Abuse of heroin

Because heroin is so easily manufactured and transported in its pure state, it constitutes one of the greatest public health hazards. The heroin content of what is sold on the street is variable: it is usually adulterated or mixed with other substances; quantities and types differ greatly and are difficult for an user to ascertain. Not surprisingly, such variations in quality and quantity expose users to an increased risk of related illness, poisoning, overdose and death.

Heroin produces a very strong dependency. The resulting increase in use is itself a major health hazard. In addition, heroin is often injected, thereby adding all the risks of infection from unclean needles or inadequate hygiene.

The major source of heroin shifted from Asia to Columbia in the 1990s; the Columbian product is much purer than the Asian (as much as 75%, compared to 5%) which means it can be taken effectively through the nose, thus avoiding the hazards of injecting. The increased ease of use, however, has made heroin attractive to a new segment of the population. While heroin used to be shunned by the affluent middle and upper classes, who preferred cocaine, it has now acquired an aura of fashionability.

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."

Abuse of heroin is increasing in a number of regions of the world. In 1970 there were about half a million regular users in the USA; in 1996 it was estimated there were as many as two million. Hospital emergency admissions for heroin crises more than doubled between 1988 and 1995.

According to a 1999 report, the quantities of heroin seized in the European Union each year amount to some 5 to 6 tonnes; nearly half the seizures were in the UK. The number of people who tried heroin at least once was estimated at between 3 million and 5 million, or roughly 1% of the EU population. Heroin users were generally people living in precarious conditions in large cities, but the drug was also finding its way into small towns and rural areas. Its victims were mostly either relatively affluent young people, who were already using ecstacy or amphetamines, or alcoholics.

According to the US Drug Abuse Warning Network (DAWN), which collects data on drug-related hospital emergency room episodes and drug-related deaths from 21 metropolitan areas in America, it ranks 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.

The 1996 US National Household Survey on Drug Abuse (NHSDA) shows a significant increase from 1993 in the estimated number of current (once in the past month) heroin users. The estimates have risen from 68,000 in 1993 to 216,000 in 1996. Among individuals who had ever used heroin in their lives, the proportion who had ever smoked, sniffed, or snorted heroin increased from 55 percent in 1994 to 82 percent in 1996. During the same period, the proportion of users who injected heroin remained about the same, at about 50 percent.