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Heroin Facts

The variability in quality of street heroin can range from 0-90%, which greatly increases the risk of accidental overdose and death.
Heroin can be injected into a vein ("mainlining"), injected into a muscle, smoked in a water pipe or standard pipe, mixed in a marijuana joint or regular cigarette, inhaled as smoke through a straw, known as "chasing the dragon," snorted as powder via the nose.
Typically, a heroin abuser may inject up to four times a day.
Recent studies suggest a shift from injecting to snorting or smoking heroin because of increased purity and the misconception that these forms of use will not lead to addiction.

Heroin

Poppies Heroin is a highly addictive drug, and its use is a serious problem in America. 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 seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for 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."

Health Hazards

Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and infectious diseases, including HIV/AIDS and hepatitis. 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 goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system.

Heroin Overdose Long-term effects 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.

Reports from 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 Withdrawal

Heroin Addiction 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.

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 ("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 1999 MTF, 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 1999, prevalence of heroin use was comparable for all three grade levels. Although past year prevalence rates for heroin use remained relatively low in 1999, these rates are about two to three times higher than those reported in 1991.

Heroin Use by Students, 1999: Monitoring the Future Study>
	8th - Graders	10th - Graders	12 - Graders
Ever Used	2.3%	2.3%	2.0
Used in the Past Year	1.4	1.4	1.1
Used in the Past Month	0.6	0.7	0.5

Community Epidemiology Work Group (CEWG)***

In June 2000, CEWG members reported that heroin indicators showed mixed trends. Mortality figures were mixed, with deaths increasing notably in Austin, Detroit, Minneapolis/St. Paul, and Phoenix, and declining in Miami, Philadelphia, St. Louis, San Diego, and Seattle. Emergency room admissions were also mixed, with 10 cities showing decreases (significant in San Francisco and Washington, D.C.), and 10 showing increases (particularly Baltimore and Miami). Heroin continues to account for a substantial proportion of treatment admissions in some CEWG areas (e.g., 47.8 percent in Baltimore, 43 percent in New York City, and 32 percent in Detroit). Heroin injection characterizes a large proportion of primary heroin treatment admissions (e.g., 90 percent in Texas). During the second quarter of 1999, the highest purity levels were found in Philadelphia (71 percent); New York (63.6 percent); Boston (61.4 percent); Newark (60.7 percent); Atlanta (57.8 percent); and San Diego (57.6 percent). Purity levels in other CEWG areas ranged from 11.8 percent in Dallas to 46.7 percent in Detroit. Injecting is on an upward trend among younger users in Baltimore, Boston, Minneapolis/St. Paul, Newark, New York City, and Seattle. In Boston, Chicago, Denver, Miami, and Washington, D.C., snorting seems to be increasing and is often the starting route for new users.

National Household Survey on Drug Abuse (NHSDA)

The 1999 NHSDA study reports the use of illicit drugs by those people age 12 and older. The lifetime prevalence (at least one use in a persons lifetime) for heroin for those people age 12 and older was 1.4 percent.