Heroin

Heroin is a depressant made from morphine, a natural substance that comes from the opium poppy plant. Pure heroin is a fine, white, bitter-tasting crystalline powder. However, heroin sold on the street varies in colour and consistency, depending on the way it is made and what other substances are added to it. It can look like a white powder, a brown grainy substance or a dark brown sticky gum. It can range widely in purity. Other drugs or substances such as quinine (used to treat a disease known as malaria) can sometimes be added to imitate the bitter taste or texture of heroin and this can fool a buyer into thinking he or she is getting a more pure form of heroin or to conceal the fact the buyer is getting less of the drug than they bargained for.

There are different ways in which heroin may be consumed. For example, heroin may be:

• dissolved in water and injected into a vein (known as "mainlining"), muscle, or under the skin ("skin-popping")
• smoked ("chasing the dragon")
• snorted

Also known as: diacetylmorphine, diamorphine, black tar, dope (heroin), dust, H, horse, junk, smack, and scag.

Effects and health risks

The effects of heroin and other illegal drugs can be unpredictable and may vary from person to person and from occasion to occasion. The way a person feels after taking heroin depends on many factors including:

• the user’s age and weight
• the user’s mood, expectations, and environment
• any medical or psychiatric conditions the user may have
• the amount of heroin taken (dose)
• how it is taken (by injection, by smoking or by snorting)
• how often and for how long heroin has been used
• the use of other drugs, including alcohol, non-prescription, prescription, and street drugs

How quickly heroin reaches the brain depends on how it is taken. For example, effects are felt within seconds after injection, while after smoking or snorting the effects are slower to appear and usually begin within 10 to 15 minutes. The effects of heroin usually last for about three to five hours.

Short-term effects

Heroin can produce an intensely pleasurable sensation called a "rush" that occurs within seconds after injection and lasts for up to a few minutes. The “rush” is followed by a tranquil phase (commonly referred to as being “on the nod”). This phase, which generally lasts about an hour, is characterized by a sense of relaxation, happiness and an absence of emotional and physical pain. Temporary relief of anxiety and depression are other effects associated with the use of heroin.

Short-term use of heroin can produce many other effects such as:

• nausea and vomiting
• reduced appetite
• pinpoint pupils and impaired night vision
• dizziness
• constipation
• itching or burning sensation of the skin
• headaches
• confusion
• lack of emotion (apathy)

Using heroin combined with alcohol or other central nervous system depressants (sedative-hypnotics) can be very dangerous because the drugs can increase each other's depressant effects and increase the risk of accidents or cardiac or respiratory depression.

Long-term health risks

Effects associated with long-term use of heroin include:

• an unstable mood
• constipation
• loss of interest in sex (decreased libido)
• missed periods in women
• breathing difficulties (respiratory impairment)

In addition, injecting drugs (such as heroin) puts you at risk for:

• skin infections
• blood poisoning (septicaemia)
• infection in the lining of the heart (endocarditis)

Sharing drug supplies (like needles, pipes, and spoons) can also spread infectious diseases such as tuberculosis, HIV, hepatitis B, and hepatitis C.

Malnutrition, life on the street, untreated infectious diseases, and dependence on heroin and other drugs all contribute to a decreased resistance to disease and poor health.

Some substances used to mix or dilute heroin, such as strychnine or chalk, may lead to serious health problems. Strychnine is poisonous and chalk can block small blood vessels cutting off blood circulation to the body’s tissues.

Birth defects

Heroin can cross the placenta and harm a developing fetus. Using heroin while pregnant is associated with:

• premature delivery
• low birth weight
• high infant mortality rates

These effects are also caused or made worse by poor nutrition, smoking, and poor prenatal care.

Heroin withdrawal can be dangerous in a pregnant woman. It can lead to spontaneous abortion in the first trimester and premature labour in the third trimester. Furthermore, babies born to regular heroin users may sometimes go into withdrawal. A baby going through heroin withdrawal may be irritable, sweaty, and exhibit shaky or jerky movements. The baby may have trouble feeding, vomit, or have diarrhea. Occasionally a baby in severe heroin withdrawal will develop seizures and die. Heroin withdrawal can be treated.

Overdose

The risk of overdose with heroin is high and unpredictable because users do not know the actual strength or the amount of drug that they are using. Heroin can suppress the activity of the part of the brain that controls breathing; therefore an overdose of heroin can be deadly.

When injected, heroin has a very rapid onset of action and a person who overdoses may lose consciousness very quickly after injecting the drug. An overdose is more likely if heroin is taken along with other depressants such as alcohol, benzodiazepines, or other opioids such as methadone.

There is an antidote called naloxone that can reverse the effects of heroin.

Addiction and withdrawal

Heroin can be very addictive. Psychological dependence and physical dependence can develop within several weeks of regular use. Regular users also becomee tolerant to heroin.

A person who is addicted to heroin finds it very hard to stop using the drug. Heroin addicts must inject the drug every six to 12 hours to avoid withdrawal symptoms. Addicts may become so preoccupied by the powerful need to get heroin to prevent withdrawal that it takes over their daily life.

The severity of symptoms of withdrawal from heroin depends on the:

• amount and frequency of use of heroin
• length of time a person has been a regular heroin user
• person's state of health
• conditions under which withdrawal happens

Symptoms of withdrawal begin within six to 12 hours after the last use. They peak over the next 24 to 48 hours and then subside after about a week. During this period a person can be extremely uncomfortable and may exhibit one or more of the following symptoms:

• intense and persistent cravings for heroin
• flu-like symptoms (runny nose and sneezing)
• frequent yawning
• sweating
• a loss of appetite
• dehydration and weight loss from not eating or drinking during the experience
• abdominal cramping
• nausea and vomiting
• diarrhea
• dilated pupils
• insomnia
• racing heartbeat and high blood pressure
• goose bumps
• involuntary jerking of the leg muscles
• anxiety and restlessness
• depression

Heroin withdrawal is rarely fatal.

Heroin addiction can be treated effectively with methadone, a long-acting drug that is taken by mouth. Treatment with methadone prevents heroin withdrawal and reduces or eliminates the cravings.