Heroin is a highly addictive, illegal opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”
Although heroin may be smoked or inhaled through the nose (“snorted”), it is often “cut” with products such as sugars, starch or powdered milk and then injected as a liquid. It is an extremely dangerous drug regardless of the method of delivery. All three routes of administration deliver the drug to the brain very rapidly, which contributes to its health risks and to its high risk for addiction.
The initial effects of heroin include a surge of sensation—a “rush.” This is often accompanied by a warm feeling of the skin and a dry mouth. Sometimes, the initial reaction can include vomiting or severe itching.
After these initial effects fade, the user becomes drowsy for several hours. The basic body functions such as breathing and heartbeat slow down. Heroin users report feeling an intense relaxation, where they feel like they don’t have a care in the world. The relaxation effect is one of the reasons why it’s so deadly; it can suppress your respiratory system to the point where your body becomes so relaxed, it stops breathing. Overdose on heroin can seriously depress breathing and may lead to death.
Within hours after the drug effects have decreased, the addict’s body begins to crave more. If he does not get another fix, he will begin to experience withdrawal. Withdrawal includes the extreme physical and mental symptoms which are experienced if the body is not supplied again with the next dose of heroin. Withdrawal symptoms include restlessness, aches and pains in the bones, diarrhea, vomiting and severe discomfort.
The intense high a user seeks lasts only a few minutes. With continued use, he needs increasing amounts of the drug just to feel “normal.”
Increase in heroin abuse in the U.S.
A study published in the journal Lancet ranked heroin as the second most harmful drug after alcohol. The National Institute on Drug Abuse classifies it as one of the most addictive. The World Health Organization says heroin users face a 20 to 30 times higher risk of death than non-drug users. Another reason why it can be so deadly is that the purity of the drug can vary dramatically from batch to batch. Someone might be used to using 10 percent pure heroin when they unknowingly do some that’s 60 percent pure and their body simply can’t handle it. Despite it being a well-documented killer, heroin abuse remains a very big problem in the U.S.
In 2013, an estimated 169,000 Americans aged 12 or older used heroin for the first time in the past year. On average, this represents roughly 460 people initiating heroin use each day. In 2013, 21,000 adolescents used heroin for the first time in the past year. There were 66,000 young adults and 82,000 adults aged 26 or older who initiated heroin use in the past year. A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows people aged 12 to 49 who had used prescription pain relievers non-medically were 19 times more likely to have initiated heroin use recently than others in that age group. The National Survey on Drug Use and Health places the average age of the typical heroin user in the range of 18 to 25.
While it used to be primarily abused by low-income, inner-city men over the past 50 years, heroin is now increasingly the drug of choice among affluent, suburbanites. Although it is significantly more popular among women, men are nearly four times as likely as women to die from a heroin overdose.
Heroin overdose deaths have skyrocketed in recent years, quadrupling from 2000 to 2013. At the same time, poisoning deaths related to painkiller abuse have leveled off, even dropping slightly in recent years.
The increase is attributed to prescription drug addicts turning to heroin due to successful efforts to curb narcotic painkiller abuse. It is now harder and more expensive to obtain prescription narcotics, thanks to improved tracking and regulation of the drugs. In addition, manufacturers have changed the formulation of painkillers like OxyContin to make them more difficult to abuse.
Once people are dependent on prescription drugs, it’s very rare for them to stop on their own with no treatment. If the drugs are suddenly less abusable, they will switch to something more readily available and less expensive that will alleviate withdrawal. A bag of heroin, at roughly $5, is far below the cost of a pack of cigarettes and far cheaper than other types of illegal recreational substances.
Injection Drug Use and HIV and HCV Infection
People who inject drugs are at high risk of contracting HIV and hepatitis C (HCV). This is because these diseases are transmitted through contact with blood or other bodily fluids, which can occur when sharing needles or other injection drug use equipment. (HCV is the most common blood-borne infection in the Unites States.) HIV (and less often, HCV) can also be contracted during unprotected sex, which drug use makes more likely.
Because of the strong link between drug use and the spread of infectious disease, substance abuse treatment can be an effective way to prevent the latter. People in drug abuse treatment, which often includes risk reduction counseling, stop or reduce their drug use and related risk behaviors, including risky injection practices and unsafe sex.
Heroin is bad for your health
Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion and infectious diseases like hepatitis and HIV. In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys or brain, causing permanent damage to vital organs.
Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—can include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”) and kicking movements (“kicking the habit”). Users also experience severe craving for the drug during withdrawal, which can precipitate continued abuse and/or relapse.
Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization.
Mortality estimates from 2000 to 2013 indicate that the United States experienced a 37 percent-per-year increase in heroin deaths. The greatest increase in heroin deaths between 2000 and 2013 occurred in the Midwest, which experienced a nearly 11-fold leap in fatal overdoses. The overdose rate quadrupled in the Northeast during that period, as heroin use spread out of urban areas like Baltimore and New York City into the rural New England states, particularly Vermont.
Reasons for increases in drug-poisoning deaths include the availability of high purity heroin causing users to accidentally overdose. Other reasons include users switching from prescription opioids which have a known dosage amount and chemical composition to heroin that often contains varying purities, dosage amounts and unknown adulterants used to cut costs and increase potency
Regular heroin users know how much of the drug their bodies can take. They increase their habit slowly, building up a high opiate tolerance. But when they quit, their bodies rapidly lose this tolerance. If they stay clean for a few weeks and then inject their usual dose, the dose may be fatal. Others die from taking heroin with cocaine and alcohol or from “bad batches” that the dealer mixed poorly or blended with toxic substances.