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Heroin is an addictive drug, and its use is

a serious problem in America. Recent

studies suggest a shift from injecting heroin to snorting or smoking because of

increased purity and the misconception

that these forms are safer.

Heroin is processed from morphine, a

naturally occurring substance extracted

from the seedpod of the Asian poppy

plant. Heroin usually appears as a white

or brown powder. Street names for heroin

include “smack,” “H,” “skag,” and “junk.”

Other names may refer to types of heroin

produced in a specific geographical area,

such as “Mexican black tar.”

Health Hazards ———

Heroin abuse is associated with serious

health conditions, including fatal overdose, spontaneous abortion, collapsed

veins, and, particularly in users who inject

the drug, infectious diseases, including

HIV/AIDS and hepatitis.

The short-term effects of heroin abuse

appear soon after a single dose and disappear in a few hours. After an injection

of heroin, the user reports feeling a surge

of euphoria (“rush”) accompanied by a

warm flushing of the skin, a dry mouth,

and heavy extremities. Following this initial euphoria, the user goes “on the nod,”

an alternately wakeful and drowsy state.

Mental functioning becomes clouded due

to the depression of the central nervous

system. Long-term effects of heroin

appear after repeated use for some period of time. Chronic users may develop

collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and

liver disease. Pulmonary complications,

including various types of pneumonia,

may result from the poor health condition

of the abuser, as well as from heroin’s

depressing effects on respiration.

Heroin abuse during pregnancy and its

many associated environmental factors

(e.g., lack of prenatal care) have been

associated with adverse consequences

including low birth weight, an important

risk factor for later developmental delay.

In addition to the effects of the drug itself,

street heroin may have additives that do

not readily dissolve and result in clogging

the blood vessels that lead to the lungs,

liver, kidneys, or brain. This can cause

infection or even death of small patches

of cells in vital organs.

The Drug Abuse Warning Network* lists

heroin/morphine among the four most frequently mentioned drugs reported in drugrelated death cases in 2002. Nationwide,

heroin emergency department mentions

Heroin
were statistically unchanged from 2001

to 2002, but have increased 35 percent

since 1995. 

Tolerance, Addiction,

and Withdrawal

With regular heroin use, tolerance develops. This means the abuser must use more

heroin to achieve the same intensity of

effect. As higher doses are used over

time, physical dependence and addiction

develop. With physical dependence, the

body has adapted to the presence of the

drug and withdrawal symptoms may

occur if use is reduced or stopped.

Withdrawal, which in regular abusers

may occur as early as a few hours after

the last administration, produces drug

craving, restlessness, muscle and bone

pain, insomnia, diarrhea and vomiting,

cold flashes with goose bumps (“cold

turkey”), kicking movements (“kicking the

habit”), and other symptoms. Major withdrawal symptoms peak between 48 and

72 hours after the last dose and subside

after about a week. Sudden withdrawal

by heavily dependent users who are in

poor health is occasionally fatal, although

heroin withdrawal is considered less

dangerous than alcohol or barbiturate

withdrawal.

Treatment ———

There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies.

Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to

stop heroin (or other opiate) use and return

to more stable and productive lives.

In November 1997, the National Institutes

of Health (NIH) convened a Consensus

Panel on Effective Medical Treatment of

Heroin Addiction. The panel of national

experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated

effectively. The panel strongly recommended (1) broader access to methadone

maintenance treatment programs for people who are addicted to heroin or other

opiate drugs; and (2) the Federal and

State regulations and other barriers

impeding this access be eliminated. This

panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive

services to enhance retention and successful outcomes in methadone maintenance

treatment programs. The panel’s full consensus statement is available by calling

1-888-NIH-CONSENSUS (1-888-644-

2667) or by visiting the NIH Consensus

Development Program Web site at

consensus.nih.gov.

Methadone, a synthetic opiate medication that blocks the effects of heroin for

about 24 hours, has a proven record

of success when prescribed at a high

enough dosage level for people addicted

to heroin. Other approved medications

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are naloxone, which is used to treat cases

of overdose, and naltrexone, both of

which block the effects of morphine,

heroin, and other opiates.

For the pregnant heroin abuser, methadone maintenance combined with prenatal

care and a comprehensive drug treatment

program can improve many of the detrimental maternal and neonatal outcomes

associated with untreated heroin abuse.

There is preliminary evidence that

buprenorphine also is safe and effective

in treating heroin dependence during

pregnancy, although infants exposed to

methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms. For women who do not

want or are not able to receive pharmacotherapy for their heroin addiction,

detoxification from opiates during pregnancy can be accomplished with relative

safety, although the likelihood of relapse

to heroin use should be considered.

Buprenorphine is a recent addition to the

array of medications now available for

treating addiction to heroin and other

opiates. This medication is different from

methadone in that it offers less risk of

addiction and can be dispensed in the

privacy of a doctor’s office. Several other

medications for use in heroin treatment

programs are also under study.

There are many effective behavioral treatments available for heroin addiction.

These can include residential and outpatient approaches. Several new behavioral

therapies are showing particular promise

for heroin addiction. Contingency management therapy uses a voucher-based

system, where patients earn “points”

based on negative drug tests, which they

can exchange for items that encourage

healthful living. Cognitive-behavioral

interventions are designed to help modify

the patient’s thinking, expectancies, and

behaviors and to increase skills in coping

with various life stressors.

Extent of Use ———

Monitoring the Future (MTF)

Survey**

According to the 2004 MTF, rates of heroin use were stable among all three

grades measured.

Community Epidemiology Work

Group (CEWG)§

In December 2003, CEWG members reported that heroin indicators were mixed

but relatively stable, continuing at higher

levels in Northeastern, north-central, and

mid-Atlantic areas where high-purity

Heroin Use by Students, 2004:

Monitoring the Future Survey

8thGraders10thGraders12thGraders

Lifetime*** 1.6% 1.5% 1.5%

Annual 1.0 0.9 0.9

30-day 0.5 0.5 0.5
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powder is available, and also in the

Northwest where black tar heroin predominates. Heroin injection and the

health risks associated with it, such as the

spread of HIV/AIDS and hepatitis C, are

of growing concern at several CEWG

sites. In 2002, rates of heroin emergency

department mentions exceeded 200 per

100,000 in Chicago, Newark, and

Baltimore and exceeded 100 per

100,000 in Seattle, New York City, San

Francisco, Boston, and Philadelphia. The

reporting of heroin/opiate-related deaths

was highest in Detroit (464) and

Philadelphia (111).

National Survey on Drug Use and

Health (NSDUH) §§

The 2003 NSDUH reports stability at low

levels for heroin use among young people. In 2002, 13,000 youth between the

ages of 12 and 17 had used heroin at

least once in the past year (“annual” use),

compared with 12,000 in 2003. Among

the general population age 12 and older,

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

1-800-729-6686.

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.