Addiction Treatment
The Dangers of Untreated Heroin Addiction
Heroin addiction has a direction. Left alone, it does not hold steady. It moves toward more use, more risk, and, in today’s drug supply, a real chance of death.
This article is blunt about what happens when heroin addiction goes untreated, because a soft version helps nobody. It also explains what changes when someone gets help, and what that looks like at our outpatient program in Berlin, NJ.
The overdose risk is different than it used to be
Ten years ago, heroin overdose was mostly about dose. Today it is about contamination. Much of the heroin sold in New Jersey contains fentanyl, a synthetic opioid roughly 50 times stronger by the Drug Enforcement Administration’s estimate, and the amount varies bag to bag. A person can use the same dealer, the same quantity, the same way, and die on a Tuesday because that batch was different.
Tolerance makes it worse in a way people do not expect. Someone who has cut back, sat in jail, or finished a detox loses tolerance quickly. Return to the old dose and the body cannot handle it. The days after a treatment stay, a release, or any stretch of abstinence are the most dangerous days in an opioid user’s life. That is well documented (Binswanger et al., NEJM 2007, on deaths after release from prison), not a scare line, and it is why we push so hard on aftercare.
The signs of an opioid overdose: unresponsive, breathing slow or stopped, blue or gray lips and fingertips, gurgling sounds, pinpoint pupils. Call 911 first. Give naloxone (Narcan) if you have it. If there is no response in 2 to 3 minutes, give another dose, and keep going until the person responds or help arrives. Naloxone does not reverse xylazine, benzodiazepines, or the other non-opioid adulterants now common in the New Jersey supply, so 911 still matters even when naloxone works. Stay with the person. In New Jersey, naloxone is free at participating pharmacies through the state’s Naloxone365 program, with no prescription and no ID. Keep it in the house.
What untreated heroin use does to the body
- Respiratory damage. Opioids suppress breathing, and repeated near-overdoses starve the brain of oxygen. Long-term users have high rates of pneumonia and other lung infections
- Infections from injecting. Hepatitis C and HIV from shared equipment. Abscesses and cellulitis at injection sites. Endocarditis, an infection of the heart’s lining and valves, which can be fatal and can require heart surgery
- Collapsed veins and circulation problems
- Chronic constipation and bowel problems, hormone disruption, a suppressed immune system
- Memory and attention problems, and in overdose survivors, sometimes lasting brain injury
What it does to the mind
The brain adapts to a flood of opioids by producing less of its own signal. Over time that leaves a person who feels little without the drug and not much with it. Depression and anxiety are close to universal in long-term heroin use, and they do not lift on their own the week someone stops.
Isolation follows. The people who used to be around get lied to, borrowed from, and eventually avoided. Shame does the rest. Many people describe the emotional side of untreated addiction as worse than the physical side.
What it does to a life
- Relationships. Trust is the first casualty. Partners, parents, and children can spend years reacting to the addiction rather than to the person
- Legal exposure. Possession, theft to fund use, impaired driving. A record follows people long after they are sober
- Work. Lost jobs, and gaps that are hard to explain later
- Money. Heroin is cheaper than pills, which is often how people got here, but a daily habit still consumes everything
Each of these feeds the others. Lose the job, lose the housing, lose the people, and the drug becomes the only reliable thing in the day.
What changes with treatment
Recovery from heroin addiction happens, far more often than the untreated version suggests. That is worth saying plainly, because the untreated version is so visible and the treated version mostly looks like ordinary life.
Two things drive the difference.
The first is medication-assisted treatment. Buprenorphine and methadone are FDA-approved for opioid use disorder. People on these medications die at roughly half the rate of people who are not on them (Sordo et al., BMJ 2017; Santo et al., JAMA Psychiatry 2021), and treatment is associated with far less overdose and illicit opioid use. Naltrexone is a third option that blocks opioids entirely. Methadone is dispensed only through federally certified opioid treatment programs. We do not dispense it, but we can help you get connected to a program that does. We prescribe and monitor buprenorphine and naltrexone on site. Medication is not “trading one addiction for another.” It is the standard of care.
The second is therapy that addresses what was underneath. Individual therapy, group therapy, and trauma therapy work on the triggers, the thinking, and the history. Where depression, PTSD, or anxiety are part of the picture, dual diagnosis care treats both at once.
Then relapse prevention. A plan for cravings, for the first argument, for the old friend who texts. Peer support. A schedule. Someone to call.
Starting at South Jersey Recovery Program
We are an outpatient program. If you are using heroin daily, you may need medically supervised detox first, and we will help you arrange one. After that, or in place of it if your clinician agrees, we offer three levels of care you attend while living at home: partial care, an intensive outpatient program several days a week during the day, and a standard outpatient program.
Call (856) 788-6914 or contact us. The consultation is confidential, and we will verify your insurance on the same call.
The bottom line
Every day without treatment carries a risk that treatment removes.
Untreated heroin addiction is not a plateau. It is a slope, and the bottom of it has moved closer since fentanyl arrived.
For more on opioid addiction and the science behind treatment, see the National Institute on Drug Abuse.
