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Heroin is a synthetic opiate drug that is     also located in the brain stem—impor-
highly addictive. It is made from mor-        tant for automatic processes critical for
phine, a naturally occurring substance        life, such as breathing, blood pressure,
extracted from the seed pod of the Asian      and arousal. Heroin overdoses frequently
opium poppy plant. Heroin usually             involve a suppression of respiration.
appears as a white or brown powder
                                              After an intravenous injection of heroin,
or as a black sticky substance, known
                                              users report feeling a surge of euphoria
as “black tar heroin.”
                                              (“rush”) accompanied by dry mouth, a
                                              warm flushing of the skin, and a heavi-
How is Heroin Abused?                         ness of the extremities. Following this
Heroin can be injected, snorted/sniffed,      initial euphoria, the user goes “on the
or smoked—routes of administration that       nod,” an alternately wakeful and drowsy
rapidly deliver the drug to the brain.        state. Mental functioning becomes cloud-
Injecting is the use of a needle to release   ed. Users who do not inject the drug
the drug directly into the bloodstream.       may not experience the initial rush, but
Snorting is the process of inhaling heroin    other effects are the same.
powder through the nose, where it is
absorbed into the bloodstream through         With regular heroin use, tolerance devel-
the nasal tissues. Smoking involves inhal-    ops. This means the abuser must use
ing heroin smoke into the lungs. All three    more heroin to achieve the same intensi-
methods of administering heroin can           ty of effect. Eventually, chemical changes
lead to addiction and other severe            in the brain can lead to addiction.
health problems.
                                              What Other Adverse Effects
How Does Heroin Affect the                    Does Heroin Have on
Brain?                                        Health?
Heroin enters the brain, where it is con-     Heroin abuse is associated with serious
verted to morphine and binds to recep-        health conditions, including fatal over-
tors known as opioid receptors. These         dose, spontaneous abortion, and—
receptors are located in many areas of        particularly in users who inject the
the brain (and in the body), especially       drug—infectious diseases, including
those involved in the perception of pain      HIV/AIDS and hepatitis. Chronic users
and in reward. Opioid receptors are           may develop collapsed veins, infection

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of the heart lining and valves, abscesses,     Heroin abuse during pregnancy, togeth-
and liver or kidney disease. Pulmonary         er with related factors like poor nutrition
complications, including various types of      and inadequate prenatal care, has been
pneumonia, may result from the poor            associated with adverse consequences
health of the abuser, as well as from          including low birthweight, an important
heroin’s depressing effects on respira-        risk factor for later developmental delay.
tion. In addition to the effects of the drug   If the mother is regularly abusing the
itself, street heroin often contains toxic     drug, the infant may be born physically
contaminants or additives that can clog        dependent on heroin and could suffer
the blood vessels leading to the lungs,        from serious medical complications
liver, kidneys, or brain, causing perma-       requiring hospitalization.
nent damage to vital organs.
Chronic use of heroin leads to physical
                                               What Treatment Options
dependence, a state in which the body          Exist?
has adapted to the presence of the drug.       A range of treatments exist for heroin
If a dependent user reduces or stops use       addiction, including medications and
of the drug abruptly, they may experi-         behavioral therapies. Science has taught
ence severe symptoms of withdrawal.            us that when medication treatment is
These symptoms, which can begin as             integrated with other supportive services,
early as a few hours after the last drug       patients are often able to stop using
administration, include restlessness, muscle   heroin (or other opiates) and return to
and bone pain, insomnia, diarrhea and          stable and productive lives.
vomiting, cold flashes with goose bumps
                                               Treatment often begins with medically
(“cold turkey”), kicking movements
                                               assisted detoxification, to help patients
(“kicking the habit”), and other symp-
                                               withdraw from the drug safely.
toms. Users also experience severe
                                               Medications such as clonidine and, now,
craving for the drug during withdrawal,
                                               buprenorphine can be used to help mini-
precipitating continued abuse and/or
                                               mize symptoms of withdrawal. However,
relapse. Major withdrawal symptoms
                                               detoxification alone is not treatment and
peak between 48 and 72 hours after the
                                               has not been shown to be effective in
last dose and typically subside after
                                               preventing relapse—it is merely the
about a week; however, some individu-
                                               first step.
als may show persistent withdrawal
symptoms for months. Although heroin           Medications to help prevent relapse
withdrawal is considered less dangerous        include:
than alcohol or barbiturate withdrawal,
                                               • Methadone, which has been used for
sudden withdrawal by heavily depend-
                                                 more than 30 years to treat heroin
ent users who are in poor health is
                                                 addiction. It is a synthetic opiate
occasionally fatal.

July 2008                                                                      Page 2 of 5
   medication that binds to the same         abuse. Preliminary evidence suggests
   receptors as heroin; but when taken       that buprenorphine also is a safe and
   orally, as dispensed, it has a gradual    effective treatment during pregnancy,
   onset of action and sustained effects,    although infants exposed to either
   reducing the desire for other opioid      methadone or buprenorphine prenatally
   drugs while preventing withdrawal         may require treatment for withdrawal
   symptoms. Properly prescribed             symptoms. For women who do not want
   methadone is not intoxicating or          or are not able to receive pharmacother-
   sedating, and its effects do not inter-   apy for their heroin addiction, detoxifi-
   fere with ordinary daily activities. At   cation from opiates during pregnancy
   the present time, methadone is only       can be accomplished with medical
   available through specialized opiate      supervision, although potential risks to
   treatment programs.                       the fetus and the likelihood of relapse to
• Buprenorphine is a more recently           heroin use should be considered.
  approved treatment for heroin addic-       There are many effective behavioral
  tion (and other opiates). It differs       treatments available for heroin addic-
  from methadone in having less risk         tion—usually in combination with med-
  for overdose and withdrawal effects,       ication. These can be delivered in resi-
  and importantly, it can be prescribed      dential or outpatient settings. Examples
  in the privacy of a doctor’s office.       are: contingency management, which
• Naltrexone is approved for treating        uses a voucher-based system where
  heroin addiction but has not been          patients earn “points” based on negative
  widely utilized because of compli-         drug tests, which they can exchange for
  ance issues. It is an opioid receptor      items that encourage healthy living; and
  blocker, which has been shown to be        cognitive-behavioral therapy, designed
  effective in highly motivated patients.    to help modify a patient’s expectations
  It should only be used in patients         and behaviors related to drug abuse,
  who have already been detoxified in        and to increase skills in coping with
  order to prevent severe withdrawal         various life stressors.
  symptoms. Naloxone is a shorter
  acting opioid receptor blocker, used       How Widespread is Heroin
  to treat cases of overdose.
For pregnant heroin abusers, methadone
maintenance combined with prenatal           Monitoring the Future Survey1
care and a comprehensive drug treat-         According to the 2007 Monitoring the
ment program can improve many of the         Future survey, there were no significant
detrimental maternal and neonatal out-       changes since 2006 in the proportion of
comes associated with untreated heroin       students in 8th, 10th, and 12th grades

July 2008                                                                    Page 3 of 5
reporting lifetime,2 past-year, and past-          National Survey on Drug Use and
month use of heroin overall.                       Health (NSDUH)3
Heroin use has been steadily declining             According to the 2006 National Survey
since the mid-1990s. Recent peaks in               on Drug Use and Health, the number of
heroin use were observed in 1996 for               current (past-month) heroin users in the
8th-graders, 1997–2000 for 10th-                   United States increased from 136,000
graders, and 2000 for 12th-graders.                in 2005 to 338,000 in 2006. The cor-
Annual prevalence of heroin use in                 responding prevalence rate increased
2007 dropped significantly, by between             from 0.06 to 0.14 percent. There were
38 percent and 40 percent, from these              91,000 first-time users of heroin aged
recent peak use years for each grade               12 or older in 2006, down from
surveyed.                                          108,000 reported in 2005. Among per-
                                                   sons aged 12 to 49, the average age at
                                                   first use of heroin was 20.7 years.
       Heroin Use by Students
  2007 Monitoring the Future Survey
                                                   Other Information Sources
             8th Grade   10th Grade   12th Grade   For additional information on heroin,
                                                   please refer to the following sources on
Lifetime       1.3%        1.5%         1.5%
                                                   NIDA’s Web site,
Past Year      0.8         0.8          0.9
                                                   • Heroin Abuse—Research Report
Past Month     0.4         0.4          0.4          Series
                                                   • Various issues of NIDA Notes (search
                                                     by “heroin” or “opiates”)
                                                   For a list of street terms used to refer
                                                   to heroin and other drugs, visit

July 2008                                                                           Page 4 of 5
  These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse,
National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social
Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and
10th-graders were added to the study. The latest data are online at
 “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the
year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days pre-
ceding an individual’s response to the survey.
 NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age
12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest
survey are available at and from NIDA at 877-643-2644.

     National Institutes of Health – U.S. Department of Health and Human Services
    This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.

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