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HEROIN

Heroin (diacetylmorphine) is an illegal, highly addictive drug and its use is a serious problem in America. It is both the most abused and the most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.

Pure heroin is a white powder with a bitter taste. Most illicit heroin is sold as a white or brownish powder and is usually "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. It 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. Another form of heroin known as "black tar" may be sticky like roofing tar or hard like coal, and its color may vary from dark brown to black. Street names for Heroin include Smack, H, Skag, Junk, Brown sugar, Horse, Mud and Black tar.

Methods of Use

Heroin is most often injected, however, high-purity heroin may also be snorted or smoked. Although smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, researchers have confirmed that all three forms of heroin administration are addictive.

Effects of Use

The short-term 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 experiences an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Other effects that heroin may have on users include respiratory depression, constricted pupils and nausea. Effects of heroin overdose include slow and shallow breathing, clammy skin, convulsions, coma, and possible death.

Health Hazards

Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins and infection of the heart lining and valves. Pneumonia may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration. Infectious diseases, including HIV/AIDS and hepatitis can occur from sharing needles or other injection equipment.

With regular heroin use, tolerance develops where 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. Withdrawal, which 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 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.

Treatment

There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. LAAM, also a synthetic opiate medication for treating heroin addiction, can block the effects of heroin for up to 72 hours. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates. Several other medications for use in heroin treatment programs are also under study.

Extent of Use

The typical heroin user consumes more heroin than just a decade ago, which is not surprising given the higher purity currently available at the street level. The 1999 National Household Survey on Drug Abuse (NHSDA) estimated that there were 149,000 new heroin users in 1998 and that nearly 80 percent of them were under the age of 26. The study also found the number of past-month heroin users had increased from 68,000 in 1993 to 208,000 in 1999. The fact that high-purity heroin can be effectively smoked and snorted may be attracting new users to the drug. Users who snort or smoke avoid the social stigma of injection and the fear of acquiring syringe-borne diseases such as HIV/AIDS and hepatitis. This change is reflected in the proportion of lifetime users who smoked or snorted, but never injected, heroin (75 percent in 1998, compared to 46 percent in 1991).

Rates of heroin use among teenagers rose significantly in eighth, tenth, and twelfth grades during the 1990s. In addition, regular users of heroin started using the drug at an earlier age. The 1999 NHSDA found that the mean age of initiation for heroin declined from 26 years in 1992 to 21.3 in 1998. However, there are some indications that heroin use among youth may have begun to level-off or decline in the later part of this decade. The 1999 Monitoring the Future survey found little change between 1996 and 1999 in annual use among tenth and twelfth graders, and concluded that use in the eighth grade has leveled-off and may have declined. Also, the report discovered that more young people perceive heroin as dangerous; 73.7 percent of tenth graders thought that trying heroin was a "great risk"--the highest percentage recorded in five years.

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