assessing drug harms and drug facts
Drug Policy Alliance - Facts About Heroin (2023)
Heroin Facts
Heroin is processed from morphine, a naturally occurring opiate extracted from the seedpod of certain varieties of poppy plants. The opium poppy has been cultivated for more than five thousand years for a variety of medicinal uses.
Heroin was first synthesized from morphine in 1874. From 1898 through to 1910, Bayer, the German pharmaceutical company, marketed it under the trademark name Heroin as a cough suppressant and as a non-addictive morphine substitute (until it was discovered that it rapidly metabolizes into morphine). One year after beginning sales, Bayer exported heroin to 23 countries.
Facts
Heroin-related overdose deaths are on the rise, but proven strategies are available to reduce the harms associated with heroin use, treat dependence and addiction, and prevent overdose fatalities. These strategies include expanding access to the life-saving medicine naloxone and its associated training; enacting legal protections that encourage people to call for help for overdose victims; and training people how to prevent, recognize and respond to an overdose.
The chance of surviving an overdose, like that of surviving a heart attack, depends greatly on how fast one receives medical assistance. Multiple studies show that most deaths actually occur one to three hours after the victim has initially ingested or injected drugs. The time that elapses before an overdose becomes a fatality presents a vital opportunity to intervene and seek medical help. The best way to encourage overdose witnesses to seek medical help is to exempt them from arrest, an approach often referred to as 911 Good Samaritan immunity laws.
Heroin is manufactured from opium poppies cultivated in four primary source areas: South America, Southeast and Southwest Asia, and Mexico. Although Afghanistan produces the majority of the world's heroin, South American heroin has become the most prevalent type available in the U.S., particularly in the Northeast, South and Midwest. The particular form known as "black tar" from Mexico, a less pure form of heroin, is more commonly found in the western and southwestern United States. This heroin may be sticky like roofing tar or hard like coal, with its color varying from dark brown to black.
Street heroin is rarely pure and may range from a white to dark brown powder of varying consistency. Such differences typically reflect the impurities remaining from the manufacturing process and/or the presence of additional substances. These "cuts" are often sugar, starch, powdered milk and occasionally other drugs, which are added to provide filler.
Heroin can be sniffed, smoked or injected. Mexican black tar heroin, however, is usually injected (once dissolved) or smoked because of its consistency. Like other opiates, heroin is a sedative drug that slows body functioning. People who use it describe a feeling of warmth, relaxation and detachment, with a lessening sense of anxiety. Due to its analgesic qualities, physical and emotional aches and pains are diminished. These effects appear quickly and can last for several hours, depending on the amount of heroin taken and the route of administration. Initial use can result in nausea and vomiting, but these reactions fade with regular use.
People who use heroin regularly are likely to develop a physical dependence. Withdrawal symptoms (“cold turkey”) may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms may include sweating, anxiety, depression, chills, severe muscle aches, nausea, diarrhea, cramps and fever.
Injection poses the greatest risk of lethal overdose by enabling large amounts of heroin (and additional contaminants if any) into the bloodstream at once. Smoking and snorting heroin can also result in overdose, especially if a non-tolerant user ingests a large amount of potent heroin and/or combines it with other depressant drugs, such as alcohol. Symptoms of a heroin overdose include slow and shallow breathing, convulsions, coma and possibly death. To avoid fatal overdose, it is strongly recommended that people who use heroin (and their peers and loved ones) be trained to administer naloxone, an overdose reversal drug that has been approved by the FDA since 1971.
The use of "dirty" or shared needles when injecting heroin can spread deadly infectious diseases such as HIV and Hepatitis B and C. Injecting drugs and/or sharing needles can contribute to other diseases and conditions that may be serious or even life threatening, including endocarditis, embolism or blood clot, botulism, tetanus, and flesh-eating bacteria. Finally, injecting may cause abscesses (a painful skin inflammation) that, in turn, may result in blood poisoning.
Methadone is an opiate agonist that has a series of actions similar to those of heroin and other medications derived from the opium poppy. Methadone is used to reduce and even eliminate heroin use by stabilizing people struggling with addiction for as long as is necessary to help them avoid returning to previous patterns of drug use. Methadone maintenance treatment has been documented in hundreds of scientific studies to reduce crime, death, disease, and drug use. Compared to the other major drug treatment modalities – drug-free outpatient treatment, therapeutic communities, and chemical dependency treatment – methadone is the most rigorously studied and has yielded the best results. There are more than115,000 methadone maintenance patients in the United States – 40,000 in New York State and 20,000 in California.
Sources
Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment. New York: Springer-Verlag; 1991
Inciardi, James A. and Lana D. Harrison, eds. 1998. Heroin in the Age of Crack-Cocaine. In Drugs, Health, and Social Policy Series 6. Thousand Oaks: SAGE Publications.
Institute of Medicine. Treating Drug Problems, vol. 1: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems. Washington, DC: National Academy Press; 1990:187.
Marlowe, Ann. 1999. How to Stop Time: Heroin from A to Z. New York: Anchor Books. ISBN: 0385720165.
About Methadone and Buprenorphine. Drug Policy Alliance. New York, 2006. Edition: 2nd.