Heroin

What is it?

Heroin is an opiate. Pure heroin is a white powder with a bitter taste, which is made from the milky ‘sap’ of the opium poppy (see right). This plant is grown as an illicit crop in countries across the Middle East, Asia and South America.

Heroin is a powerful painkiller, which depresses the Central Nervous System. This produces a feeling of relaxation, security and well being.

Medicinal uses

Although opium has been known and used as a sedative and intoxicant in some cultures for several thousand years, heroin is a relatively new substance. It was first synthesized from morphine in 1874 in Germany and given the name heroisch - meaning ‘powerful’.

Heroin was not extensively used in medicine until around the beginning of this century. At that time it then received widespread acceptance from the medical profession as a sedative and anaesthetic as shown by the poster at right. Physicians remained unaware of its potential for addiction.

When the dangers of heroin came to be appreciated many governments around the world took steps to control its manufacture and it came under very strict prescription controls.

Today heroin does not have many legitimate medical applications, as synthetic sedatives and anaesthetics have replaced the opium-based compounds that were used in the past.

Abuse of Heroin

Illicit heroin comes in the form of a powder which may vary in colour from white to dark brown because of impurities left from the manufacturing process or the presence of adulterants. The powder can be sniffed or dissolved in water and injected. It can also be smoked by mixing with tobacco or heating on tin foil and inhaling the fumes, or swallowed after being wrapped in paper.

Heroin on the streets is usually diluted with other substances - ranging from lactose to paracetemol. However, the amount by which the drug is ‘cut’ varies from purchase to purchase or day to day and so its purity in any particular locality can vary enormously - depending pretty much on the mood of the dealers. Many deaths have resulted from overdosing on a batch of unusually pure heroin.

A few years ago powders sold as illicit heroin only actually contained 1 to 10 percent of the drug. In recent years street supplies have become stronger and the UK national average purity of heroin is now around 40 percent, although it can range from 1 to 98 percent (hence the likelihood of accidental overdose).

Along with an increase in purity, the cost of heroin has fallen. A gram of the drug now costs around 60 Pounds Sterling on the street.

Until recently, most heroin users took the drug by injection - either into a vein, under the skin or into a muscle. This is the most practical and ‘efficient’ way to take impure heroin.

The availability of higher purity heroin has meant that more users can now snort or smoke the drug and still achieve the desired effect. Smoking and sniffing of heroin appears to be on the increase in the UK as of 1997/8.

Although this may seem like ‘good’ news, as sniffing or smoking heroin eliminates the health risks associated with injecting drugs, it has a downside. Many people may try heroin by sniffing or smoking it, who may not have tried the drug if they had to inject it.

Sniffing or smoking heroin is likely to be more appealing to new users because it eliminates both the fear of acquiring syringe-borne diseases such as HIV/AIDS and hepatitis, and the initial distaste regarding self-injection.

It would certainly be a cause for concern if the reduction in the cost of heroin and increase in its purity leads to the drug becoming more acceptable to young people.

What effect does it have?

All opiates tend to relax the user and kill pain to some degree. Heroin is the most powerful opiate and when it is injected, the user feels an immediate ‘rush’ of relaxation and well-being. Physical pain is completely removed - and so is emotional pain.

It can be hard for non-users to understand the attraction of drugs - particularly heroin - but a major reason why any individual may feel drawn to use heroin again after an initial experience is that it produces such a powerful sense of security and tranquillity. It produces a state of mind where all cares and worries seem far removed. Nothing matters. Perhaps it’s like being in the womb.
The best description this writer has ever found is:

“But with heroin, ahhh. You can just sit in a sewer all day and be soooo happy and feel soooo good”
(“Junk” - Melvin Burgess, 1996 Penguin Books)

Of course, these pleasant sensations have nothing to do with reality. No matter how good a user may feel, the reality is the sewer - or whatever other situation exists - and this is usually quite unpleasant - hence the need to escape from it.

Side effects from heroin use - particularly for new users - include restlessness, nausea and vomiting. The user may go ‘on the nod’ or ‘gouch out’ - going back and forth from appearing fairly alert to almost falling asleep. The pupils of the eye are reduced to pinpricks.

Tolerance

If heroin is used regularly over a period of time then a tolerance to the drug builds up. It makes no difference what method of taking heroin a person may employ - and regularly can mean using many times each day, or only two or three times each week.
Users have to take larger amounts of heroin in order to get the same effect as previously. Tolerance can build up quite quickly - over a matter of weeks - although it continues to increase as long as a user takes heroin regularly.

If a person is abstinent from heroin for a time, their tolerance to the drug decreases. If they should use heroin again in the same amounts as previously, an overdose could easily occur.

Consequences of heroin use

Risks to physical health

One of the most obvious risks of taking heroin is that of overdose. This can occur whatever method is used to take the drug, although intravenous injection is most dangerous in this respect as the whole dose is delivered directly into the blood system.

Heroin is a Central Nervous System depressant and when it’s taken vital functions such as higher brain activity, breathing and heart rate are inhibited - or slowed down. If a large dose is taken - or the heroin is exceptionally pure - the user may become comatose and the skin feels cold and clammy. Breathing becomes shallow and intermittent and death may occur.

Other physical health risks related to heroin use are associated with the means of taking the drug. Users who inject heroin might often employ contaminated needles or syringes. This can lead to severe blood infection and damage the heart.

In case anyone thinks this is a joke, it’s how this writer’s best friend died. He (my mate Keith) got septicaemia from an unsterile needle. This damaged the valves of his heart and he nearly died shortly after. He had to have operations to put in plastic heart valves and a pacemaker. He lived for a few years after that but then his heart gave out. That’s reality.

Injecting heroin - or any drug - in situations where shared needles are used, perhaps accidently, leaves the users open to infection from the HIV virus that causes AIDS. Hepatitis B or C, both of which are serious infections, can be spread in this way and are common among intravenous heroin users.

Another immediate physical danger associated with heroin use exists if the drug is combined with other substances. Other depressant drugs, such as alcohol, benzodiazepines and barbiturates are particularly dangerous as they are all CNS depressants. As heroin is also a powerful CNS depressant, the combined effect of mixing these drugs can depress breathing or heart rate to such an extent as to cause respiratory failure or heart failure.

Dependence

Physical and psychological dependence upon heroin is likely to occur, especially if a person uses a lot of the drug or even uses it occasionally over a long period of time. The method of taking heroin makes no difference here - a person who sniffs or smokes heroin can become dependent on the drug just as easily as a person who injects it.

Heroin use can result in a powerful physical addiction.

Coming off the drug can be very difficult because withdrawal symptoms - although lasting for only a few days - are fairly severe. Abstinence can bring on symptoms such as chronic diarrhoea, muscle cramps, vomiting, insomnia, sweating, anxiety, and tremors. The prospect of going through such a painful withdrawal puts many heroin users off the idea of trying to stop using the drug.

Once the physical withdrawal is over, a craving for the drug may still persist for a long time and relapses are common. Generally speaking, a heroin user who wishes to stop using the drug completely needs a strong support network to help him or her overcome the craving for the drug.

Social consequences

It costs a lot of money to maintain a regular intake of heroin. Many regular users resort to crime of one kind or another to fund their drug use. This has serious implications for our society, as the social costs of drug-related crime are enormous. An estimate of the size of the problem was provided in research by the UK Home Office in 1997, which found that 20 percent of all people arrested in Britain were on heroin.

Effect on pregnant women

Researchers estimate that nearly half of the women who are dependent on heroin suffer anaemia, heart disease, diabetes, pneumonia, or hepatitis during pregnancy and childbirth. They have more spontaneous abortions, breech deliveries, caesarean sections, premature births and stillbirths.

Infants born to these women often have heroin withdrawal symptoms, which may last several weeks or months. Many of these babies die.

Legal consequences

Heroin is a Class A drug. It is illegal to supply or possess it. Penalties are high.

(Drugs similar to heroin, such as morphine, opium, methadone, dipapanone and pethidine are also Class A drugs. Codeine and dihydrocodeine (DF118) are Class B drugs unless they are prepared for injection when they become Class A drugs.)