May 2006 Page 1 of 4

Heroin is an addictive drug, and its use

is a serious problem in America. 

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*

reports that eight percent of drug-related

emergency department (ED) visits in the

third and fourth quarters of 2003

involved heroin abuse. Unspecified opiates—which could include heroin—were

involved in an additional 4 percent of

drug-related visits.

Heroin
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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 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 are naloxone, which is used to

treat cases of overdose, and naltrexone,
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both of which block the effects of morphine, heroin, and other opiates.

Buprenorphine is the most recent addition to the array of medications 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.

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.

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 2005 MTF, rates of

heroin use were stable among all three

grades measured.

Community Epidemiology Work

Group (CEWG) §

Heroin indicators, as measured by the

Community Epidemiology Work Group

(CEWG), remained high in Baltimore,

Newark, Boston, Chicago, New York

City, Philadelphia, San Francisco,

Seattle, and Washington, DC. Baltimore

Heroin Use by Students, 2005:

Monitoring the Future Survey

8th-Graders 10th-Graders 12th-Graders

Lifetime*** 1.5% 1.5% 1.5%

Annual 0.8 0.9 0.8

30-day 0.5 0.5 0.5
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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.

and Newark ranked highest of all

CEWG areas in the percentage of 

heroin items analyzed by forensic labs

in 2004; heroin was identified in 34

percent of items analyzed in Newark,

and in 26 percent of items analyzed in

Baltimore. Eighty-two percent of drug

treatment admissions (excluding alcohol)

in 2004 were attributable to primary

heroin abuse in Newark, followed by

74 percent in the Boston area, and 60

percent in Baltimore. 

National Survey on Drug Use and

Health (NSDUH) §§

The 2004 NSDUH reports a significant

decrease in lifetime heroin use among

Americans age 12 or older, most

notable in those 26 or older. An

increase in past-month use of heroin 

was reported, however, among persons

age 21 to 25. 

* These data are from the annual Drug Abuse Warning Network, funded by the Substance Abuse and Mental Health

Services Administration, DHHS. The survey provides information about emergency department visits that are induced

by or related to the use of an illicit drug or the nonmedical use of a legal drug. The latest data are available at 800-

729-6686 or online at www.samhsa.gov. 

** These data are from the 2005 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. 

*** “Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to use at least once during

the year preceding an individual’s response to the survey. “30-day” refers to use at least once during the 30 days preceding an individual’s 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 reports are

available at www.drugabuse.gov/about/organization/cewg/pubs.html. 

§§ 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

800-729-6686.