Heroin is a highly addictive drug, and its use is a serious problem in
America. Current estimates suggest that nearly 600,000 people need treatment
for heroin addiction. Recent studies suggest a shift from injecting heroin to
snorting or smoking because of increased purity and the misconception that
these forms of use will not lead to addiction.
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."
Heroin abuse is
associated with serious health conditions, including fatal overdose,
spontaneous abortion, collapsed veins, and infectious diseases, including
HIV/AIDS and hepatitis.
effects of heroin abuse appear soon after a single dose and disappear in a few
hours. After an injection of heroin, the user reports feeling a surge of
euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and
heavy extremities. Following this initial euphoria, the user goes "on the nod,"
an alternately wakeful and drowsy state. Mental functioning becomes clouded due
to the depression of the central nervous system.
of heroin appear after repeated use for some period of time. Chronic users may
develop collapsed veins, infection of the heart lining and valves, abscesses,
cellulitis, and liver disease. Pulmonary complications, including various types
of pneumonia, may result from the poor health condition of the abuser, as well
as from heroin's depressing effects on respiration.
In addition to the
effects of the drug itself, street heroin may have additives 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.
SAMHSA's 1995 Drug Abuse Warning Network (DAWN), which collects data on
drug-related hospital emergency room episodes and drug-related deaths from 21
metropolitan areas, rank heroin second as the most frequently mentioned drug in
overall drug-related deaths. From 1990 through 1995, the number of
heroin-related episodes doubled. Between 1994 and 1995, there was a 19 percent
increase in heroin-related emergency department episodes.
Tolerance, Addiction, and
With regular heroin
use, tolerance develops. This means the abuser must use more heroin to achieve
the same intensity or effect. As higher doses are used over time, physical
dependence and addiction develop. With physical dependence, the body has
adapted to the presence of the drug and withdrawal symptoms may occur if use is
reduced or stopped.
in regular abusers may occur as early as a few hours after the last
administration, produces drug craving, restlessness, muscle and bone pain,
insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"),
kicking movements ("kicking the habit"), and other symptoms. Major withdrawal
symptoms peak between 48 and 72 hours after the last dose and subside after
about a week. Sudden withdrawal by heavily dependent users who are in poor
health is occasionally fatal, although heroin withdrawal is considered much
less dangerous than alcohol or barbiturate withdrawal.
Extent of Use
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
| Ever Used
| Used in Past Year
| Used in Past Month
Community Epidemiology Work Group
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.
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
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.
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.
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