Heroin

Heroin is a powerful, addictive pain-killing drug. It is one of the most-used, most-rapidly acting, and most addictive of the opiate family, which includes opium, morphine, and codeine.

All opiates are derived from opium, a naturally occurring juice extracted from the seed pod of certain varieties of poppy (Papaver somniferum and Papaver setigerum). Heroin or 'diacetylmorphine' is a semi-synthetic derivative of morphine.

Heroin is increasingly used in clubland as a chill-out drug and has also recently become popular on the gay scene. It's relatively cheap and many smoke it to ease comedown from E, speed or coke.

Heroin is a class A illegal substance in the UK, schedule I in the US.

Appearance

Pure heroin is a white powder with a bitter taste. Street heroin comes in granule, powder, solution or pill forms and varies in colour from white to dark brown thanks to additives or impurities left from the manufacturing process.

Heroin in the UK often resembles packet chicken soup. In fact, strictly speaking, it isn't heroin at all - true heroin is a hydrochloride salt, soluble in water. The brown sold in the UK is diamorphine base - a product intended mainly for smoking, and is not soluble in water.

Injecting

Most regular users inject either intravenously (into a vein) or intra-muscularly (into a muscle, usually the shoulder) after heating heroin powder in a little water.

The brown heroin that dominates the UK and Dutch - market is insoluble in water and must be dissolved in acid, usually citric acid from lemons.

Snorting / smoking

However, an increasing number of people choose to smoke or snort lines of heroin, rather than inject.

When smoked, heroin is heated on foil and the vapour inhaled through a tube or rolled-up bank note. This is known as 'chasing the dragon'.

Effects

Heroin is an opioid - a very powerful painkiller. The body and the brain are packed with opioid receptors, meant for endorphines, the body's own natural pain-killing substances produced in emergency moments of shock or injury.

Heroin mimicks endorphines and binds rapidly with endorphine receptors, extending and magnifying their natural painkilling effect. The result is a surge of pleasurable sensation, or "rush." This rush is usually accompanied by a warm feeling and a sense of well-being.

Rapid effect

The effects are rapid but depend on method on ingestion. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds).

Intra-muscular injection produces a relatively slow onset (between 5 to 8 minutes). Sniffing or smoking usually provides peak effects within 10 to 15 minutes.

First-time or infrequent users often experience nausea and vomiting.

Once the initial rush has passed there can be a feeling of heaviness, as though your bones have melted down into your feet; followed by a feeling of distance from events around you, as though you've been wrapped in cotton wool. The result is a comforting glow. Nothing matters.

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.

Afterwards

Heroin sedates the central nervous system, clouding mental function and making you feel drowsy for several hours after a dose. You may appear to be asleep, but actually be awake.

Long-term effects of heroin use

Despite the myths, heroin is a relatively harmless drug, especially compared to alcohol or nicotine.

However, chronic heroin abuse can result in scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses and other soft-tissue infections, and liver or kidney disease.

Constipation caused by a combination of poor eating and the effects of the drug on the bowels can lead to haemorrhoids. Addicts can also suffer from malnutrition because they're never hungry.

One of the most detrimental long-term effects of heroin is addiction itself. Addiction is a chronic, relapsing disease, 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 abusers 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 sweats 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.

Medical complications of chronic heroin use

Medical consequences of chronic heroin use 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 problems.

Of course, sharing of 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.

Dangers

Overdose

The biggest risk is death from overdose. It's impossible to judge the purity of street heroin. Many accidental overdoses have occurred when a batch of particularly pure heroin is released onto the streets, overwhelming the built-up tolerances of regular users.

Smoking or snorting, rather than injecting, reduces the chance of OD'ing but does not eliminate it.

Heroin works on the central nervous system. The heartbeat slows. The breathing is dramatically slowed. Consciousness may be lost. Any of these effects can be fatal if the dose is too high.

Depending on purity and the user, a lethal dose of heroin may range from 200 to 500mg, but hardened addicts have survived doses of 1800mg and over.

However, with street heroin there is no absolutely certain "safe dosage". It depends on tolerance, amount and purity taken.

Tolerance

Overdose can occur when a dose taken is greater than that you're used to. A tolerable dose for an addict could be fatal to a first-time user.

Take a little to begin with and wait.

Tolerance to heroin in particular is quickly acquired. Even occasional weekend users need to take more to get the same effect over time.

Remember - tolerance can drop. Some users have overdosed on their 'regular dose', after just a few week's break.

Purity

Making and selling illegal drugs is not a precise science. Often drugs from the same dealer and batch have varying strengths. The active ingredient need not necessarily be evenly mixed in. If it's a powder, chop it through. If it's in a bottle, shake it thoroughly

Even experienced users can be caught out by a different level of purity in a sample and accidentally overdose

lessen the risk of overdose
There is clear evidence that death from heroin-related overdose is rarely instantaneous and therefore an overdose is not automatically fatal.

Precautions can lessen the chances of a fatal OD, and steps that can be taken to help someone who's OD'ing.

* never using heroin when you're alone, particularly behind a locked door
* never mix heroin with any other drugs
* always source from a trusted dealer (if you're buying from a new source, always take a small amount first)

Use of needles

We strongly advise you not to inject heroin.

Injecting has two main safety problems: the transmission of HIV and other diseases (especially Hepatitis B & C) through sharing needles, and the dangers of injecting crap under your skin.

About 10% of London's drug users are HIV-positive
50% have Hepatitis B
80-90% have Hepatitis C

As a rule, never share needles. Sharing equipment just isn't worth the risk. Clean works are available free from Needle Exchanges and some pharmacies.

Adulterants

Heroin is often cut with as nutmeg, sucrose, starch, caffeine, chalk, powdered milk, flour, talcum powder.

While none of these substances are dangerous themselves, when injected they can cause chronic problems such as itchy and inflamed skin and veins. The powder solution injected is also likely to contain bacteria

Addiction

While its addictiveness has been much exaggerated, heroin remains a highly habit forming substance.

One dose of heroin will not make you an addict. An estimated 25 to 40% of street users are not physically dependent. There are plenty of regular users who set strict limits on their heroin-use and do not become addicts.

However, heroin is highly physically addictive, more so than morphine, and on a par with nicotine. Regularity of use is as important as the amount in the development of addiction.

To compound things, the body quickly builds a tolerance to the drug. Long term, larger and larger doses are needed to achieve the same effect.

Bizarrely, tolerance also appears to be partially related to the environment where the drug is taken. Studies have shown that users who take heroin in an unusual or different place to normal are more likely to overdose.

No-one knows why this should be, but one theory is that the bodies of addicts who go to the same location to take the drug every time become conditioned to taking it there: their body gears up for what's to come and therefore they have a higher tolerance in that location. When they shoot up somewhere else, their body hasn't prepared itself and they overdose. This, however, is only speculation.

Mixing with other drugs

Heroin is a bad mixer and will only make the chances of unconsciousness, vomiting and choking greater. Only 21% of fatal overdoses in a recent Australian survey came about through using heroin on its own.

Please note: there have been very few scientific studies into the effects of combining psychoactive drugs. The information presented here is anecdotal. It is based on the subjective reports of experienced users. Different people will respond differently to different drugs and drug combination. Know your body.

Alcohol don't; alcohol and heroin both depress the central nervous system. The combination has proven fatal

Amphetamines mixing uppers and downers is not good; speed's stimulant effects may mask the opiate effects of heroin and make overdoses more likely

Cocaine don't; mixing the two (known as a 'speedball') is especially dangerous; the two drugs potentiate each other, increasingly their effectiveness twofold. The cocaine acts as a powerful stimulant raising the heartbeat but its effects wear off quickers than heroin which in turn slows the heart. As a result, the heart can lose rhythm entirely. John Belushi and River Pheonix both died after taking speedballs.

Ecstasy MDMA's effects may mask opiate effects of heroin and make overdose easier

Ghb don't; GHB is a liquid sedative anaesthetic; mixing it with heroin could fatally depress the central nervous system

Ketamine doesn't work

LSD psychedelic drugs mess with the effects of opiates, making them unpredictable and usually unpleasant

Mushrooms as above

Tobacco no harmful effects