Heroin is a highly addictive drug, and its use is a serious problem in
America. Recent studies suggest a shift from injecting heroin to snorting or smoking
because of increased purity and the misconception that these forms of use will not lead to
Heroin is processed from morphine, a naturally occurring substance extracted from the
seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder.
Street names for 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 abuse is associated with serious health conditions, including fatal overdose,
spontaneous abortion, collapsed veins, and infectious diseases, including HIV/AIDS and
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.
In addition to the effects of the drug itself, street heroin may have additives that do
not readily dissolve and result in clogging the blood vessels that lead to the lungs,
liver, kidneys, or brain. This can cause infection or even death of small patches of cells
in vital organs.
Reports from SAMHSA's 1995 Drug Abuse Warning Network (DAWN), which collects data on
drug-related hospital emergency room episodes and drug-related deaths from 21 metropolitan
areas, rank 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
Tolerance, Addiction, and Withdrawal
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
There is a broad range of treatment options for heroin addiction, including medications as
well as behavioral therapies.
Science has taught us that when medication treatment is integrated with other supportive
services, patients are often able to stop heroin (or other opiate) use and return to more
stable and productive lives.
In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on
Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded
that opiate drug addictions are diseases of the brain and medical disorders that indeed
can be treated effectively. The panel strongly recommended (1) broader access to methadone
maintenance treatment programs for people who are addicted to heroin or other opiate
drugs; and (2) the
Federal and State regulations and other barriers impeding this access be eliminated. This
panel also stressed the importance of providing substance abuse counseling, psychosocial
therapies, and other supportive services to enhance retention and successful outcomes in
methadone maintenance treatment programs. The panel's full consensus statement is
available by calling 1-888-NIH-CONSENSUS (1-888-644-2667) or by visiting the NIH Consensus
Program Web site at http://consensus.nih.gov.
Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24
hours, has a proven record of success when prescribed at a high enough dosage level for
people addicted to heroin. LAAM, also a synthetic opiate medication for treating heroin
addiction, can block the effects of heroin for up to 72 hours. Other approved medications
are naloxone, which is used to treat cases of overdose, and naltrexone, both of which
block the effects of morphine, heroin, and other opiates. Several other medications for
use in heroin treatment programs are also under study.
There are many effective behavioral treatments available for heroin addiction. These can
include residential and outpatient approaches. Several new behavioral therapies are
showing particular promise for heroin addiction.
Contingency management therapy uses a voucher-based system, where patients earn
"points" based on negative drug tests, which they can exchange for items that
encourage healthful living. Cognitive-behavioral interventions are designed to help modify
the patient's thinking, expectancies, and behaviors and to increase skills in coping with
various life stressors.
Extent of Use
Monitoring the Future Study (MTF)**
According to the 1999 MTF, rates of heroin use remained relatively stable and low since
the late 1970s. After 1991, however, use began to rise among 10th- and 12th-graders, and
after 1993, among 8th-graders. In 1999, prevalence of heroin use was comparable for all
three grade levels. Although past year prevalence rates for heroin use remained relatively
low in 1999, these rates are about two to three times higher than those reported in 1991.
Heroin Use by Students, 1999:
Monitoring the Future Study
|Used in the Past Year
|Used in the Past Month
Community Epidemiology Work Group (CEWG)***
In June 2000, CEWG members reported that heroin indicators showed mixed trends. Mortality
figures were mixed, with deaths increasing notably in Austin, Detroit, Minneapolis/St.
Paul, and Phoenix, and declining in Miami, Philadelphia, St. Louis, San Diego, and
Seattle. Emergency room admissions were also mixed, with 10 cities showing decreases
(significant in San Francisco and Washington, D.C.), and 10 showing increases
(particularly Baltimore and Miami). Heroin continues to account for a substantial
proportion of treatment admissions in some CEWG areas (e.g., 47.8 percent in Baltimore, 43
percent in New York City, and 32 percent in Detroit). Heroin injection characterizes a
large proportion of primary heroin treatment admissions (e.g., 90 percent in Texas).
During the second quarter of 1999, the highest purity levels were found in Philadelphia
(71 percent); New York (63.6 percent); Boston (61.4 percent); Newark (60.7 percent);
Atlanta (57.8 percent); and San Diego (57.6 percent). Purity levels in other CEWG areas
ranged from 11.8 percent in Dallas to 46.7 percent in Detroit. Injecting is on an upward
trend among younger users in Baltimore, Boston, Minneapolis/St. Paul, Newark, New York
City, and Seattle. In Boston, Chicago, Denver, Miami, and Washington, D.C., snorting seems
to be increasing and is often the starting route for new users.
National Household Survey on Drug Abuse (NHSDA)ý
The 1999 NHSDA study reports the use of illicit drugs by those people age 12 and older.
The lifetime prevalence (at least one use in a persons lifetime) for heroin for those
people age 12 and older was 1.4 percent.
By age category, 0.4 percent were in the 12-17 range; 1.8 percent were 18-25; and 1.4
percent were users age 26 and older.
"Lifetime" refers to use at least once during a respondent's lifetime.
"Past year" refers to an individual's drug use at least once during the year
preceding their response to the survey. "Past month" refers to an individual's
drug use at least once during the month preceding their response to the survey.
* State Resources and Services Related to Alcohol and Other Drug Problems for Fiscal Year
1995: An Analysis of State Alcohol and Drug Abuse Profile Data, written by the National
Association of State Alcohol and Drug Abuse Directors (NASADAD), July 1997, is available
from NASADAD at 202-293-0090.
** The MTF survey is conducted by the University of Michigan's Institute for Social
Research and is funded by National Institute on Drug Abuse, National Institutes of Health;
it has tracked 12th graders' illicit drug use and related attitudes since 1975. In 1991,
8th and 10th graders were added to the study. For the 1998 study, 49,866 students were
surveyed from a representative sample of 422 public and private schools nationwide. Copies
of the latest survey are available from the National Clearinghouse for Alcohol and Drug
Information at 1-800-729-6686.
*** CEWG is a NIDA-sponsored network of researchers from 20 major U.S. metropolitan areas
and selected foreign countries who meet semiannually to discuss the current epidemiology
of drug abuse. CEWG's most recent report is Epidemiologic Trends in Drug Abuse, Volume I,
NHSDA is an annual survey conducted by the Substance Abuse and Mental Health Services
Copies of the latest survey are available from the National Clearinghouse for Alcohol and
Drug Information at 1-800-729-6686.