ADDICTS SEE DRUG AS A LOVER, NOT A KILLER

Invented in an effort to cure morphine addiction, heroin has proved an even
more potent opiate, its promise of immediate ecstasy luring users into a
powerful and often deadly habit.

"Some people have likened IV heroin to an orgasm. It's an instant feeling
of euphoria," said Dr. Neal Schofield, director of the chemical dependency
program at St. Clare's Hospital/Boonton Township.

Heroin taken intravenously affects the body immediately, and heroin snorted
or smoked takes a few seconds longer. It calms the body, relieving pain,
soothing the gastrointestinal system and slowing breathing. In an overdose,
the body gets so calm that it stops breathing. "You're tranquilized to
death," Schofield said. The high lasts only a few hours and the drug leaves
the body in about 36 hours.

Heroin was invented at the turn of the century by Bayer, the aspirin
company, which was trying to find a replacement for the highly addictive
painkiller morphine that hooked injured Civil War veterans. The word heroin
is derived from a German word meaning "heroic drug."

"For a while they thought they had something, but when people got off it,
withdrawal set in, much more than with morphine," Schofield said.

Heroin is so addictive that users will do anything to get a fix. "You'll
steal, you'll watch your buddy choke and instead of calling 911, you'll
take his wallet, you'll prostitute yourself," Schofield said.

Eventually, heroin replaces all relationships, said Gregg Benson, program
administrator of all inpatient chemical dependency services at St. Clare's
Hospital/Boonton Township. The high is so satisfying that it overrides even
the fears of people normally terrified of needles, he said.

Behavior around heroin use is highly ritualized. Some addicts will pump the
plunger in and out of a needle in their arm to prolong the onset of the
high, Benson said.

"It is a very sexualized experience with what in effect becomes their
lover," Benson said.

Searching for the drug, finding the drug and buying the drug all prepare
the brain for use of the drug, causing the addict to start feeling high on
the way to a buy. "The actual use of the drug is whipped cream on the
sundae," he said.

This is one reason drug counselors tell ex-addicts to avoid old
acquaintances and hangouts. Even hearing a familiar song or visiting the
location of a drug purchase can set off a neurological response that makes
the addict hunger for the drug.

When heroin enters the body, blood carries it to receptors in the brain.
"It's a little bit like a virus. It gets into everything," Schofield said.
"That's why going off it is like being pulled apart."

Users can start feeling the high just by looking at a needle, said Dr. Lee
Suckno, a psychiatrist affiliated with St. Clare's Health Services. "It's
association," he explained.

Heroin stimulates an increased release of dopamine into the bloodstream,
precipitating euphoria. "Opioids start a chain reaction when these nerve
cells, which are dopaminergic, release more dopamine. Dopamine makes people
feel good," Schofield said.

However, if you stimulate those dopamine-releasing cells all the time, they
don't have much dopamine left to release. "That's when the pleasure begins
to peter out and you get very small response," Schofield said.

Eventually, heroin users take it only to maintain a normal state and avoid
withdrawal.

The euphoria varies. Some people say they were hooked by the euphoria after
the first time they took heroin, Schofield said. "Physiologically, if they
have been using it a few days to a couple of weeks, they are in very unsafe
territory."

Even after a short period of use, withdrawal can set in. Symptoms include
nausea, vomiting, muscle cramps, insomnia and sweating.

With this often comes piloerection, when the body is so wired that its hair
follicles stand up and it looks like a plucked chicken. Thus the expression
"cold turkey."

The body produces its own opiates. When it receives a drug, the brain
thinks it no longer needs to produce its own painkillers. This is part of
what makes withdrawal so painful. It can take months of abstinence from
heroin before the brain restarts its opiate production.

While physical recovery can be achieved in a few months, most people need
treatment for three years, Schofield said.

Withdrawal symptoms are compounded when heroin users are taking other
drugs, which is frequently the case, he said. "It's like 100-fold worse if
you take two drugs."

Many heroin addicts also use cocaine, a stimulant. With heroin slowing the
body down and cocaine speeding it up, the heart can simply shut down. Or it
can pump blood faster but less effectively. In either case, the result is
death.

The amount of heroin in a lethal dose varies. Users lose tolerance during a
period of abstinence, making it easier to overdose when they go back to the
drug, Suckno said.

If enough heroin is taken to stop the heart and lungs, death is swift. When
the brain has been without oxygen for three minutes, its cells start to
die. Death is slower if the heroin merely slows the lungs. The brain does
not get sufficient oxygen and suffers damage, which can lead to disability
or, finally, death.

Checked-by: Mike Gogulski