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."

Heroin (diacetylmorphine) is obtained from morphine by a simple chemical process. Since heroin can be fully replaced by equally effective and far less dangerous analgesics, WHO and the United Nations Commission on Narcotic Drugs have recommended a ban both on the manufacture and use of heroin for any purpose. Most countries comply with this decision.

Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of the Asian poppy plant.

The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system.

Long-term effects of heroin appear after repeated use for some period of time. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration.

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.

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.