Heroin is a highly addictive drug, and a serious problem. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction. 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, chiva, H, skag, and junk. Other names may refer to types of heroin produced in a specific geographical area, such as "Mexican black tar."

What is heroin?

Heroin is an illegal, highly addictive drug. It is both the most abused and the 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. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as "black tar heroin." Although purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.

Statistics

United States of America : According to the 1998 National Household Survey on Drug Abuse, which may actually underestimate illicit opiate (heroin) use, an estimated 2.4 million people had used heroin at some time in their lives, and nearly 130,000 of them reported using it within the month preceding the survey. The survey report estimates that there were 81,000 new heroin users in 1997. A large proportion of these recent new users were smoking, snorting, or sniffing heroin, and most (87 percent) were under age 26. In 1992, only 61 percent were younger than 26.

The 1998 Drug Abuse Warning Network (DAWN), which collects data on drug-related hospital emergency department (ED) episodes from 21 metropolitan areas, estimates that 14 percent of all drug-related ED episodes involved heroin. Even more alarming is the fact that between 1991 and 1996, heroin-related ED episodes more than doubled (from 35,898 to 73,846). Among youths aged 12 to 17, heroin-related episodes nearly quadrupled.

How is heroin used ?

Heroin is usually injected, sniffed/snorted or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

Injection continues to be the predominant method of heroin use among addicted users seeking treatment; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now the most widely reported means of taking heroin among users admitted for drug treatment.

With the shift in heroin abuse patterns comes an even more diverse group of users. Older users (over 30) continue to be one of the largest user groups in most national data. However, the increase continues in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been appearing in more affluent communities.

What are the immediate ( short-term ) effects of heroin use ?

Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching.

After the initial effects, abusers usually will be drowsy for several hours. Mental function is clouded by heroin's effect on the central nervous system. Cardiac function slows. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot be accurately known.

What are the long-term effects of heroin use ?

One of the most detrimental long-term effects of heroin is addiction itself.
Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse. As with abusers of any addictive drug, heroin abusers gradually spend more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers' primary purpose in life becomes seeking and using drugs. The drugs literally change their brains.

Physical dependence develops with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the fetus of a pregnant addict.

At some point during continuous heroin use, a person can become addicted to the drug.
Sometimes addicted individuals will endure many of the withdrawal symptoms to reduce their tolerance for the drug so that they can again experience the rush. Physical dependence and the emergence of withdrawal symptoms were once believed to be the
key features of heroin addiction. We now know this may not be the case entirely, since craving and relapse can occur weeks and months after withdrawal symptoms are long gone. We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict.

Heroin symptoms

• Sweating
• Dry mouth
• Nausea
• Vomiting
• Increased urination
• Track Marks in arms or legs
• Itchy skin
• Suppression of pain
• Slowed breathing
• Skin abscesses
• Pinned Pupils - pupils literally the size of a pin head no matter how light or dark it is
• Nodding out- falling asleep at inappropriate times such as in the middle of a conversation
• Spoon that are burnt on the bottom for heroin injection
• Syringes used for heroin injection
• Tourniquets used for heroin injection
• Small balloons that have never been used but are tied in a knot at the end. Used for transporting heroin
• Small bags with powder residue on them. Used for transporting heroin
• Small pieces of burnt tinfoil. Used for smoking heroin
• Rolled-up dollar bills and razor blades used for snorting heroin

Potential Negative Effects of Heroin:

• Restlessness
• Constipation
• Sweating
• Menstrual irregularities
• Collapsed veins
• Liver disease
• Lowered resistance to infection
• Respiratory failure
• Respiratory illnesses such as pneumonia
• respiration; breathing difficulties
• Tolerance
• Withdrawal
• Overdose
• Addiction
• Bacterial infections
• Infection of heart lining and valves
• Arthritis and other rheumatologic problems
• Infectious diseases, for example, HIV/AIDS and hepatitis B and C due to sharing needles

Nine out of ten heroin addicts when questioned about their addiction will deny it. However, there are several early warning signs that may serve as pointers. One should not jump to conclusions if merely a few of these are noticed in the suspected user. The final confirmation should be left to a Doctor or drug rehabilitation facility.

How to identify a heroin addict

• On waking up, the heroin addict rushes to the bathroom. But unlike most people, the addict spends longer periods of time. This may extend to well over an hour because heroin, being a narcotic, causes constipation. Also, while high the addict is disoriented in
  time. Often addicts go for early morning walks to procure the drug and return home 'high'. It is also possible to detect withdrawal symptoms when the addict wakes up in the morning. This usually manifests in a running nose and eyes, restlessness, yawning,
  coughing, sneezing, gooseflesh, fever, chills, cramps in the abdomen, back and calf muscles, muscular twitching, aching joints, loose motions, vomiting and mental confuson. Despite taking such long periods of time in the bathroom, the heroin addict usually does
  not like cleanliness. He may not bathe for weeks
• Eating habits serve as useful indicators. The heroin addict generally has a poor appetite. It is easy for parents to notice that their child is eating less or losing weight fast. On an average, the addict could loose between 8-12 kilograms by the time he completes one year of addiction
• There are also changes in the heroin addict's food preferences. There is a sudden craving for sweet dishes - this is because brown sugar is bitter. Often, the addict may interrupt his or her meal and go to the bathroom to vomit. Also, the addict may slip into a heroin 'nod' and doze off at the table. The addict's sleep pattern becomes owlish. The addict stays awake during the night. At times the sleep is punctuated by bouts of coughing. In the later stages of addiction, the addict does not seem to sleep at all
• Compulsive lying is perhaps the hallmark of an addict. Along with this is manipulative behavior and constant justifications with rationalisations. In fact, even when the drug addict is caught red handed with the drug on him, he will usually try to wriggle out of the mess. "Mom, this is just snuff. It helps me cut down on smoking. You see, I don't want to get Cancer. I am trying to give up and instead of encouraging me, you do this. You think I am mad to smoke Heroin and waste my life?" This is a typical example of manipulation. Many parents succumb to such explanation
• Some addicts, when interviewed, also revealed that heroin initially triggered off sexual promiscuity. Male addicts talked of frequenting brothels. This is because, during the first few days, heroin serves as an aphrodisiac, and delays ejaculation time by as much as 45 minutes. However, after a month or two, the sex drive wanes. Patients often complain of impotency. The impotency that sets in is reversible. In about a month after giving up, the patient is back to normal. Depression sets in at this point. An average college male, who has a keen interest in the opposite sex, suddenly loses all interest. (This is usually more marked from the third year of addiction)are other tell-tale signs. If the heroin addict is allowed to smoke normal cigarettes in the house, the contents of the ashtray will be very different from the non- addict's. There will be loose and un-burnt tobacco. This is because a little bit of tobacco is removed
  from the cigarette to create space for the brown sugar to be added. If the addict is chasing the drug, one can notice matchsticks much more in proportion to the cigarette butts. The match sticks will be burnt to the end. If the drug is smoked in cigarettes, then one finds that the cigarette is smoked down to the filter. "We don't even waste a speck of smack", is the explanation
• There may be more direct evidence in the form of a 'puddiya' (paper pouch or packet) or a vial or a plastic packet containing a chalky brown powder. Or, one may find on the heroin addict a stained foil, a stained coin, a 'toker' and a candle. If the addict is a 'mainliner'
  (intravenous user) then needle marks or abscesses will be seen on the forearms usually below the elbow joint. In hard core users, pin pricks or abscesses can even be seen on their legs. One patient had needle marks on his neck, close to the jugular vein. The mainliner's paraphernalia will include a spoon, a candle, a lime, a needle (often rusty and infected) and a syringe
• The other marks seen on the addict’s body are scratch marks, usually on the face, arms and legs. This is due to the Histamine released. In later stages of addiction, skin infections are common. The addict has what can be described as a 'zombie' look. When observed closely, tightening of the skin of the face is noticeable. The eyes will be glassy and there will be dark circles under them and the eyelids are usually droopy, and the mouth partially open
• The heroin addict's mood will fluctuate frequently. From calm when he is high, to restless when deprived of his drug. Chances are that he or she will either be depressed or very happy. Anti-authority behavior or socially deviant behavior is usually displayed. Addicts
  are known to neglect their schools or college, or if they are employed, their work
• One sure method of identifying an addict is by observing the pupils. In bright light the pupil constricts, and in the dark it dilates. This is because the pupils regulate the light that strikes the retinas. In the heroin user however, the pupils become pin point, (very small) and during the addict's withdrawals, they dilate. So, pinpoint pupils in the dark or at night is an almost conclusive sign of heroin addiction. Similarly, dilated pupils in broad daylight is also proof of heroin withdrawal

What are the medical complications of chronic heroin use ?

Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of neumonia
and tuberculosis) may result from the poor health condition of the abuser as well as from heroin's depressing effects on respiration. Many of the additives in street heroin may include substances 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.

Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems. Of course, sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse-infections with hepatitis B and C, HIV, and a host of other bloodborne viruses, which drug abusers can then pass on to their sexual partners and children.that normal street doses of heroin are ineffective at producing euphoria, thus making the use of heroin more easily extinguishable. Methadone's effects last for only about 24 hours - four to six times as long as those of heroin - so people in treatment need to take it only once a day. Also, methadone is medically safe even when used continuously for 10 years or more. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives. Unfortunately, providing someone with
Methadone is like providing him/her with another addictive drug.

Methadone dosages must be carefully monitored in patients who are receiving antiviral therapy for HIV infection, to avoid potential medication interactions.

Ibogaine

Refer all our material on the Ibogaine treatment currently available in South Africa.

Behavioral therapies

Although behavioral and pharmacologic treatments can be extremely useful when employed alone, science has taught us that integrating both types of treatments will ultimately be the most effective approach. There are many effective behavioral treatments available for heroin addiction.

These can include residential and outpatient approaches. An important task is to match the best treatment approach to meet the particular needs of the patient. Moreover, several new behavioral therapies, such as contingency management therapy and cognitive-behavioral interventions, show particular promise as treatments 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 healthy 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. Both behavioral and pharmacological treatments help to restore a degree of normalcy to brain function and behavior, with increased employment rates and lower risk of HIV and other diseases and criminal behavior.

What are the opioid analogs and their dangers ?

Drug analogs are chemical compounds that are similar to other drugs in their effects but differ slightly in their chemical structure. Some analogs are produced by pharmaceutical companies for legitimate medical reasons. Other analogs, sometimes referred to as "designer" drugs, can be produced in illegal laboratories and are often more dangerous and potent than the original drug.

Two of the most commonly known opioid analogs are fentanyl and meperidine (marketed under the brand name Demerol, for example).
Fentanyl was introduced in 1968 by a Belgian pharmaceutical company as a synthetic narcotic to be used as an analgesic in surgical procedures because of its minimal effects on the heart.

Fentanyl is particularly dangerous because it is 50 times more potent than heroin and can rapidly stop respiration. This is not a problem during surgical procedures because machines are used to help patients breathe. On the street, however, users have been found dead with the needle used to inject the drug still in their arms.

Injecting heroin

Injecting Heroin is like a ritual for the user. Once the Heroin is purchased the preparation starts. Firstly everything will be put out on display and placed in order. The kit includes heroin, syringe with needle, spoon, lighter or candle, cigarette filter, belt, citric acid and water. The Heroin is put onto the spoon with citric acid, the right amount of water will then be mixed with the Heroin and citric acid, (the citric acid is used to breakdown the Heroin so it can be injected). At the same time the spoon is held over the heat source so all the three substances are mixed together.

Once mixed, a cigarette filter will be placed onto the spoon, the solution will then be drawn up the syringe through the filter, this is to filter out any impurities. It is now ready to be injected into a vein usually in the arm. The belt or similar implement such as a shoe lace is tied tightly around the arm to stop the blood flow, this will cause the veins to stand out for easier injection. After long periods of use the veins will become damaged and other areas of the body are used for injecting into. Other places used are in the groin area, behind the knees or in serious cases in the neck. It has been know for addict’s veins to collapse.

The myth that Injecting heroin is more economical than administering it in other ways may be true, but the consequences are much more severe. Injecting heroin gives a rush and provides, in colloquial terms, a 'bigger bang for the buck' than smoking or snorting the drug. However, injecting heroin results in higher levels of dependence on the drug. Injectors use more often and quickly develop a tolerance to heroin. Many people have to use more of the drug and use it more often. So, while injecting may give a bigger short term effect, it costs substantially more financially and healthwise in the long term.

Paraphernalia used for injecting heroin:

• Alcohol swabs which are available in a box of about 100 for $2 at any supermarket.
• A syringe - also known as "works". Many times found taken from doctors offices or hospitals.
• The bottom of a soda can, used as a "spoon" to dissolve the heroin in. The bottom is torn off of a can as close to the bottom as possible. Or a regular spoon is used.

How injecting heroin is done:

• The "spoon" is thoroughly cleaned with an alcohol swab. In this example black tar heroin is used. It has no smell except for a faint smell of vinegar. It comes wrapped in plastic inside a tiny balloon. A chunk is placed in the spoon.
• The syringe is used to suck up about 50-75 units of water and squirt it into the spoon. The spoon is then heated from the bottom with a lighter to make it dissolve.
• A piece of cotton is rolled into a ball a little bigger than a tic-tac. The cotton is dropped into the heroin and it puffs up like a sponge. The tip of the syringe is pushed into the center of the cotton and the plunger is slowly pulled back until all of the heroin is sucked
  in. This cotton is necessary to filter out any particles, germs and such in the heroin solution before injecting.
• The area on the body chosen for injection is thoroughly cleaned with an alcohol swab. The area on the bend of the arm is commonly used because it's so darned easy to get the needle into the vein properly.

Heroin overdose

Heroin works on the central nervous system. The abusers heartbeat slows as well as their breathing. They may loose consciousness. Any of these effects can be fatal if the dose is too high. Depending on purity and the user, a lethal dose of heroin may range from 200 to 500mg, but hardened addicts have survived doses of 1800mg and over. However, with street heroin there is no absolutely certain "safe dosage". It depends on tolerance, amount and purity taken.

Overdose can occur when a dose taken is greater than that you're used to. A tolerable dose for an addict could be fatal to a first-time user. Tolerance to heroin in particular is quickly acquired. Even occasional weekend users need to take more to get the same effect over time. Tolerance can drop. Some users have overdosed on their 'regular dose', after just a few week's break.

Symptoms of a Heroin overdose include but are not limited to:

• muscle spasticity
• slow and labored breathing
• shallow breathing
• stopped breathing (sometimes fatal within 2-4 hours)
• pinpoint pupils
• dry mouth
• cold and clammy skin
• tongue discoloration
• bluish colored fingernails and lips
• spasms of the stomach and/or intestinal tract
• constipation
• weak pulse
• low blood pressure
• drowsiness
• disorientation
• coma
• delirium