Do You Know... Heroin

Updated June 01, 2005 9:34 AM

Street Names: junk, H, smack, horse, skag, dope

What is it?
Heroin is a dangerous and illegal drug with a high addictive potential. It is also an effective painkiller.

Heroin belongs to the opioid family of drugs. Also in the opioid family are the "opiates," such as morphine and codeine, which are natural products of the opium poppy; and "synthetic" opioids, such as Demerol® and methadone, which are chemically manufactured. Heroin is a "semi-synthetic" opioid; it is made from morphine that has been chemically processed, giving it a stronger and more immediate effect. Heroin is converted back into morphine in the brain.

When heroin was first introduced in the late 19th century, it was promoted as a pain reliever and cough suppressant. By the early 20th century, the dangers of heroin were recognized. Laws were introduced throughout North America and Europe to restrict the production, distribution and use of heroin. In some countries, there are circumstances where heroin may be prescribed by physicians. In Britain, for example, doctors may prescribe heroin for extreme pain. This treatment is usually reserved for patients who are terminally ill. Although Canadian drug regulations were changed in the 1980s to allow heroin to be prescribed, it is rarely used. In Britain, the Netherlands and Switzerland, a small number of people who are heroin-dependent, and who have not responded to other treatments, receive heroin by prescription in carefully monitored mainten-ance programs.

Where does it come from?
Most heroin is produced in Asia and Latin America, where opium poppies are grown. Morphine is extracted from the opium gum in laboratories close to the fields, and then converted into heroin in labs within or nearby the producing country.

What does it look like?
In its pure form, heroin is a fine, white, bitter-tasting crystalline powder that dissolves in water. When it is sold on the street, its colour and consistency vary, depending on the manufacturing process and what additives it has been mixed, or "cut," with. Street heroin may come in the form of a white powder, a brown, sometimes grainy substance or a dark brown sticky gum. The purity of heroin varies from batch to batch, and can range from two to 98 per cent.

Some additives, such as sugars, starch or powdered milk are used to increase the weight for retail sale, or other drugs may be added to increase the effects of the heroin. Quinine may be added to imitate heroin's bitter taste, making it difficult to determine the purity of the drug.

How is it used?
The most common ways of using heroin are:

injection - either into a vein ("mainlining," intra-venous or I.V. use), into a muscle (intramuscular or I.M. use) or under the skin ("skin-popping" or subcutaneous use)
snorting - inhaling the powder through the nostril (also called sniffing)
inhaling or smoking - this method is also referred to as "chasing the dragon," and involves gently heating the heroin on aluminum foil and inhaling the smoke and vapours through a tube.
Injection may be chosen because this method gives the greatest and most immediate effect for the least amount of drug. People who are dependent on heroin may inject two to four times a day. The drug is more likely to be snorted or smoked when heroin of high purity is available, or by occasional users who prefer not to inject.

Who uses heroin?
Heroin use is found among a range of people, from a variety of cultural, social, economic and age groups. Twice as many males as females use heroin. First-time users tend to be young, in their teens or 20s, but most people who use heroin regularly are over 30.

How does heroin make you feel?
The way heroin, or any drug, affects you depends on many factors, including:

• your age
• how much you take and how often you take it
• how long you've been taking it
• the method you use to take the drug
• the environment you're in
• whether or not you have certain pre-existing medical or psychiatric conditions
• if you've taken any alcohol or other drugs (illicit, prescription, over-the-counter or herbal).

When heroin is injected into a vein, it produces a surge of euphoria, or "rush." This effect is felt in seven to eight seconds, and lasts from 45 seconds to a few minutes. The initial effect with snorting or smoking is not as intense. Following the rush comes a period of sedation and tranquillity known as being "on the nod," which may last up to an hour. When heroin is injected under the skin or into a muscle, the effect comes on more slowly, within five to eight minutes.

New users often experience nausea and vomiting. The desired effects include detachment from physical and emotional pain and a feeling of well-being. Other effects include slowed breathing, pinpoint pupils, itchiness and sweating. Regular use results in constipation, loss of sexual interest and libido, and an irregular or stopped menstrual cycle in women.

Heroin use causes changes in mood and behaviour. People who are dependent on heroin may be docile and compliant after taking heroin, and irritable and aggressive during withdrawal.

How long does the feeling last?
Regardless of how it is used, the effects of heroin gener-ally last for three to five hours, depending on the dose.

People who are dependent on heroin must use every six to 12 hours to avoid symptoms of withdrawal. The initial symptoms are intense, and include runny nose, sneezing, diarrhea, vomiting, restlessness and a persistent craving for the drug. Also associated with withdrawal are goose bumps and involuntary leg movements, leading to the expressions "cold turkey" and "kicking the habit." With-drawal symptoms peak within a couple days, and usually fade within five to 10 days. Other symptoms, such as insomnia, anxiety and craving, may continue for some time. Heroin withdrawal is not life-threatening, but can be extremely uncomfortable.

Is heroin dangerous?
Yes. Heroin is dangerous in a number of ways. Overdose is the most immediate danger of heroin use. Heroin depresses the part of the brain that controls breathing. In an overdose, breathing slows down, and may stop completely. A person who has overdosed is unconscious and cannot be roused, and has skin that is cold, moist and bluish. A heroin overdose can be treated at a hospital emergency room with drugs, such as naloxone, which blocks heroin's depressant effects.

The risk of overdose is increased by:

The unknown purity of the drug. Ironically, many overdoses are due to increases in the quality of the drug sold on the street.
Injection, because the drug reaches the brain more quickly than by other ways of taking the drug, and because the dose is taken all at once.
Combining heroin with other sedating drugs, such as alcohol, benzodiazepines and methadone.
Other dangers associated with heroin use include:

• Injection: injection drug use puts the user at high risk of bacterial infection, blood poisoning, abscesses, endocarditis (an infection of the lining of the heart) collapsed veins and overdose. Sharing needles greatly increases the risk of becoming infected with, or spreading, HIV and hepatitis B or C.
• Unknown content of the drug: the unknown purity and potency of the drug makes it difficult to determine the correct dose and to protect from overdose. In add-ition, heroin is often cut with additives, which may be poisonous, such as strychnine, or that do not dissolve (and can clog blood vessels), such as chalk.
• Combining heroin with other drugs, such as cocaine (speedballs): when drugs interact inside the body, the results are unpredictable, and sometimes deadly.
• Dependence: the constant need to obtain heroin, and the repeated use of the drug, can result in criminal involvement or other high-risk behaviour, breakdown of family life, loss of employment and poor health.
• Pregnancy: women who use heroin regularly often miss their periods; some mistakenly think that they are infertile, and become pregnant. Continued use of heroin during pregnancy is very risky for the baby.

Is heroin addictive?
Yes. Regular use of heroin, whether it is injected, snorted or smoked, can lead to physical and psychological dependence within two to three weeks.

Not all people who experiment with heroin become dependent. Some use the drug only on occasion, such as on weekends, without increasing the dose. With regular use, however, tolerance to the effects of the drug develop, and more and more heroin is needed to achieve the desired effect. Continuous use of increasing amounts of the drug inevitably leads to dependence.

Once dependence is established, stopping use can be extremely difficult. People who have used heroin for a long time often report that they no longer experience any pleasure from the drug. They continue to use heroin to avoid the symptoms of withdrawal, and to control the powerful craving for the drug, which is often described as a "need." Cravings may persist long after the drug is discontinued, making relapse, or beginning to use again, difficult to avoid.

What are the long-term effects of using heroin?
Heroin dependence, and the medical, social and legal complications that often result from heroin use, can be devastating to the lives of the people who use the drug.

Research using brain scans has revealed that long-term regular use of heroin results in changes in the way the brain works. While the effect of these changes is not fully understood, this research has shown that it may take months or years for the brain to return to normal functioning after heroin use is stopped.

Methadone maintenance treatment, which prevents heroin withdrawal and reduces or eliminates drug cravings, is the most effective treatment for heroin dependence currently available. (For more information on methadone, see Do You Know…Methadone.)

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©2003 Centre for Addiction and Mental Health. A PAHO/WHO Collaborating Centre.
Fully affiliated with the University of Toronto.

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ID#P13479 published April 11, 2006 10:48 AM