Heroin Addiction

People who abuse heroin are often self-medicating away psychiatric and physical pain.

Heroin is a highly addictive opioid drug which has a devastating impact on addicted individuals and society including :

• Disruptions in family, workplace, and educational environments;
• Social consequences such as crime, violence;
• Medical consequences including: HIV/AIDS, Hepatitis C, Tuberculosis;
• Symptoms of Addiction:
• Tolerance, or needing more and of the drug just to feel normal;
• Physical dependence resulting in withdrawal symptoms if opioids are abruptly stopped;
• Psychological dependence including craving drugs and addict behaviors
• How does Heroin Affect the brain?
• Heroin act by attaching to specific proteins called opioid receptors, which are found in the brain involved in reward and pleasure. Using larger amounts increases the “high” but also the risk of overdose.
• The Dangers of Heroin-Opioid Use
• Heroin is very dangerous to adolescent brain development and can cause irreversible delays in brain maturation such as impaired cognitive, intellectual performance and social behavior.
• A high dose of heroin can cause death from cardiac or respiratory arrest when used alone or in combination with other drugs.

Tolerance to the euphoric effect of opiates develops faster than tolerance to the dangerous effects. Therefore, people often overdose by mistake because they are trying to get a higher high and take too much.

Heroin Withdrawal

Those who are addicted to heroin and stop using the drug abruptly have severe withdrawal, known on the street as “Dope Sickness”.

Today we have excellent medications to help people comfortably and safely get off heroin and control the cravings to keep them off.   Some of the medications stop the urges to use, others stop the pleasure from the high. Furthermore, medications can be used to minimize withdrawal symptoms and maximize comfort, eliminating the fears of being sick during withdrawal.

• When heroin is abruptly discontinued, symptoms of withdrawal appear. These include restlessness, irritability, muscle and bone pain, insomnia, cramps, diarrhea, vomiting cold flashes with goose bumps and severe drug cravings.
• Heroin withdrawal can be very uncomfortable, but unlike withdrawal from alcohol and sedatives such as benzodiazepines and barbiturates, it is not life threatening.
• The physical withdrawal symptoms can last anywhere from one week to one month, and the emotional symptoms such as depression, low energy, anxiety and insomnia can last for several months. Psychological dependence can be a lifelong problem.

Dual Diagnosis

Heroin addiction often occurs when people try to “self-medicate” serious psychiatric  illnesses.  People with both Heroin Addiction and a Psychiatric Disorder are call Dual Diagnosis.

• Many people use heroin to cope with psychiatric problems.  Long term, this will not work, but will makes matters worse;
• This is why diagnosing and treating co-occurring psychiatric problems is so important in Addiction Medicine;
• Addiction Recovery Models , must address both the Co-occurring psychiatric issues in order to be successful.
• Kittay’s Addiction and Psychiatry Model treats Dual Diagnosis and is effective.

Self-medicating with an opioid like heroin is a dangerous path, therefore, diagnosing and treating co-occurring psychiatric problems is essential to addiction recovery.  The sooner one gets help with a qualified Addiction Medical Doctor, the sooner one can break the bonds of addiction.

Poly-Addiction

Nearly all people who use Heroin, use at least one other substance; most have tried at least three.

Your  Individual Evaluation & Treatment Plan for Heroin Addiction includes:

• Addiction, Medical and Psychiatric Evaluation;
• Medically Supervised Home Outpatient Detoxification;
• Evaluation and Treatment of Co-occurring Medical Disorders and Poly-Addictions;
• Maintenance Treatment with Suboxone, Subutex or Sublocade to manage cravings and prevent relapse;
• Vivitrol or Rivia to prevent cravings and addiction relapse;
• Medication Management of Anxiety, Sleep and/or Co-Occurring Psychiatric Disorders;
• Cognitive Behavioral Restructuring of Stresses and Cues;
• Relapse Prevention.

The vast majority of heroin addictions can be safely and comfortably treated outpatient, and do not need inpatient care.

Treatments are individually tailored for safety, comfort and effectiveness to minimize withdrawal symptoms and avoid medical complications. Medications are prescribed to help prevent cravings, reduce use and prevent relapse.  Medications target the brain’s reward systems, and the way nerve cells communicate restoring balance in brain chemistry. Psychiatric problems and symptoms are medically treated as necessary.

Medications for Heroin Addiction

Safe and effective FDA approved Medications are available for Heroin detox and to prevent relapse. Heroin addictions can be treated using the medications such as Suboxone, Subutex, Sublocade, or Vivitrol.

These medicines prevent pain pills from producing their high and/or stopping cravings and withdrawal symptoms. Treatments are individually structured for safety, comfort and effectiveness.

The majority of our patients can be safely and comfortably detoxified as home as outpatients, and do not need to be inpatient.  Once detoxed, medications to help maintain sobriety are prescribed to manage cravings and prevent relapse. Many patients do not need to go to a rehab facility  and unlike methadone, patients on these medicines are routinely seen monthly instead of in a clinic daily.

Suboxone® , Subutex®, Vivitrol ® , and a new breakthrough medication  Sublocade®  are effective in helping people stop using Heroin.

Suboxone® or Subutex®

• Dr. Kittay is a DEA licensed Suboxone and provider Subutex;
• FDA approved medications are used for detoxification and/or maintenance treatment of Heroin Addiction;
• Prevents opioid withdrawal symptoms and craving;
• Used to slowly detoxify from opioids over days, weeks to months in a safe and comfortable way to minimize the pain, discomfort and anxiety associated with withdrawal;
• Prescribed for maintenance treatment and may be used this way for several months to years;
• A tool to manage physical and psychological opioid dependency while a patient in working toward sustained abstinence.

New:  SublocadeIn 2018, there is a  breakthrough medication for  treating heroin addiction.

• Dr. Kittay is a DEA licensed Sublocade provider;
• Newly  FDA approved medication is changing the treatment of heroin addiction;
• Active ingredient is the same as in Suboxone and Subutex, but it is  given subcutaneously only monthly;
• Prescribed for maintenance treatment and may be used this way for several months to years;
• A tool to manage physical and psychological opioid dependency while a patient in working toward sustained abstinence;
• Minimal risk of misuse or diversion with its use.

Suboxone, Subutex or Sublocade Buprenorphine Treatment is NOT Replacing One Drug Addiction with Another.

• Some people argue that Buprenorphine treatment is just substituting one addictive drug for another or not a positive treatment for Opioid addiction. The National Institutes of Drug Addiction disagrees;
• Buprenorphine is a highly effective and safe treatment for preventing opioid substance misuse;
• The stabilizing effects of Buprenorphine Therapy helps people enjoy a healthy life style and meet family and career commitments;
• The cycle of rush, “crash”, withdrawal, and craving which leads to increasing chemical and psychological dependency is avoided; It keeps people away from the street culture of crime and violence associated with drug use. It reduces risky and destructive addict behaviors such as IV-needle use and discourages poly drug use;
• Buprenorphine saves lives and keeps you safe.

Vivitrol®

• Dr. Kittay is a Provider of Vivitrol.
• A once-a-month Intramuscular Injection administered in the privacy of a doctor’s office. Because it is not a pill, it cannot be skipped which helps to prevent relapse and/or overdose;
• Is used as a tool to manage physical and psychological opioid dependency while a patient in working toward sustained abstinence;
• Is a FDA approved medication that prevents heroin users from getting “high” even if they use drugs by blocking the euphoric effects of these drugs;
• Is a non-habit-forming medication that can be used to treat co-occurring alcohol opioid addiction;
• The active ingredient can be taken orally as a medication called Rivia.

WARNING!  MIXING HEROIN WITH FENTANYL CAN BE FATAL!   The Penny has a lethal dose of Fentanyl next to it.                    

•  With less prescription opioid painkillers on the street, people are turning to heroin as their drugs of choice. Increasingly heroin is being mixed with over even more dangerous opioids such as Fentanyl and other related drugs. Fentanyl, is up to 50 times more potent than heroin, and is often mixed with heroin
• or sold as heroin to people who don’t realize how dangerous it is. Fentanyl is deadly; it was present in 69 percent of Massachusetts’ opioid-related deaths in 2016.
• A related drug, Carfentanil is the most potent commercial opioid in the world, according to the U.S. Drug Enforcement Agency.  It is at least 100 times more powerful fentanyl. This agent was linked to the death of the famous singer – “Prince”. Carfentanil is illegally entering the United States from China by mail, and is beginning to be smuggled across our southern borders by cartels from Latin America.
• The only official use of Carfentanil, is to sedate large zoo animals like moose, buffalo and elephants. It takes just two milligrams of Carfentanilto knock out a 2,000-pound African elephant. Veterinarians who administer the drug use gloves and face masks to prevent exposure to it, because a dose the size of a grain of salt could kill a person – and may be lethal even when absorbed through the skin.
• Overdosing on Carfentanil is not the same as overdosing on pure heroin. Not only is it incredibly powerful causing a person to stop breathing and die in minutes, it is also incredibly resistant to naloxone, better known as Narcan, the opioid antidote that serves as the last line of defense against a heroin overdose. A typical heroin overdose requires one or two Narcan doses to work, but when heroin is laced with Carfentanil, it may require six or more shots to counteract the drug.