Nearly half of the heroin addicts followed in a 33-year study had died by its completion. The study, appearing in the May issue of the Archives of General Psychiatry, describes the destructive impact heroin has on the people who use it.

Heroin is a narcotic. Narcotic drugs have potent pain relief effects associated with significant mood and behavioral changes, and the potential for dependence and tolerance resulting from repeated use. Heroin addiction carries severe consequences including death and illness.

Researchers from the Drug Abuse Research Center of UCLA, led by Yih-Ing Hser, Ph.D, published a long-term study examining the course of heroin addiction in a group of men over 33 years.

The study included 581 male heroin addicts admitted to the California Civil Addict Program — a compulsory drug-treatment program for narcotic-dependent criminal offenders committed under court order. The participants were admitted to the program between 1962 and 1964.

Follow-up interviews and examinations were conducted in 1974-1975, then again in 1985-1986, and most recently in 1996-1997. The follow-up protocols reported on each subject s general health, mental health, employment, criminal involvement, and substance abuse history. By the time of the final interview, 284 (48.9 percent) of the original 581 heroin addicts had died, a death rate much higher than the in general population.

Of the living subjects, 242 were available for the final follow-up. Of the 284 confirmed deaths, the most common cause (21.6 percent) was drug overdose, 45 of which were caused by heroin and 16 from other drugs. Other significant causes of death included liver disease, heart disease, cancer, AIDS, and homicide.

The authors note, “the overall high mortality rates and the many overdose deaths provide evidence of the severe consequences of heroin use and, perhaps, the mediating factors, such as the heavy drinking and criminal lifestyle, that often accompany heroin addiction.”

Even among the surviving members of the study group, the problems associated with long-term heroin use were severe. Overall the group showed stable patterns of heroin use, causing the authors to conclude that “reaching long-term abstinence from heroin use is a very slow process.”

Even those addicts who managed to abstain for 5 years had a 25 percent relapse rate, some even relapsing after 15 years. Many of those who did abstain from heroin used other drugs during that period.

Of those subjects interviewed at the third follow-up, many reported illegal drug use in the previous year: 40.5 percent still used heroin, 35.5 percent used marijuana, 19.4 percent used cocaine, 10.3 percent used crack, and 11.6 percent used amphetamines. Drinking and smoking were also common.

Study participants who still used heroin at the last interview also had high rates of disability (53.1 percent), hepatitis (41.7 percent), sexually transmitted diseases (30.5 percent), unemployment (76.7 percent), drug dealing (25.8 percent) and other crimes (12.4 percent). Many current users were also in prison and suffering from mental illness.

The rates of these health and social problems were all significantly lower for subjects who had succeeded in abstaining from heroin use for the 5 years prior to the final interview. The benefits of abstinence were obvious to Christine Grella, Ph.D, a co-author of the study, who commented to the New York Times that subjects who stayed away from heroin “were well-functioning and they looked good.”

Throughout the course of the study, only about 10 percent of the subjects were actively participating in methadone maintenance treatment in a given year. Methadone is a synthetic chemical with similar effects to heroin, but it has milder withdrawal symptoms. It is a leading treatment for heroin addiction.

Methadone may have helped some addicts abstain from heroin use, but the emphasize that “for some, heroin addiction has been a lifelong condition associated with severe health and social consequences.”

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