Heroin is a potent opioid very similar to morphine, with the potential for overdose. Responding to a heroin overdose can save lives.

The use and misuse of opioids have gained a lot of attention in the U.S., mainly because of a rise in life-threatening overdoses. There has been a staggering increase of over 500% in drug overdose deaths since the late 1990s. Opioids are involved in most of these overdoses in what has widely been considered an opioid overdose epidemic. 

The overdoses involving opioids like heroin have risen more rapidly in the last decade and continued to grow in recent years. The effects of this on families and communities can be devastating. Understanding more about what happens during a heroin overdose, the signs of an overdose and how you can help has the potential to save lives. 

What Is a Heroin Overdose? 

Heroin is a potent opioid with a chemical structure very similar to morphine. As heroin is processed in the body, morphine is among the active metabolites produced. Heroin and its metabolites interact with opioid receptors in the brain, creating different effects, including pain relief, euphoria and the potential for respiratory depression. 

Heroin is often injected intravenously, reaching peak levels in the bloodstream within minutes. There is a dose-dependent potential for opioid toxicity as opioid receptors are flooded. When toxicity occurs, respiratory depression becomes the primary concern. Respiratory depression refers to the body’s failure to produce the normally automatic signals to support breathing, which can cause individuals to stop breathing. Respiratory depression is what makes an overdose deadly. 

How Fentanyl Contributes to Heroin Overdose 

In recent years, the increased availability and practice of lacing or even replacing street drugs with fentanyl has added tremendous risk for individuals who use heroin. Fentanyl is 100 times more potent than morphine and much stronger than heroin, so relatively small doses can be dangerous. This has been frustrating — if fentanyl is so deadly, why are dealers using it in their products? 

Unfortunately, the practice has the potential to continue due to several factors. Because of the smaller quantities of fentanyl needed for effect, it is cheaper to produce and easier to smuggle across borders. In some instances, fentanyl has been used because heroin was in short local supply. These products are also highly addictive. Each of these factors provides incentives to dealers to continue using fentanyl in their products, contributing to the risks of overdose.

While fentanyl is available by prescription, and these sources provide a consistent, reliable product, most of the fentanyl incorporated in products sold as heroin is produced illicitly. There are no quality control measures to ensure the correct dose is delivered and no tests to ensure the product is pure. Because of fentanyl’s potency, inadvertently taking a higher dose than intended produces a much higher risk of overdose. 

Heroin Overdose Statistics 

The national trends in opioid overdose rates highlight the dangers of fentanyl and synthetic opioid involvement in the illicit market and the impact this has on heroin users. In general, the rates of heroin overdoses are not increasing, but the rates of overdoses involving synthetic opioids are rising sharply. 

On a national level, the overdose fatalities involving heroin peaked in 2016 and 2017. Despite some reductions in recent years, the overall rates involving heroin are still 368% higher than in 1999. The number of overdose deaths involving any opioid continues to rise sharply, with synthetic opioids like fentanyl being a major contributor. 

These issues are pervasive across all communities in the U.S. but have a comparatively larger impact in the Midwest and Northeast. Many states in these regions continue to experience disproportionate increases in overdoses with the involvement of synthetic opioids, with levels often accounting for 70% or more of the reported deaths. Large cities and lower-income areas are affected at higher rates, but ultimately, all communities have experienced increased overdoses. 

Symptoms of Heroin Overdose

The symptoms of a heroin overdose align with the standard signs of opioid overdose. Some of these signs include: 

• Drowsiness or loss of consciousness
• Shallow, labored breathing
• Pinpoint pupils
• Cyanosis, e.g., fingernails or lips turning blue or white

Cyanosis is a result of inadequate oxygen levels in the bloodstream. In the case of a heroin overdose, the body is not receiving enough oxygen because of respiratory depression. The term respiratory depression refers to difficulty breathing. 

Heroin Overdose Causes and Risk Factors 

Due to heroin’s relatively short half-life, active use often leads to dosing several times daily and the potential for a more rapid buildup of tolerance. An inherent problem is that the tolerance to euphoric effects may develop more quickly than the tolerance to the effects of respiratory depression. The longer heroin is used, the more likely higher doses are required, and an overdose may occur. 

The increased amount of synthetic opioids like fentanyl in the market has also increased risk. Unfortunately, these products can be consumed without the user’s knowledge. Dosing variability and higher potency introduce a higher risk of accidental overdose. 

What To Do if Someone Overdoses on Heroin

Finding someone you suspect may be overdosing can be harrowing. Familiarizing yourself with the signs of overdose further and formulating a plan can help. Your ability to respond can save lives. Here are the steps to follow: 

• Call 911 if any of these symptoms occur:

• Clammy or pale face
• Unresponsive; limp body, unable to awaken or speak
• Gurgling noises or vomiting
• Lips or fingernails are blue, white or purple
• Breathing is labored or has stopped
• Slowed or stopped heartbeat

• Provide naloxone, if able
• If you suspect the individual is no longer breathing or the heart has stopped, perform CPR until paramedics arrive. 

Naloxone is now available without a prescription as a part of a nationwide effort to increase access to the medication. Like someone managing severe allergies carrying an Epipen, having a form of naloxone such as Narcan on hand acts as a safety net and can potentially save the lives of loved ones or community members. The medication is helpful to have regardless of whether an opioid was prescribed or used in other capacities. An individual’s ability to purchase naloxone does not depend on using a prescription product. 

Heroin Overdose Treatment

Upon arrival at the emergency department, medical management of a heroin overdose follows the basic tenets of opioid overdose management, including: 

• Maintaining oxygen levels, often with the use of ventilation
• Identifying and managing any other substances that may also be present, as needed
• Management of withdrawal symptoms
• Psychosocial support for the management of withdrawal and opioid addiction

Initial care primarily focuses on navigating the effects of respiratory depression and ensuring adequate oxygen levels are maintained. From there, supportive care is provided depending on individual needs. 

Heroin Addiction Treatment 

Longer-term psychological and social support in the form of treatment plans utilizing individualized therapy, group settings and medications becomes the focus after initial overdose treatment. These treatment options are also helpful for individuals who may not have overdosed but are seeking comprehensive help with managing heroin use.

With quality, nonjudgmental support, the path to recovery becomes more navigable. Residential programs are available at the Recovery Village Kansas City. If you or a loved one are concerned or struggling with heroin use, Recovery Advocates are available to help — reach out for more information today!