What is heroin?

Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates.

Heroin 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.

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 “Heroin black tar”.

How is heroin used?

Heroin is usually injected, sniffed/snorted or smoked. Typically, a heroin user 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 intramuscular 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, researches have confirmed that all three forms of heroin administration are addictive.

Injection continues to be the predominant method of heroin use among addicted users seeking drug treatment; however there seems to be a shift in heroin use patterns (USA and Western Europe) from injection to sniffing and smoking.

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 by accompanied by nausea, vomiting, and severe itching.
Short-term effects of heroin

·         “Rush”
·         Depressed respiration
·         Clouded mental functioning
·         Nausea and vomiting
·         Suppression of pain
·         Spontaneous abortion

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 the purity of the drug cannot be accurately known.

What are the long- term effects of heroin use?

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 and 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.

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. Pregnant women should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery; rather drug treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely in the nursery. Research has demonstrated also that the effects of in utero exposure to methadone are relatively benign.

Why 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. In fact, drug abuse is the fastest growing vector for the spread of HIV in Vietnam.

Research has found that drug abusers can change the behaviours that put them at risk for contracting HIV, through drug treatment, prevention, and community-based outreach programs. They can eliminate drug use, drug-related risk behaviours 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 drug treatment are highly effective in preventing of HIV. 

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