How Does a Heroin Overdose Kill You ?

Heroin is one of the most addictive drugs in the world, and thousands will die every year from a heroin overdose. Used for centuries for anything from a cough to pain relief, the potential for addiction and death was not fully realized until 1900. Heroin was made illegal in 1920, leaving millions of addicts desperate for opiate drugs.

Categorically, heroin is a central nervous system depressant, synthesized from the psychoactive chemicals in the opium poppy. Both opium and heroin can result in life-threatening central nervous system depression.

The Effects of Heroin: Addiction and Withdrawals
Snorted, smoked or injected, heroin reaches the brain through the bloodstream quickly. Once there, it binds to the opioid receptors, resulting in the relief of anxiety and pain. In effect, it gives the user a calm, euphoric sensation of escape from reality that can last for several hours.

Addiction occurs upon repeated use of the drug. The user’s brain has been, in essence, “hijacked” by heroin. It becomes dependent on the drug to feel good. In addition, it needs more and more of the drug to achieve the same results (tolerance).

When the user “comes down”, or stops using the drug, withdrawal symptoms occur. They are typically the opposite of what it feels like be high. Withdrawals are also a big incentive for people to keep using. Commonly, this is known as being “dope sick”.

Withdrawal symptoms include:

Depression and Anxiety
Body aches and increased pain sensitivity
Runny nose, tears
Diarrhea, stomach pain and spasms
Nausea and vomiting


While not fatal, symptoms are extremely unpleasant can can result in severe depression and suicidal feelings.

Signs of a Heroin Overdose

Overdoses may occur for several reasons. One, heroin is illicit and unregulated, so it is not often possible to know the actually purity (potency) of the drug. It is fairly unpredictable.
Also, the heroin may be laced (combined) with another drug. Fentanyl is common. Fentanyl is also a synthetic opioid, but many times more powerful than heroin. It can easily be fatal on its own accord. When mixed with heroin, the effects can multiply drastically.
Finally, multiple drug intoxication also increases the risk of overdose. For example, drinking alcohol or taking other depressants can also amplify the effects of all substances in question.
Consequently, heroin kills because it slows down the central nervous system, including respiration, to a fatal degree.

Signs and Symptoms

Awake, but unable to talk
Body is very limp
Face is very pale or clammy
Fingernails and lips turn blue or purplish black
For lighter skinned people, the skin tone turns bluish purple, for darker skinned people, it turns grayish or ashen.
Breathing is slow and shallow, erratic, or stopped altogether]
Pulse (heartbeat) is slow, erratic, or undetectable
Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
Loss of consciousness and unresponsive to outside stimulus

If you notice someone exhibiting these signs, you should immediately call 911. Fortunately, a heroin overdose is not instantaneous, and can be stopped if caught in time.

First responders, such as emergency medical personnel, commonly use the anti-overdose drug Narcan (naloxone) to reverse the effects of an overdose and save a life.

Naloxone is an opioid antagonist, meaning that it blocks the life-threatening effects of an opioid overdose. In the case of more powerful opioids, such as fentanyl. more than one dose may be required to reverse an overdose. However, naloxone is usually a very effective antidote, and many pharmacies throughout the country have begun to allow the purchase of naloxone without a prescription.

Areas In The U.S. With The Highest Alcohol Consumption And Drug Use

Areas in the U.S., such as New England, the Midwest, and the Southwest all have their own tendencies toward substance abuse. Just like food, entertainment, and hobbies. these diverse parts of the country consist of certain trends in terms of drug use and alcohol consumption.

The Substance Abuse and Mental Health Services Administration (SAMHSA) releases a yearly survey of Americans over age 12. This survey asks the participant if they have used narcotic painkillers for recreational purposes, or have consumed marijuana, cocaine, or alcohol. States were subsequently ranked based on the population’s use of each of the four substances.

The results were bad news for Colorado and northern New England states.

Colorado was the #1 consumer of the three drugs as well as alcohol. Marijuana has been legalized in Colorado, so it’s of no surprise that the state is among the top consumers.
However, Colorado has the distinction of being top in all categories, including illicit drug use.

Marijuana is also heavily consumed in Washington, Alaska, and Oregon, which have also legalized the drug. Oregon was also a top consumer of recreational opioids.

Vermont, Massachusetts, and New Hampshire are among the top consumers of cocaine, marijuana, and alcohol. Maine and Connecticut also lead in two of those categories. New York residents are heavy cocaine consumers.

Washington D.C., like Colorado, is a bit of an outlier in terms of substance use. It stands out at a high ranking within its area, being closer in consumption of substances to northern New England.

The most religious areas of the U.S. is the Southeast and Bible Belt. Many counties are dry, and folks there have traditionally reported using less substance use in general. However, many of top users of prescription painkillers are in this area, including Arkansas, Alabama, Oklahoma, Louisiana, and Virginia.

States in the Midwest and Plains are not among the highest consumer of any illicit drugs. However, Wisconsin, Minnesota, and North Dakota have a high proportion of alcohol users – likely stemming from a pattern established during the Scandinavian and German mass migration.

In the West, Californians, Arizonians. and New Mexico residents do their fair share of cocaine. This is probably due to the proximity to the Mexican border and heavy trafficking of the drug coming from the south. Arizona is also among the top in recreational use of painkillers.

Factors in substance abuse variations may include differences in state legislation, industry regulations, tradition, regional drug markets, religious and cultural mores, and socioeconomic population traits.

The Difference between Opiates and Opioids

It’s human nature to avoid suffering, and one of the most frequent reasons why people seek medical treatment from a doctor is to help with pain relief. When over-the-counter pain relievers don’t provide the relief that a patient is seeking, the doctor can prescribe a stronger pain medication.

However, when not used according to the doctor’s instructions, or used for a long period of time they can lead to drug addiction.

Difference Between Opiates And Opioids
Opiates: A Natural Pain Remedy
Opiates are alkaloids derived from the opium poppy. Opium is a strong pain relieving medication, and a number of drugs are also made from this source.

Types Of Opiates

Opioids: Synthetic Pain Medications
Opioids are synthetic or partly-synthetic drugs that are manufactured to work in a similar way to opiates. Their active ingredients are made via chemical synthesis. Opioids may act like opiates when taken for pain because they have similar molecules.

Types Of Opioids

Percocet, Percodan, OxyContin (oxycodone)
Vicodin, Lorcet, Lortab (hydrocodone)
Demerol (pethidine)
Dilaudid (hydromorphone)
Duragesic (fentanyl)
How Opiates And Opioids Work
Both of these types of drugs alter the way that pain is perceived, as opposed to making the pain go away. They attach onto molecules that protrude from certain nerve cells in the brain called opioid receptors. Once they are attached, the nerve cells send messages to the brain that are not accurate measures of the severity of the pain that the body is experiencing. Thus the person who has taken the drug experiences less pain.

Drugs in these classes also affect how the brain feels pleasure. A person who takes them who is not in pain will experience a feeling of elation, followed by deep relaxation and/or sleepiness.

Addiction To Opiates And Opioids
When people use these medications only to treat pain as directed and for a short time, they are less likely to become addicted. Prescription drug addiction occurs when patients develop a tolerance for the level of medication they have been described and no longer get the same level of relief.

They may not have the same expectations for relief as their physicians and may equate the term “painkillers” with the medication being able to take away all of their pain, while their doctor may be thinking in terms of pain management, which means bringing the pain to a level where they can function at a reasonable manner. When expectations do not match, patients may take more of the pain medication than prescribed to get a higher level of relief and in turn develop a drug addiction issue.

Alcohol causes at least Seven kinds of Cancer

There is “strong evidence” that alcohol causes seven cancers, and other evidence indicates that it “probably” causes more, according to a new literature review published online July 21 in Addiction.

Epidemiologic evidence supports a causal association of alcohol consumption and cancers of the oropharynx, larynx, esophagus, liver, colon, rectum, and female breast, says Jennie Connor, MB, ChB, MPH, from the Department of Preventive and Social Medicine, University of Otago, in Dunegin, New Zealand.

In short, alcohol causes cancer.

This is not news, says Dr Connor. The International Agency for Research on Cancer (IARC) and other agencies have long identified alcohol consumption as being causally associated with these seven cancers.

So why did Dr Connor, who is an epidemiologist and physician, write a new review? Because she wants to “clarify the strength of the evidence” in an “accessible way.”

There is “confusion” about the statement, “Alcohol causes cancer,” explains Dr Connor.

Public and scientific discussion about alcohol and cancer has muted the truth about causality, she suggests.

“In the public and the media, statements made by the world’s experts are often given the same weight as messages from alcohol companies and their scientists. Overall messages become unclear. For these reasons, the journal [Addiction] has tagged this piece [her review] as ‘For Debate,’ ” she told Medscape Medical News.

The use of causal language in scientific and public discussions is “patchy,” she writes.

For example, articles and newspaper stories often use expressions such as “alcohol-related cancer” and “alcohol-attributable cancer”; they refer to a “link” between alcohol and cancer and to the effect of alcohol on “the risk of cancer.”

These wordings “incorporate an implicit causal association, but are easily interpreted as something less than cancer being caused by drinking,” observes Dr Connor.

“Stop drinking alcohol” is a catch phrase that could be ― but is not ― akin to “stop smoking,” she also suggests.
Currently, alcohol’s causal role is perceived to be more complex than tobacco’s, and the solution suggested by the smoking analogy — that we should all reduce and eventually give up drinking alcohol — is widely unacceptable,” writes Dr Connor.

The newly published review “reinforces the need for the public to be made aware of the causal link between alcohol and cancer,” said Colin Shevills, from the Alcohol Health Alliance UK, in a press statement.

“Research shows that only around 1 in 10 people [in the UK] are currently aware of the alcohol-cancer link,” he said.

“People have the right to know about the impact of alcohol on their health, including its link with cancer, so that they can make informed choices about how much they drink,” added Shevills.

The lack of clarity about alcohol causing cancer, Dr Connor believes, is related to alcohol industry propaganda as well as the fact that the “epidemiological basis for causal inference is an iterative process that is never completed fully.”

What the Epidemiology Says

Dr Connor writes that the strength of the association of alcohol as a cause of cancer varies by bodily site. The evidence is “particularly strong” for cancer of the mouth, pharynx, and esophagus (relative risk, ~4-7 for ≥50 g/day of alcohol compared with no drinking) but is less so for colorectal cancer and liver and breast cancer (relative risk, ~1.5 for ≥50 g/day).

“For cancers of the mouth, pharynx, larynx and oesophagus there is a well-recognized interaction of alcohol with smoking, resulting a multiplicative effect on risk,” adds Dr Connor.

Other cancers are also likely caused by alcohol. Dr Connor writes that there is “accumulating research” supporting a causal contribution of alcohol to cancer of the pancreas, prostate, and skin (melanoma).

The exact mechanisms as to how alcohol, either alone or in combination with smoking, cause cancer “are not fully understood,” although there is some supporting “biological evidence,” she says.

One British expert had an opinion about alcohol’s carcinogenicity.

In a statement about the new review, Prof Dorothy Bennett, director of the Molecular and Clinical Sciences Research Institute at St. George’s, University of London, said: “Alcohol enters cells very easily, and is then converted into acetaldehyde, which can damage DNA and is a known carcinogen.”

In the new review, Dr Connor describes various hallmarks of causality that have been found in epidemiologic studies of alcohol and these seven cancers, such as a dose-response relationship and the fact that the risk for some of these cancers (esophageal, head and neck, and liver) attenuates when drinking ceases.
Current estimates suggest that alcohol-attributable cancers at the seven cancer sites make up 5.8% of all cancer deaths worldwide, she states.

The alcohol industry has a lot at stake, she says, which in turn leads to “misinformation” that “undermines research findings and contradicts evidence-based public health messages.”

A recent example comes from New Zealand, where a symposium on alcohol and cancer was covered by national media. An opinion piece by an industry-funded scientist in the capital’s daily newspaper disputed the evidence reported from the conference. That essay was entitled: “To Say Moderate Alcohol Use Causes Cancer Is Wrong.”

The essay included the statement: “While chronic abusive alcohol consumption is associated with a plethora of health problems including cancer, attributing cancer to social moderate drinking is simply incorrect and is not supported by the body of scientific literature.”

But there is no safe level of drinking with respect to cancer, says Dr Connor, citing research about low to moderate levels of alcohol.

This was also the conclusion of the 2014 World Cancer Report, issued by the World Health Organization’s IARC.

The promotion of health benefits from drinking at moderate levels is “seen increasingly as disingenuous or irrelevant in comparison to the increase in risk of a range of cancers,” writes Dr Connor.

Public health campaigns “with clear messages” are needed to spread the word about alcohol’s carcinogenicity.

“I think that the UK is leading the way. Alcohol consumption as a public health issue has had high exposure in the UK over quite a number of years,” said Dr Connor, who provided links to two awareness campaigns, the Balance campaign, and the Balance Northeast campaign.

Earlier this year, the United Kingdom issued new guidelines on alcohol drinking, recommending that men drink no more than women and warning that any amount of alcohol increases the risk of developing a range of cancers.

Organizations in New Zealand are also taking action. The New Zealand Medical Association, the Cancer Society of New Zealand, and the National Heart Foundation have all adopted evidence-based position statements that “debunk” cardiovascular benefits as a motivation to drink and that highlight cancer risks, Dr Connor said.

Call your Republican Representative or Senator and raise Holy Hell!

President Obama signed a bill aimed at addressing opioid addiction Friday, though he called out Republicans for the measure’s shortcomings.

Lawmakers in both parties reached a compromise over the bipartisan Comprehensive Addiction and Recovery Act, though Senate Democrats held out hope until the final hour that they could win more funding for treatment.
“This legislation includes some modest steps to address the opioid epidemic,” Obama said in a statement. “Given the scope of this crisis, some action is better than none. However, I am deeply disappointed that Republicans failed to provide any real resources for those seeking addiction treatment to get the care that they need.”

He also noted that GOP lawmakers had blocked an additional $920 million in funding for addiction treatment.

The bill passed the Senate 92-2 last week, with Sens. Ben Sasse (R-Neb.) and Mike Lee (R-Utah) the only dissenters.

Despite overwhelming support, many Democrats are calling for stronger measures to address the crisis.

“My administration has been doing everything we can to increase access to treatment, and I’m going to continue fighting to secure the funding families desperately need,” Obama said in his statement Friday. “In recent days, the law enforcement community, advocates, physicians, and elected officials from both sides of the aisle have also joined in this call.”

“Now, it’s up to Republicans to finish the job and provide adequate funding to deal with this public health crisis,” he added. “That’s what the American people deserve.”

The Current State of the Opioid Abuse Epidemic

Two Princeton economists startled Americans recently when they reported that between 1999 and 2013, white middle-aged men and women in the United States, especially those with a high school education, were dying at an increasing rate from prescription and illegal drug overdose, alcohol and liver-related disease, and suicide.[1] Such results are not news to those engaged in day-to-day patient care; to those patients who continue to endure debilitating pain and chronic disease; or to those who have buried a loved one from a drug or alcohol overdose. Fortunately, there is the impression that finally the government and media are paying attention to this national epidemic.[2]
Presidential candidates are sharing personal stories of pain and loss and thus diminishing the stigma associated with pain, depression, posttraumatic stress, and addiction. The President’s first mention of healthcare in his final State of the Union Address was about the crushing problem of drug abuse. In February 2016, Obama announced his plans to invest over $1.1 billion in the next 2 years to expand access to treatment for prescription drug abuse and heroin use, improve access to the overdose-reversal drug naloxone for first responders, and support targeted enforcement activities.[3]
The Princeton study also forces us to recognize that drug abuse is not a malady afflicting only poor, minority, inner-city communities but rather is an across-the-country phenomenon, affecting rural white adults in particular.[1] Of note, this mortality trend countering the declining death rates from other chronic diseases demonstrates that the undertreatment of pain among minorities has inadvertently “protected” them from overdose, thus reducing a decades-long death rate gap between white and nonwhite patients. These realizations are driving bipartisan support in Washington that is reflected in the Comprehensive Addiction and Recovery Act (CARA), intended to revise punitive drug policies, promote best medical practices, and strengthen data sharing among states’ prescription drug monitoring programs.[4]
But are these laudable and necessary efforts the right way to go? Will increased access to care for those already harmed by addiction, addressing the enduring shortfalls in prescriber education, and research into alternative abuse-deterrent medications actually reverse this deadly epidemic?
The short answer is maybe but probably not without more initiative. Why so?

A Social Problem, Not Just a Medical Issue
First, researchers are struggling to understand why white individuals, in particular, are doing so poorly with drug abuse. Although there are no definite answers, many speculate that this cohort of patients suffers, in addition to social and economic isolation, from acute job loss. It is known that poverty, stress, and lack of social support are independent risk factors for opioid abuse. Similarly, job loss per se has been found to increase the risk for cardiovascular disease (CVD) and death.[5] Of note, recession alone does not increase CVD mortality; however, when recession is associated with job loss, heart attacks, strokes, and deaths rise. This suggests that increases in stress, despair, and possibly time spent engaging in related unhealthy behaviors often seen with financial insecurity (eg, physical inactivity, smoking, drinking, and drug abuse) may be culprits.
Second, and even more surprising, is that although awareness of the harms of opioid abuse is rising, the overwhelming majority of patients who survived an overdose continue to be prescribed high-dose opioids, often by the same prescriber.[6] It is easy to attribute these results to poor care, bad decisions, or sloppy prescribing, but it might be possible that many of the prescribers simply do not know that their patients are overdosing. Given the fact that there are no widespread systems in place to notify prescribers when overdoses occur, it is highly unlikely that prescribers will suddenly increase the level of medical supervision and care for these patients.
Third, the notion that there is a small group of prolific prescribers who are driving the opioid overdose epidemic is not accurate. The bulk of prescriptions are written by general practitioners trying to help patients with a broad array of health conditions. In fact, the distribution patterns of prescribing opioids among Medicare and Medicaid patients are no different from other drugs given for chronic diseases, where 10% of all drug prescribers account for 60% of all drug prescriptions.[7] These statistics would suggest that focusing on law enforcement, albeit merited, does not warrant significant additional resources to address improper prescribing at large.
Fourth, and most disappointing, is that despite a plethora of local, regional, state, and federal efforts to curb the overdose epidemic, things are actually getting worse. More people died from prescription and illicit drug overdoses over the past year than during any previous year on record.[8] Clearly, there is a need to do a better job in prescribing and intervening before prescription drug misuse or other substance use progresses to addiction. But are these responses a big enough step in the right direction?

Underassessment: The Overlooked Problem
The 18th century French philosopher Voltaire had many amusing quotes about medicine, such as: “common sense is not so common” and “the Art of Medicine consists of amusing the patient, while nature cures the disease.” However, there is one quote in particular that is worth mentioning that might provide an overlooked solution for the overdose epidemic. Voltaire said (most probably after a dissatisfying encounter with his physician): “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings [of whom] they know nothing.”[9]This statement is still relevant for current medical practice 250 years later, but is it still accurate?
Clearly the understanding of diseases and pharmacology have infinitely increased since Voltaire’s era, a time when the concepts of infections and antibiotics were unimaginable, let alone unknown. Obviously we know much more about how to prescribe medicines and how to cure diseases, but what about knowing our patients? How well do healthcare providers know their patients nowadays; and how does this intimate, context-sensitive, and unbiased knowledge contribute to the decision to prescribe (or not) drugs? When was the last time a healthcare professional used an online multidimensional, patient-reported outcome tool during a routine office visit incorporating data on sleep, movement, and diet based on a wearable FitBit-like device? When was the last time a prescriber was able to show a patient a longitudinal treatment outcome on a dashboard in real time to justify continuing or stopping treatment?
If your answer is never, you probably understand that the problem of medicine in general, and pain medicine in particular, is not the over- or underprescription of opioids, or over- or undertreatment of anything, but rather a fundamental underassessment of complex physical conditions and nuanced life narratives.
So yes, $1 billion funding of appropriate, cost-effective treatments can be expected to help with the current epidemic, but in order to reduce and not just halt rising death rates, prescribers really need to get to know their patients, like Voltaire said. Beyond human contact, professionals need to start quantifying human social traits (ie, phenotypes) at every clinical encounter in addition to their routine use of lab tests and imaging. Insurance companies need to pay for this, so that lack of time will not be an excuse for not measuring behavior, and patients need to have this actionable information (ie, health data) available. Not measuring pain interference, mood, diet, activity, exercise, and sleep limits the understanding of the effects of any therapy and makes prescribers incapable of guiding patients and their families to cope with, and remove, the obstacles that deny them the health and wellbeing they seek.