Heroin

www.druginfo.adf.org.au
  • Heroin is one of a group of drugs known as opioids.  It is manufactured from morphine which comes from the opium poppy.
  • Other opioids include opium, morphine, codeine, pethidine, oxycodone, buprenorphine and methadone. 
  • Heroin can range from a fine white powder to off-white granules or pieces of brown ‘rock’. 
  • It has a bitter taste but no smell and is usually packaged in “foils” [aluminium foil] or small, coloured balloons.

 

Onset & Duration

Onset

  • Heroin withdrawal occurs within 8-24 hours of last use (may be slower with other opiates such as methadone)

Duration

  • Heroin:  Peaks 2-4 days and ceases at 7-10 days
  • Methadone symptoms emerge 36-48 hours after last dose and low grade symptoms can remain for 3-6 weeks
Clinical Features
  • Anxiety, craving, muscle tension, muscle and bone ache, muscle cramps, sleep disturbance, sweating, hot and cold flushes, goose-bumps (piloerection), yawning, runny eyes and nose, abdominal cramps, nausea, vomiting, diarrhoea, palpitations, elevated blood pressure and pulse, dilated pupils and agitation
  • Potential Complications
  • Dehydration - Increasing thirst, dry mouth, weakness or light-headedness, darkening of the urine or decrease in urination
Care & Treatment
  • Pharmacotherapy-based withdrawal regime

Diarrhoea

  • Atropine Sulphate/Diphenoxylate Hydrochloride (Lomotil)
  • Loperamide Hydrochloride (Imodium)
  • Drink plenty of fluids - 6 - 8 glasses of water a day
  • Eat regular meals

Headaches

  • Paracetamol (Panadol)
  • Massage

Nausea and Vomiting

  • Metoclopramide (Maxolon)
  • Prochlorperazine (Stemetil)
  • Eat small meals and snacks often
  • Drink plenty of water
  • If vomiting, stop eating solid food and try small sips of liquid, or sucking an ice cube. Try a small amount of food once you have kept fluids down for a few hours
  • Rehydration/sports/isotonic drinks such as ‘Powerade'
  • Avoid citrus and caffeine on an empty stomach

Pronounced agitation or insomnia

  • Benzodiazepines: Diazepam, Temazepam tablets* (*Risk/benefit analysis required due to propensity for misuse and exacerbation of depressive symptoms)
  • Reduce coffee, tea, cola and energy drinks during the day and have none after 2 pm
  • Eat 3 meals a day and avoid heavy, spicy meals late at night
  • Avoid napping during the day and keep to regular bed and wake times
  • Exercise regularly (in the day, not after 6 pm)
  • Use relaxation techniques
  • Avoid doing things (i.e. tough phone calls) that might upset you before going to sleep
  • Have a bath in the evening

Stomach cramps

  • HyoscineButylbromide (Buscopan)
  • Have a bath
  • Use a heat rub/ wheat bag
  • Massage

Aches and pains

  • Quinine 300–600 mg at night as required for skeletal muscle cramps (Quinine is potential toxic in overdose (causing blindness or severe liver disease) therefore supply may need to be monitored.
  • Ibuprofen
  • Paracetamol
  • Have a bath
  • Use a heat rub/ wheat bag
  • Do gentle exercise e.g. walking
  • Massage

Cravings

  • Remove ‘cues’ or reminders of use as these intensify craving.
  • Keep busy, use distractions
  • Focus on what is happening at the moment and take each hour and day as it comes. Thinking too far ahead can often be overwhelming and counterproductive.

Sweating & hot and cold flushes

  • Have regular showers or baths
  • Paracetamol