What is heroin?
Heroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of the Asian poppy plant. It is both the most abused and the most rapidly acting of the opiates (drugs that come from the plant, including morphine, codeine, pethidine). Street names associated with heroin include ‘smack,’ ‘H’, ‘skag’ and ‘junk’. Heroin is typically sold as a white or brownish powder or as the black sticky substance known on the streets as ‘black-tar heroin’. Although purer heroin is becoming more common, most street heroin is ‘cut’ with other drugs or with substances such as sugar, starch, powdered milk or quinine. Street heroin can also be cut with strychnine or other poisons.
Because heroin abusers do not know the actual strength of the drug they are buying or its true contents, they are at risk of overdose or death. Heroin also poses particular problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.
How is it used?
Heroin is usually injected, sniffed/snorted or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. 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.
What are the short-term effects?
Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a ‘rush’. The intensity of the rush is a function of how much of the drug is taken and how rapidly it enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting and severe itching.
After the initial effects, abusers will usually be drowsy for several hours. Mental function is clouded by heroin’s effect on the central nervous system. Cardiac functions slow. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot accurately be known.
What are the long-term effects?
Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin’s depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging in 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. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.
Of course, sharing injection equipment or fluids can lead to some of the most severe consequences of heroin abuse – infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.
How does heroin abuse affect pregnant women?
Heroin abuse can cause serious complications during pregnancy, including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome). Pregnant women should not be detoxified from opiates because of the increased risk of miscarriage or premature delivery; rather, treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely after they’re born. Research has demonstrated also that the effects of in utero exposure to methadone are relatively benign.