194 Heroin
Breaking heroin addiction depends on the reason someone takes the drug.
Severe withdrawal symptoms mimic influenza, but someone willing to put up
with them for a couple of days can emerge with no more dependence on the
drug. Physical dependence with heroin is a relatively trivial part of addiction.
Few addicts take the substance simply to avoid the withdrawal syndrome.
Instead, they take the drug to cope with assorted frustrations in life. If those
frustrations are resolved, the heroin addiction will resolve. If those difficulties
remain, heroin may remain the best way the addict knows to cope with them,
and addiction will persist.^2 Both heroin and tobacco can reduce stress, and if
heroin users cut back on that drug, they often increase their cigarette con-
sumption.
Although heroin is traditionally considered the final step in illicit drug use,
with previous substances leading from one to another until the climax of her-
oin is reached, scientific research does not support that scenario. Experienced
drug users have typically used assorted substances over the years, but the
“gateway” hypothesis in which one substance leads to another has been re-
futed time and again. Nor is heroin necessarily the final stopping place for
addicts. For example, research demonstrates that some heroin users move on
to amphetamines as their main drug.
Drug interactions.Some persons use heroin and amphetamines together or
heroin and cocaine together, a potentially fatal practice called speedballing, in
order to get a variety of simultaneous drug sensations. Analysis of fatalities
attributed to heroin suggests thatalcoholincreases risk of death.
Cancer.Whether heroin can cause cancer is unknown. One study found that
cells of heroin addicts show chromosome damage that might promote cancer,
but the damage becomes less over a period of months if addicts switch from
heroin tomethadone. Other research has found that intravenous heroin users
are more likely to get cancer than the general population, but factors other
than heroin may be involved.
Pregnancy.Although heroin usage apparently damages chromosomes, the
damage may be from breakdown products rather than heroin itself. A study
of several dozen infants found that those from heroin-using mothers had six
or seven times the amount of chromosome damage found in infants from
mothers who did not use the drug. This damage did not translate into con-
genital malformations, however. Researchers have examined children born to
women who abused heroin during pregnancy and found no indication that
the drug causes birth defects. Infants may be smaller than normal upon birth,
but heroin’s role is uncertain because the women tend to abuse additional
drugs and engage in other conduct harmful to fetal development. Infants born
to such mothers may have dependence with heroin and undergo withdrawal
symptoms. Sudden infant death syndrome is more common in babies with
fetal exposure to heroin than in babies without any illicit drug exposure, but
researchers are uncertain whether the drug is a more important factor than
overall home environment. Physical and mental development of children
whose mothers used heroin during pregnancy is slightly slower than normal,
an observation supported by findings in rat experiments. Examination of
school-age boys who had fetal exposure to heroin finds them to be much like
other children despite lower scores on various physical and psychological