Heroin comes in three forms that are commonly used as an illicit narcotic: white crystalline powder (a hydrochloride salt, or diacetylmorphine hydrochloride); a non-crystalline powder (produced primarily in Afghanistan and used as free-base), and a black tar (produced in Mexico, and contains other morphine derivatives besides heroin).
Until the early 2000s, 87 percent of the world’s heroin came from Afghanistan. However, from 2007 to 2011, Mexican drug cartels escalated production of heroin to claim the Number Two spot for heroin production.
Heroin is used as a medically appropriate painkiller, or analgesic. It also has widespread illicit use as a street drug or recreational drug. Heroin is a controlled substance under Schedule I and IV on the International Convention of Narcotic Drugs system. In some European countries, heroin is used to treat addiction to other opioids. In the U.S., treatment for opioid addiction is often carried out with the drugs methadone or buprenorphine.
Heroin is usually injected or smoked by users, and works quickly to deliver a "high," due to its fast-acting effect on the mid-brain of the user. Euphoria and complete relaxation are its most habit-forming effects. Tolerance to the drug, and dependence on it develop quickly. Users of other opioid medications report that heroin and morphine are the two most addictive drugs in this category because this level of euphoria is not achieved with synthetic opioids such as Oxycodone, Fentanyl or Hydromorphone.
Who's Taking Heroin?
Heroin appeals to people most inclined to seek relaxation and to stop the internal chatter of a troubled mind. With its sedative properties, heroin is most popular with those personality types who wish to “chill.” As a central nervous system depressant, heroin relaxes the body and mind into a state of euphoric numbness.
Since 2002, there has been a noted increase in heroin use among a surprising and unlikely population sector: middle-to-upper class teens or college students, as well as affluent young adults who work in white collar jobs. Treatment centers have seen an increase in the number of patients from this population sector who are seeking help for addiction to heroin.
Heroin users who inject heroin receive an effect faster than they would from consuming other opioids (usually in pill form). Because heroin is an acetyl compound substance, it crosses the blood brain barrier almost immediately and converts into morphine, which binds to the receptors in the brain more quickly than others. For this purpose, its effects are faster and more powerful in small doses than are other opioid compounds, including morphine.
The nearly instantaneous effects of heroin are:
- analgesia (pain relief)
- anxiety reduction
The user who continues with heroin will develop additional receptors for the drug, thus enacting the need for more of the substance with each use. This is known as drug tolerance. From tolerance quickly develops dependence. The user is now addicted to the drug.
Heroin use carries the following risks, along with the escalating danger of addiction:
- High risk for developing HIV and hepatitis, due to sharing of needles
- Abscesses at injection sites
- Heart disease, such as infective endocarditis
- Kidney disease and damage to the renal system
- Opioid dependence and withdrawal
Death from heroin overdose occurs when the heart stops, due to the decreased heart rate it produces. Some users combine heroin with other drugs, thus increasing their risk for overdose. Due to its sedating effects, users are susceptible to poor judgment when under the influence of heroin and risk accidental death due to poor motor skills while driving a car or operating other equipment. Users who also smoke cigarettes have been known to “nod off” while smoking and set themselves on fire or otherwise injure themselves when they pass out.
How Addictive Is Heroin?
Heroin is highly addictive. Users who inject heroin have instantaneous effects of euphoria and relaxation. This is due to the type of action heroin produces in the brain of the user. Because it rapidly creates a need for more of the drug, tolerance develops quickly. Heroin addiction is one of the fastest to occur. Smokers, and those who take heroin in non-injection forms, are equally susceptible to addiction, but it takes hold somewhat more slowly.
Risk of overdose on heroin is great. The euphoric feeling creates a desire for more of the substance. Users are heavily sedated on heroin and use more than they can assimilate into their bodies. Heroin overdose happens frequently with users who are not familiar with the drug, but it has also killed those who were long-time users and got too high a dose at one time.
Many celebrity drug overdoses have occurred with heroin. Occasionally there were other substances involved, but heroin is the most common drug-overdose death.
When the heroin user misses a dose, withdrawal sets in. Withdrawal is an excruciating process of nausea, vomiting, muscle cramps and severe muscle contractions, chills and flu-like symptoms that can last for up to five days. Users frequently go back to heroin use when the discomfort of withdrawal occurs.
Addiction to heroin is difficult to treat due to the severe withdrawal symptoms that occur. While withdrawal is not life-threatening, it is extremely unpleasant. Most users return to heroin. In many countries, substitute drugs are given to assist users with addiction. Great controversy exists about the efficacy of such drugs. Many of the drugs currently in use in the U.S. are equally addictive, creating a new problem for users who are attempting to get “clean” of heroin.
Medical treatment is not necessary, but some people prefer to be medically detoxed to avoid symptoms of withdrawal. Users will need to research all options to make informed choices about treatment for heroin addiction.
Former heroin addicts have maintained abstinence from heroin for many years. Some attend treatment programs and then maintain abstinence in 12-Step recovery programs. Others may find religious groups that help with their recovery. It is believed that no addict will return to using heroin or any other drug, including alcohol, as long as they wish to remain “clean” and seek out support to help they maintain their sobriety.