Heroin
Trends and Harms
Heroin is a powerful drug that numbs pain and produces strong feelings of euphoria and well-being. It also slows down breathing, heart rate and blood pressure, which can lead to drowsiness, coma, respiratory failure and even death. People who use heroin are at great risk of becoming dependent on it.
While heroin is often associated with the opium poppy, it is not derived directly from the poppy. Rather, heroin is made by chemically changing morphine, a drug present in a gummy substance extracted from the seed pod of the opium poppy. Heroin and morphine belong to a group of drugs known as opiate analgesics, which are used to treat extreme pain. The heroin sold on the street is a white or brownish powder. It is often diluted or 'cut' with substances like starch, powdered sugar, talcum powder or more toxic substances such as quinine. Heroin can also include other contaminants produced through crude preparation methods that use toxic substances such as gasoline, industrial solvents or sulphuric acid.
While heroin use by young people is relatively low, it is generally higher among vulnerable groups like the homeless and young offenders. The following summary provides information on trends in heroin use by young people worldwide as well as the associated harms.
Trends in Use
Limited information is available concerning trends in heroin use by young people; however, a 1999 United Nations report summarizes various studies conducted in countries around the world between 1990 and 1997 and provides an indication of use worldwide. (It is important to note that samples and survey methods differ, and comparisons between countries should be made with great caution.) According to the report, the highest rate of heroin use among youth is in Europe. In Denmark, Greece, Ireland and Italy, 2 per cent of youth (age 15-16) report having used heroin at lease once in their lives. The report also states that some countries in Western Europe are experiencing an increase in heroin smoking. Heroin injection increased during the 1990s in Eastern Europe and this trend has also touched youth. Other figures provided by the report include 1.4 per cent of youth age 14-24 in Australia and 1.2 per cent of youth age 13-22 in the United States have used heroin. A more recent survey conducted in 2002 in the United States by the National Institute on Drug Abuse reports that 1.8 per cent of students in grade 10 (ages 15-16) have used heroin at least once.
Even though the number of youth who report using heroin is relatively low, there is still a need to closely monitor levels of use. Recent reports point to concerns with heroin use by some groups of young people, including young offenders, school dropouts and homeless young people. For example, 22 per cent of a sample of 11-17-year-olds detained by police in Australia between 1999 and 2002 reported having used opiates (including heroin); 22 per cent also reported using cocaine.
Another concern is related to indications that heroin Is being used in areas where use was previously thought to be nonexistent. A recent study found that, for the first time, young people living in small cities and towns in several regions in the United Kingdom are using heroin.
Harms Associated with Use
Heroin is usually injected directly into a vein, however, some people inject it under the skin, smoke or sniff it. Another method involves inhaling the fumes that are released when the heroin is heated ('chasing the dragon'). The immediate effects of heroin are felt soon after the drug is injected or smoked and last a few hours. If heroin is injected into a vein, the person feels a surge of intense pleasure, a 'rush', lasting 30 to 60 seconds, followed by a warm, relaxed, and detached feeling. People who use heroin for the first time usually feel nauseous and vomit. Other immediate effects include a dry mouth and a heavy feeling in the arms and legs. If larger amounts are used, the person can feel drowsy and sedated, or slip into a coma, or die from respiratory failure.
The effects of long-term heroin use are related to the drug itself and the way it is used (i.e. injected or smoked). Lung problems due to the effects of heroin on respiration are common, as is constipation, decreased sexual drive and menstrual irregularities. Sharing needles can lead to hepatitis, HIV/AIDS and tetanus. Dirty needles can cause infections at the injection site or infections in the lining and valves of the heart (endocarditis). Regular injecting can result in problems such as collapsed veins and abscesses, and smoking heroin can lead to pneumonia and other lung conditions. Lifestyle is also a factor. If heroin use leads to financial or legal problems, the above effects can be made worse by issues such as poor nutrition and bad housing.
Overdose
Both fatal and non-fatal overdose can occur among heroin users. Non-fatal overdose occurs when there is loss of consciousness and respiration is depressed, but the person does not die. Fatal overdose is usually due to respiratory failure.
While it is commonly believed that high potency heroin causes overdose, the research on this is inconclusive. A report prepared by the World Health Organization sees heroin purity as a contributing factor to overdose but not as the sole factor. Similarly, a report on heroin overdose by the Australian National Drug and Alcohol Research Centre concludes that the evidence to support heroin purity as a factor in overdose is sparse. Another factor often cited, but again lacking conclusive evidence, is the role of additives or contaminants in overdose death. Quinine has been associated with overdose deaths, however in general the evidence connecting contaminants and adulterants with overdose death is unclear and varies between regions.
While the role of heroin purity and contaminants in overdoses is unclear, there is evidence that overdose risk increases when regular heroin use is stopped and then started again. During the break from use, tolerance is reduced, and if use starts again, there is an increased risk of overdose. Also, long-term, regular use of heroin is a risk factor for overdose. This can be explained, at least partially, by differences in how tolerance develops to the effects of heroin. Tolerance means the body gets used to the presence of the drug and higher doses become necessary to maintain the intensity of effects. When a person uses heroin on a regular basis, tolerance to the respiratory depressive effects of heroin increases at a slower rate than tolerance to the euphoric effects. This can lead to a heroin user injecting higher doses to achieve the warm, relaxed or 'high' effects of the drug, with increased risk of respiratory depression.
Another important risk factor for overdose is using heroin with other central nervous system depressant drugs such as alcohol and tranquilizers. Drugs such as alcohol and tranquilizers can have synergistic interactions with heroin, increasing their respiratory depressant effects and, as a result, increasing overdose risk.
Tolerance, Dependence and Withdrawal
With regular use, tolerance as well as physical and psychological dependence to heroin develops fairly rapidly. As tolerance develops and the user gradually increases the amount to achieve the desired effects, a plateau is reached where no amount of the drug is sufficient to produce the desired intense effects. At this stage, dependent users continue to use largely for the purpose of delaying withdrawal sickness.
Withdrawal sickness usually starts six to 12 hours after heroin is last used, reaches peak intensity after about 36 to 72 hours, and is usually over within seven to 10 days. Withdrawal symptoms include severe anxiety, insomnia, vomiting, nausea, diarrhoea, profuse sweating, muscle spasms, bone pain, chills, shivering, tremors, and strong craving. Feelings of weakness and illness may last longer, and it may be six months or longer before total recovery from withdrawal occurs. While many people successfully stop using heroin after long-term use, withdrawal and not using heroin again can be very difficult.
Annual report 2003
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Drug use among a sample of juvenile detainees
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Canberra, Australia: Australian Institute of Criminology, 2003.
Heroin and other opiates
London, United Kingdom: DrugScope, 2003.
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Warner-Smith, M.; Lynskey, M.; Darke, S.; Hall, W.
Sydney, Australia: National Drug and Alcohol Research Centre, 2000.
Hidden heroin users
Eggington, Roy; Parker, Howard
In: Evans, K.; Alade, S (Eds.) Vulnerable young people and drugs London, United Kingdom: DrugScope, 2000.
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Johnston, Lloyd D.; O'Malley, Patrick M.; Jerald G. Bachman
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Opioids
Edmonton, Canada: Alberta Alcohol and Drug Abuse Commission, 2002.
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Gary Roberts, Senior Associate
Canadian Centre on Substance Abuse
Phone: 613-235-4048-225/613-829-3152(home)
Fax: 613-235-8101/613-829-3307(home)