Heroin is an addictive drug, and its use is    an alternately wakeful and drowsy state.
a serious problem in America. Recent           Mental functioning becomes clouded due
studies suggest a shift from injecting her-    to the depression of the central nervous
oin to snorting or smoking because of          system. Long-term effects of heroin
increased purity and the misconception         appear after repeated use for some peri-
that these forms are safer.                    od of time. Chronic users may develop
                                               collapsed veins, infection of the heart lin-
Heroin is processed from morphine, a
                                               ing and valves, abscesses, cellulitis, and
naturally occurring substance extracted
                                               liver disease. Pulmonary complications,
from the seedpod of the Asian poppy
                                               including various types of pneumonia,
plant. Heroin usually appears as a white
                                               may result from the poor health condition
or brown powder. Street names for heroin
                                               of the abuser, as well as from heroin’s
include “smack,” “H,” “skag,” and “junk.”
                                               depressing effects on respiration.
Other names may refer to types of heroin
produced in a specific geographical area,      Heroin abuse during pregnancy and its
such as “Mexican black tar.”                   many associated environmental factors
                                               (e.g., lack of prenatal care) have been
Health Hazards ———                             associated with adverse consequences
                                               including low birth weight, an important
Heroin abuse is associated with serious        risk factor for later developmental delay.
health conditions, including fatal over-
                                               In addition to the effects of the drug itself,
dose, spontaneous abortion, collapsed
                                               street heroin may have additives that do
veins, and, particularly in users who inject
                                               not readily dissolve and result in clogging
the drug, infectious diseases, including
                                               the blood vessels that lead to the lungs,
HIV/AIDS and hepatitis.
                                               liver, kidneys, or brain. This can cause
The short-term effects of heroin abuse         infection or even death of small patches
appear soon after a single dose and dis-       of cells in vital organs.
appear in a few hours. After an injection
                                               The Drug Abuse Warning Network* lists
of heroin, the user reports feeling a surge
                                               heroin/morphine among the four most fre-
of euphoria (“rush”) accompanied by a
                                               quently mentioned drugs reported in drug-
warm flushing of the skin, a dry mouth,
                                               related death cases in 2002. Nationwide,
and heavy extremities. Following this ini-
                                               heroin emergency department mentions
tial euphoria, the user goes “on the nod,”

February 2005                                                                     Page 1 of 4
were statistically unchanged from 2001        Science has taught us that when medica-
to 2002, but have increased 35 percent        tion treatment is integrated with other sup-
since 1995.                                   portive services, patients are often able to
                                              stop heroin (or other opiate) use and return
Tolerance, Addiction,                         to more stable and productive lives.
and Withdrawal
                                              In November 1997, the National Institutes
With regular heroin use, tolerance devel-
                                              of Health (NIH) convened a Consensus
ops. This means the abuser must use more
                                              Panel on Effective Medical Treatment of
heroin to achieve the same intensity of
                                              Heroin Addiction. The panel of national
effect. As higher doses are used over
                                              experts concluded that opiate drug addic-
time, physical dependence and addiction
                                              tions are diseases of the brain and med-
develop. With physical dependence, the
                                              ical disorders that indeed can be treated
body has adapted to the presence of the
drug and withdrawal symptoms may              effectively. The panel strongly recom-
occur if use is reduced or stopped.           mended (1) broader access to methadone
                                              maintenance treatment programs for peo-
Withdrawal, which in regular abusers          ple who are addicted to heroin or other
may occur as early as a few hours after       opiate drugs; and (2) the Federal and
the last administration, produces drug        State regulations and other barriers
craving, restlessness, muscle and bone        impeding this access be eliminated. This
pain, insomnia, diarrhea and vomiting,        panel also stressed the importance of pro-
cold flashes with goose bumps (“cold          viding substance abuse counseling, psy-
turkey”), kicking movements (“kicking the     chosocial therapies, and other supportive
habit”), and other symptoms. Major with-      services to enhance retention and success-
drawal symptoms peak between 48 and           ful outcomes in methadone maintenance
72 hours after the last dose and subside      treatment programs. The panel’s full con-
after about a week. Sudden withdrawal         sensus statement is available by calling
by heavily dependent users who are in         1-888-NIH-CONSENSUS (1-888-644-
poor health is occasionally fatal, although   2667) or by visiting the NIH Consensus
heroin withdrawal is considered less          Development Program Web site at
dangerous than alcohol or barbiturate         consensus.nih.gov.
                                              Methadone, a synthetic opiate medica-
                                              tion that blocks the effects of heroin for
Treatment ———                                 about 24 hours, has a proven record
There is a broad range of treatment op-       of success when prescribed at a high
tions for heroin addiction, including med-    enough dosage level for people addicted
ications as well as behavioral therapies.     to heroin. Other approved medications

February 2005                                                                  Page 2 of 4
are naloxone, which is used to treat cases    therapies are showing particular promise
of overdose, and naltrexone, both of          for heroin addiction. Contingency man-
which block the effects of morphine,          agement therapy uses a voucher-based
heroin, and other opiates.                    system, where patients earn “points”
                                              based on negative drug tests, which they
For the pregnant heroin abuser, metha-
                                              can exchange for items that encourage
done maintenance combined with prenatal
                                              healthful living. Cognitive-behavioral
care and a comprehensive drug treatment
                                              interventions are designed to help modify
program can improve many of the detri-
                                              the patient’s thinking, expectancies, and
mental maternal and neonatal outcomes
                                              behaviors and to increase skills in coping
associated with untreated heroin abuse.
                                              with various life stressors.
There is preliminary evidence that
buprenorphine also is safe and effective
in treating heroin dependence during          Extent of Use ———
pregnancy, although infants exposed to
methadone or buprenorphine during preg-       Monitoring the Future (MTF)
nancy typically require treatment for with-   Survey**
drawal symptoms. For women who do not         According to the 2004 MTF, rates of her-
want or are not able to receive pharma-       oin use were stable among all three
cotherapy for their heroin addiction,         grades measured.
detoxification from opiates during preg-
nancy can be accomplished with relative
safety, although the likelihood of relapse       Heroin Use by Students, 2004:
to heroin use should be considered.              Monitoring the Future Survey
                                                             8th-    10th-   12th-
Buprenorphine is a recent addition to the                   Graders Graders Graders
array of medications now available for
                                              Lifetime***     1.6%      1.5%       1.5%
treating addiction to heroin and other
opiates. This medication is different from    Annual          1.0       0.9        0.9

methadone in that it offers less risk of      30-day          0.5       0.5        0.5
addiction and can be dispensed in the
privacy of a doctor’s office. Several other
medications for use in heroin treatment       Community Epidemiology Work
programs are also under study.                Group (CEWG) §
                                              In December 2003, CEWG members re-
There are many effective behavioral treat-
                                              ported that heroin indicators were mixed
ments available for heroin addiction.
                                              but relatively stable, continuing at higher
These can include residential and outpa-
                                              levels in Northeastern, north-central, and
tient approaches. Several new behavioral
                                              mid-Atlantic areas where high-purity

February 2005                                                                   Page 3 of 4
powder is available, and also in the                                was highest in Detroit (464) and
Northwest where black tar heroin pre-                               Philadelphia (111).
dominates. Heroin injection and the
health risks associated with it, such as the                        National Survey on Drug Use and
spread of HIV/AIDS and hepatitis C, are                             Health (NSDUH) §§
of growing concern at several CEWG                                  The 2003 NSDUH reports stability at low
sites. In 2002, rates of heroin emergency                           levels for heroin use among young peo-
department mentions exceeded 200 per                                ple. In 2002, 13,000 youth between the
100,000 in Chicago, Newark, and                                     ages of 12 and 17 had used heroin at
Baltimore and exceeded 100 per                                      least once in the past year (“annual” use),
100,000 in Seattle, New York City, San                              compared with 12,000 in 2003. Among
Francisco, Boston, and Philadelphia. The                            the general population age 12 and older,
reporting of heroin/opiate-related deaths                           404,000 had used annually in 2002,
                                                                    compared with 314,000 in 2003.

* The Drug Abuse Warning Network survey is funded by the Substance Abuse and Mental Health Services Administration
(SAMHSA). Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information
at 1-800-729-6686, or at www.samhsa.gov.
** These data are from the 2004 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National
Institutes of Health, DHHS, and conducted 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.
*** “Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to an individual’s drug use at
least once during the year preceding their response to the survey. “30-day” refers to an individual’s drug use at least
once during the month preceding their response to the survey.
 CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign
countries who meet semiannually to discuss the current epidemiology of drug abuse. CEWG’s most recent report is
Epidemiologic Trends in Drug Abuse, Advance Report, December 2003.
  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 the National Clearinghouse for Alcohol and Drug Information at

     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.

February 2005                                                                                                   Page 4 of 4

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