Heroin

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Heroin and morphine belong to a group of drugs called opiates. Opiates are derived from the opium poppy. Morphine was first identified as a painkiller in 1806. The problem with morphine was that people who took it often became addicted to it. They also experienced other undesirable side effects, such as nausea. At the end of the nineteenth century, a German scientist changed the molecules of morphine, hoping to produce a new drug that, like morphine, would relieve pain but that, unlike morphine, would not be addictive. This new drug was heroin. Within a year or two of its introduction, most of the medical community knew that heroin was not only stronger than morphine but that people who used it were even more likely to become addicted. By the 1920s, heroin had become the most widely abused of the opiates.

Heroin and morphine act in nearly identical ways on the body. Studies in cancer patients with severe pain show very little difference in the pain relief offered by the two drugs. They also produce similar feelings of euphoria (intense well-being). However, heroin may take effect more quickly, and it is two to three times stronger when injected. This is probably because heroin crosses from the blood into the brain more easily than does morphine. But when heroin is taken by mouth, its strength is the same as morphine's. Because heroin offers no major advantage over morphine in treating pain, heroin has no approved medical uses in the United States.

Heroin is available and used only as an illegal "street" drug. The purity of street heroin varies greatly, and many other substances and drugs are "cut" (mixed with) street heroin. As a result, the user has no way to know what he or she is buying. This makes street heroin doubly dangerous.

Typically, heroin is injected into the veins (intravenously). The injection provides a rapid "rush," or an immediate feeling of euphoria. This rush is thought to be the important factor in the addictiveness of heroin. The drug can also be injected under the skin (subcutaneously) or deep into the muscle (intramuscularly). Swelling and redness of veins due to repeated injections are called track marks. These tracks are one of the signs that a person is abusing drugs. Less commonly, heroin can be inhaled or smoked in a cigarette.

According to the National Household Survey on Drug Abuse, in 2000 an estimated 308,000 people 12 and older used heroin within the past year. A survey of high school students conducted in 2001 showed that 1 percent of 8th graders and 0.9 percent of 10th and 12th graders reported using heroin at some point in the past year, representing a small but important decline from the previous year.

Users of heroin develop tolerance to its effects. Chronic, or long- term, users of the drug become less sensitive to its euphoric and analgesic (painkilling) actions, as well as to its rush. Once users develop tolerance, they need to increase doses of the drug to achieve the effects they desire. Heroin users also become physically dependent on the drug, and experience withdrawal symptoms if they stop taking it. Heroin's effects last for approximately four to six hours. As a result, addicts must take the drug several times a day to prevent the appearance of withdrawal symptoms. The need to continue taking the drug to avoid withdrawal is an important factor in heroin's addictiveness.

People who take opiate drugs for medical reasons can be taken off the drug gradually without withdrawal symptoms. The dose must be lowered by 20 to 25 percent daily for two or three days until all use is ended. However, abruptly stopping morphine or heroin has very different results. The withdrawal symptoms that occur after abruptly stopping heroin include:

• eye tearing
• yawning
• sweating
• restlessness
• dilated pupils
• irritability
• diarrhea
• abdominal cramps
• waves of gooseflesh (the term "cold turkey" describes the goose- flesh that follows from abruptly stopping the drug)

The heroin withdrawal syndrome reaches a peak about two or three days after stopping the drug, and symptoms usually disappear within seven to ten days. Some low-level symptoms may last for many weeks.

Heroin use by a pregnant woman seriously affects the developing fetus. Babies of mothers dependent on heroin are born dependent. Special care must be taken to help them withdraw during their first weeks. Although withdrawal for the baby is miserable, heroin withdrawal is not usually life threatening.

Overdosing is a common problem among heroin addicts. One reason for frequent overdoses is the varying purity of the street drug, which makes it difficult for the addict to judge the size of a dose. Also, some substances used to cut the drug may be toxic (poisonous) themselves, contributing to a drug overdose. Furthermore, as a user becomes tolerant to the heroin rush and the euphoria, he or she may increase the dose past the point of safety in an attempt to intensify these sought- after sensations.

When a person takes an overdose, he or she falls into a stupor. It is difficult to wake the person up. The pupils are typically small and the skin may be cold and clammy. Seizures may occur. Breathing becomes slow, and the lips may darken to a bluish color. This blueness indicates that there is not enough oxygen in the blood. Most dangerously, heroin overdose causes respiratory depression, or a slowed rate of breathing. As a result, blood pressure may then fall. Most people who die after a heroin overdose die because of this respiratory failure. Typically, the heroin user has also taken other drugs—whether on purpose or because they were mixed with the heroin—and/or drunk alcohol. The presence of other substances in the body makes the heroin overdose even more dangerous.

Smack (1999), by Melvin Burgess, is the story of two teenagers who run away and become embroiled in heroin addiction. In a life filled with sex, drugs, and rock n roll, the two struggle to return to the real world and recover from their addictions.

Addiction: Concepts and Definitions; Heroin Treatment: Behavioral Approaches; Heroin Treatment: Medications; Opiate and Opioid Drug Abuse.

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