Heroin is a highly addictive drug, and its use is a serious problem in America. Current estimates
suggest that nearly 600,000 people need treatment for heroin addiction. Recent studies suggest a
shift from injecting heroin to snorting or smoking because of increased purity and the misconception
that these forms of use will not lead to addiction.
Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of
the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names associated
with heroin include "smack," "H," "skag," and "junk." Other names may refer to types of heroin
produced in a specific geographical area, such as "Mexican black tar."
Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and infectious diseases, including HIV/AIDS and hepatitis.
The short-term effects of heroin abuse appear soon after a single dose and disappear in a few
hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush")
accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this
initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental
functioning becomes clouded due to the depression of the central nervous system.
Long-term effects of heroin appear after repeated use for some period of time. Chronic users may
develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver
disease. Pulmonary complications, including various types of pneumonia, may result from the poor
health condition of the abuser, as well as from heroin's depressing effects on respiration.
In addition to the effects of the drug itself, street heroin may have additives 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.
Reports from SAMHSA's 1995 Drug Abuse Warning Network (DAWN), which collects data on
drug-related hospital emergency room episodes and drug-related deaths from 21 metropolitan areas,
rank heroin second as the most frequently mentioned drug in overall drug-related deaths. From
1990 through 1995, the number of heroin-related episodes doubled. Between 1994 and 1995, there
was a 19 percent increase in heroin-related emergency department episodes.
Tolerance, Addiction, and Withdrawal
With regular heroin use, tolerance develops. This means the abuser must use more heroin to
achieve the same intensity or effect. As higher doses are used over time, physical dependence and
addiction develop. With physical dependence, the body has adapted to the presence of the drug and
withdrawal symptoms may occur if use is reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few hours after the last
administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and
vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit"),
and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last
dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in
poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than
alcohol or barbiturate withdrawal.