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Heroin is a highly addictive drug and is the most widely abused and most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.1

Pure heroin, which is a white powder with a bitter taste, is rarely sold on the streets. Most illicit heroin is a powder varying in color from white to dark brown. The differences in color are due to impurities left from the manufacturing process or the presence of additives. Another form of heroin, "black tar" heroin, is primarily available in the western and southwestern U.S. This heroin, which is produced in Mexico, may be sticky like roofing tar or hard like coal, with its color varying from dark brown to black.2

Heroin can be injected, smoked, or sniffed/snorted. Injection is the most efficient way to administer low-purity heroin. The availability of high-purity heroin, however, and the fear of infection by sharing needles has made snorting and smoking the drug more common. National Institute on Drug Abuse (NIDA) researchers have confirmed that all forms of heroin administration are addictive.3

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Extent of Use

According to the 2005 National Survey on Drug Use and Health (NSDUH), approximately 3.5 million Americans aged 12 or older reported trying heroin at least once during their lifetimes, representing 1.5% of the population aged 12 or older. Approximately 379,000 (0.2%) reported past year heroin use and 136,000 (0.1%) reported past month heroin use.4

The 2005 NSDUH results also indicate that there were 108,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. This is a reduction from 118,000 past year heroin initiates in 2004.5

Among students surveyed as part of the 2006 Monitoring the Future study, 1.4% of eighth, tenth, and twelfth graders reported lifetime use of heroin.6

**Percent of Students Reporting Heroin Use, 2006**
** ****8th Grade****10th Grade****12th Grade**
**Past month use******

    0.3% 

    0.5% 

    0.4% 

**Past year use******

0.8 

0.9 

0.8 

**Lifetime use******

1.4 

1.4 

1.4 

Approximately 75.3% of eighth graders, 83.6% of tenth graders, and 76.2% of twelfth graders surveyed in 2006 reported that using heroin occasionally without a needle was a �great risk.� Additionally, nearly 90% of 12 th graders surveyed in 2006 reported that using heroin regularly was a �great risk.�7

**Percent of Students Reporting Risk of Using Heroin, 2006**
**Percent Saying �Great Risk�****8th Grade****10th Grade****12th Grade**
**Try once/twice w/o needle******

    60.4% 

    70.0% 

    62.6% 

**Use occasionally w/o needle******

75.3 

83.6 

76.2 

Regarding the ease by which one can obtain heroin, 13.0% of eighth graders, 17.4% of tenth graders, and 27.4% of twelfth graders surveyed in 2006 reported that heroin was "fairly easy" or "very easy" to obtain.8

The Centers for Disease Control and Prevention (CDC) also conducts a survey of high school students throughout the United States called the Youth Risk Behavior Surveillance System (YRBSS). Among students surveyed for the 2005 YRBSS, 2.4% reported using heroin at least one time during their lifetimes.9

Percent of Students Reporting Lifetime Heroin Use, 2001-2005
** ****2001****2003****2005****9th grade**    3.2%		   3.5%		     2.8% 	  **10th grade** 	3.3			 2.9	  	2.5  **11th grade** 2.8	 3.0		 1.8	 	  **12th grade** 	3.0	 2.9	  	2.0	  **Total** 	3.1			 3.3	 		2.4  
Approximately 0.5% of college students and 1.7% of young adults (ages 19-28) surveyed in 2005 reported lifetime use of heroin.10

Percent of College Students/Young Adults Reporting Heroin Use, 2004–2005
** ****College Students****Young Adults****2004****2005****2004****2005****Past month** 	0.1%	0.1%		 0.1%			0.1%	 **Past year** 0.4		0.3		 	0.3	 0.4**Lifetime** 0.9		 0.5		 	1.9	1.7
According to data from the Bureau of Justice Statistics, approximately 23.4% of State prisoners and 17.9% of Federal prisoners surveyed in 2004 indicated that they used heroin/opiate at some point in their lives.11

Percent of Prisoners Reporting Heroin/Opiate Use, 1997 and 2004
** ****State Prisoners****Federal Prisoners****1997****2004****1997****2004****At time of offense** 5.6%		 4.4%3.0 		3.2 **In month before offense** 9.2		8.2 	5.4	 	5.8 **Regularly*** 15.0		 13.1	8.9	 	 9.2**Ever in lifetime** 24.5		 23.4	16.1	 	17.9  * Used drugs at least once a week for at least a month.
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Health Effects

The short-term effects of heroin abuse appear soon after taking the drug. Intravenous injection provides the greatest intensity and most rapid onset of the initial rush that users experience. Intravenous users typically experience the rush within 7 to 8 seconds after injection, while intramuscular injection produces a slower onset of this euphoric feeling, taking 5 to 8 minutes. When heroin is sniffed or smoked, the peak effects of the drug are usually felt within 10 to 15 minutes.12

In addition to the initial feeling of euphoria, the short-term effects of heroin include a warm flushing of the skin, dry mouth, and heavy extremities. After the initial euphoric feeling, the user experiences an alternately wakeful and drowsy state. Due to the depression of the central nervous system, mental functioning becomes clouded.13  Additionally, breathing may be slowed to the point of respiratory failure.14

After repeatedly using heroin for a period of time, the long-term effects of the substance begin to appear in the user. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver disease. Additionally, pulmonary complications, including various types of pneumonia, may also result in the user.15

One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity or effect that they are seeking. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop.16

Within a few hours after the last administration of heroin, withdrawal may occur. This withdrawal can produce effects such as drug craving, restlessness, muscle and bone pain, and vomiting. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week.17

In addition to the effects of the drug itself, users who inject heroin also put themselves at risk for contracting HIV, hepatitis C (HCV), and other infectious diseases. Approximately 70–80% of the new HCV infections in the U.S. each year are among injection drug users.18

Street heroin is often mixed with various substances, including sugar, starch, quinine, and sometimes, strychnine or other poisons, causing an added danger to using heroin. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at a great risk of overdose or death.19

Of an estimated 106 million emergency department (ED) visits in the U.S. during 2004, the Drug Abuse Warning Network (DAWN) estimates that 1,997,993 were drug-related. DAWN data indicate that heroin was involved in 162,137 ED visits.20

Treatment

A variety of effective treatments are available for heroin addiction. For example, methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has proven successful for heroin addiction. Additionally, buprenorphine and many behavioral therapies are also used to treat heroin addiction.21

From 1994 to 2004, the number of admissions to treatment in which heroin was the primary drug of abuse increased from 216,452 in 1994 to 265,895 in 2004. Heroin admissions represented 13.0% of the total drug/alcohol admissions to treatment during 1994 and 14.2% of the treatment admissions in 2004. The average age of those admitted to treatment for heroin during 2004 was 36 years.22

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Arrests & Sentencing

 During FY 2004, there were 32,980 Federal arrests for drug law violations, 1,881 of which were for heroin. Additionally, the Drug Enforcement Administration (DEA) reported 2,273 arrests for opiates in FY 2004.23

Between October 1, 2004 and January 11, 2005, there were 391 Federal offenders sentenced for heroin-related charges in U.S. Courts. Approximately 97.4% of the cases involved trafficking. Between January 12, 2005 and September 30, 2005, there were 1,279 Federal offenders sentenced for heroin-related charges in U.S. Courts. Approximately 97.8% of the cases involved trafficking.24

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Production & Trafficking

The U.S. heroin market is supplied entirely from foreign sources of opium. Heroin available in the U.S. is produced in four distinct geographical areas: South America (Colombia), Southeast Asia (primarily Burma), Mexico, and Southwest Asia (principally Afghanistan).25

An estimated 90 percent of the world's opium gum production occurs in Afghanistan.  However, most of the heroin used in the United States comes from poppies grown in Colombia and Mexico, although their opium gum production accounts for less than four percent of the world's total production. Mexico's geographical location allows Mexican growers and refiners to supply an estimated 30 to 40 percent of the U.S. heroin market, primarily west of the Mississippi River. Colombia supplies heroin to most of the remainder of the states east of the Mississippi.26

During FY 2003, Federal agencies seized 5,643 pounds of heroin under the Federal-wide Drug Seizure System (FDSS). FDSS contains information about drug seizures made within the jurisdiction of the United States by the DEA, Federal Bureau of Investigation, U.S. Customs Service, U.S. Border Patrol, and U.S. Coast Guard.27

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Legislation

Heroin was first synthesized from morphine in 1874 and became widely used in medicine in the early 1900s. At that time, physicians were unaware of heroin's potential for addiction. The first comprehensive control of heroin in the U.S. occurred with the Harrison Narcotic Act of 1914. Heroin currently falls into Schedule I of the Controlled Substances Act based on its potential for abuse and its lack of accepted medical use.28

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Street Terms29

 Common Terms Associated with Heroin
**Term** 	Definition	Term	 Definition  **A-bomb** Marijuana mixed w/heroin		Hell dust	 Heroin  **Big H** 	Heroin	Nose drops	 Liquefied heroin  **Dragon rock** Heroin mixed w/cocaine	 Smack	Heroin	 
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Other Links

A Collection of Articles That Address Research on Heroin   This resource presents links to and full text of National Institute on Drug Abuse (NIDA) research articles concerning heroin.

Breaking Heroin Sources of Supply  This fact sheet provides an overview of efforts to reduce domestic heroin availability. 

Buprenorphine Physician Locator  This on-line resource assists individuals in locating physicians who can prescribe buprenorphine (Suboxone® and Subutex®) for treatment of opioid addiction. 

�Cheese�  This fact sheet provides information about �Cheese� or �starter heroin.� "Cheese" is a street term that refers to the combination of heroin and ground up cold medicine (Tylenol PM) containing acetaminophen and diphenhydramine. The mixture is a tan powder that is snorted. 

Heroin Movement Worldwide  This Central Intelligence Agency (CIA) Web site provides information about heroin production, consumption, and trafficking. 

Heroin Publications  This site presents a listing of heroin-related publications from various sources. 

Methadone Fact Sheet  This fact sheet provides an overview of issues dealing with methadone treatment. 

Price and Purity of Illicit Drugs: 1981 Through the Second Quarter of 2003  This report extends, improves, and augments previous estimates of trends in the price and purity of five major illicit drugs, including heroin. 

Proceedings from the Fentanyl-Laced Heroin Demand Reduction Forum  On July 28, 2006 ONDCP convened a forum to bring together law enforcement and public health officials, prevention specialists, and treatment providers from Federal, State, and local governments to discuss the public health threat and response techniques arising from the recent deaths related to fentanyl-laced heroin. 

Substance Abuse Treatment Facility   Locator  This on-line resource can be used to locate drug/alcohol treatment programs throughout the United States. 

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Sources 

1 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report, May 2005 

2 Drug Enforcement Administration, Drugs of Abuse, 2005 

3 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report, May 2005 

4 Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health: National Findings, September 2006 

5 Ibid. 

6  National Institute on Drug Abuse and University of Michigan, 2006 Monitoring the Future Study Drug Data Tables, December 2006  

7 Ibid. 

8 Ibid. 

9 Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance—United States, 2005, June 2006 

10 National Institute on Drug Abuse and University of Michigan, Monitoring the Future National Survey Results on Drug Use, 1975–2005, Volume II: College Students & Adults Ages 19–45 (PDF), 2006 

11 Bureau of Justice Statistics, Drug Use and Dependence, State and Federal Prisoners, 2004, October 2006 

12 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report, May 2005 

13 National Institute on Drug Abuse, InfoFacts: Heroin, March 2005 

14 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report, May 2005 

15 National Institute on Drug Abuse, InfoFacts: Heroin, March 2005 

16 Ibid.

17 Ibid.

18 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report, May 2005 

19 Ibid. 

20 Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits (PDF), April 2006 

21 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report, May 2005 

22 Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Highlights—2004 (PDF), February 2006 

23 Bureau of Justice Statistics, Compendium of Federal Justice Statistics, 2004,December 2006

24 United States Sentencing Commission, 2005 Sourcebook of Federal Sentencing Statistics, June 2006 

25 Drug Enforcement Administration, Drugs of Abuse, 2005 

26 U.S. Department of State, International Narcotics Control Strategy Report, 2006, March 2006 

27 Drug Enforcement Administration, Federal-Wide Drug Seizure System, as reported in Sourcebook of Criminal Justice Statistics

28 Drug Enforcement Administration, Drugs of Abuse, 2005 

29 Office of National Drug Control Policy, Street Terms: Drugs and the Drug Trade

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