Heroin
Heroin is an opiate drug that is synthesized
from morphine, a naturally occurring
substance extracted from the seed pod of
the Asian opium poppy plant. Heroin usually
appears as a white or brown powder or as a
black sticky substance, known as “black tar
heroin.”
How Is Heroin Abused?
Heroin can be injected, snorted/sniffed, or
smoked—routes of administration that rapidly
deliver the drug to the brain. Injecting is
the use of a needle to administer the drug
directly into the bloodstream. Snorting
is the process of inhaling heroin powder
through the nose, where it is absorbed into
the bloodstream through the nasal tissues.
Smoking involves inhaling heroin smoke into
the lungs. All three methods of administering
heroin can lead to addiction and other
severe health problems.
How Does Heroin Affect
the Brain?
Heroin enters the brain, where it is converted
to morphine and binds to receptors known as
opioid receptors. These receptors are located
in many areas of the brain (and in the body),
especially those involved in the perception
of pain and in reward. Opioid receptors are
also located in the brain stem—important for
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automatic processes critical for life, such as
breathing (respiration), blood pressure, and
arousal. Heroin overdoses frequently involve a
suppression of respiration.
After an intravenous injection of heroin, users
report feeling a surge of euphoria (“rush”)
accompanied by dry mouth, a warm flushing
of the skin, heaviness of the extremities, and
clouded mental functioning. Following this
initial euphoria, the user goes “on the nod,”
an alternately wakeful and drowsy state.
Users who do not inject the drug may not
experience the initial rush, but other effects
are the same.
With regular heroin use, tolerance
develops, in which the user’s physiological
(and psychological) response to the drug
decreases, and more heroin is needed to
achieve the same intensity of effect. Heroin
users are at high risk for addiction—it is
estimated that about 23 percent of individuals
who use heroin become dependent on it.
What Other Adverse Effects
Does Heroin Have on
Health?
Heroin abuse is associated with serious
health conditions, including fatal overdose,
spontaneous abortion, and—particularly
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in users who inject the drug—infectious
diseases, including HIV/AIDS and hepatitis.
Chronic users may develop collapsed
veins, infection of the heart lining and
valves, abscesses, and liver or kidney
disease. Pulmonary complications, including
various types of pneumonia, may result
from the poor health of the abuser as well
as from heroin’s depressing effects on
respiration. In addition to the effects of
the drug itself, street heroin often contains
toxic contaminants or additives that can
clog blood vessels leading to the lungs,
liver, kidneys, or brain, causing permanent
damage to vital organs.
Chronic use of heroin leads to physical
dependence, a state in which the body
has adapted to the presence of the drug.
If a dependent user reduces or stops
use of the drug abruptly, he or she may
experience severe symptoms of withdrawal.
These symptoms—which can begin as
early as a few hours after the last drug
administration—can include restlessness,
muscle and bone pain, insomnia, diarrhea
and vomiting, cold flashes with goose
bumps (“cold turkey”), and kicking
movements (“kicking the habit”). Users also
experience severe craving for the drug
during withdrawal, which can precipitate
continued abuse and/or relapse. Major
withdrawal symptoms peak between 48
and 72 hours after the last dose of the
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drug and typically subside after about 1
week. Some individuals, however, may
show persistent withdrawal symptoms for
months. Although heroin withdrawal is
considered less dangerous than alcohol or
barbiturate withdrawal, sudden withdrawal
by heavily dependent users who are in poor
health is occasionally fatal. In addition,
heroin craving can persist years after drug
cessation, particularly upon exposure to
triggers such as stress or people, places,
and things associated with drug use.
Heroin abuse during pregnancy, together
with related factors like poor nutrition
and inadequate prenatal care, has been
associated with adverse consequences
including low birthweight, an important risk
factor for later developmental delay. If the
mother is regularly abusing the drug, the
infant may be born physically dependent on
heroin and could suffer from serious medical
complications requiring hospitalization.
What Treatment Options
Exist?
A range of treatments exist for heroin
addiction, including medications and
behavioral therapies. Science has taught us
that when medication treatment is combined
with other supportive services, patients are
often able to stop using heroin (or other
opiates) and return to stable and productive
lives.
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Treatment usually begins with medically
assisted detoxification to help patients
withdraw from the drug safely. Medications
such as clonidine and buprenorphine can
be used to help minimize symptoms of
withdrawal. However, detoxification alone
is not treatment and has not been shown
to be effective in preventing relapse—it is
merely the first step.
Medications to help prevent relapse include
the following:
· Methadone has been used for more
than 30 years to treat heroin addiction.
It is a synthetic opiate medication that
binds to the same receptors as heroin;
but when taken orally, it has a gradual
onset of action and sustained effects,
reducing the desire for other opioid drugs
while preventing withdrawal symptoms.
Properly administered, methadone is not
intoxicating or sedating, and its effects do
not interfere with ordinary daily activities.
Methadone maintenance treatment
is usually conducted in specialized
opiate treatment programs. The most
effective methadone maintenance
programs include individual and/or
group counseling, as well as provision
of or referral to other needed medical,
psychological, and social services.
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· Buprenorphine is a more recently
approved treatment for heroin addiction
(and other opiates). Compared with
methadone, buprenorphine produces less
risk for overdose and withdrawal effects
and produces a lower level of physical
dependence, so patients who discontinue
the medication generally have fewer
withdrawal symptoms than those who
stop taking methadone. The development
of buprenorphine and its authorized use
in physicians’ offices give opiate-addicted
patients more medical options and extend
the reach of addiction medication. Its
accessibility may even prompt attempts
to obtain treatment earlier. However, not
all patients respond to buprenorphine—
some continue to require treatment with
methadone.
· Naltrexone is approved for treating
heroin addiction but has not been widely
utilized due to poor patient compliance.
This medication blocks opioids from
binding to their receptors and thus
prevents an addicted individual from
feeling the effects of the drug. Naltrexone
as a treatment for opioid addiction is
usually prescribed in outpatient medical
settings, although initiation of the
treatment often begins after medical
detoxification in a residential setting. To
prevent withdrawal symptoms, individuals
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must be medically detoxified and opioid-
free for several days before taking
naltrexone.
· Naloxone is a shorter-acting opioid
receptor blocker, used to treat cases of
overdose.
For pregnant heroin abusers, methadone
maintenance combined with prenatal
care and a comprehensive drug treatment
program can improve many of the
detrimental maternal and neonatal
outcomes associated with untreated heroin
abuse. Preliminary evidence suggests
that buprenorphine may also be a safe
and effective treatment during pregnancy,
although infants exposed to either
methadone or buprenorphine prenatally
may still require treatment for withdrawal
symptoms. For women who do not want or
are not able to receive pharmacotherapy
for their heroin addiction, detoxification
from opiates during pregnancy can be
accomplished with medical supervision,
although potential risks to the fetus and the
likelihood of relapse to heroin use should be
considered.
There are many effective behavioral
treatments available for heroin addiction—
usually in combination with medication.
These can be delivered in residential
or outpatient settings. Examples are
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individual or group counseling; contingency
management, which uses a voucher-based
system where patients earn “points” based
on negative drug tests—these points can
be exchanged for items that encourage
healthy living; and cognitive-behavioral
therapy, designed to help modify a patient’s
expectations and behaviors related to drug
abuse, and to increase skills in coping with
various life stressors.
How Widespread Is Heroin
Abuse?
Monitoring the Future Survey†
According to the Monitoring the Future
survey, there was little change between
2008 and 2009 in the proportion of 8th-
and 12th-grade students reporting lifetime,††
past-year, and past-month use of heroin.
There also were no significant changes in
past-year and past-month use among 10th-
graders; however, lifetime use increased
significantly among this age group, from
1.2 percent to 1.5 percent. Survey measures
indicate that injection use rose significantly
among this population at the same time.
Use of Heroin by Students
2009 Monitoring the Future Survey
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|
8th Grade
|
10th Grade
|
12th Grade
|
Lifetime
|
1.3%
|
1.5%
|
1.2%
|
Past Year
|
0.7%
|
0.9%
|
0.7%
|
Past Month
|
0.4%
|
0.4%
|
0.4%
|
National Survey on Drug Use and
Health (NSDUH)†††
According to the 2008 National Survey
on Drug Use and Health, the number of
current (past-month) heroin users aged 12
or older in the United States increased from
153,000 in 2007 to 213,000 in 2008.
There were 114,000 first-time users of
heroin aged 12 or older in 2008.
Other Information Sources
For additional information on heroin, please
refer to the following links on NIDA’s Web
site, www.drugabuse.gov:
· Heroin Abuse—Research Report Series
· Various issues of NIDA Notes (search by
“heroin” or “opiates”)
For street terms searchable by drug name,
cost and quantities, drug trade, and drug
use, visit www.whitehousedrugpolicy.
gov/streetterms/default.asp.
Data Sources
†
Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s
Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in
1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov.
††
the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days
preceding an individual’s response to the survey.
†††
12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health
and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at
877–643–2644.
Updated March 2010
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These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National
“Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during
NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged
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