Heroin
Also known As:
H, Brown, China white, Chiva, Dope, Horse, Junk, Smak, and Tar.
What is it?
Heroin is from the opioid family of drugs which includes natural, synthetic and semi-synthetic opioids. Opiates, such as morphine and codeine, are natural opioids found in the opium poppy. Synthetic opioids, such as methadone, are chemically made. Heroin is a semi-synthetic opioid: it is made from morphine that has been chemically processed. It enters the brain quickly and produces a more immediate effect (CAMH, 2019).
How does it work?
When heroin is used it produces euphoria or a “rush”, followed by a period of sedation and tranquility (CAMH, 2019). Heroin binds to mu-opioid receptors in the brain, which regulate feelings of pain and well-being. When these receptors are activated in the brain’s reward centre, they stimulate the release of the neurotransmitter dopamine, which contributes to habit-forming behaviour (NIH, 2018).
What does it look like?
In its pure form, heroin, is a fine, white, bitter-tasting powder that dissolves in water. When it is sold on the street, its colour and consistency vary depending on how it is made and what additives it has been “cut” with (CAMH, 2019).
Street heroin may come in the form of a white powder (a.k.a. “White China” ), a brown and sometimes grainy substance or a dark brown sticky gum (a.k.a. “Tar”). The purity of heroin varies from batch to batch (CAMH, 2019).
Is there a safe dose?
Under prohibition, there is no safe dose. Because heroin is an illicit drug that is typically cut with other substances, its content and potency is usually unknown. Due to individual differences and tolerance, a dose that is safe for one person may be lethal for another. Heroin is increasingly being adulterated with highly dangerous fentanyl and carfentanil, which can cause deadly overdoses from extremely small doses.
Effects
When heroin is injected into a vein, it produces a surge of euphoria, or “rush.” This feeling is not as intense when it is snorted or smoked. Following the rush, there is a period of sedation and tranquility known as being “on the nod.” New users often experience nausea and vomiting (CAMH, 2019).
The desired effects of heroin include detachment from physical and emotional pain and a feeling of well-being. Other effects include slowed breathing, pinpoint pupils, itchiness and sweating. Regular use results in constipation, loss of sexual interest and libido and irregular or missed periods in women (CAMH, 2019).
The effects of heroin may be different depending on factors such as your age, how much you use, how often you use it, how long you have been using it, the method of consumption, the environment you’re in, existing medical and psychiatric issues, and other drug and alcohol use (CAMH, 2019).
Desired Effects include:
Euphoria
Tranquility
Detachment from physical and emotional pain
A sense of well-being
Physical effects include:
Sedation
Nausea
Vomiting
Slowed breathing
Pinpoint pupils
Itchiness
Sweating
How long does it last?
If heroin is injected into a vein, the rush is felt in seven or eight seconds and lasts from 45 seconds to a few minutes. When it's injected under the skin or into a muscle, the effect comes on slower, within five to eight minutes. Someone may be "on the nod” for up to an hour. Regardless of how it is used, the effects of heroin generally last for three to five hours, depending on the dose. People who use heroin daily must use every six to 12 hours to avoid symptoms of withdrawal (CAMH, 2019).
Side effects and cautions
Overdose
Heroin is dangerous for a number of reasons. The most immediate danger is overdose. In an opioid overdose, breathing slows down and may stop completely. A person who has overdosed is unconscious and cannot be roused, and has skin that is cold, moist and bluish (CAMH, 2019).
If someone is overdosing, call 911 immediately. While you are waiting for medical help to arrive, you can use naloxone to temporarily reverse the effects of the overdose.
The risk of overdose is increased by (CAMH, 2019):
The unknown purity of the drug, which makes it difficult to determine the correct dose
Injection, because the drug reaches the brain more quickly than by other ways of taking the drug, and because the dose is taken all at once
Combining heroin with other sedating drugs, such as alcohol, benzodiazepines or methadone.
Addiction
Regular use of heroin can lead to addiction within two to three weeks. Signs of addiction include (CAMH, 2019):
using over a longer period or using more than planned
wanting to quit or cut down, or trying unsuccessfully to quit
spending a lot of time and effort getting, using and recovering from opioids
experiencing cravings
failing to fulfil responsibilities at work, school or home as a result of opioid use
continuing to use opioids despite the negative social consequences caused by opioid use
giving up activities that were once enjoyable
using opioids in dangerous situations
needing to take more of the drug to get the same effect (tolerance, a sign of physical dependence)
feeling ill when opioid use suddenly stops (withdrawal, a sign of physical dependence)
showing signs of opioid intoxication (e.g., nodding off, pinpoint pupils).
Not all people who experiment with heroin become addicted. Some people use the drug only on occasion, such as on weekends, without increasing the dose. However, with regular use, people develop tolerance, and they may need more of the drug to achieve the same effects. This can lead to physical dependence on heroin (CAMH, 2019).
Once someone is dependent, stopping their use can be extremely difficult. People who have used heroin for a long time often report that they no longer experience any pleasure from the drug. They may continue to use heroin to avoid the symptoms of withdrawal and to control their craving for the drug (CAMH, 2019).
Long-Term Effects
Research using brain scans shows that long-term regular use of heroin results in changes in the way the brain works. While the effect of these changes is not fully understood, this research illustrates that it may take months or years for the brain to return to previous functioning after a person stops using heroin (CAMH, 2019).
Because heroin is an illicit substance, there may be other long-term effects associated with impurities in the drug, and harms resulting from overdoses (CAMH, 2019).
Other considerations
Injecting. Injection drug use can put a person at high risk of bacterial infections, blood poisoning, skin infections and collapsed veins. Sharing needles increases the risk of becoming infected with, or spreading, HIV and hepatitis B or C (CAMH, 2019). Always use new sterile equipment.
Mixing drugs: Combining heroin with other drugs, such as cocaine (in “speedballs”): When drugs interact inside the body, the results are unpredictable and sometimes deadly (CAMH, 2019).
High-risk behaviour: Addiction can cause a constant need to obtain heroin and the repeated use of the drug can result in high-risk behaviour and breakdown of family and social life (CAMH, 2019).
Pregnancy: Women who regularly use heroin often miss their periods; some mistakenly think that they are infertile, and become pregnant. Continued use of heroin during pregnancy is very risky for the baby (CAMH, 2019). If pregnant, it is important to seek opioid replacement therapy.
Therapeutic Uses?
While there are no known therapeutic uses for heroin - other opiates, such as codeine, morphine, methadone, and fentanyl are regularly used for therapeutic purposes. Opioids are typically used to relieve severe pain, and are also used as substitution therapies to manage withdrawal symptoms in people with opioid addictions.
Harm Reduction Tips
Follow these tips In order to reduce the possible harms related to opioids:
Start with a low dose and increase your dose slowly. Don’t rush.
Don’t mix opioids with other drugs. It is particularly dangerous to mix heroin with other depressants, such as benzodiazepines (i.e. Valium, Xanax) and alcohol.
Don’t use alone: Use the buddy system and stagger your use with another person. If you must use alone, call a friend to tell them you are using and arrange a call-back
If injecting, don’t share injection equipment, always use new equipment, disinfect your skin, and follow safer injection tips.
If possible, use in a comfortable, safe, and familiar environment
Keep naloxone on hand in case of overdose. If someone finds you unconscious, they will be able to use your naloxone kit to revive you
Legal Status: Use, Possession, & Distribution
Heroin is classified under the “Controlled Drugs and Substances Act” as a Schedule I drug. This means that heroin is among the most heavily policed drugs, and even small possession can lead to criminal charges and “possible imprisonment for a term not exceeding seven years” (Government of Canada, 2019).
References
Centre for Addiction and Mental Health (CAMH). (2019). Heroin. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/heroin
Government of Canada. (2019). Controlled Drugs and Substances Act. Retrieved from https://laws-lois.justice.gc.ca/eng/acts/c-38.8/
National Institute on Drug Abuse (NIH). (2018). Heroin: What effects does heroin have on the body. Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/how-heroin-used
Image sources
Banner, yellow, and black tar heroin images. (2019). Drug Free VA. Retrieved from https://drugfreeva.org/sink-or-swim/drug-facts/street-drugs/heroin/#