Heroin & Heroin Addiction Information
What Is Heroin?
Heroin
is an illegal, highly addictive drug. It is both the most abused and the
most rapidly acting of the opiates.
Heroin is typically sold as a white or brownish powder or as the
black sticky substance known on the streets as "black tar
heroin." Although purer heroin is becoming more common, most street
heroin is "cut" with other drugs or with substances such as
sugar, starch, powdered milk or quinine. Street heroin can also be cut
with strychnine or other poisons.
Because heroin abusers do not know the actual strength of the drug or
its true contents, they are at risk of overdose or death. Heroin also
poses special problems because of the transmission of HIV and other
diseases that can occur from sharing needles or other injection
equipment.
Heroin
is processed from morphine, a naturally occurring substance extracted
from the seed pod of the Asian poppy plant. Heroin usually appears as a
white or brown powder. Street names associated with heroin include
"smack," "H," "skag," and
"junk." Other names may refer to types of heroin produced in a
specific geographical area, such as "Mexican black tar."
What is the scope of heroin use in the United States?
According to the 1996 National Household Survey on Drug Abuse, which
may actually underestimate illicit opiate (heroin) use, an estimated 2.4
million people use heroin at some time in their lives, and nearly
216,000 of them reported using it within the month preceding the survey.
The survey report estimates that there were 141,000 new heroin users in
1995, and that there has been an increasing trend in new heroin use
since 1992. A large proportion of these recent new users were smoking,
snorting, or sniffing heroin, and most were under age 26. Estimates of
use for other age groups also increased, particularly among youths age
12 to 17: the incidence of first-time heroin use among this age group
increased fourfold from the 1980s to 1995.
The 1996 Drug Abuse Warning Network (DAWN), which collects data on
drug- related hospital emergency department (ED) episodes from 21
metropolitan areas, estimates that 14 percent of all drug-related ED
episodes involved heroin. Even more alarming is the fact that between
1988 and 1994, heroin-related ED episodes increased by 64 percent (from
39,063 to 64,013).
NIDA's Community Epidemiology Work Group (CEWG), which provides
information about the nature and patterns of drug use in 20 cities,
reported in its December 1996 publication that heroin was the primary
drug of abuse related to drug abuse treatment admissions in Newark, San
Francisco, Los Angeles, and Boston, and it ranked a close second to
cocaine in New York and Seattle.
Heroin in the Monitoring the Future Study (MTF)
According to the 1997 MTF, an annual survey of drug use among 8th-,
10th-, and 12th- graders, rates of heroin use remained relatively stable
and low since the late 1970s. After 1991, however, use began to rise
among 10th- and 12th- graders, and after 1993, among 8th- graders. In
1997, prevalence of heroin use was comparable for all three grade
levels. Although the annual prevalence rates for heroin use remained
relatively low in 1997, these rates are approximately two to three times
higher than those reported in 1991.
Heroin
Use by Students, 1997:
Monitoring the Future Study |
|
8th Graders |
10th Graders |
12th Graders |
| Ever Used |
2.1% |
2.1% |
2.1% |
| Used in Past Year |
1.3 |
1.4 |
1.2 |
| Used in Past Month |
0.6 |
0.6 |
0.5 |
Heroin and the Community Epidemiology Work Group (CEWG)
In December 1996, CEWG reported that the availability of low-priced,
high-quality heroin continues to increase, especially in the East and
some areas of the Midwest. This increase has also been reported in some
cities that previously had escaped the influx of high-quality heroin.
Quantitative indicators and field reports continue to suggest an
increasing incidence of new users (snorters) in the younger age groups,
often among women. One concern is that young heroin snorters may shift
to needle injecting, because of increased tolerance, nasal soreness, or
declining or unreliable purity. Injection use would place them at
increased risk of contracting HIV/AIDS.
In some areas, such as Boston and San Francisco, the recent initiates
increasingly include members of the middle class. In Newark, heroin
users are usually found in suburban populations.
National Household Survey on Drug Abuse (NHSDA)
The 1996 NHSDA shows a significant increase from 1993 in the
estimated number of current (once in the past month) heroin users. The
estimates have risen from 68,000 in 1993 to 216,000 in 1996.
Among individuals who had ever used heroin in their lives, the
proportion who had ever smoked, sniffed, or snorted heroin increased
from 55 percent in 1994 to 82 percent in 1996. During the same period,
the proportion of users who injected heroin remained about the same, at
about 50 percent.
How is Heroin Used?
Heroin is usually injected, sniffed/snorted, or smoked. Typically, a
heroin abuser may inject up to four times a day. Intravenous injection
provides the greatest intensity and most rapid onset of euphoria (7 to 8
seconds), while intramuscular injection produces a relatively slow onset
of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak
effects are usually felt within 10 to 15 minutes. Although smoking and
sniffing heroin do not produce a "rush" as quickly or as
intensely as intravenous injection, NIDA researchers have confirmed that
all three forms of heroin administration are addictive.
Route of Administration Among Heroin Treatment Admissions in
Selected Areas
 |
| Source:
Community Epidemiology Work Group, NIDA, June 1996 |
Injection continues to be the predominant method of heroin use among
addicted users seeking treatment; however, researchers have observed a
shift in heroin use patterns, from injection to sniffing and smoking. In
fact, sniffing/snorting heroin is now a widely reported means of taking
heroin among users admitted for drug treatment in Newark, Chicago, New
York, and Detroit.
With the shift in heroin abuse patterns comes an even more diverse
group of users. Older users (over 30) continue to be one of the largest
user groups in most national data. However, several sources indicate an
increase in new, young users across the country who are being lured by
inexpensive, high-purity heroin that can be sniffed or smoked instead of
injected. Heroin has also been appearing in more affluent communities.
What are the immediate (short-term) effects of heroin use?
Soon after injection (or inhalation), heroin crosses the blood-brain
barrier. In the brain, heroin is converted to morphine and binds rapidly
to opioid receptors. Abusers typically report feeling a surge of
pleasurable sensation, a "rush." The intensity of the rush is
a function of how much drug is taken and how rapidly the drug enters the
brain and binds to the natural opioid receptors. Heroin is particularly
addictive because it enters the brain so rapidly. With heroin, the rush
is usually accompanied by a warm flushing of the skin, dry mouth, and a
heavy feeling in the extremities, which may be accompanied by nausea,
vomiting, and severe itching.
Short-term effects of heroin
- "Rush"
- Depressed respiration
- Clouded mental functioning
- Nausea and vomiting
- Suppression of pain
- Spontaneous abortion
After the initial effects, abusers usually will be drowsy for several
hours. Mental function is clouded by heroin's effect on the central
nervous system. Cardiac functions slow. Breathing is also severely
slowed, sometimes to the point of death. Heroin overdose is a particular
risk on the street, where the amount and purity of the drug cannot be
accurately known.
What are the long term effects of heroin use?
Medical consequences of chronic heroin abuse include scarred and/or
collapsed veins, bacterial infections of the blood vessels and heart
valves, abscesses (boils) and other soft-tissue infections, and liver or
kidney disease. Lung complications (including various types of pneumonia
and tuberculosis) may result from the poor health condition of the
abuser as well as from heroin's depressing effects on respiration. Many
of the additives in street heroin may include substances that do not
readily dissolve and result in clogging the blood vessels that lead to
the lungs, liver, kidneys, or brain. This can cause infection or even
death of small patches of cells in vital organs. Immune reactions to
these or other contaminants can cause arthritis or other rheumatologic
problems.
Of course, sharing of injection equipment or fluids can lead to some
of the most severe consequences of heroin abuse - infections with
hepatitis B and C, HIV, and a host of other blood-borne viruses, which
drug abusers can then pass on to their sexual partners and children.
How does heroin abuse affect pregnant women?
Heroin abuse can cause serious complications during pregnancy,
including miscarriage and premature delivery. Children born to addicted
mothers are at greater risk of SIDS (sudden infant death syndrome), as
well. Pregnant women should not be detoxified from opiates because of
the increased risk of spontaneous abortion or premature delivery;
rather, treatment with methadone is strongly advised. Although infants
born to mothers taking prescribed methadone may show signs of physical
dependence, they can be treated easily and safely in the nursery.
Research has demonstrated also that the effects of in utero exposure to
methadone are relatively benign.
Why are heroin users at special risk for contracting HIV/AIDS and
hepatitis B and C?
Because many heroin addicts often share needles and other injection
equipment, they are at special risk of contracting HIV and other
infectious diseases.
Infection
of injection drug users with HIV is spread primarily through reuse of
contaminated syringes and needles or other paraphernalia by more than
one person, as well as through unprotected sexual intercourse with
HIV-infected individuals. For nearly one-third of Americans infected
with HIV, injection drug use is a risk factor. In fact, drug abuse is
the fastest growing vector for the spread of HIV in the nation.
NIDA-funded research has found that drug abusers can change the
behaviors that put them at risk for contracting HIV, through drug abuse
treatment, prevention, and community-based outreach programs. They can
eliminate drug use, drug-related risk behaviors such as needle sharing,
unsafe sexual practices, and, in turn, the risk of exposure to HIV/AIDS
and other infectious diseases. Drug abuse prevention and treatment are
highly effective in preventing the spread of HIV.
NOTE: See additional Heroin information page links in the Related
Links column at the right.
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