What is Heroin ?
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Heroin is also called as diacetylmorphine. It is a Schedule I drug which is a controlled substance as per the rules of many countries. It is considered as one of the most potent and addictive drug substance. It is potent because among other drugs, it has the highest chances of addiction in the form of physical and also psychological dependence. When heroin is injected intravenously during use, the drug gets metabolized completely only after it is circulated through the entire body. This is called as first pass metabolism. The main reason behind this is that injected heroin becomes acetylated making it fat soluble and so the drug crosses the blood brain barrier very fast. This is the main reason behind its quick metabolism. Once the heroin reaches the brain, heroin is deacetylated and it breaks down into the various metabolites and the last metabolite is morphine. This morphine then unites to the receptor, mu-opioid. This binding of the morphine particles to the mu receptors makes the users experience euphoria and high effect associated with it. There is also a pain relief that the user experiences when using heroin.
Along with some pleasurable effects of heroin, there are many side effects and long time use can lead to itching at the site of injection, inflammation, the dental hygiene gets poor, immunity gets low, memory loss and physical weakness. The sharing of needles and syringes during IV use of heroin is responsible for transmission of sexually transmitted disease like HIV and AIDS. The habit forming nature of the drug makes it very difficult for the users to quit but there are many who have been able to kick heroin out of their body and systems.Heroin & Human System
How Long Does Heroin Stay In Your System ?
So How long does heroin stay in your system ??? Heroin is a very addictive drug and those who have been addicted also know what it is to deal with withdrawal symptoms. So it is a very common query as to how long does the heroin stay in the system and when are you totally freed from it. The metabolism of heroin gives a clear understanding of how heroin moves in the body. Once the heroin enters the body, the person will experience a “high” for few minutes to few hours depending on the dosage and mode of administration. The half life of heroin (It is the time taken by the body to metabolize the drug by 50% after its entry into the body) is very short hence heroin lasts in the body for about 3-8 minutes only. It’s by product that is morphine can be found upto 3-4 hours. This indicates that after the intake of heroin, half of the drug gets cleared from the system in less than 10 minutes. Users assume that when the “high” effect of the drug wears of, the drug is gone from the body but the fact is that even after the high effect wears of, half of the heroin concentration is still present in the body and its metabolites.
This can be understood better with the help of an example. If someone took heroin that has a half life lasting for 8 minutes, then the drug would stay in the system for 44 minutes. Heroin is a drug that is very rapidly metabolized and removed from the system but its break down products or metabolites stay in the body for a greater time period. After entry into the body, heroin gets deacetylated to a compound called 6-monoacetylmorphine which is then broken down into morphine. Generally the normal half life of morphine is somewhere between one hour to 7 hours. Due to this after ingestion, heroin stays in the system for one and a half days before the body can be totally free from it. If the person is a chronic user, then the drug stays in the system for a longer duration than it is detectable by a drug analysis. If the person takes a large quantity of heroin, the system cannot metabolize it completely so it can be detected for a longer time. The metabolized products are eliminated but if it is in excess, then it tends to stay in the tissues of the body and gets stored in the fat cells and there by resulting in a delayed clearance rate. There are many factors that can influence the heroin metabolism and we shall now learn about it in details.
Factors That Influence The Metabolism of Heroin Your System
Once we have understood the metabolism and half like of heroin, we can understand the factors affecting its absorption. It is essential to understand that the half life, absorption, metabolism rate and excretion varies from one individual to the other. One person may notice that heroin is getting excreted from the system within 24 hours while the other may feel its effects for a longer period of time. This difference is mainly observed because of personal factors like mode of administration, ingested dose and frequency of use. The following are some of the identified factors affecting heroin metabolism.
(1) Individual variation: There are many factors that vary from one person to the other that decide the way heroin behaves in your body. The factors are age, height weight and BMI, dietary intake, liver function, genetics and whether the person is already taking any medications or not.
(a) Age: It is a general and well known fact that with age the metabolism rate of the body changes. Younger people have faster metabolism rates than older people and so they tend to metabolize the drug faster. The drug takes longer to get excreted in the body of a 60 year old as compared to that of a 20 year old. So if the user is young, the drug tends to get metabolized at a very fast rate.
(b) Body Mass Index: The body mass index is calculated by a fixed formula involving the height and weight of the person. It has a very strong impact on the metabolism of the heroin. People who are obese with a high BMI can metabolize a small quantity of heroin. But if a person ingests a large amount as compared to his body mass index, then the metabolism is not that efficient. The body size plays a very important role in the metabolism of the heroin.
(c) Diet: A healthy diet and adequate amounts of water make the person more fit and such persons can metabolize the heroin much more efficiently. While this is a very influential factor the extent to which it affects the metabolism is still not known. Since healthy diet and water intake affect the metabolism they are known to influence the speed of the heroin break down in the body.
(d) Genetics: There are many studies that show that the variations in cytochrome P450 2D6 alter the speed of heroin metabolism. But these factors do not influence the clearance of the drug from the body. There are many categories that have been formed based on the genetic study and they are:
- Very fast metabolizers
- Extensive metabolizers
- Intermidiate metabolizers
- Poor metabolizers (It is known that people falling under the category of poor metabolizers retain the drug for a greater time than a rapid metaboliser)
(e) Liver and Kidney function: As we know almost all drugs are metabolized through the liver. So it is very important for a person to have a good liver function. If the liver is deranged due to any reason or not functioning well, then the heroin will not be metabolized and some of the drug will be retained in the body for a greater time duration. With age the liver functions may tend to deteriorate so it is said that an older person cannot metabolize the heroin as effectively as a young person with a robust liver function.
(f) Metabolism: The basic metabolism of the body decided how the heroin is absorbed and excreted from the body. A person with a sluggish basic metabolism may taken longer for the heroin to break down into its metabolites than a person with a fast metabolic rate. There is a liver enzyme called CY2D6 that causes most of the drug metabolism through the liver. Some genetic factors can influence this liver enzyme and alter the rate of absorption of the heroin.
(g) Medications: It is a possibility that if the person is taking other drugs and metabolites, then the absorption of heroin may get affected- it may be prolonged or fastened depending on the drug in question. So it is essential to know how the drug interacts with the heroin. There are many drug supplements that tend to hasten the process of detoxification and thereby affecting the clearance of the drug.
(2) Dosage of the drug:
The dosage means the amount of heroin which the person ingests at a particular time. The dosage mainly decides how long the heroin will stay in the body before it is eliminated. If two persons smoke heroin at the same time and one of them takes in a greater quantity, then the time taken to clear the heroin from the system will be different in both. Both of them can metabolize the heroin but if the dosage is more, then the metabolism tends to slow down a bit.
This is mainly because the body can metabolize only a particular dose of heroin at a time. If this threshold is exceeded then the drug tends to be flooded in the system and begins to get stored in the fat cells of the body. If the drug gets stored in the fat cells, the drug test may not be positive but the heroin will be present in the tissues and not be totally eliminated from the body.
If a user takes a smaller dose of the heroin then it will clear from his body at a faster pace. And if the dose is bigger than the elimination will take time and be incomplete. The amount of heroin entering the system also depends a lot on the way that it is taken (injected, inhaled or snorted). We shall discuss the modes of drug ingestion later in this series.
(3) Frequency of Dosage
The effect of the heroin in any given individual depends on the frequency of the drug use. If a person is a chronic user and takes heroin multiple times a day since many weeks or months, the threshold and tolerance is much higher. A first time user will have a relatively low tolerance and the drug will affect him much more than it will in a person who has been taking it since a long time. The doses that a chronic user can tolerate are at times so large that a person taking the drug for the first time cannot even take them.
The tolerance to the drug is related a lot to the dosage and the frequency of usage. Excessive usage tends to overwhelm the body and its ability to get rid of the heroin. This happens when the user takes a large dose of heroin at relatively regular intervals. The high doses are metabolized in the body but the efficacy is reduced and some amount of the drug tends to stay back in the system and begins to accumulate in the fat cells of the body. Infrequent or new users take smaller doses and are not tolerant of the effect of the drug. So their bodies are able to clear out the heroin from the system more effectively and completely. In infrequent users the heroin does not accumulate in the fat cells and tissues of the body.
(4) Purity of the Heroin
It is a known fact that the purity of the heroin affects the concentration in the body. Greater the purity level, longer the heroin tends to stay in the system. High purity forms deliver a higher level of the drug in the body as compared to a low purity form of the drug. There are four grades used to classify the purity of heroin. They are:
- Number 4- purest form
- Number 3- pure form
- Number 2- less pure form
- Number 1- least pure form
The purity level thus affects the metabolism of heroin by means of the dosage. Number four which is the purest form of the drug is found as white salt and is mostly used in injections. The pure form that is number 3 form is used for smoking. The less pure forms that is number 2 and 1 are considered as unprocessed forms of heroin.
When we consider the purity of the drug heroin the clearance of the drug from the system is also to be considered. If a person takes a very small dose of the number 4 heroin, it will stay in the system much longer than the least pure form that is number 1.
(5) Mode of Ingestion
There are many modes of ingestion of heroin. The common modes are intravenous (IV) injections, smoking, snorting (insuffulation), oral ingestion. The way the heroin is taken will affect the effect of the drug in the body. The absorption, metabolism and clearance also depend on the mode of taking the drug. There are certain modes of use that are known to be associated with a faster clearance as compared to others. We shall now discuss each of the modes in details:
Intravenous injections: IV injections are the commonest form of heroin use as it is associated with maximum efficacy and the drug enters the blood within 10-20 seconds of injection. Since it reaches the blood so fast, the bioavailability is 100% and the high associated with it is more effective when compared to other modes of administration. The effect lasts for 4-5 hours. The heroin that is used in Iv injections is generally of a higher grade purity and so its metabolites remain in the body of the users for a much longer time as compared to other routes of ingestion.
IV injections produce the fastest and most extreme elevation of the heroin metabolites like 6-monoacetylmorphine and morphine. These metabolites if detected on a blood test, can be found within just one minute of the administration and also tends to stay in the blood for a much longer duration. In regular users who take the drug daily, the drug can be found in the urine non metabolized. Intravenous drug users tend to fail a drug test as the heroin takes much longer to leave their system. This category of drug users are at the highest risk of getting diseases like HIV/AIDS as the sharing of contaminated needles and syringes with blood in them is responsible for the transmission of the disease.
Smoking: Smoking the heroin means that it is inhaled up the nostrils and absorbed into the lungs. This mode of ingestion leads to a high in 10 seconds and the effect lasts for 3 to 5 hours. In this mode, the highest concentration of the drug is reached within 1-2 minutes so the active metabolites can be found in the blood after one minute of the smoking. The bioavailability of the heroin is much less than when it is injected into the blood. The higher grade purity heroin is generally used for smoking and it is absorbed very quickly by the alveoli in the lungs. Since the smoked heroin reaches the lunges first, its first pass metabolism by the liver is avoided, thus the drug and its break down products tends to stay in the body longer than in a case where the drug is ingested.
Snorting: This method is also called insuffulation. The heroin is put onto a flat surface and made into a thin line. Then using a paper roll or a small tube, the heroin is inhaled or snorted into the nose. This method delivers the heroin directly into the blood stream via the paranasal tissues. The high effect is achieved within 2 minutes and it lasts for 3 to 5 hours. The heroin that is used for snorting is usually of the less purer grade than that is used for injections and smoking. Because of this reason, it is detectable later in the blood. In this mode also the drug is first metabolized by the nasal mucous membranes and it skips the liver resulting in higher levels of circulating metabolites in the body. Sometimes snorting is associated with second peak or high effect as some of the drug gets ingested and is absorbed by the gastric mucosa. In comparison with injectable heroin, snorting yields 2-6 times lower the number of metabolites.
Oral Ingestion: Ingestion is another known mode of heroin use. The bioavailability of the drug is the lowest when taken orally. The time taken for the high effect is also more. The lower purity grade heroin is used for ingestion and its absorption rate is not so fast. Since the absorption is slow, the metabolites are not so easily detected. When ingested, the heroin goes to the liver for first pass metabolism. So the rate of detection of its break down products is lower than it is in the case of injection, snorting and inhaling.
Metabolism & Excretion of Heroin in the Body
In order to understand the metabolism of heroin, we must begin from the time of ingestion. Once heroin enters the system, it is rapidly metabolized into 6-monoacetylmorphine and then morphine. Then the metabolites morphine-3-glucuronide and morphine-6-glucuronide are formed. These are then excreted into the urine and bile. If a person took heroin via an intravenous injection, 70% of the drug metabolites will be excreted in the urine. The other break down products that appear in the urine are normorphine, codeine, morphine-3-6-diglucuronide. Most of the ingested morphine undergoes glucuronidation in the liver.
In general, the half life of heroin is 1-7.8 minutes. The clearance rate of the drug from the body is 1939 liters per hour. The average blood flow to the liver is at the rate of 80 liters per hour so most of the heroin must be metabolized by the peripheral tissues and the circulation. In most of the users, the entire amount is converted into the metabolites before it can be excreted in the urine by the kidneys. But in long term users, a small part of it remains un metabolized and is excreted in the urine.
If the use is intravenous, then 6-monoacetylmorphine is detectable for upto 3 hours in the plasma and for upto 5 hours in the urine. If the mode is inhalation, then the metabolites will appear in the urine sample a little later.
It is believed that longer half lives of morphine and metabolites (M3G and M6G) is due to enterohepatic circulation. Due to this, the metabolites travel into the liver and biliary tract before they enter the digestive tract. In the gut, these are hydrolyzed by glucuronidase enzymes into morphine and then it gets reabsorbed into the blood and gets recirculated before it is eliminated.
Drug Tests for Heroin
There are many tests available to assess if a person has been using heroin (or another opium derivative). Heroin has a very fast metabolism rate and has a very short half life. This is the reason many drug tests cannot detect the heroin. So in this case, the drug tests are done to look for the metabolites of heroin like 6-monoacetylmorphine, morphine(MOR), M3G and M6G.
Urine tests: The commonest test used to detect the metabolites of heroin is a urine test. After the collection of the urine sample, it will be analyzed for the presence of diacetylmorphine and other metabolites. It is very rare that any user has non metabolized diacetylmorphine in the urine.
In frequent users who normally take the drug via intravenous injections, a small fraction gets detected in the urine. Urine samples are most likely to detect the presence of the metabolites like 6-monoacetylmorphine, morphine etc. Urine tests are likely to come positive 2 to 5 hours after ingestion of the drug. Opioid metabolites are found in the urine for upto 1-3 days post ingestion. If the person is regular or a heavy drug user, it is unlikely that the drug will be detected in the urine 3 days after ingestion.
Blood Tests: This is another way of checking whether the person has consumed heroin or not. Heroin and its metabolites tend to leave the blood within two hours so it is very difficult to make a decision based on the blood test alone unless the person has ingested the heroin just prior to the blood sampling. So a blood test is used only when you want to confirm that a person is high on heroin. Some metabolites of the drug are recycled through the blood and so the results of blood tests are not very accurate. So blood tests are less preferred as they can give wrong results.
Hair tests: The hair test is an accurate way of knowing whether the person has been using heroin over a period of a few months. The hair sample is collected and it needs to be at least 3-6 cm long. The sample is sent for analysis and it helps to determine whether the person has been using heroin. There is a drawback of this test. It cannot detect whether the person has consumed heroin in the last few days. So the test may be positive and it is indicative that the person has had heroin in the past. The heroin stays in the hair for a much longer time than it does in the bloodstream. There are some labs that can detect the presence of the heroin in the hair after 7 days of consuming the drug. But in most cases the hair test is used to assess the use of heroin in the past 90 days. The factors that could affect the test results are the length of hair and the amount of heroin ingested. The results may vary in different labs.
Saliva tests: This is a rare test to assess whether the person has consumed heroin or not. Saliva tests are easy to conduct and are also non invasive unlike blood tests. The saliva sample is analyzed in a laboratory and checked for heroin metabolites. Saliva tests are considered to be most accurate when the sample is collected within one hour of ingestion of the heroin. This category of tests is considered less effective than urine tests but the detection window period is longer than that in blood tests. The results of the test also vary person to person as the rate of metabolism of the drug is different in each person.
Tips To Enhance Heroin Clearance from the System
If you have stopped consuming the drug and you want to clear your system from the drug, you can make use of the following tips. These tips are just for your use and they are not meant to alter or manipulate any test results in case you are subjected to any kind of tests. They are meant to help your body recover and get back to normal and healthy functioning without the influence of any foreign substance.
- Stop immediately: This is the most important and obvious tip if you wish to clear your system of the heroin. You must stop consuming the drug immediately. If you think that taking a small dose after you have stopped, will not be detected on a blood test, you are wrong. The fact is that the longer you use the drug, the more time it takes to get completely cleared from the system. With each use, you put your body at a risk as the drug gets stored in the fat cells and thus takes longer for clearance.
- Drink plenty of water: If you to flush out any toxic substance from your body then the trick is to drink plenty of water. It will help to remove all the metabolites and toxins. You should avoid taking beverages like sodas that can add toxins to your body and disturb the normal functioning. There is no fixed rule about how much water you should drink but it should be sufficient to keep the body hydrated and altleast 5-6 glasses per day.
- Exercise: If you have used heroin and you want to clear the system of the drug, you could try some light exercise. Small sprints and jogs are generally enough as exercise. You may be already suffering from withdrawal symptoms and so will not be able to exercise a lot. The exercise will help to improve blood circulation and make you feel fresh and will fasten the recovery process. Exercise also helps to burn fat which in turn will help to eliminate the heroin accumulated in the fat cells.
- Supplements: Taking the right supplements will help your body to recover from the withdrawal symptoms as they will help the body to metabolize the heroin much faster and make the body cells free from the drug. There are some supplements that improve liver and kidney functions and also speed up the metabolism like vitamin B complex and folic acid. Thus the right supplements will help your body to get rid of the heroin faster.
- Diet: If you have a diet that includes junk food, then the toxins build up in the body and put a strain on the system. Junk foods contain artificial sweeteners and preservatives that are harmful for your body and slow down the metabolism rate. By taking a healthy and balanced diet, you can provide your body with anti oxidants and nutrients that are needed for optimum functioning.
If you have been a user of the drug, and have been tested you could put down your comments here and also mention the type of test. This will help others understand the details of drug metabolism and also give you a chance to interact and share your views and concerns. If you have been a frequent user, mention the mode of ingestion, dosage and the duration of consumption of the drug. You can also share any tips or advice you have on drug clearance from the system. Feel free to share your experience here.