The number of heroin overdoses is increasing across the U.S. at an alarming rate, but many of the related deaths are preventable, according to a new report. With proper diagnosis and treatment that begins close to an hour after an overdose, a majority of patients should survive, says Karl Sporer, M.D., UC San Francisco assistant professor of medicine and author of the analysis, which appears in the April 6 issue of Annals of Internal Medicine.
He also emphasizes that overdose preventive measures like methadone maintenance, in which heroin users receive a synthetic narcotic drug to help treat their addiction, have proved effective, and increasing the availability of this type of program could reduce the number of deaths.
A specialist in emergency medicine who treats patients at the UCSF-affiliated San Francisco General Hospital Medical Center, Sporer began researching the medical literature a year ago for all current information on acute heroin overdoses when he found no comprehensive update was available.
The Annals article covers the pharmacology of heroin, incidence of fatal overdoses, diagnosis, treatment, complications, and prevention programs. "One surprise was the documentation of the dramatic activity of heroin in the body compared to morphine and other opiates," he says. "Heroin is more soluble in the fat cells so it crosses the blood-brain barrier within 15-20 seconds, rapidly achieving a high level in the brain and central nervous system, which accounts for both the 'rush' experienced by users and the toxicity."
Heroin produces its effects by acting on key receptors in the central nervous system that are linked to a slowed breathing rate, feelings of euphoria, and physical dependence on the drug, he adds.
In the U.S., heroin-related emergency department visits have doubled from 33,900 in 1990 to 70,500 in 1996. Of persons who inject heroin, the average annual death rate is two percent.