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Heroin
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
July 2008 Page 1 of 5
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.
Abuse?
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, www.drugabuse.gov:
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
www.whitehousedrugpolicy.gov/
streetterms/default.asp.
July 2008 Page 4 of 5
1
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 www.drugabuse.gov.
2
“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.
3
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 www.samhsa.gov 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.
July 2008 Page 5 of 5
