21 DRUG DEPENDENCE

heating of heroin powder and inhaling the fumes through a rolled note. The use ofintravenous route is rare here.The amount of heroin used varies from individual to individual. However, highlevels of tolerance occur with chronic use. Some studies indicate that the chronic usercould tolerate up to 1.0 gm doses i.v. without serious effect. In the body, heroin like anyother opiate, binds to the opiate receptor sites. It also stimulates the mood regulatingcenters of the brain, such as the hypothalamus, to produce euphoria. It depresses theCNS and regulates the perception of pain.Heroin effects are dose-dependent like most other street drugs. Like the others itis contaminated with a variety of other chemicals and impurities. Heroin and syntheticopiates are very powerful and dangerous drugs. Heroin Addiction is also one of the mostdifficult drug habits to kick.Withdrawal Syndrome and TreatmentThe signs and symptoms of opiate withdrawal may be graded to indicate thedifferent stages and severity of the syndrome. But the grading is somewhat arbitrary, asthe symptoms and signs of any particular grade may not all be present simultaneously.Table 1. Opiate Withdrawal Syndrome(adapted from Hamid Ghodse: Drugs and Addictive Behaviour. Blackwell Science)Grade 1:Grade 2:Grade 3:YawningSweatingRunning eyes and noseRestless sleepDilated pupilsGoosefleshMuscle twitchingHot and cold flushes: shiveringAching bones and musclesLoss of appetiteIrritabilityInsomniaLow-grade feverIncreased pulse rateIncreased respiratory rateIncreased blood pressureRestlessnessAbdominal crampsNausea and vomitingDiarrhoeaWeight loss2