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What is heroin?
A) Heroin is an illegal, highly addictive opiate drug.
Its abuse is more widespread than any other opiate. Heroin
is processed from morphine, a naturally occurring substance
extracted from the seed pod of certain varieties of poppy
plants. It 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 or its true
contents, they are at risk of overdose or death. Heroin
also poses special problems because of the transmission
of HIV and other diseases that can occur from sharing
needles or other injection equipment.
What are the current trends for heroin abuse?
A generation ago, the heroin (colloquially known as "smack")
available in the U.S. was barely five percent pure and used
by a relatively small percentage of young people because it
had to be injected with a needle. Now, it appears smack is back
with a vengeance and it's addicting large groups of new users.
The Office of National Drug Control Policy issued a report (April
1992, No. 5, pp. 1-6) claiming "a massive increase in heroin
use and addiction is not likely." One reason for this was,
"...the apparent absence of new initiates (i.e., heroin
users with little or no prior drug-using experience)."
However, based upon recent news reports and other sources (see
the A.T. Forum Web site for News Updates), the ONDCP report
appears to have been premature, to say the least.
Just this past February, Attorney General Janet Reno admitted
heroin is more plentiful, purer, and less expensive than it
was just a few years ago. "If we do not counteract the
heroin threat now," she said, "we risk repeating the
terrible consequences of the 1980s' cocaine and crack epidemic."
Authorities estimate that heroin addiction has increased 20
percent and worldwide production has grown sharply, even as
other illegal substance abuse is declining.
Reports of problems have sprung-up countrywide. In California,
heroin sold in the San Joaquin Valley is cheap, potent, and
plentiful - business is booming in area emergency rooms as two
or three overdose cases appear each day. In Colorado, Boulder
County officials may establish a methadone clinic for the first
time in 16 years to deal with increasing heroin addiction. On
the East Coast, heroin is reported to be 40 to 70 percent pure
and around $10 for a small packet. The number of heroin-related
hospital emergencies has more than doubled in New York City
and surrounding areas.
Many drug abusers mistakenly believe inhaling heroin, rather
than injecting it, reduces the risks of addiction or overdose.
In some areas, "shabanging" - picking up cooked heroin
with a syringe and squirting it up the nose - has increased
in popularity. Street heroin carries prophetic names: "DOA,"
"Body Bag," "Instant Death," and "Silence
of the Lamb." Rather than scaring off young initiates,
the implied danger seems to actually increase the drug's allure.
What are some other names for heroin?
"smack", "junk", "horse", "skag",
"H", "China white"
So Heroin is an opiate. What are some of the other opiates?
Opium, Morphine, Codeine, Merperidine , Hydrocodone (Lortab,
Vicodin), Oxycodone (Percodan, Roxicet, Roxiprin, Tylox, Percocet),
Stadol, Talwin, Dilaudid, Fentanyl, Buprenorphine, Methadone,
Propoxyphene (Wygesic, Darvocet)
What are the statistics on heroin addiction in the United States?
According to the 1996 National Household Survey on Drug Abuse,
which may actually underestimate illicit opiate (heroin) use,
an estimated 2.4 million people use heroin at some time in their
lives, and nearly 216,000 of them reported using it within the
month preceding the survey. The survey report estimates that
there were 141,000 new heroin users in 1995, and that there
has been an increasing trend in new heroin use since 1992. A
large proportion of these recent new users were smoking, snorting,
or sniffing heroin, and most were under age 26. Estimates of
use for other age groups also increased, particularly among
youths age 12 to 17: the incidence of first-time heroin use
among this age group increased fourfold from the 1980s to 1995
The 1996 Drug Abuse Warning Network (DAWN), which collects data
on drug- related hospital emergency department (ED) episodes
from 21 metropolitan areas, estimates that 14 percent of all
drug-related ED episodes involved heroin. Even more alarming
is the fact that between 1988 and 1994, heroin-related ED episodes
increased by 64 percent (from 39,063 to 64,013).
In 1996, it was reported that heroin was the primary drug of
abuse related to drug abuse treatment admissions in Newark,
San Francisco, Los Angeles, and Boston, and it ranked a close
second to cocaine in New York and Seattle.
How is heroin 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 musculature 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, NIDA researchers have confirmed that all three forms
of heroin administration are addictive.
Injection continues to be the main method of use among heroin
addicts; however, researchers have observed a shift in heroin
use patterns, from injection to sniffing and smoking. In fact,
sniffing/snorting heroin is now a widely reported means of taking
heroin among users admitted for drug treatment in Newark, Chicago,
New York, and Detroit.
With the shift in heroin abuse patterns comes an even more diverse
group of users. Older users (over 30) continue to be one of
the largest user groups in most national data. However, several
sources indicate an increase in new, young users across the
country who are being lured by inexpensive, high-purity heroin
that can be sniffed or smoked instead of injected. Heroin has
also been appearing in more affluent communities.
What are the immediate (short-term) effects of heroin use?
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 drug is taken and how
rapidly the drug 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 usually will 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 be accurately known.
What are the long-term effects of heroin addiction and use?
One of the most detrimental long-term effects of heroin is heroin
addiction itself. Addiction is a chronic problem, characterized
by compulsive drug seeking and use, and by neurochemical and
molecular changes in the brain. Heroin also produces profound
degrees of tolerance and physical dependence, which are also
powerful motivating factors for compulsive use and abuse. As
with abusers of any addictive drug, heroin addicts gradually
spend more and more time and energy obtaining and using the
drug. Once they are addicted, the heroin abusers' primary purpose
in life becomes seeking and using drugs. The drugs literally
change their brains.
Physical dependence develops with higher doses of the drug.
With physical dependence, the body adapts to the presence of
the drug and withdrawal symptoms occur if use is reduced abruptly.
Withdrawal may occur within a few hours after the last time
the drug is taken. Symptoms of withdrawal include restlessness,
muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes
with goose bumps ("cold turkey"), and leg movements.
Major withdrawal symptoms peak between 24 and 48 hours after
the last dose of heroin and subside after about a week. However,
some people have shown persistent withdrawal signs for many
months. Heroin withdrawal is never fatal to otherwise healthy
adults, but it can cause death to the fetus of a pregnant addict.
At some point during continuous heroin use, a person can become
addicted to the drug. Sometimes addicted individuals will endure
many of the withdrawal symptoms to reduce their tolerance for
the drug so that they can again experience the rush.
Physical dependence and the emergence of withdrawal symptoms
were once believed to be the key features of heroin addiction.
We now know this may not be the case entirely, since craving
and relapse can occur weeks and months after withdrawal symptoms
are long gone. We also know that patients with chronic pain
who need opiates to function (sometimes over extended periods)
have few if any problems leaving opiates after their pain is
resolved by other means. This may be because the patient in
pain is simply seeking relief of pain and not the rush sought
by the addict.
What are the medical complications of chronic heroin addiction
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 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
One of the greatest risks of being a heroin addict is death
from heroin overdose. Each year about one percent of all heroin
addicts in the United States die from an overdose of heroin
despite having developed a fantastic tolerance to the effects
of the drug. In a non-tolerant person the estimated lethal dose
of heroin may range from 200 to 500 mg, but addicts have tolerated
doses as high as 1800 mg without even being sick.
Are heroin users at special risk for contracting HIV/AIDS and
hepatitis B and C?
Because many heroin addicts often share needles and other injection
equipment, they are at special risk of contracting HIV and other
infectious diseases. Infection of injection drug users with
HIV is spread primarily through reuse of contaminated syringes
and needles or other paraphernalia by more than one person,
as well as through unprotected sexual intercourse with HIV-infected
individuals. For nearly one-third of Americans infected with
HIV, injection drug use is a risk factor. In fact, drug abuse
is the fastest growing vector for the spread of HIV in the Nation.
Research has found that drug abusers can change the behaviors
that put them at risk for contracting HIV, through drug abuse
treatment, prevention, and community-based outreach programs.
They can eliminate drug use, drug-related risk behaviors such
as needle sharing, unsafe sexual practices, and, in turn, the
risk of exposure to HIV/AIDS and other infectious diseases.
Drug abuse prevention and treatment are highly effective in
preventing the spread of HIV.
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), as well.
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