Monday, May 9, 2011
Medical Mondays: Heroin Today, Problems Tomorrow
Our question today comes from Laurel Garver. She's got a great blog called Laurel's Leaves, so check it out if you've never been by.
Laurel asked, "What kind of long-term medical illnesses might a former heroin abuser have? What kinds of symptoms might they suffer from?"
Great questions. Sadly, this was easy for me to answer, as intravenous drug addicts and past users were often seen at the hospital where I trained in residency and medical school.
Heroin is a semi-synthetic drug derived from morphine, which is itself a derivative of the opium poppy.
Chemical name: diacetylmorphine
Street name: dope, horse, smack, tar, dragon, hero, Hera, white, black, brown, chiva, junk, among many others
(Slight aside: did you know morphine was named after the Greek God of Dreams, Morpheus, son of Hypnos, the God of Sleep? Cool.)
As for long term illnesses, I'm going to focus on purely medical ones, rather than long term issues involving addiction itself.
Many injection drug users do not use sterile technique and may share needles with other drug users. This has several consequences.
1) Heart problems. The dirty needle can "drag" bacteria living on the skin's surface into the blood stream. These types of skin bacteria have a penchant for infecting the valves heart. This infection is called endocarditis, and can gradually or acutely cause valve problems. A past heroin user might have damaged valves from a past endocarditis infection, which could later put them at risk for another endocarditis infection (say, after dental surgery), or heart failure (symptoms include shortness of breath, tiredness and fatigue, leg swelling and fluid build up in the lungs).
2) Hepatitis. Hepatitis B and C are blood-borne viruses that are easily transmitted via shared needles with an infected person. Both can cause cirrhosis of the liver (liver scarring and poor function) and eventual liver failure, as well as liver cancer. Symptoms of cirrhosis include fatigue, yellowing of the eyes, wasting of muscles, an enlarged abdomen from fluid in the belly cavity, reddish palms and little, spidery blood vessels on the skin, and occasional confusion. They can also have problems with vomiting blood or rectal bleeding.
3) HIV. The human immunodeficiency virus can be transmitted for the same reason hepatitis is. Carriers may be completely asymptomatic until the virus kills off enough of one of the body's natural infection fighting cells (the T-cells). When that happens (the lapse time can vary widely--2 week to 20 years), certain infections can take the opportunity to attack the individual (called opportunistic infections, or OIs). This is when the diagnosis of AIDS (Acquired ImmunoDeficiency Syndrome) occurs. These OIs include herpes, thrush (yeast in the throat), tuberculosis, and pneumonias, among others. They are also at risk of certain cancers, including lymphomas and Kaposi's sarcoma. Luckily, there are excellent anti-viral medications available today that are effective in controlling the virus, though there still is no cure or effective vaccine.
Okay, this post is getting way too long and I am getting flashbacks of working on the inpatient HIV/AIDS ward from my training. Whew.
There is a quote from the movie "The Crow" that is oddly fitting to close here, especially since yesterday was Mother's Day. The paranormal hunk a.k.a the Crow a.k.a Brandon Lee, says to an absentee mom/drug addict:
"Mother is the word for God on the lips and hearts of all children. Heroin is bad for you. There's a little girl on the streets, waiting for her mother."