Is heroin damaging to the body?

October 27, 2005 12:17 AM

What's the medical opinion on heroin and opiates and their damage to the body?

Ok, I lied. This is just about heroin. Here's the story:

I must admit that I managed to leave Comedy Central on last night long enough for the Adam Corolla show to come on. This particular show featured his old radio partner "Dr. Drew". Adam had him go through all the various evils that intoxicants would cause upon your body, but when he got to heroin (right when they were running out of time) he said that most problems are caused via the nature of addiction and *not* from the drug itself -- ie, the sharing of needles, the collapsing of veins, etc. In fact, Dr. Drew claimed that when heroin (LET THE HERO IN!) was discovered by Bayer, it was lauded as a source of pain relief which was not harmful to the body. Dr. Drew went on to say (briefly) that the problems usually associated with heroin were due to both the nature of its consumption and the extreme lengths (and thus lack of judgement) that addicts would go to in order to get their fix. Simply, he said that heroin was largely not in and of itself harmful to the body (and seemingly, much less harmful than alcohol, which ten seconds earlier he declared one of the most damaging intoxicants that can put in the human body).

Is this true? I realize that heroin leads to a type of addiction that is mostly unknown outside of cigarettes, and makes people do crazy and stupid things, and further, that heroin users are probably statistically likely to behave in a manner that will cause damage to the body. However, I find it hard to believe that heroin use itself does not cause serious damage to the body, especially because of the reports of overdose that one reads nearly every day. This belief is somewhat tempered by the giving out of opiates that I've seen in the hospital recently. If you're terribly ill and someone can give you a morphine drip without worrying whether it will exacerbate your condition, well, then, perhaps it isn't particularly harmful as one would think.

So, my question is: is "Dr. Drew" correct? And, if so, is this a rule that only applies to "pure" heroin (which is likely unavailable to addicts)? (He did mention that Vicodin, for example, which combines an opiate with Tylenol, is very damaging, due to the Tylenol). What's the deal with heroin you buy on the street? Is it so far from medical opiates that it will have significantly more damaging effects than Dr.Drew accounted for? Why do I hear about so many people dying from their heroin habit? Are we safe to say that it's not the heroin, and the other damages that heroin might put on their body? Are overdoses caused by "bad" heroin or too much heroin?

I'm mostly curious because I've recently been reading the Stahl book that was made into the film "Permanent Midnight" where he makes the assertation that heroin "preserves" rather than kills, and points out that Bill Burroughs kicked it due to alcoholism (probably more related to his speed addiction, but we don't need to quibble) and that "classic" heroin writers such as Burroughs himself and say, uh. Keith Richards, are still alive and well.

So what's the deal here? I know heroin is terrible -- don't get me wrong, I've friends who've been/are addicted (and it's not pretty), but does the drug itself cause damage to the body, or is it the environment that the drug creates?

posted by fishfucker to health & fitness (37 comments total)

er. replace tylenol with aspirin. Sorry.
posted by fishfucker at 12:19 AM on October 27, 2005

oh, and i suppose a side question here is: is alcohol as bad as Dr.Drew made it out to be? Is it one of the most damaging intoxicants that can be put in your body?
posted by fishfucker at 12:45 AM on October 27, 2005

I've heard and read this too. This reference says that the "dangers of heroin use" stem from its illegality.

It can affect your immune system. If you don't take care, regular use will affect your digestive system (enzyme activity, chronic constipation..etc), although I've read that peripheral opioid antagonists like methylnaltrexone can prevent such effects, and yet not interfere with the psychoactivity (since it doesn't cross the blood-brain barrier). I think the key point is that one can lead a functioning life as an addict if you have easy access to a pure, metered dosage like the addicts in the heroin maintenance programs in Britain, Switzerland and the Netherlands, where a select number of addicts (who have failed a few rehab programs) are supplied heroin by the government. So, if heroin inherently lead to major health problems, I doubt some programs would last long, whereas, as I understand it, it's been running for quite some years now.
posted by Gyan at 12:50 AM on October 27, 2005

As far as heroin ODs are concerned, that generally is a result of tolerance and uneven purity in the street product. This is my layman understanding of it, so feel free to correct me. With regular use of opiates, one develops tolerance to the drug such that one requires greater amounts to get the same effect. Street heroin ranges in purity from a few percent, say, 5, to almost pure, say, 95. So, if you're used to dealing with 100mg product of a certain purity, and you get a new batch, which is many times purer, you might be in trouble. The other way, is if you stay off for a few days, during which your tolerance breaks down, Now, if you shoot the same amount, probably trouble. However, an interesting research paper I came across, mentioned that most ODs had low levels of morphine (the metabolic byproduct of heroin, and indeed the actual psychoactive agent) and the most probable cause was a combination of drugs especially cocaine, alcohol, benzodiazepines..etc
posted by Gyan at 1:05 AM on October 27, 2005

great answer, gyan. thanks.
posted by fishfucker at 1:18 AM on October 27, 2005

wait, though.. Why would a product so much more "pure" kill you? Is that the heroin making your system fail, or the fact that you can't accomadate the drugs?
posted by fishfucker at 1:22 AM on October 27, 2005

Heroin, in the brain, acts on mu-opioid receptors and among other things, depresses respiration. Too much heroin and breathing stops. A person trying opiate for the first time, probably takes in 3-5 mg. With regular use, after a long period, he might need upto a gram or more, although it more commonly stabilizes at 200-300 mg, according to the data from the heroin programs I mentioned above.
posted by Gyan at 1:27 AM on October 27, 2005

I agree with gyan. Purer means a higher dose of the active constituent acting on the brain producing euphoria on the one hand but more importantly, depression of breathing. Hence increasing the death rate, because street users determine their dose by cost/amount of powder. The same looking amount of powder might be 10 times stronger and they won't know until it's too late.

Anecdotally I can attest to this phenomenon of an increase in ODs when a purer batch of smack is about. I used to work in a few emergency departments and it would happen in waves - no OD for weeks and then blam! 10 or 30 in one shift. All because someone was inaccurate when cutting the smack for street sale or new to the scene etc.

I also saw a Prof. of addiction studies on tv a few years back who said the only difference if you took identical twins and gave one 60 years of healthy life and the other pure intravenous doses of heroin 5 times a day for the same amount of time would be that the one injecting would be more prone to constipation.

Further, when I was in UK, we gave heart attack victims diamorphine (heroin) as a pain reliever -- there is nothing better -- so that is at least notional evidence to the effect that there is likely little in it that is directly detrimental to one's health.

My understanding is that ethanol is toxic to every cell in our bodies.
posted by peacay at 1:35 AM on October 27, 2005

Also, on addiction: much like addictiopn to coffee or cigarettes, addiction in and of itself is not (necessarily) a problem. It *can* be a problem, and if you're (general you here) any sort of person who would have a break in their purchases, or can't handle themselves, don't do heroin. However, if you can consistently get unadulterated batches, then as long as you have your "fix," there are little repercussions.

I can vouch for the whole constipation thing, though.
posted by Lockeownzj00 at 1:49 AM on October 27, 2005

I was just recently chatting with a psychiatrist who specializes in addiction and at one point he said that heroin is actually a potent antipsychotic. I suspect this isn't part of the common wisdom but it doesn't seem too implausible. Personally, I think that most recreational drug users are self-medicating anyway, and I wouldn't be surprised if there could be an imbalance in opiate levels just like in serotonin/dopamine levels.
posted by Astragalus at 5:12 AM on October 27, 2005

Astragalus writes "I wouldn't be surprised if there could be an imbalance in opiate levels just like in serotonin/dopamine levels"

You mean of course endorphins. Perhaps. I don't think it has been fully elucidated/investigated.
posted by peacay at 5:31 AM on October 27, 2005

Astragalus writes "I was just recently chatting with a psychiatrist who specializes in addiction and at one point he said that heroin is actually a potent antipsychotic."

First gen anti-psychotics were just major tranquilizers, so this is not a surprise.

While I generally concur with the opinions offered here about heroin and the body, I've got to add that the issue of purity is huge. The damage done to your body by the various cutting agents can be quite severe, and certainly people who take pills with an opiate and Tylenol often end up ruining their livers.

Also, I think that Lockeownzjoo understates the problems with injection. Anyone who's spent any time around heroin addicts knows that the rates of HIV and Hep C are epidemic in the IVDU community. People also get infections quite frequently and abcesses etc. Even without infection people ruin their veins, collapsing valves that keep blood from pooling etc. Often long term heroin users will have swollen hands because blood pools in them because their valves are shot. There is also a whole underground economy in which people get drugs from other addicts due to their skill with finding a vein to shoot into when someone has ruined all theirs.
posted by OmieWise at 6:04 AM on October 27, 2005

So basically, what everyone's trying to say is that Dr. Drew was correct. Someone explained it to me once as "Heroin slows everything down in the body." The drug itself--without being cut, without being used to the point of od--is not toxic to the body the way, say, crack or methamphetamine are. It does cause constipation. Many users say it affects your teeth, your skin, etc., but rotting teeth and open sores are the result of poor hygiene. When you're high, when you're addicted to heroin, you don't care about ANYTHING but the drug. You don't care about your health, your money, your teeth, etc. That is why the heroin epidemic has caused so many medical and societal problems.
posted by chelseagirl at 6:34 AM on October 27, 2005

Heroin does not slow down everything, just your cardio-vascular system. I don't know if you use toxicity correctly. Cocaine is not really toxic, but continued use can cause strain and stress on the heart. There are well documented cases of morphine addicts living well into old age. As long as an addict is able to maintain nourishment there's no reason for opiates to negatively affect your body.

Alcohol is hard on your liver and digestive tract (increasing chances of cancer), but isn't supa-bad. People are hardcore several times a day alcoholic and live well into their 50s-60s without terrible health effects. That is to say if I did cocaine every day for 30 or more years I'd probably have a heart attack, we've had alcohol in our ancestry so long that our bodies cope fairly well to it (compared to other drugs, sans marijuana).

Though anecdotely a lot of heroin addicts seem rather brain dead. I don't know whether this is due to other drugs or impurities causing what looks like mild retardation or other factors. I doubt this has to do with opiate addiction directly.
posted by geoff. at 8:10 AM on October 27, 2005

The other thing to look at about the toxicity of alcohol vs. heoin is that abuse of alcohol also does bad things to your body [the same way overusers of heroin neglect hygeine etc]. So, if you use alcohol to the exclusion of other things often you wind up diabetic because you are pouring sugars/starches into your body and not eating enough food. Nutrition deficiencies can also give you neuropathy (often similar to beriberi) and I've known serious alcoholics who gave themselves scurvy, but that's avoidable as are many side effects of alcohol use IF you're making sure you stay healthy.

I have heard the same anecdotes about heroin where the only health/medical issue is lack of supply and I had a relative who went through a decade of severe addiction and came out of it [as near as I can tell] completely unscathed except for the shellshock of having been deep in the drug culture and, of course, hepatitis. So, in an ideal-world utopia, this is true of heroin. My only caveat, is that the world is rarely ideal.
posted by jessamyn at 9:04 AM on October 27, 2005

This thread has had consistently good answers, so I have little to add except that opiates (including heroin) do have some side effects that can be unpleasant at least, particularly constipation. Nausea is another side effect, but it usually goes away eventually. The chronic constipation is why people who are prescribed long-term narcotic therapy are also given a mild laxative.

This is getting a bit off-topic, but I don't think jessamyn is right about alcohol and diabetes. Any association between the two is probably due to the fact that people who drink heavily and continue to eat a normal amount of calories will become obese from the extra calories from alcohol and the link between obesity and diabetes is well established. The rest of her comment about nutrition and alcohol is right on, though. Alcohol is definitely worse than heroin to use on a daily basis in large quantities, but for both alcoholics and heroin addicts the majority of the harm they do themselves is due to not taking care of themselves in any number of ways, as has been mentioned several times already.
posted by TedW at 9:14 AM on October 27, 2005

great answers, guys. I'm surprised that I reached this age without hearing that heroin is one of the "less harmful" illegal drugs (leaving questions of addiction and purity aside, for the moment) while having never heard how much more damaging other intoxicants are. We are really doing ourselves a disservice by failing to teach these sorts of things. If someone were to tell me, when I was younger, that alcohol, for example, was so much more damaging to the body, then I might have tempered my use of it as a teenager/young adult.
posted by fishfucker at 11:18 AM on October 27, 2005

Thanks to that TV show, Lost, I was just wondering this same thing. One of the characters, Charlie, is a recovering heroin addict and, of course, he finds an old Cessna crashed on the island that is *full* of heroin. I was thinking that, in theory, he should be able to get back on that dragon with little risk of damaging his body. Also, I assume that the heroin is rather pure since it was obviously enroute from the source to its destination.
So, thanks for asking this question.
posted by NoMich at 12:12 PM on October 27, 2005

Alcohol is hard on your liver and digestive tract (increasing chances of cancer), but isn't supa-bad. People are hardcore several times a day alcoholic and live well into their 50s-60s without terrible health effects.

Can't say I agree with you geoff. - living in a country where the average alcohol intake is far higher than in the US, and having been employed on the working end of a mortuary table, alcohol is supa-bad. In fact binge drinking among youth in the UK has gotten to such a point that people in their teens and 20s are showing signs of cirrhotic livers. It's nasty, and it kills.
posted by methylsalicylate at 12:39 PM on October 27, 2005

Here is an old ad for Heroin from a nurse's periodical (page 44 in the PDF).
posted by bikergirl at 1:00 PM on October 27, 2005

fishfucker writes "I'm surprised that I reached this age without hearing that heroin is one of the 'less harmful' illegal drugs (leaving questions of addiction and purity aside, for the moment) while having never heard how much more damaging other intoxicants are."

fishfucker- I can't endorse this view because it relies on a hypothetical that just doesn't exist in the big bad world. It's a bit like saying you can breath CO2 just fine if the carbon is lopped off, strictly true but useless and dangerous in practice. Of course I agree that the dangers of alcohol need to be explained well to everyone, but one certainly needn't compare it to benignly hypotothetical heroin in order to stress the point.

bikergirl-That's an awesome ad. Thanks.
posted by OmieWise at 1:12 PM on October 27, 2005

well, agreed. I think the gist of what I'm getting at is that we're largely ill-informed about scheduled drugs, and that this lack of knowledge is harmful.
posted by fishfucker at 1:38 PM on October 27, 2005

OmieWise : "I can't endorse this view because it relies on a hypothetical that just doesn't exist in the big bad world."

I think your CO₂ analogy is farfetched. There was a Scottish study last year that surveyed heroin users and found that 70% of them were living functional lives. It so happens that the worst disasters on heroin tend to be pretty severe, but the overall picture is somewhat different. Note that heroin is illegal and very taboo, unlike cannabis. The controlled users will be hidden.
posted by Gyan at 1:39 PM on October 27, 2005

Dr. Drew's 100% correct, and you correctly transcribed his major points without distorting them, which makes you correct too.

Dirty needles are problem #1 with heroin. Impure street drugs are problem #2 - you never know what you're getting when you buy street heroin; it's not very well regulated. It gets cut with things like sugar, talc, rat poison, PCP, cheap (and cheaply purified) synthetic opiates that can have toxic contaminants, et cetera.

You gotta figure that cutting with talc (which kills junkies every year by ruining their lungs) is a cost-cutting measure; while cutting with rat poison is sort of a moral editorial, the kind that a not very bright person might essay.

The occasional reports of heroin toxicity, like myopathy associated with 'chasing the dragon', are probably actually due to toxicities from solvents, such as the volatile benzene derivatives used to "chase the dragon" better.

If you assume perfect sterile technique and reagent-grade heroin, the major ill effects will include nausea, severe constipation, itching, and sleepiness. You get tolerant to most of these; after tolerance, withdrawal can be an ill effect. While severely unpleasant (check out W.S. Burroughs' Junky for some vivid descriptions), the withdrawals are not as bad as that from alcohol; no one dies of heroin withdrawal unless they get suicidally depressed and jump off a bridge.

Most people don't realize that heroin is very similar to morphine; it is called 'diacetylmorphine', which means that it is a morphine molecule with a couple extra acetyls hooked to it. This makes it more lipophilic; hence, it crosses the BBB faster. In the brain the acetyls are cleaved off by enzymes, turning it into morphine, and it then binds to opiate receptors there just as morphine does.

Sidetrack :The toxicity of alcohol to every organ system in the body cannot be overstated. Were it not for historical reasons (which include the fact that it's been used throughout recorded history, and the fact that Prohibition was tried and failed miserably) it would easily be classed as Schedule I owing to its toxicities, addictiveness, and unsuitability for any beneficial effects.

I drink a bit of wine or beer now and again, by the way; but I don't try to fool myself into thinking that it's good for me.
posted by ikkyu2 at 2:05 PM on October 27, 2005

According to Walter Willett (Harvard) alcohol is good, in moderation, especially for men:
Moderate drinking seems to be good for the heart and circulatory system, and probably protects against type 2 diabetes and gallstones.
posted by davar at 2:27 PM on October 27, 2005

It amazed me that the cast on Lost never thought to stockpile the heroin stash to use it for analgesia.
posted by megatherium at 2:32 PM on October 27, 2005

A few more comments:

• Heroin, like other narcotics, can cause respiratory depression leading to death if you overdose. This requires very high doses, twenty to fifty fold higher than the euphorigenic dose. It's probably the only significant dose-dependent outright dangerous effect of the pure drug.
• One drink per day increases risk of first unprovoked epileptic seizure by 50%, and the effect is dose dependent and exponential (Brust JCM, Hauser WA, et al., NEJM, sometime in the 80's). I wonder what Walter Willett has to say about that?
• Alcohol's negative health effects are not in question. No responsible physician should ever recommend alcohol to her patients. Alcohol has a myriad of effects, including:
  • GABA agonism.
  • Osmotic diuresis.
  • Central anxiolysis.
  • Membrane permeability and deformability effects.
  • Hemorrheological effects.
  • Vasodilator effects.
  • A direct pressor effect.
  • Metabolic alterations, including ketosis/acidosis.
  • Direct cellular toxicity, including to nuclear DNA and endoplasmic reticulum, via generation of free radicals (oxidative stress).
  • Induction of the microsomal endothelial oxidizing system.
  • Acidification of the urine.
  Some one or more of these effects is probably responsible for the anti-CV and anti-stroke effects of alcohol. Physicians understand that the reason to study alcohol's effects is so that we can isolate the beneficial part from the toxic part and design drugs based on conferring the benefit without the toxicity.

posted by ikkyu2 at 7:12 PM on October 27, 2005

1) In addition to heroin, as I understand it (and maybe this is another askmefi question in the making...) but LSD similarly is quite harmless to the body in general.

2) If you're really interested in this, and are afraid of the impurities of the street variety, you should know that heroin (or something like it) is pretty easy to make in your backyard (amazon and ebay links).
posted by pwb503 at 9:08 PM on October 27, 2005

ikkyu2 writes "Heroin, like other narcotics, can cause respiratory depression leading to death if you overdose. This requires very high doses, twenty to fifty fold higher than the euphorigenic dose. It's probably the only significant dose-dependent outright dangerous effect of the pure drug."

It's not without some caution that I seek some clarification from the likes of your good self ikkyu2, but my (admittedly limited, although both from study and work) understanding has always been that the exact opposite is true. I'm talking about the bold type.

That is, the difference between therapeutic and overdose levels is very very small. And particularly so with addicts, who are apt to overdose when their gear is even slightly purer than normal.

So, with respect, I would ask that you point me to some authoritarian literature on this.
posted by peacay at 2:31 AM on October 28, 2005

peacay, this is what Wikipedia has to say:

Heroin overdoses are more rare than one might first expect. As noted above, an overdose is immediately reversible with an opioid antagonist injection. The overwhelmingly vast majority of reported heroin overdoses are actually adulterant poisonings or fatal interactions with alcohol or methadone. True overdoses are rare because the LD50 for a person already addicted is prohibitively high, to the point that there is no general medical concensus on where to place it. Several studies done in the 1920s gave addicts doses of 1600mg-1800mg of heroin in one sitting, and no adverse effects were reported. This is approximately 160-180 times a normal recreational dose. Even for a non-addict, the LD50 can be credibly placed above 350mg.
posted by Gyan at 7:21 AM on October 28, 2005

PK: Neurological Aspects of Substance Abuse, JCM Brust's authoritative monograph, covers this topic in some detail - there's a whole chapter on heroin. Your local medical library should have it.

Most folks who die of respiratory depression with heroin on board also have ethanol and/or barbiturates/benzos on board too.
posted by ikkyu2 at 8:42 AM on October 28, 2005

Whoa!

An overdose of these drugs hit with varying degrees of severity. I do not know the direct symptom of an overdose of LSD. But one can go crazy if one does not have the daily dose.

ikkyu2, I realize that the transcriptor and/or the reporter might have misconstrued, but this statement is flat-out surreal and false.
posted by Gyan at 9:35 AM on October 28, 2005

And yes, I realize that the charitable interpretation is that the LSD remark is an interjection.
posted by Gyan at 9:39 AM on October 28, 2005

methylsalicylate, if you're still monitoring this -- do you have any studies or anything? I believe you and I'd like to read more about it -- I always assumed that alcoholics took at least 10 years of daily drinking to show signs of cirrhotic livers. This is really new to me. I know of men in their 60s who drink in the morning, noon and night. While I know there are obviously exceptions I just assumed that in such cases they'd not have much longer to live (taking say 20 years off their life) but seeing alcohol damage in "normal" heavy college drinking is incredible. I'm googling now let me know if you have heard of any major articles on this.
posted by geoff. at 5:48 PM on October 29, 2005

Gyan, I've heard Dr. Brust deliver this spiel to many years' worth - I am tempted to say "a generation" - of medical students. He's not the type to say that "an overdose hit with severity." He's a proper old Boston Brahmin, a stickler for proper grammar and precision and correctness in speaking.

I think it likely that he was referring to the fact that LSD ingested in milligram quantities has effects which, behaviorally and subjectively, are entirely distinct from the microgram quantities that are routinely ingested in the vicinity of Haight St. But there is clearly something missing/lost in transcription here; bear in mind that this is an Indian magazine and they must be interviewing Dr Brust during a visit to India, so jet lag and language barriers are a factor. (John is a full professor of neurology at Columbia and the chair of neurology at Harlem Hospital, New York, when he's at home; he's trained many hundreds of neurologists, of which I am one.)

The rest of that interview, excepting the paragraph in question, sounds like him, for what it's worth.
posted by ikkyu2 at 5:02 PM on October 30, 2005

1) In addition to heroin, as I understand it (and maybe this is another askmefi question in the making...) but LSD similarly is quite harmless to the body in general.

Not similar at all. It's only similar in the sense that it really barely fucks you up (health-wise) at all.

There has also only ever been one recorded case of a potential LSD overdose, and that was an IV, going extremely over the limit.

You just can't OD on LSD. I dare you to try. You'll just trip balls.
posted by Lockeownzj00 at 7:14 PM on October 31, 2005

Lots of great answers here. I'd like to mark them all, but it would make the thread unreadable, so I tried just to mark the most comprehensive ones.

Thanks all!
posted by fishfucker at 5:14 PM on December 23, 2005