Heroin is an illegal drug processed from morphine, a natural opiate derived from specific varieties of poppy. Heroin is the single most abused opiate in the U.S., and has one of the most serious addiction rates of all illegal drugs.
Street heroin comes in a variety of forms. Most commonly, heroin resembles a white or brownish-white powder with a bitter taste. Heroin may also be sold on the street as a sticky black substance known as black-tar heroin. Of the two varieties, powdered heroin is the most common.
Heroin Effects: The Rush
Once heroin enters the brain, the body converts the drug into morphine, which binds to the brain’s opiate receptors. This results in the heroin high, a sudden surge of intense pleasure known among heroin users as “the rush.” During a heroin rush the skin flushes and the arms and legs feel heavy. Dry mouth is common, and the heroin user may also experience nausea, vomiting or intense itchiness.
Once the immediacy of the rush ends, heroin abusers are drowsy for several hours. Users refer to this period of time as being “on the nod.” Mental functioning is slow and disoriented. Heart function and breathing slows, sometimes to the point of unconsciousness, coma and death.
Unlike many illegal drugs, the high produced by heroin doesn’t last long, so addicts commonly abuse heroin as many as four times a day. The frequency of heroin use means heroin addiction develops faster than many other illegal drugs.
Methods of Heroin Use
Heroin, like many illegal drugs, can be abused in several different ways. Intravenous heroin abuse is the most common method employed by heroin addicts, as the heroin rush occurs almost immediately â€” seven to eight seconds after injection. Injecting heroin also intensifies the strength of the rush.
Sharing needles used for heroin abuse and other illegal drugs increases the risk of HIV/AIDS and hepatitis B and C. In response to this, smoking and snorting heroin are increasingly preferred methods of use. A common myth among illegal drug users is that heroin is less addictive when these methods are employed. In fact, heroin abuse is addictive in any form.
Heroin, Additives and Other Illegal Drugs
Pure heroin is dangerous enough, but when diluted or “cut” with additives, the drug becomes even more dangerous. Sellers of heroin are hardly concerned with the health of their customers. Common additives include starch, powdered milk, sugar, quinine and strychnine.
Heroin is often used with other illegal drugs, including marijuana and cocaine. Different street terms describe different combinations of heroin and other illegal drugs. For instance, a mixture of heroin and cocaine may be referred to as a “snowball” or a “speedball.”
Fentanyl and Mependone
Fentanyl and mependone (DemerolÂ®) are drug analogs of heroin. They’re designer drugs similar to heroin in effect, but different in chemical composition. Both fentanyl and mependone have legitimate medical uses, but are illegal when sold on the street.
Fentanyl is sometimes sold as heroin or mixed with heroin. This is especially dangerous as fentanyl is approximately fifty times as powerful as heroin and can stop lung function almost immediately. Some addicts using fentanyl in place of heroin have died so quickly they died with the needles still in their arms.
Health Complications of Heroin
Like many illegal drugs, heroin is powerfully addictive. Long-term heroin use actually changes the brain’s molecular structure and neurochemical make-up. These physical changes make the addict particularly dependent on heroin.
Heroin addiction produces an increasing tolerance for the drug’s effects. Larger and larger doses of heroin must be taken to duplicate the original rush experienced by the addict. Eventually, heroin craving becomes so overwhelming that heroin addicts have only two goals: the procuring and use of heroin.
In addition to addiction, heroin abuse causes a number of medical complications. The risks of HIV/AIDS, hepatitis B and hepatitis C are much higher in heroin addicts than in the general population. Between sixty to ninety percent of intravenous drug users are believed to be infected with hepatitis C.
Intravenous heroin abuse is not the only factor that contributes to high hepatitis and HIV/AIDS infection rates in heroin addicts. Unprotected sex and trading sex for illegal drugs are common practices among addicts.
Other Medical Conditions Associated with Heroin
These symptoms are prevalent among heroin addicts:
- abscesses and boils
- bacterial infections of heart valves
- blood-borne bacterial infections
- kidney disease
- liver disease
- lung infections
- track marks (scarred, collapsed veins due to needle use)
The additives present in street heroin and other illegal drugs do not necessarily dissolve well, and may build up in the arteries. The build up of these additives can result in local cell death and infection in the lungs, liver, heart and brain.
Additives used to cut heroin accumulate in the bloodstream and may prompt an immune response in the body. The resulting allergic reactions and inflammation can cause arthritis and other inflammatory conditions.
Heroin Withdrawal Symptoms
The physical dependence caused by heroin addiction results in some of the most severe withdrawal symptoms of all illegal drugs. Within hours of ceasing heroin use, the addict experiences severe restlessness, muscle pain, bone pain, vomiting, diarrhea, cold flashes and unwanted leg movements.
In most cases, heroin withdrawal symptoms peak within 48 hours, and are much less severe after the first week of abstinence. However, some recovering heroin addicts report withdrawal symptoms months after treatment and abstinence. Sudden heroin withdrawal can be fatal to a fetus if the addict is pregnant. For this reason most pregnant heroin addicts are treated with methadone.
Methadone: The Mainstay of Heroin Treatment
Methadone, a synthetic opiate, has been used for over thirty years to relieve heroin withdrawal symptoms, bring the babies of heroin addicts as close to term as possible and complement psychological heroin addiction treatment.
Methadone’s success as a heroin treatment stems from the medication’s ability to block heroin’s pleasurable effects while simultaneously reducing the severity of withdrawal symptoms. Craving is relieved by methadone, which can be safely used for long periods of time.
Methadone can be taken orally, and a single dose lasts almost 24 hours, the equivalent of four to six heroin doses. If the heroin addict does relapse while taking methadone, methadone blocks heroin’s rush, so the addict receives nothing to reinforce the relapse.
Pregnancy, Methadone and Heroin
Pregnancy coupled with heroin addiction must be handled with great care. While heroin detoxification is usually the first stage of heroin treatment, sudden cessation of heroin while pregnant can result in miscarriage, spontaneous abortions or premature delivery. Instead, treatment while pregnant relies heavily on methadone. Although this means the baby may be born with a methadone dependency, methadone dependency can be treated and has fewer complications than heroin dependency.
Alternatives to Methadone
Effective though methadone is, it is not always appropriate for heroin treatment. Recovering addicts undergoing HIV antiviral treatment, for instance, may experience drug interactions if also taking methadone.
Like methadone, LAAM ( levo-alpha-acetyl-methadol) is a synthetic opiate that can block heroin effects. LAAM can block heroin for as long as 72 hours when taken orally. The longer duration of LAAM compared to methadone means only three doses are needed a week.
Depending on dosage, naltrexone (ReViaÂ®) can also block heroin effects for up to three days. Naltrexone blocks the heroin rush, and has been proven, like methadone, to help prevent relapses. Naltrexone, when taken in large doses, can cause liver failure.
Finally, a weaker medication called buprenorphine (BuprenxÂ®, SubutexÂ®, SuboxoneÂ®) is available. Buprenorphine is less likely to cause overdoses than methadone. Buprenorphine also reduces physical dependency on heroin, and so is effective for the reduction of heroin withdrawal symptoms.
Addiction Counseling and Methadone
After detoxification, counseling and therapy is recommended for heroin treatment. Two forms of therapy have proven most effective for heroin treatment:
- Cognitive-Behavioral Therapy: During therapy the recovering addict learns to identify triggers that lead to heroin abuse and relapses. New coping strategies are developed for these triggers that do not involve recourse to illegal drugs.
- Contingency Management: A voucher-based therapy, contingency management rewards recovering heroin addicts for remaining in treatment and abstaining from heroin. Vouchers can be redeemed for healthy alternatives to illegal drugs such as free movies, music or meals.
Therapy can take place on an in-patient or out-patient basis, but the most effective heroin treatment regimen appears to be three to six month community residential programs in combination with methadone or other medications.
Street Names for Heroin
Addicts use hundreds of street terms for heroin, and street slang is changing all the time. The following are only a few of the many street terms for heroin:
- WTC (after September 11, 2001)
- Bin Laden (after September 11, 2001)
- black stuff
- brain damage
- Capital H
- China cat (high potency heroin)
- hell dust
- crop (low grade heroin)
National Institute on Drug Abuse. (updated 2004). Heroin. NIDA InfoFacts.
National Institute on Drug Abuse. (2000, September). Heroin abuse and addiction [NIH Publication No. 00-4165). NIDA Research Report Series.
Office of National Drug Control Policy. (2003, June). Heroin. [NCJ 197335]. ONDCP Drug Policy Information Clearinghouse Fact Sheet.
Office of National Drug Control Policy. (updated 2002). Street terms: Drugs and the drug trade.