According to the National Institute on Drug Abuse, 3.7 million Americans have used heroin at least once in their lives and there are anywhere between 121,000-164,00 new users each year. Heroin is classified as an opioid and is made from morphine, a substance found naturally in poppy seeds. The drug is very addictive and has the fastest onset of action when injected. Individuals and society pay a steep price for addiction, in the form of destroyed personal and professional lives, higher crime rates, hepatitis and HIV transmission and even death.
So, how does heroin work? Heroin works by triggering certain “receptors” in our brains and bodies leading to the release of chemicals that make us feel euphoric and reduce pain. Think of this mechanism like a lock and key. Heroin is the key that opens the lock, i.e. the receptors.
These same receptors, the opioid receptors, cause other physical changes including sedation, reduced respiration, miosis (constricted pupils) and constipation. Under some circumstances, such as overdosage or mixing heroin with alcohol, respirations can become so depressed that the user actually experiences respiratory arest, which can be fatal.
When a heroin user looks for help, there are a number of treatment options. The most widely recognized treatment option is Methadone maintenance treatment. For over 30 years, clinics have been dispensing methadone to heroin addicts to try to wean them from their addiction. Methadone is a longer and more gradually acting opioid that helps to reduce withdrawal symptoms (restlessness, pain, insomnia, diarrhea, vomiting, cold flashes, kicking movements) and craving that drive so many users back to heroin.
Though methadone is supposed to be a bridge to recovery from addiction, many users lapse back to heroin use without methadone. Accordingly, users often remain on methadone for years, sometimes even indefinitely.
Methadone treatment is not without risks and drawbacks. Though considered less addictive, methadone is still an addictive drug. Patients who overdose on methadone can also suffer the same fatal respiratory depression as on heroin.
Additionally, not all states permit methadone treatment and many recovering addicts are forced to drive hundreds of miles to receive help. Even when they do get help, laws in many states require that people continue to receive supervised treatment for up to 5 years before they’re eligible to take methadone without supervision at home. Many people report feeling stigmatized by the intrusiveness and inconvenience of forced clinic visits.
When a user considers or experiences all the cons to methadone treatment, they may be directed down another path. In 2002, a different opioid hit the market, designed to address some of the these issues – Suboxone. Suboxone is a trade name for a drug made up of 4 parts of an opioid called buprenorphine and one part opioid antagonist, naloxone. While buprenorphine has a very strong affinity for its receptor, it is only activates it partially. In theory, this means that it will hog up all the receptors if a person decides to use it simultaneously with a full activator like heroin, but it won’t have as powerful an effect.
The addition of naloxone, an antagonist that attaches to receptors and prevents them from being activated, is to prevent people from injecting Suboxone. When the formulation is crushed and injected, the naloxone is designed to block many of the receptors, essentially causing a user to suffer a very unpleasant or, even, severe withdrawal.
Suboxone can be taken in pill form and there’s a new film form – both are meant to be absorbed under the tongue.
Additionally, under the Drug Treatment Act 2000, specially licensed doctors can prescribe buprenorphine from their offices, instead of clinics. They often very quickly begin giving their patients a one month supply to take at their own convenience at home. Patients don’t have to deal with the inconvenience and stigma of making daily visits to a clinic. Suboxone was approved under the DTA 2000 in 2002.
Many users also report feeling more confidant, almost like their “old selves”, with Suboxone. Since Suboxone is only a partial agonist, it also causes a milder “high” and is not as prone to abuse or overdose. But, like methadone and heroin, Suboxone can cause side effects like nausea, vomiting and constipation. Moreover, at least one experienced professional worries that doctors who prescribe Suboxone are not properly trained in important supplemental therapies like addiction counseling. At $200-$300 per office visit, many providers also may not have much of an incentive to wean their patients from the treatment.