The information contained in this page is culled from The Heroin User's Handbook by our own Dr. H. For more information on diseases of concern to heroin users, see this book.
- Pulmonary Edema
- Blood Clots
- High Blood Pressure
- Liver Damage
You can get hepatitis from ingesting heroin in any way but it is most likely with snorting because the heroin is never cooked. Hepatitis has a strong association with injection because of unhygienic procedures. Regardless of the method of administration, when you keep the company of heroin users, you risk infection of hepatitis. Although it may not seem the case, a sneeze or a cough can propel particles ten or more feet from the location of the ejection. These particles can land on syringes or other implements thereby being input into your body.
Hepatitis is the inflammation of the liver. There are several different forms of this disease but three are primary: A, B, and C. Each is caused by a distinct virus. I will discuss each form of hepatitis below but first we must discuss the liver and its importance to life.
The liver is a regenerative organ. It has three primary functions: modulation of blood sugar (energy) levels; creation of bile; and removal of poisons. The liver gets blood from two sources: oxygenated blood from the hepatic artery and nutrient rich blood from the portal vein which comes from the stomach, intestines, spleen, and pancreas. The blood from the small intestines carries absorbed nutrients such as sugars and amino acids. When there is an excess of these nutrients, the liver stores them. When there is a deficiency, the liver releases them. In this way, the liver buffers the blood sugar levels so that they never get too high nor too low. The liver also secretes bile. Bile is the substance in the body that digests fat down to sugar so that the body can use it.
Probably the most important function of the liver is removing poisons from the body. This is critical to the body's ability to heal itself. Most drugs are seen by the liver as poisons, so excessive drug use can greatly tax the liver. Alcohol is particularly associated with liver damage. In fact, alcohol abuse is the number one cause of cirrhosis of the liver.
Cirrhosis of the liver is the chronic destruction of its cells. A cirrhotic liver loses its organization which is critical to this complex organ. As a result of this, the liver stops functioning. When the liver cells are damaged, they are replaced by scar tissue. This tissue has none of the liver cell functions. In effect, that part of the liver is no longer liver. When cirrhosis of the liver begins, it causes the liver to be enlarged because of the regenerative process that is happening. But later the liver shrinks because of the contraction of the scar tissue.
Hepatitis A is the least serious form of hepatitis. It usually comes from contaminated water or food and spreads under conditions of poor sanitation. The incubation period is two to six weeks. It's symptoms include: loss of appetite, nausea, mild fever, darkness of urine, and sometimes jaundice (yellowish pigmentation of the skin). In general, the liver will be enlarged but no permanent liver damage results.
Hepatitis B is much more serious than type A. It can lead to chronic (long-term) hepatitis or cirrhosis of the liver. Hepatitis B is generally transmitted via blood: shared or dirty syringes and unprotected sex. The symptoms for type A are about the same as for type B but the onset is slower: it generally takes two to six months for type A symptoms to appear. The severity of the disease depends largely on the physical health of the sufferer before the disease took effect. This is why Hepatitis can be particularly hard on junkies.
Hepatitis C is quite similar to type B. There are only a few differences. The incubation period is highly variable. Generally it is anywhere from two weeks to six months. But increasingly the disease seems able to stay dormant many years. There is currently no cure for Hepatitis C.
As if anyone doesn't know this: AIDS is an acronym for Acquired Immunodeficiency Syndrome. And it is believed to be caused by HIV which is another acronym of Human Immunodeficiency Virus. AIDS destroys your immune system. This makes you very susceptible to infection. This is because HIV invades your white blood cells and destroys their ability to fight infection.
HIV is a retrovirus which means that it carries its genetic information via RNA instead of DNA. What does this mean? Nothing. Nothing, at all. What matters is this: if you get AIDS you will die within about a decade. Once infected with HIV, it will lay dormant for two to eight years. Once symptoms develop you are said to have AIDS. These symptoms are: weight loss, enlarged lymph nodes, diarrhea, fever, and night sweats.
If you experience any of the symptoms of AIDS you should, of course, see a doctor. But generally, a doctor will not be able to do much for you if it is caught after becoming full blown AIDS. For this reason, you should get tested for HIV infection as often as is reasonable. This means every six months if you are involved in dangerous activities such as sharing needles or having unprotected sex. If you are living a reasonably clean life then you should test for HIV every two years-if you're doing heroin, you aren't living that clean a life.
Various drugs and therapies can prolong the life of a person infected with HIV. But by far the best thing you can do for yourself is to get healthy. Your first reaction to finding out you are infected will likely be to submerge yourself in heroin. But this will only put added pressure on your body and cause you to have a shorter, and more important, sicker life. Try to look on the bright side: you might live longer with AIDS alone than you would have with heroin alone.
Leukoencephalopathy is a neurological disease that adversely affects the material that surrounds neurons in the brain and spinal cord--helping them transmit messages and protecting them from electrical activity from other neurons. It was first noted in the 1930s in children suffering from leukemia. The first case associated with heroin use was documented in 1982.
The symptoms of the disease include mental deterioration, vision loss, speech difficulty, loss of coordination, paralysis, and, ultimately, coma and even death in as many as 25% of those with the disease.
The most common way that heroin users get this disease is by infection when the immune system is weak due to AIDS. A relatively small number of people contract the disease directly as a result of smoking heroin. The mechanism is still not understood, but it is believed to result from contact with an uncommon adulterant used to cut street heroin.
The earliest symptoms of leukoencephalopathy are slurred speech and difficulty walking. Any heroin smoker showing these signs (which may come on many days after the last use), should see a doctor immediately. If treated quickly recovery is possible. This disease is treated at length in our article leukoencephalopathy.
Endocarditis is an infection of the inner lining of the heart. If left untreated, it is fatal. There are two disease types: Acute Infectious Endocarditis and Subacute Infectious Endocarditis. They are caused by different strains of bacteria and progress at different rates. The subacute form is most common. It is caused by a Streptoccus bacterium (the same thing that causes Strep Throat) called Streptoccus viridans. If untreated it will kill you within a year. The acute form of Endocarditis is caused by a couple of different bacteria: Staphylococcus aureus and Streptococcus hemolyticus. It will kill you in about a month.
The bacteria adhere to the inner lining of the heart--the endocardium. Once there, they grow. These bacterial colonies become very large and pieces of them break off and enter the circulatory system. These bacterial "particles" then get trapped in various places in the body. Because of this, you will have some indication that you should see a doctor. The symptoms are: Petechiae in the skin, blood in the urine, and a long-term low-grade fever.
Pulmonary Edema is the swelling of lung tissue. The main result of this is to reduce the lung capacity, usually to about 50% of its full capacity. It can lead to very potent pneumonia which can lead to death. Generally this is a problem associated with heroin related sudden death. It appears to be linked with existing lung disease but whether this is due to heroin, adulterants, or other causes (e.g., cigarettes) is unclear.
A thrombus is a blood clot. They form primarily in veins because blood moves more slowly in veins than in arteries. The clotting process is started by the platelets in the blood, which adhere to some surface. Normally, the walls of the veins are too smooth to allow this, but injection scars inside of veins create such surfaces. To reduce the risk of clotting, exercise-pay particular attention to parts of your body in which you inject.
These clots may stick in the walls and form hard clumps that interfere with the flow of blood. These are fairly common amongst injectors. They are usually frightening at first, but over time users find that they aren't particularly painful and that they don't seem to cause any problems other than making the vein in which they reside useless for injection.
All of the garbage that gets introduced into the body as a result of the ingestion of un-pure heroin can cause many different problems. These foreign substances can react with each other and with normal parts of the body to produce particulate matter. Over time, this material will be removed from your body. But until then, it will often be found floating through your blood stream. The presence of this material constricts the flow of blood and so leads to high blood pressure.
This situation is particularly bad for junkies. First, junkies do not stop using for long enough for their bodies to recover and expel the foreign substances. Second, almost all junkies smoke cigarettes. Third, most junkies do not eat well; the number one junkie food is high in fat: pizza. Infrequent chippers should not have to worry so much about high blood pressure. Regardless, all heroin users should check their blood pressures often-I recommend once a week.
The liver may be infected due to viruses introduced in the administration process. Life is not possible without the liver. It is the primary means by which your body removes toxins. Many drugs are very straining to the liver; heroin is not. But unclean administration can introduce any number of viruses which can attack the liver.
Tetanus comes from the tetanus bacillus that lives in the intestines of all animals (including humans). It is excreted in fecal matter and can live in soil indefinitely. For obvious reasons it is most commonly found in manure. It lives in dead tissue (like skin) and does not cause local inflammation--this is one reason why it is such a dangerous disease; you often won't know that you have it until it is too late.
The tetanus bacillus creates a toxin which it passes to the central nervous system. This toxin causes the nervous system to misbehave-telling muscles to stiffen and often causing painful spasms and convulsions. The first muscles affected are usually the jaws which explains why Tetanus is often referred to as "Lock Jaw." If the respirator muscles are affected, asphyxiation can occur. This point cannot be stressed enough: Tetanus from even a very small wound can kill you. Stay current on your Tetanus shots.
Most of the diseases that are of concern to heroin users have similar symptoms. These symptoms are listed in the table below. If you notice any of these, you should consult with a doctor. Most of the diseases are curable and those that are not can be helped greatly by a doctor.
|Blood in urine|
|High Blood Pressure|
|Uncontrollable Muscle Tightness|
|Symptoms of concern to heroin users.|