Drug Facts - Heroin

Overview

Heroin is a highly addictive drug and is the most widely abused and most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.

Pure heroin, which is a white powder with a bitter taste, is rarely sold on the streets. Most illicit heroin is a powder varying in color from white to dark brown. The differences in color are due to impurities left from the manufacturing process or the presence of additives. Another form of heroin, "black tar" heroin, is primarily available in the western and southwestern U.S. This heroin, which is produced in Mexico, may be sticky like roofing tar or hard like coal, with its color varying from dark brown to black.

Heroin can be injected, smoked, or sniffed/snorted. Injection is the most efficient way to administer low-purity heroin. The availability of high-purity heroin, however, and the fear of infection by sharing needles has made snorting and smoking the drug more common. National Institute on Drug Abuse (NIDA) researchers have confirmed that all forms of heroin administration are addictive.

Extent of Use

According to the 2008 National Survey on Drug Use and Health (NSDUH), approximately 3.8 million Americans aged 12 or older reported trying heroin at least once during their lifetimes, representing 1.5% of the population aged 12 or older. Approximately 453,000 (0.2%) reported past year heroin use and 213,000 (0.1%) reported past month heroin use.

In 2008, there were 114,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. The average age at first use among recent initiates aged 12 to 49 was 23.4 years in 2008. There were no significant changes in the number of initiates or in the average age at first use from 2007 to 2008. The number of heroin initiates was not significantly different from the number in 2002 (117,000).

Among students surveyed as part of the 2008 Monitoring the Future study, 1.4% of eighth graders, 1.2% of tenth graders, and 1.3% of twelfth graders reported lifetime use of heroin.

Approximately 75.5% of eighth graders, 83.1% of tenth graders, and 73.2% of twelfth graders surveyed in 2008 reported that using heroin occasionally without a needle was a “great risk.” Additionally, approximately 86.4% of twelfth graders surveyed in 2008 reported that using heroin regularly was a “great risk.”

Regarding the ease by which one can obtain heroin, 13.3% of eighth graders, 17.2% of tenth graders, and 25.4% of twelfth graders surveyed in 2008 reported that heroin was "fairly easy" or "very easy" to obtain.

The Centers for Disease Control and Prevention (CDC) also conducts a survey of high school students throughout the United States called the Youth Risk Behavior Surveillance System (YRBSS). Among students surveyed for the 2007 YRBSS, 2.3% reported using heroin at least one time during their lifetimes.

Approximately 0.5% of college students and 1.6% of young adults (ages 19-28) surveyed in 2007 reported lifetime use of heroin.

According to data from the Bureau of Justice Statistics, approximately 23.4% of State prisoners and 17.9% of Federal prisoners surveyed in 2004 indicated that they used heroin/opiate at some point in their lives.

Health Effects

The short-term effects of heroin abuse appear soon after taking the drug. Intravenous injection provides the greatest intensity and most rapid onset of the initial rush that users experience. Intravenous users typically experience the rush within 7 to 8 seconds after injection, while intramuscular injection produces a slower onset of this euphoric feeling, taking 5 to 8 minutes. When heroin is sniffed or smoked, the peak effects of the drug are usually felt within 10 to 15 minutes.

In addition to the initial feeling of euphoria, the short-term effects of heroin include a warm flushing of the skin, dry mouth, and heavy extremities. After the initial euphoric feeling, the user experiences an alternately wakeful and drowsy state. Due to the depression of the central nervous system, mental functioning becomes clouded. Additionally, breathing may be slowed to the point of respiratory failure.

After repeatedly using heroin for a period of time, the long-term effects of the substance begin to appear in the user. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver disease. Additionally, pulmonary complications, including various types of pneumonia, may also result in the user.

One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity or effect that they are seeking. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop.

Within a few hours after the last administration of heroin, withdrawal may occur. This withdrawal can produce effects such as drug craving, restlessness, muscle and bone pain, and vomiting. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week.

In addition to the effects of the drug itself, users who inject heroin also put themselves at risk for contracting HIV, hepatitis C (HCV), and other infectious diseases. Approximately 70–80% of the new HCV infections in the U.S. each year are among injection drug users.

Street heroin is often mixed with various substances, including sugar, starch, quinine, and sometimes, strychnine or other poisons, causing an added danger to using heroin. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at a great risk of overdose or death.

Of an estimated 113 million emergency department (ED) visits in the U.S. during 2006, the Drug Abuse Warning Network (DAWN) estimates that 1,742,887 were drug-related. DAWN data indicate that heroin was involved in 189,780 ED visits.

Treatment

A variety of effective treatments are available for heroin addiction. For example, methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has proven successful for heroin addiction. Additionally, buprenorphine and many behavioral therapies are also used to treat heroin addiction.

From 1997 to 2007, the number of admissions to treatment in which heroin was the primary drug of abuse increased from 235,143 in 1997 to 246,871 in 2007. Heroin admissions represented 14.6% of the total drug/alcohol admissions to treatment during 1997 and 13.6% of the treatment admissions in 2007. The average age of those admitted to treatment for heroin during 2007 was 36 years.

Arrests & Sentencing

During FY 2004, there were 32,980 Federal arrests for drug law violations, 1,881 of which were for heroin. Additionally, the Drug Enforcement Administration (DEA) reported 2,273 arrests for opiates in FY 2004.

During FY 2008, there were 1,476 Federal offenders sentenced for heroin-related charges in U.S. Courts. Approximately 97.3% of these cases involved trafficking and 0.8% of cases involved simple possession.

The Arrestee Drug Abuse Monitoring (ADAM) II program is designed to gather information on drug use and related matters from adult male offenders within 48 hours of arrest. ADAM II serves as a critical source of data for estimating trends in drug use in local areas, understanding the relationship between drugs and crime, and describing drug market activity in the adult male arrestee population in 10 U.S. sites during 2008. Self-report data on recent use show a consistently high frequency of use among arrestees who use heroin. In 7 of the 10 sites arrestees who admit heroin use report that they use it 15 or more days out of the month.

Production & Trafficking

The U.S. heroin market is supplied entirely from foreign sources of opium. Heroin available in the U.S. is produced in four distinct geographical areas: South America (Colombia), Southeast Asia (primarily Burma), Mexico, and Southwest Asia (principally Afghanistan).

Much of the heroin used in the United States comes from poppies grown in Colombia and Mexico, though opium gum production in these countries accounts for less than 4% of the world’s total production and Colombian production has been cut by 60% since 2001. Mexico supplies most of the heroin found in the western United States while Colombia supplies most of the heroin east of the Mississippi. Colombian law enforcement eradicated 375 hectares of opium poppy in 2007, while the Government of Mexico (GOM) reported eradicating 7,784 hectares of opium poppy.

According to 2006 Federal-wide Drug Seizure System (FDSS) data, Federal agencies seized 1,774 kilograms of heroin. FDSS contains information about drug seizures made within the jurisdiction of the United States by the DEA, Federal Bureau of Investigation, U.S. Customs Service, U.S. Border Patrol, and U.S. Coast Guard.

Legislation

Heroin was first synthesized from morphine in 1874 and became widely used in medicine in the early 1900s. At that time, physicians were unaware of heroin's potential for addiction. The first comprehensive control of heroin in the U.S. occurred with the Harrison Narcotic Act of 1914. Heroin currently falls into Schedule I of the Controlled Substances Act based on its potential for abuse and its lack of accepted medical use.

Street Terms

Term Drug(s)
A-bomb Marijuana mixed with Heroin
Big H Heroin
Dragon Rock Heroin mixed with Cocaine
Hell Dust Heroin
Nose Drops Liquefied Heroin
Smack Heroin

Taken from the Office of National Drug Control Policy Website.