The Physiology of a Heroin Overdose

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not-even-once.com
​Last week we published a feature titled "Smackdown," which tells a tragic tale of the region's heroin epidemic and the growing number of lives the drug has taken. Two of the central characters in our story died from overdoses, and one woman, Angela Halliday, has been charged with drug-induced homicide in each case.

In reporting the story, we were curious to know the physiological process of how heroin can completely shut down a body, to the point of death. We checked in with a few experts, including Kate Tansey, executive director of the St. Louis County Children's Service Fund. Tansey has hooked up with St. Louis County Police Chief Tim Fitch; Dan Duncan, with the National Council on Alcoholism and Drug Abuse; and Lt. Chuck Boschert, deputy commander of the Bureau of Drug Enforcement of St. Louis County. They've spent the last few months traveling to St. Louis County high schools to educate parents on the dangers of heroin and unveil a new PR campaign to counteract the epidemic, called not-even-once.com.

Here's what we learned.

After a person injects his or herself with heroin, which is a synthetic drug made from opium, the liquid travels through the body's bloodstream and into the brain's limbic system, which controls emotions and feelings of pleasure, explains Tanzey. The opiates bind to the brain's "mu" receptors, which, in normal situations, attach to the body's naturally produced endorphins. When the heroin floods these mu receptors, the body starts to metabolize morphine, which creates a warm, pleasant rush.

"It's like you're suddenly sinking down into a soft couch, and your eyes start to droop," one user tells Daily RFT.

During the process, says Tanzey, the morphine also infiltrates the spinal cord, which cuts off certain signals that the body delivers to the brain. The biggest danger occurs when the drug hits the body's autonomic system, which controls breathing.

As the heroin depresses the respiratory centers in the brain, the user's breathing begins to slow. Two things are occurring here: First, the morphine is relaxing the muscles, including the lung muscles. Second, the body finds it increasingly difficult to respond to the buildup of carbon dioxide.

"Normally when you're asleep and low on oxygen, there's a trigger that says you've got too much carbon dioxide, which tells you that you must breath," Laureen Marinetti, the chief forensic toxicologist with Ohio's Montgomery County Coroner's Office, tells Daily RFT. "But that trigger gets depressed by heroin and opiates, and the body's sensors don't realize that it's time to exhale to get rid of the bad gas and let the good gas in.

"The dangerous thing with opiates is you get tolerant to the euphoric effects, but you never get tolerant to the respiratory-depressant effects, and that's why so many people die from them," continues Marinetti.

The length of time it takes from the moment of injection to the time of death varies from user to user. Respiratory failure can occur immediately after an injection, but it can also occur hours later. Victims of fatal heroin overdoses are, in general, victims of hypoxia.

Users who overdose can sometimes be saved with a 911 call and a quick shot of Narcan, an opioid antagonist that blocks the mu receptors. Until paramedics arrive, says Marinetti, overdose victims must keep breathing. If other people are present, sometimes physical stimulation -- face-slapping, etc. -- can sustain a person's breathing. But, depending on the level of overdose, such actions are sometimes too little, too late.

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10 comments
Shwoniervr
Shwoniervr

DwDignity; The very purpose of civilized living is so that humanity might transcend the base tendacies of nature.Your comments are likely, only an indication of your lack of education;I fear however, the very real possibility that you,and those of like mind, are proof that at least some human beings can not be civillized,regardless of our best collective efforts.

Penkente
Penkente

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DwDignity
DwDignity

As I said in a comment on a previous post, I fail to see the "tragedy" of the lives being taken here.  I see natural selection at work and there's nothing tragic about that.  More dead heroin junkies is a good thing, especially when they commit suicide in such an efficient way.  More power to 'em!

Wake_upbomb
Wake_upbomb

One the one hand, I could sort of see your point.  The constant fuckup who screws over friends and family finally ODs.  Everyone saw it coming.  But what about those just curious about the drug? Many of us have been curious about drugs.  One or two hits off a joint...no big deal life goes on.  But heroin can kill on your first hit.  Some kid gets curious and accidently dies.  You celebrate that??  Sure you do.  It's Natural Selection.  Do you also celebrate when some kid accidently gets run over by a flatbed truck?  By your logic, that's Natural Selection, too.  It makes me sad.  I wish everyone had to watch Requiem For A Dream in school.  If that doesn't scare you away from junk, nothing will.  No one Dies with Dignity.  You live with it. 

yut
yut

It's unfortunate that you make such insensitive comments. You would probably feel much differently if someone in your life had difficulty with addiction. 

DwDignity
DwDignity

It isn't unfortunate at all yut.  I wish I could feel sorry for these people and on a certain level I do, but there are so many people that are far more deserving a sympathy.  We have so many tragedies that are caused by forces beyond our control that I cannot feel sorry for anyone that makes a concious choice to engage in bad behavior that threatens their existence.And I have had a close relationship with a someone who dealt with addiction – my brother.  His alcoholism killed him 2 years ago.  We intervened numerous times.  Told him it would kill him.  His friends did too.  He knew the whole time it was bad for him and admitted it was…he knew very well the consequences of his actions.  I know medical science very often refers to addiction as a disease, but I think it is dangerous to think of it as such.  At what point do we hold people accountable for their actions especially when they know what they are doing is bad for them and wrong? I wish we could as the Buddhists say “have compassion for all things” but the world is so short of everything right now.  There isn’t enough compassion to go around much less the resources needed to turn these people’s lives around (which isn’t our responsibility by the way).  Heroin is deadly.  99% of people know that.  The 1% that choose to ignore the warnings deserve their fate.  

ginni
ginni

@DwDignity  All people make choices that have overt or covert health consequences. Opiate use is one of those choices that can manifest plain as day; however, some people can use opiates and not become addicted or live with addiction for years without showing signs of struggle. Anyone can use an opiate and become addicted. I helped a man through his treatment process who had being living with a heroin addiction for a decade. He was the owner of his successful business, never letting his addiction stand in the way of his work. When he came to me, he expressed the importance of becoming clean for he and his wife's soon-to-be child. This was his turning point. Everyone has one. I worked with one woman whose addiction lost her everything. She was so many miles from where she had once been. Her face was gaunt, hair patchy and she was covered in sores. She was originally from a country where women have no real human rights. Everyday, she was beaten, every day she was demeaned. On one occasion, she was mending a shirt of her father's. She pricked herself on the needle, drawing blood, a little getting on the shirt. Her father came over and broke her hand for it. She was raped and became pregnant out of wedlock. She was blamed and her family tried to kill her. She was relocated to another country via HR advocates. She is traumatized by her experience; she used heroin to cope with the flashbacks, fear, grief, guilt, shame, self-hatred, remorse, disgust. Now, I assume YOU are wondering what she did to deserve this--of course people make their choices, outcomes following. At what point should we blame society for bringing people up with harmful ideals? She was so traumatized and was never taught proper coping skills; it made sense that she could escape with a substance. Who are you to judge this? Do you know where people come from? Their stories, the shoes they have walked in? Please, stop and take a bit to evaluate your own biases. I assume you have some hang-ups in regard to your brother's addiction. This space can be so beautiful as you (people who have experienced addiction/loved ones of those) have seen it first hand; however, it can distort our vision, dilute our values/beliefs and make us angry/hateful toward others who reflect our angst. I am sorry for what you experienced with your brother. It is an immensely painful space, where no body has control. What I am hearing in your message is anger and resentment. Please, do yourself the biggest favor and seek help. Perhaps, you have sought help before and it didn't work, or worked for a while. Keep searching and supporting yourself. It may be the breath of fresh are you are needing.

yut
yut

I'm not suggesting that people not be held accountable for their actions. However, I wouldn't approach a heroin addict's death in a celebratory fashion as you implied you did in the first post.

I'm sure you clearly cared about your brother and showed that by trying to intervene to help him save his life. Why is it different for someone to try and help a heroin addict?

Also, how do you quantify compassion?

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