Table of Contents
- What is it?
- What Heroin is Called on the Street
- What Heroin Looks, Tastes, and Smells Like
- How Heroin is Used
- How Heroin Works
- Symptoms and Physical Consequences
- Abuse, Overdose, and Fatality Rates
- Responding to Overdose
What Heroin is (A Brief History)
Heroin (diacetylmorphine) is a semi-synthetic opioid derived from sap of the poppy plant. Originally synthesized from morphine by English chemist C.R. Alder Wright in 1874, it became available commercially in the late 1890’s by German pharmaceutical giant Bayer as a highly effective cough suppressant. They called the new drug Heroin.
Initial studies didn’t show the highly addictive properties of heroin. In fact, it was marketed as a more potent and safer alternative to morphine. Although many doctors began blowing the whistle as early as 1899, widespread recognition of its dangers lagged.
“It possesses many advantages over morphine. It’s not hypnotic, and there’s no danger of acquiring a habit.” wrote the Boston Medical and Surgical Journal still in 1900.
By the time the US government realized the evils of heroin addiction and began to formulate a policy response, nationwide abuse had begun in earnest. Heroin had gone from wonder drug to recreation substance of choice in the space of less than a decade.
The words of Hamilton Wright, a Teddy Roosevelt appointee and the nation’s first Opium Commissioner, described the scourge of heroin to the New York Times in 1911. It remains eerily relevant over 100 years later.
“The habit has this nation in its grip to an astonishing extent. Our prisons and our hospitals are full of victims of it, it has robbed ten thousand businessmen of moral sense and made them beasts who prey upon their fellows … it has become one of the most fertile causes of unhappiness and sin in the United States.”
The Harrison Narcotics Tax Act was the first major federal policy rollout aimed at preventing opiate addiction and by the mid 20’s heroin had been completely banned in America. Although in other countries (such as the UK) heroin is still used in the medical field, in this country it is classified as a schedule I drug under the Controlled Substance Act (CSA) and has no accepted medical use.
Aside from isolated outbursts such as in the 70’s, the heroin epidemic largely receded. In the last 25 years, however, it has returned with a vengeance. Tracing back to the mid 90’s when prescription opioids took center stage, abuse of heroin rapidly increased alongside it. Since 2010, it has once again been considered a crisis.
What Heroin is Called on the Street
- China white
- Hell Dust
What Heroin Looks, Tastes, and Smells Like
In its purest form, heroin is a refined white powder. However, on the street it is almost never found pure. When cut, heroin can vary greatly in color. It has been found as brown, black, pink/ beige or in the form of sticky black tar.
Fillers such as sugar, starches, and powdered milk are often added to increase profit margins. Stimulants like caffeine are mixed in to increase potency. More grievously, heroin is cut by dealers with opioids. Fentanyl is considerably cheaper to manufacture and easier to smuggle. This practice is a chief driver of heroin overdose deaths according to the CDC.
Heroin is commonly described as having a strong vinegar like smell. This is particularly true of dark or brown powdered heroin per a fact sheet released by the Department of Justice. As with its appearance, its odor is altered depending on the additives of a particular batch. Smells like band-aids, cat urine and litter, and even chocolate have been all been reported by drug abusers, as well the odor of any number of cutting agents used.
Its taste is naturally bitter, but once again, due to its varied additives it is difficult to identify strictly by taste alone.
How Heroin is Used
Heroin is ingested in a myriad of ways. Purer heroin is smoked or snorted. Impure versions are generally dissolved and injected through the muscles and veins. Injecting cocaine and heroin together are a common practice known as speedballing. This synergy of different drug effects generates a very specific high and is exceedingly dangerous.
The National Institute on Drug Abuse (NIDA) says that smoking or snorting is the method of choice for many new users. There is a fear of injection drugs due to the threat of “dirty” needles and its increased risk of infections like HIV and Hepatitis C. Available data also suggests that smoking or snorting decreases risk of overdose.
Degree of purity is on a batch by batch basis depending on many external factors. The dealer, the manufacturer, its place of origin, and with what it is laced all play a role in determining its potency. It is therefore difficult for the end user to understand the potency of a specific dose and leads to tragic consequences including overdose and death.
How Heroin Works
Like all opioids, heroin binds to the mu opioid receptors. These receptors reside in the areas of the brain that control pain and emotion and blocks pain messages. At the same time, Dopamine, the chemical that motivates us to engage in activities we find pleasurable and rewarding, increases its release. This produces the exhilaration and euphoria which is the root of addiction.
As the body builds up tolerance for the increased dopamine levels it needs higher dosages to feel that lift. Natural output of dopamine is no longer adequate to feel even normal, let alone euphoric.
Heroin’s effects wear off relatively quickly. Once the euphoria is gone, the body begins to search for the missing “high” and induces a constant demand to be fed. In other words, the user is now addicted.
Symptoms and Physical Consequences of Heroin
There are many symptoms and signs that indicate heroin addiction. If you are a family member of a sufferer of Substance Use Disorder (SUD) here are some things to be on the lookout for:
- Mood swings
- Confusion and impaired judgement
- Neglect of work and social responsibilities
- Possession of needles and other paraphernalia
- Itchiness and constant scratching
- Weight Loss
- Dry Mouth
- Nausea and vomiting
- Dilated pupils
- Flushed skin
- Injection scabs and sores
Besides indirect risks such as HIV infection mentioned above, there are a host of medical issues that stem directly from heroin abuse. Liver and kidney damage and respiratory illnesses such as Pneumonia are all effects of prolonged use. Suicide ideation, financial ruin and homelessness are all common in people who struggle with heroin addiction.
Abuse, Overdose, and Fatality Statistics
Heroin use has been increasing across the entire range of the American population since 2010. In 2015, over 80,000 ER visits were reported for heroin-related poisonings. Demographics historically not associated with rampant heroin abuse such as women, the privately insured and people with higher incomes, have suffered some of the most significant increases, per the Centers for Disease Control and Prevention (CDC).
Overdose deaths relating to heroin rose quintupled in the period between 2010 and 2017 and claimed over 15,000 lives in the final year of that study. As mentioned, many heroin deaths are linked to fentanyl combinations which are cheaper to produce and considerably more deadly.
Responding to Overdose
If a heroin user shows signs of overdose, it is imperative to act quickly. Breathing may slow or stop, and although he or she might be awake, they will have difficulty speaking. Other signs include blue fingernails and lips, limp extremities, clammy skin, vomiting, and gurgling sounds. If while sleeping, one hears unfamiliar sounds from a SUD sufferer, do not mistake it for snoring. It may be an overdose.
Naloxone should be administered immediately, and emergency services should be called.
Once the overdose has passed, it is vital for the drug user to enter detox and rehab. An overdose experience can be a catalyst for entering treatment and getting “clean”.
Great care should be taken when choosing a treatment provider. Detox must take place under the observation of competent medical professionals, as withdrawal can be fraught with emergencies and must be done carefully. Subsequent rehab and treatment will be needed for a sustainable recovery.
Find a facility that has integrity and their clients’ well-being foremost in their priorities. The heroin user’s life is at stake.