normal after you’ve stopped using drugs. Each drug, such as heroin and prescription opioid drugs, is treated by a specific medication. People who use more than one drug need treatment for each of the drugs they use.

• Treat related mental health issues:  You may be helped by medications that treat mental health conditions that put you at risk for opioid addiction such as depression or anxiety.

Three FDA-approved medications are used in the U.S. to treat opioid addiction:  methadone, buprenorphine, and naltrexone.

For detailed information on these medications see our MEDICATIONS TO TREAT ADDICTION section on Heroin & Opioids

Medication-Assisted Treatment

This approach uses new medications, combinations of medications, and new ways to take them to treat heroin and opioid addiction. It is combined with counseling and therapies that help you understand the choices you’ve made and support a healthier lifestyle, personal growth and feelings of well-being.

For detailed information on these medications see our MEDICATIONS TO TREAT ADDICTION section on Heroin & Opioids.

You can learn more about Treatment Approaches to Drug Addiction at the National Institute on Drug Abuse website.

Support

• GROUP SUPPORT from 12-step programs like Narcotics Anonymous and other peer-based recovery programs is an important part of staying motivated and feeling connected, understood, and supported. Find out about these and other programs in the Recovery Support section below
• INDIVIDUAL AND GROUP THERAPY help you manage stress and anxiety, change how you think about drug use, help you develop new skills so you can cope better, and if on medication, help you use it in the right way and long enough to be effective.
• RESIDENTIAL OR OUTPATIENT TREATMENT
  You may benefit from residential (inpatient) or outpatient treatment. These programs are very structured. They are designed to help you recognize and change harmful patterns – and learn more positive ways to interact with others, handle stress, stay committed to your sobriety and start on a new path.

Other Treatment Approaches

ACUPUNCTURE
Acupuncture lessens the “high” from heroin. It can also ease withdrawal symptoms, help reduce cravings, stress and anxiety and improve mood and sleep.

• The National Acupuncture Detoxification Association (NADA) has detox protocols that are being used in over 250 hospitals and 700 addiction treatment centers in the U.S. and U.K.
• To find an acupuncture practitioner visit our Holistic Support section.

COGNITIVE BEHAVIORAL THERAPY (CBT)
CBT is a common form of short-term talk therapy that helps you see how your thoughts underlie addiction. It opens up new ways of thinking that are more positive, healthy and realistic. It also helps you develop better ways to cope with stress and life’s challenges during recovery.

• For more information on CBT for addiction click here.

MINDFULNESS TRAINING
Mindfulness is a type of meditation that teaches you to focus on the present moment in a relaxed and calm way. It can help reduce cravings triggered by stress.

• An 8-week outpatient program called Mindfulness-Based Relapse Prevention (MBRP) can be taken after you’ve completed initial treatment. It combines practicing mindfulness with learning new life skills . In this way you can cope better with problems, triggers and difficult thoughts and feelings without using a drug to avoid them. For more information on MBRP click here or visit https://www.mindfulrp.com/ for a list of therapists who offer this work and free audio recordings of MBRP mindfulness practices.

GUIDED IMAGERY
Chronic stress can leave you open to addiction. Without a belief in your ability to cope, it is easy to use drugs as a way to escape emotional pain. One simple technique to help you cope is Guided Imagery. This is an easy to learn tool that can help you feel calmer and focus on how you want to live your life. In this way you can take better care of yourself and bounce back during hard times. Imagery can be done on your own with a guided imagery audio/video or by working with a counselor or therapist.

• Here’s a free online guided imagery exercise to try (9 minutes): Dr. Emmet Miller: Changing your habits, addictions and behaviors
• Visit our web page on Guided Imagery for a good place to find recovery audios.

Opioid Treatment for Teens

Opioid Treatment for Older Adults

Our TREATMENT section has many different recovery options to help you find the approaches that best meet your needs.

Also see our PROGRAMS AND SUPPORT section for ongoing ways to support your recovery.

Medications used under the care of a medical professional are an important part of the treatment for opioid use disorder. The newest form of medication treatment is called Medication-Assisted Treatment (MAT).

MAT combines specific medications (methadone, buprenorphine, or naltrexone) with counseling and short-term therapies focused on changing patterns of thinking and taking positive action. These medications are safe to use short or long-term.

The main goal of MAT is to help people stay in recovery and prevent opioid overdose. It is used to block the “high” from opioids, reduce cravings and help the brain and body heal.

Medications can be used to lessen withdrawal symptoms, prevent relapse, and treat both addiction and related mental health issues.

Click Here to find certified practitioners and opioid treatment programs by state for Medication Assisted Treatment

What They Do

• Ease withdrawal:  One reason people keep taking opioids is to avoid the discomfort of withdrawal. Medications help ease withdrawal symptoms during detox. But detox is only the first step. If you do not receive treatment and support after detox you are more likely to start using opioids again.

• Prevent relapse:  Medications can be used to decrease cravings and help your brain and body return to normal after stopping drug use. Each drug, such as heroin and prescription opioid drugs, is treated by a specific medication. If you use more than one drug you need treatment for each of the drugs you use.

• Help with other mental health problems:  Medications can help treat depression or anxiety, which can contribute to opioid addiction.

To learn more about available treatments visit the National Institute on Drug Abuse website.

Do They Work?

Strong evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and help people stay in treatment.

Buprenorphine and methadone do not produce a "high" and lessen withdrawal symptoms and cravings. People can live normally while taking them. They can work, go to school, and take part in other forms of treatment and support to help their recovery.

If the goal is to wean off the maintenance medication, it should be done slowly while working with a treatment provider. It may take months or even years for brain circuits to recover from long-term drug use. These medications provide the support that is needed during this time. In cases of serious and long-term opioid use, a person may need these supports indefinitely.

BUPRENORPHINE

Buprenorphine was approved by the FDA in 2002 as a new treatment for opioid addiction. It is the first approved narcotic drug for addiction that can be prescribed by doctors in their offices. Since 2002 it has been available as a tablet and since 2010 as a film put under the tongue. In 2016 the FDA approved a 6-month buprenorphine implant and in 2017 a once-a-month buprenorphine injection. Both are available to patients stabilized on buprenorphine, so daily doses are not needed.

Different Forms:

• Bunavail (buprenorphine and naloxone):  a small rectangular film you place inside your cheek, where it dissolves. It contains the drugs buprenorphine and naloxone.
• Buprenex:  a form of buprenorphine that is injected.
• Butrans:  a medicated adhesive patch that is placed on the skin containing buprenorphine. Use these patches exactly as directed by your doctor.
• Subutex:  buprenorphine in tablet form that is dissolved under the tongue.
• Zubsolv (buprenorphine and naloxone):  tablets that you dissolve under your tongue.
• Sublocade:  a once-a-month injection of buprenorphine. Patients must be started on Zubsolv or Subutex before taking Sublocade.

What it does:  Buprenorphine has major advantages over methadone or naltrexone. It is more effective at reducing drug cravings than naltrexone. While methadone is usually prescribed daily, buprenorphine is only needed every other day and there is a lower risk of overdose compared to methadone. Subutex is used in the first few days a person starts treatment.

How it works:  Opioids attach to receptors in the brain, but they are not a perfect fit. Buprenorphine stimulates these opiate receptors but not strongly enough to produce the “high” that opioids would. Because of this it helps to ease withdrawal symptoms and drug cravings. If a user tries to take another opioid such as heroin while taking buprenorphine, there will be no effect.

Side effects:  Headaches, flu-like symptoms, dizziness, constipation, upset stomach, sleep problems.

Note:  It can cause dependence and withdrawal symptoms when stopped.

For a more complete list of side effects visit this NIH page.

Availability:  Physician Prescription

Other Helpful Resources:

• What is Buprenorphine Treatment Like? A fact sheet that answers many questions about taking buprenorphine, written by a nurse researcher at Yale University.

• The Facts about Buprenorphine for Treatment of Opioid Addiction Describes how buprenorphine works, its proper use, side effects, and how it fits with counseling in the recovery process.

• SAMHSA’s Buprenorphine Practitioner Locator
  Click here for a nationwide list of doctors who are qualified to prescribe Buprenorphine. You can choose Physician List Search at the bottom of the page to search by city, county, zip code or state or just click on the state you want on the map.

METHADONE

What it does:  Methadone is a long acting medicine that reduces cravings and blocks the effect of opioids. It prevents withdrawal symptoms in people who are now in a treatment program.

How it works:  It turns on opioid receptors in the brain – but it does it more slowly than other opioids so it doesn’t produce a high. This lets you slowly detox without withdrawal symptoms or cravings. Because its effects last between 24 and 36 hours, most people can take just one daily dose.

Side effects:  Drowsiness, weakness, nausea, constipation, headache, loss of appetite.

For a more complete list of side effects visit this NIH page.

Availability:  Physician prescription. Methadone is not available through a local pharmacy. Patients must visit a special outpatient treatment provider or clinic. Click here for a list of methadone clinics by state.

NALTREXONE (ReVia®, Vivitrol®, Depade®)

What it does:  Naltrexone blocks opioid receptors in the brain from being turned on. Instead of controlling withdrawal and cravings, it prevents any opioid drug from producing a high.

How it works:  It blocks the part of your brain that feels pleasure when taking opioids. Because of this you do not feel the rush, high or pain relief that opioids bring. It also decreases the desire to take opioids.

Naltrexone can be taken by mouth once a day or every other day, has few side effects and is not addicting. It is part of a complete treatment program including counseling or psychotherapy, lifestyle changes and social support.

Side effects:  nausea and vomiting, stomach pain, headache, dizziness, sadness, nervousness, sleepiness, diarrhea or constipation

Some people have had trouble staying on Naltrexone because of its side effects. But in 2010 an injectable, long-acting form of naltrexone (called Vivitrol®) was approved by the FDA for treating opioid addiction. The effects of Vivitrol® last for weeks, making it a good choice for people who cannot easily access healthcare or who have a hard time taking their medications regularly.

For a more complete list of side effects visit this NIH page.

Availability:  Physician prescription

New Medication Approaches

Recent approaches to heroin and opioid addiction include new medications, combinations of medications, and new ways to take them.

Comparing Naltrexone and Suboxone

The National Institute on Drug Abuse compared two medications to prevent relapse. Suboxone (a combination of buprenorphine and naloxone) was given daily as a film put under the tongue. Naltrexone (Vivitrol) was given as a monthly injection. To take Vivitrol you must have first fully detoxed, but some people have a hard time doing that. This makes Suboxone easier to use.

The study showed that if you can’t use Vivitrol because you couldn’t complete detox you can now start treatment with Suboxone instead - and get the same good results. Suboxone is also much less expensive than Vivitrol, which costs $1,000 per injection.

Implantable Buprenorphine (Probuphine)
In May 2016 the FDA approved the use of Probuphine, a form of buprenorphine that is implanted in the arm. It provides a constant, low-level dose of buprenorphine for six months in patients who are already stable on low-to-moderate doses of the pill or film placed under the tongue. Because the medication is implanted under the skin, you don’t have to remember to take it or visit a clinic every day. In a study of Probuphine, 63% of patients showed no opioid use during the six months of treatment.

Monthly Sublocade Injection
Sublocade is a once-a-month injection of buprenorphine approved by the FDA in 2017. Buprenorphine reduces opioid withdrawal symptoms and the desire to use opioids. In order to have a Sublocade injection you must have been on a stable dose of buprenorphine for at least seven days.

Sublocade was studied in 850 adults with opioid addiction. Patients taking the Sublocade injection had more drug-free weeks compared to those who took a fake pill that has no actual effect (called a placebo). The most common side effects were constipation, nausea, vomiting, headache, drowsiness and injection-site pain.

Reversing an Opioid Overdose
Naloxone quickly restores normal breathing when a person is overdosing on heroin or prescription opioids. Many states allow you to get naloxone from a pharmacist without bringing in a prescription from a doctor. This was done to help family, friends, and other potential bystanders of overdose save lives.

It is available as a prefilled auto-injection device (EVZIO) or as a prepackaged nasal spray (NARCAN Nasal Spray). Visit NIDA’s Naloxone Resources webpage to learn more.

12-step programs

Twelve-step programs are an important part of the recovery process. They are based on a set of guiding principles and the ongoing support of people who share their experiences of stopping drug use and staying drug-free – the lifelong process of recovery. People recovering from many types of addiction can join a 12-step program.

NON 12-STEP SUPPORT PROGRAMS

These self-help support groups give you tools to change the negative and defeating thoughts that are part of addiction. Unlike 12-step programs, they do not rely on a higher power, sponsors, or steps for sobriety. The focus is on finding strength and self-control within yourself. There are in-person meetings with peers as well as daily online meetings, chat rooms and message boards.

Faith-Based Recovery Programs

These programs approach recovery through various religious traditions including Christian, Jewish, Islamic and Buddhist.

A faith-based recovery program understands that addiction and substance use is not just a physical problem – it reflects the spiritual and emotional suffering of an individual. These recovery programs seek to restore each person’s well-being through guidance and spiritual support, and encourages them to transform their lives totally.

To learn more about the different faith-based programs see our PROGRAMS & SUPPORT section.

APPS

Mobile apps give you another tool to support your recovery. They offer practical support for recovery that is affordable, private and always available.

Apps can track sober time, help you manage triggers and emotions, find and share meetings, contact your sponsor discretely, keep you motivated, connect you with a recovery community, and more.

Many good apps are available for both the iPhone/iPad and Google Android phones. Of note, it is estimated that 7 out of 10 free apps use ads. This can be distracting and because ads use data they can cost you money in the long run. Many apps offer a premium version as an in-app purchase which has extra useful features and usually no ads. You can try out the free version of the app and upgrade to premium if it is helping you.

Build a Sober Network

Connect with people socially who are also working on their sobriety for support, sharing and encouragement. Addiction can be isolating. Support helps you heal.

Chat rooms and online meetings

A chat room lets you communicate in real time on the Internet. Everyone who is logged in sees what you are typing, but two people can still have a private chat on the side. People from any location can join in, making them an ideal format for groups of people.

Chat meetings are chat rooms with a chairperson who introduces topics for people to address. Chat meetings are scheduled in advance for a specific period of time.

NA Online meetings usually use Zoom. The group sets them up, gets a meeting code and password and sends the information to all members of the group. Or the group sends the information to Central Office, who post the info online.

Holistic approaches

When you stop taking opioids your body and mind need time to recover. Withdrawal can occur any time you stop or cut back on long-term use.

During this period you may feel very uncomfortable – nervous, restless, depressed, irritable or confused. You may also have physical symptoms like nausea and vomiting, pain, sweating, cravings and fatigue. Your sleep and eating may be disturbed for a period of time.

Feeling anxious and worried can make you vulnerable to opioid addiction. When you don’t believe in your ability to handle the stressful parts of your life it is easy to use drugs as a way to escape emotional pain.

Holistic therapies help you cope with these symptoms and feelings. They are valuable to long term recovery as well by supporting deep healing and bringing new healthy experiences to the process.

Over time you can build better health, inner calm and strength – so you can think more clearly and focus on what is best for you. You may also find it easier to connect with others, your deeper self or to something greater than yourself, however you define that.

For those in recovery, holistic approaches work best when they are part of professional treatment and they are often part of addiction recovery programs. Studies show that success rates improve strongly when holistic approaches are included in treatment.

• Practices such as massage, yoga, meditation and exercise help reduce stress and ease withdrawal symptoms. This makes it easier to cope with emotions tied to drug use and lowers the risk of relapse.
• Through mindful meditation you begin to notice your thoughts and feelings but not react to them in the usual way. You learn how to focus on the present, stay centered and keep your mood steady. This helps you experience your cravings and triggers without being overwhelmed by them.
• Acupuncture lessens the “high” from heroin. It can also ease withdrawal symptoms. This can reduce cravings and relapse and improve your mood and sleep. Acupuncture is often a part of recovery programs for opioid use disorder.
• Relaxation approaches such as deep breathing, hypnotherapy, and guided imagery use the power of your mind to help you - so that you have tools at hand when you need them.
• The arts, including playing music, painting, writing, drumming, crafts and dance are good ways to deal with emotions. Even sharing your thoughts and feelings with others in recovery can be very helpful in building trust and not feeling alone.

Part of a holistic approach also includes being in nature. Finding a safe, quiet and natural place can refresh the soul and provide the space to explore whatever form of spirituality moves you.

To learn more about specific holistic therapies and their place in recovery visit our HOLISTIC SUPPORT section.

sober living homes

Sober homes are designed to provide safe and supportive group living for people recovering from addiction. They are based on peer support, structure and learning new life skills in a setting that is free of alcohol or drugs. They serve as a transition between treatment and return to normal life.

Thousands of sober homes exist in the United States and there are many different types. At a minimum, they offer peer-to-peer recovery support while others have professional clinical services to promote long-term recovery. There are residences for specific populations such as specific languages, male or female, women with children, different age groups, co-occurring problems, medication status, and prison re-entry.

See our SOBER HOUSING section to find sober homes near you and across the country.