Heroin Information

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Heroin was first synthesized in 1874 from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It was commercially marketed in 1898 as a new pain remedy and became widely used in medicine in the early 1900s until it became a controlled substance in 1914 under the Harrison Narcotic Act. Heroin is a highly addictive drug and is considered the most abused and most rapidly acting opiate.

Heroin comes in various forms, but pure heroin is a white powder with a bitter taste. Most illicit heroin comes in powder form in colors ranging from white to dark brown. The colors are due to the impurities left from the manufacturing process or the presence of additives. “Black tar” is another form of heroin that resembles roofing tar or is hard like coal. Color varies from dark brown to black.

Effects

Heroin can be injected, smoked, or snorted. Intravenous injection produces the greatest intensity and most rapid onset of euphoria. Effects are felt in 7 to 8 seconds. Even though effects for sniffing or smoking develop more slowly, beginning in 10 to 15 minutes, sniffing or smoking heroin has increased in popularity because of the availability of high-purity heroin and the fear of sharing needles. Also, users tend to mistakenly believe that sniffing or smoking heroin will not lead to addiction.

After ingestion, heroin crosses the blood-brain barrier. While in the brain, heroin converts to morphine and binds rapidly to opioid receptors. Users tend to report feeling a “rush” or a surge of pleasurable sensations. The feeling varies in intensity depending on how much of the drug was ingested and how rapidly the drug enters the brain and binds to the natural opioid receptors. The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the user’s arms and legs. The user may also experience nausea, vomiting, and severe itching. Following the initial effects, the user will be drowsy for several hours with clouded mental function and slow cardiac function. Breathing is slowed, possibly to the point of death.

Repeated heroin use produces tolerance and physical dependence. Physical dependence causes the user’s body to adapt to the presence of the drug and withdrawal symptoms occur if use is reduced. Withdrawal symptoms begin within a few hours of last use and can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements. These symptoms peak between 24 and 48 hours after the last dose and subside after about a week, but may persist for up to a month. Heroin withdrawal is not usually fatal in an otherwise healthy adult, but can cause death to the fetus of a pregnant addict.

Consequences of Use

Chronic heroin use can lead to medical consequences such as scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses and other soft-tissue infections, and liver or kidney disease. Poor health conditions and depressed respiration from heroin use can cause lung complications, including various types of pneumonia and tuberculosis.

Addiction is the most detrimental long-term effect of heroin use because it is a chronic, relapsing disease characterized by compulsive drug seeking and use, as well as neurochemical and molecular changes in the brain.

Long-term effects of heroin use also can include arthritis and other rheumatologic problems and infection of bloodborne pathogens such as HIV/AIDS and hepatitis B and C (which are contracted by sharing and reusing syringes and other injection paraphernalia). It is estimated that injection drug use has been a factor in onethird of all HIV and more than half of all hepatitis C cases in the United States.

Heroin use by a pregnant woman can result in a miscarriage or premature delivery. Heroin exposure in utero can increase a newborns’ risk of SIDS (sudden infant death syndrome).

Street heroin is often cut with substances such as sugar, starch, powdered milk, strychnine and other poisons, and other drugs. These additives may not dissolve when injected in a user’s system and can clog the blood vessels that lead to the lungs, liver, kidneys, or brain, infecting or killing patches of cells in vital organs. In addition, many users do not know their heroin’s actual strength or its true contents and are at an elevated risk of overdose or death.

According to Drug Abuse Warning Network (DAWN) emergency department (ED) data, there were 93,064 reported mentions of heroin in 2001, an increase of 47.4% since 1994 (see table 2). Preliminary ED data for the first half of 2002 revealed that there were 42,571 mentions of heroin. A drug mention refers to a substance that was recorded (mentioned) during a visit to the ED. Heroin represented 15% of 638,484 total ED episodes in 2001. Approximately 56% of heroin ED mentions were for people ages 35 and older. Almost half (43%) of heroin ED mentions were for whites.

According to DAWN’s 2001 mortality data, of the 42 metropolitan areas studied, 19 areas saw a decrease in the number of heroin/morphine mentions, while 9 areas reported an increase in heroin/morphine mentions.

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