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What is
Heroin?
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Heroin is an illegal, highly addictive drug. It is both the most
abused and the most rapidly acting of the opiates. It 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, orquinine. Street heroin can also be cut
with |
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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.
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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.
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
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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 |
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 |
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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
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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?
| One of the most
detrimental long-term effects of heroin is addiction itself. Addiction is a
chronic, relapsing disease, characterized by compulsive drug seeking and use,
and by neurochemical and molecular changes in the brain. Heroin also produces
profound degrees of tolerance and physical dependence, which are also powerful
motivating factors for compulsive use and abuse. As with abusers of any
addictive drug, heroin abusers gradually spend more and more time and energy
obtaining and using the drug. Once they are addicted, the heroin abusers'
primary purpose in life becomes seeking and using drugs. The drugs literally
change their brains. |
Long-term effects of
heroin
>>Addiction
>>Infectious diseases,
for example, HIV/AIDS
and
hepatitis B and C
>>Collapsed
veins
>>Bacterial infections
>>Abscesses
>>Infection of heart
lining
and valves
>>Arthritis and other
rheumatologic
problems |
Physical dependence
develops with higher doses of the drug. With physical dependence, the body
adapts to the presence of the drug and withdrawal symptoms occur if use is
reduced abruptly. Withdrawal may occur within a few hours after the last time
the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone
pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold
turkey"), and leg movements. Major withdrawal symptoms peak between 24 and 48
hours after the last dose of heroin and subside after about a week. However,
some people have shown persistent withdrawal signs for many months. Heroin
withdrawal is never fatal to otherwise healthy adults, but it can cause death
to the fetus of a pregnant addict.
At some point during
continuous heroin use, a person can become addicted to the drug. Sometimes
addicted individuals will endure many of the withdrawal symptoms to reduce
their tolerance for the drug so that they can again experience the rush.
Physical dependence and the emergence of withdrawal symptoms were once
believed to be the key features of heroin addiction. We now know this may not
be the case entirely, since craving and relapse can occur weeks and months
after withdrawal symptoms are long gone. We also know that patients with
chronic pain who need opiates to function (sometimes over extended periods)
have few if any problems leaving opiates after their pain is resolved by other
means. This may be because the patient in pain is simply seeking relief of pain
and not the rush sought by the addict.
What are the medical complications of
chronic 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. |
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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.
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