HEROIN (DIACETYLMORPHINE) FACT SHEET

What is heroin? Heroin is an opiate drug. All opiates are either 1) derived from the opium poppy (papaver somniferium) and are known as natural or organic opiates, or 2) are made in a laboratory and referred to as synthetic opiates. Under federal law, heroin is a schedule I drug.

Where do opium poppies grow?

At the present time, a large percentage of the opium used to make the heroin that ends up in the U.S. is grown in Colombia. In 1993, 15% of the heroin seized by the U.S. Drug Enforcement Administration originated in South America. By 1998, this percentage had increased to 65%. Other countries or regions in which opium grows include Turkey, Mexico, Iran, Afghanistan, the former Yugoslavia and the "golden triangle" of Southeast Asia (Thailand, Laos and Burma-Myamnar)

What are some slang names for heroin?

Street names for heroin include junk, smack, doogie, boy, H, and la chiva (a Spanish name for heroin).

How is heroin made?

Heroin is made from morphine, which in turn is extracted from the opium poppy. For this reason, heroin is known as a semi-synthetic opiate. Other semi-synthetic opiates include oxycodone (Percodan®), dihydromorphenone (Dilaudid®) and hydrocodone (Vicodin®).

What does heroin look like?

Because heroin is a schedule I drug, it is made illegally and can appear in many different forms. Usually it is a powder that can be white, tan, brown or black. Another form of heroin is known as "black tar" or "chicle" (Spanish for "chewing gum"). It appears as a solid, gummy substance that can be smoked or melted down and injected.

How is heroin taken?

Heroin can be swallowed, smoked, inhaled ("snorted"), or injected. Recently, many heroin users have been smoking or snorting the drug in an effort to avoid contaminated "rigs" or "works" (hypodermic needles and syringes). Although some users believe that heroin does not produce physical dependence when snorted or smoked, this is untrue. A person can become physically dependent on heroin regardless of the route of administration.

What are the acute (immediate) effects of heroin?

The three basic signs of heroin use are:

• Sedation
• Euphoria (intoxication)
• Analgesia (pain relief)

Few if any other drugs have all three of these characteristics. In addition:

• Soon after being administered, heroin crosses the blood-brain barrier.
• In the brain, heroin is converted to morphine and binds (attaches) rapidly to opioid receptors.
• Heroin is particularly addictive because it enters the brain so rapidly.
• Those abusers who inject ("shoot", "fire", "slam", "mainline") heroin typically report feeling a surge of pleasurable sensation, a "rush" immediately after injection.
• 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.
• The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities,
• Other immediate effects of heroin may include nausea, vomiting and severe itching.
• After the initial effects, abusers usually will be drowsy and euphoric for several hours. The intoxicating effects of heroin are produced through its effect on the reinforcement reward system.
• Mental function is clouded by heroin's effect on the central nervous system.
• Cardiac functions (e.g., pulse rate) slow.
• Breathing is also severely slowed, sometimes to the point of death.
• The pupils of the eyes become constricted (smaller). The term "pinpoint pupils" is sometimes used to describe this action.
• Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot be accurately known.

What are the long-term effects of heroin use?

• Addiction, including tolerance and physical dependence
• In the case of physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly.
• Heroin withdrawal occurs within a few hours after the last time the drug is taken.
• Most of heroin withdrawal involves the locus coeruleus, which is a brain area physically distinct from the reinforcement reward system.
• Symptoms of withdrawal are generally the exact opposite of the signs of intoxication. For example, during heroin intoxication the pupils become constricted. During withdrawal, they become dilated (larger). Other opiate withdrawal symptoms include:
  1. drug hunger (craving)
  2. lacrimation (eyes tear)
  3. rhinitis (runny nose)
  4. restlessness
  5. anxiety
  6. depression
  7. muscle and bone pain
  8. stomach, leg and back cramps
  9. nausea
  10. insomnia
  11. diarrhea,
  12. vomiting,
  13. chills/cold flashes with goose bumps ("cold turkey")
  14. sweating
  15. leg movements ("kicking the habit")
• Major withdrawal symptoms peak about 48 hours after the last dose of heroin and subside after 3-4 days.
• Some people have shown persistent withdrawal signs for many months. This period of extended, low-level withdrawal is called the "post-acute withdrawal syndrome."
• Heroin withdrawal is virtually never fatal to otherwise healthy adults, but it can cause death to the fetus of a pregnant addict.
• Physical dependence and the emergence of withdrawal symptoms were once believed to be the key features of heroin addiction.
• The role of craving has since been recognized as a significant factor; relapse can occur weeks and months after withdrawal symptoms are long gone.
• Persons who suffer chronic pain and who need opiates to function (sometimes over extended periods) generally do not become addicted to these opiates and have few if any problems quitting opiates after their pain is resolved.
• This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict.

What are the health consequences of heroin use?

• Many of the health-related consequences of heroin use are caused not by the drug itself, but by the lifestyle of the addict or the injection of heroin.
• Pure heroin is almost never seen "on the street." Currently, the purity of heroin is at an all-time high and ranges from 35-60%, depending on the area in which it is found.
• Other substances found in street heroin include quinine, chocolate powder (in brown heroin), human hair, dirt, live bacteria, talcum powder, corn starch, and other drugs that the buyer does not know about.
• These adulterants can produce health consequences that would not be seen if street heroin was pure.
• Health consequence related to injection of heroin include collapsed veins and infections at the site of injection, in the heart, or in other parts of the body. In addition, the HIV virus and serious diseases such as gonorrhea, syphilis and hepatitis B & C can be passed from one addict to another through the sharing of "rigs" or "works" (injection paraphernalia).
• Death from heroin overdose can occur as the result of respiratory arrest. In 1998, the federal Drug Abuse Warning Network identified 4,330 fatal reactions to heroin nationwide. Only cocaine produced more fatal reactions. The largest percentage of these reactions occurred in people between 26 and 34 years of age.
• The use of other drugs (especially alcohol) with heroin greatly increases the risk of death.

Blood-Brain Barrier: