When Drug Addiction Becomes a Medical Emergency: A Doctor’s Viewpoint of Heroin
As someone who has worked in emergency medicine for more than a decade, I can attest that society will usually judge people suffering from addiction based on morals. Society will consider the person addicted to heroin as someone who has a moral failing or poor decision-making. However, I have come to realize this: heroin use is not a moral failing, it is a complicated medical emergency that can spiral out of control faster than most people think.
Every time I work an ER shift, I am treating patients who are fighting a battle within their body on multiple fronts from using heroin. This is no longer just about the brain anymore. This is about a drug that has an effect on every major system in the human body simultaneously.
Viewing Heroin as a Medical Emergency
Allow me to explain what is happening when someone uses heroin repeatedly. It is not just that the person feels good; the drug re-wires the chemistry of the brain. Heroin attaches to opioid receptors that are distributed throughout the central nervous system, which affects the experience of pain, pleasure, and even responses to drive for the basic functions of survival.
This does not happen overnight and the changes in brain chemistry do happen quickly—within just a few weeks of use, we start to see a major change to brain function. From a doctor’s perspective, the rate in which tolerance develops is what makes this dangerous.
Here is the worse part: as tolerance goes up, the amount of drug required for someone to feel a fraction of what they felt previously goes up. Every time the user increases the amount of the drug, they are literally closing the gap between the high they desire and an overdose. Ultimately, the human body does not just desire heroin; it needs the drug to function.
Medical institutions throughout the country are starting to realize an important fact: treatment of heroin addiction must be done, and maintained, with medical management from Day 1. The withdrawal from heroin is more than uncomfortable; it is actually life threatening. I have seen individuals seize, be severely dehydrated, or even suffer from cardiovascular problems, warranting medical assistance.
When the ED is Episode 1
The ED has become the frontlines for people who are using heroin, and there is a now shift in our delivery of care from heroin overdose. Those who have used heroin chronically will present to the emergency department with a perfect storm of medical emergencies together.
The number one risk is respiratory depression. Heroin will cause respiratory depression where you are breathing too slow, too shallow, or not at all. When paramedics brought in an overdose, in minutes, not hours, we can begin to reverse the process with naloxone (Narcan). The naloxone will obviate someone from dying from the overdose, but it does not address the heroin use/dependence. In general, these patients will use again within hours or days.
And then we will see infections. For people who inject heroin, we will typically see blood stream infections, endocarditis (infection of the heart valves), and localized abscesses around the injection site. The treatment of those infections can require weeks of intravenous antibiotics and sometimes surgery. Heroin can also depress the immune system’s response, leaving individuals exposed to various infections ranging from pneumonia to hepatitis.
And compounding the tragedy, the exhibit patients return over and over. In the past, traditional medicine’s focus was to treat acute emergency and send the patient home, and as we’ve come to observe and learn, this does not work.
It’s A New Medical Approach
The medical world has drastically altered the way we approach heroin addiction. From treating the symptoms, we are now treating addiction as a legitimate medical condition.
The modern treatment of heroin addiction includes the entire medical team: emergency physicians, addiction specialists, psychiatrists, social workers, and case managers that all work together to form one comprehensive treatment plan which is able to target addiction from multiple layers.
Detoxification, for example, should never occur without medical supervision. Heroin withdrawal can accompany a severe level of anxiety, muscle cramping, nausea, insomnia, etc., that can last for weeks. There are also medications available to make withdrawal safer and more manageable.
We also have learned that detoxification is only the first step. The brain requires time, sometimes months to years, to heal and relearn how to operate without the drug on board. During that time, individuals continue advancing medical issues that require care.
Long Road to Recovery
What many people don’t understand is that heroin addiction creates lasting health problems that persist long after someone stops using. The cardiovascular system, liver function, and neurological health can remain compromised for months or years, sometimes creating new medical emergencies down the road.
Our approach now focuses on treating both the addiction and the overall physical health of the patient. Many people started using heroin to self-medicate chronic pain or mental health conditions, so we need to address these underlying issues too.
We’ve also changed how we think about relapse. Instead of viewing it as a moral failure or treatment failure, we now understand relapse as part of managing a chronic condition—similar to how we approach diabetes or hypertension. When someone struggles with maintaining sobriety, we adjust their treatment plan rather than give up on them.
This shift has led to better outcomes when patients connect with comprehensive heroin addiction rehab programs that understand addiction as a medical condition requiring long-term support.
Healthcare Integration
The healthcare system is evolving to meet this crisis face-on. We have moved from treating addiction as a separate, discrete issue to launching addiction medicine specialists throughout our healthcare systems. This creates better coordination, and therefore care.
The emergency room is also getting better at connecting patients directly to ongoing treatment resources at the moment of crisis. Research shows individuals are most open to receiving help when they are going through a health emergency, and we have increased resources available to connect these individuals at that very moment.
Increased awareness of and coordinated medical care has changed how healthcare interacts with heroin addiction. Acute emergencies in a separate box to be treated, seen as emergencies to a now complex medical condition needing ongoing managed care.
This marks a core change in medicine’s relationship with addiction, from a moral failing to what it is, a serious medical health problem that requires a similar level of ongoing attention as any other medical emergency requiring care.
