What is Heroin?
Heroin is one of a group of drugs known as ‘opiates’ (sometimes called ‘narcotic analgesics’). Other opiates include opium, morphine, codeine, pethidine and methadone.
Heroin and other opiates are ‘depressant’ drugs. Depressant drugs do not necessarily make you feel depressed. Rather, they slow down the activity of the central nervous system and messages going to and from the brain and the body. This includes physical, mental and emotional responses.
Alcohol, benzodiazepines and cannabis are also depressant drugs.
History and uses
Opium takes its name from the opium poppy, which grows in many parts of the world – commonly in Asia and the Middle East, but also in the USA and Australia. When the seedpod of the poppy is cut, a sticky resin oozes out (opium). Opium is refined to produce the natural painkillers morphine and codeine.
For centuries, opium has been used by many cultures as a medicine and as a recreational drug. Morphine, codeine and pethidine are still widely used for medical purposes.
This century, powerful painkillers have been produced in the laboratory. These drugs have similar effects to the natural opiates. For example, methadone is used in Australia as a substitute for heroin in the treatment of people dependent on heroin.
How is heroin made and used?
Heroin is made from morphine or codeine by a chemical process, but has a stronger painkilling effect than the drugs from which it is made.
Heroin comes as white to off-white granules or pieces of ‘rock’ with a bitter taste, but no smell. It is packaged in ‘foils’ (aluminium foil) or coloured small balloons.
It is most commonly injected into a vein. It can also be smoked (‘chasing the dragon’) or snorted.
Smack, skag, dope, H, junk, hammer, slow, gear, harry, horse.
Heroin use in Australia
- In 1998, 2.2% of the total population had tried heroin at some time in their life. 1
- The average age of first-time use of heroin was 21.5 in 1998. 1
- 1.7% of the population aged 14 to 19 years have tried heroin at some time in their life. 1
- Those aged between 20-29 and 30-39 have the highest rate of lifetime use (4.7% and 3.0%), with males more likely to use than females. 1
- In 1997, 636 deaths were attributed to opiates, 2.8% of total drug-related deaths (alcohol is 16% and tobacco 80%). The majority of opiate attributed deaths (79%) were in the 20 to 39 year age group. 2
- A small proportion of secondary students (4%) had used opiates at some stage. 3
1 1998 National Drug Strategy Household Survey, First results, August 1999, Australian Institute of Health and Welfare, Canberra.
2 Drug use in Australia and its impact (media release), 1999, Australian Institute of Health and Welfare.
The effects of any drug (including heroin) vary from person to person. It depends on many factors including an individual’s size, weight and health, how the drug is taken, how much is taken, whether the person is used to taking it, the person’s mood and whether other drugs are taken. The effects also depend on the environment in which the drug is used – for example, whether the person is alone, with others, or in a social setting.
The effects of heroin may last three to four hours.
- Intense pleasure: Heroin may cause a rush of intense pleasure and a strong feeling of wellbeing.
- Pain relief: Heroin relieves physical pain. After using heroin, feelings of pain, hunger or sexual urges are diminished.
- Physical symptoms: Breathing, blood pressure and pulse become slower. The pupils of the eyes also get much smaller. The mouth dries out.
- Drowsiness: As the amount used increases, the user may feel warm, heavy and sleepy.
- Nausea and vomiting can occur.
In greater quantities
The above immediate effects intensify and last longer with higher quantities of heroin. As the quantity used increases, the following effects are also likely to occur:
- Concentration: The ability to concentrate is impaired.
- Likelihood of sleep: The user is likely to fall asleep (‘on the nod’).
- Breathing: Breathing becomes shallower and slower.
- Nausea: With higher quantities, nausea and vomiting are more likely to occur.
- Bodily effects: Sweating, itching and increased urinary output is also likely.
Using a large quantity of heroin can cause death. Breathing becomes very slow, body temperature drops, and heartbeat becomes irregular.
Overdose may occur if:
- too much heroin is injected, or it is a strong batch
- heroin is used with alcohol or sedatives (benzodiazepines).
Most overdoses occur as a result of poly-drug use (i.e. heroin with another drug).
To reverse the effects of a heroin overdose, the drug Narcan is injected by the Ambulance Officer. This drug will restart breathing. The Narcan may not last as long as the heroin, so the person will feel stoned again and may even become unconscious again. It is important that another quantity of heroin is not taken again that day as it may combine with the original quantity of heroin taken and could cause an overdose.
While unconscious, the person may also inhale vomit, which could cause a chest infection or long-term problems. After an overdose, it is strongly advisable to seek assessment at a hospital.
Apart from overdosing, the major problem of short-term use of any opiate is the way it is used.
Under medical supervision, short-term use of opiates should not produce problems. Many people are given pethidine for two or three days after an operation and do not experience any health problems.
But illicit drugs like heroin often lead to complicated health problems. Some of these problems are more likely to occur if the drug is injected, for example, skin, heart and lung infections and diseases like hepatitis and HIV.
In its pure form, heroin is relatively non-toxic to the body, causing little damage to body tissue and other organs. However, it is highly addictive and regular users are very likely to become dependent on it, even after a few days. Some long-term effects include constipation, menstrual irregularity and infertility in women, and loss of sex drive in men.
Users often spend less on other things like housing and food and, combined with reduced appetite, this can lead to malnutrition and susceptibility to infections.
Impure heroin: Street heroin is usually a mixture of pure heroin and other substances, such as caffeine and sugar.
Additives can be very poisonous. They can cause collapsed veins, tetanus, abscesses and damage to the heart, lungs, liver and brain. Because the users don’t know the purity, and as a consequence the amount to take, it is easy to accidentally overdose and even die.
Hepatitis & HIV
Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis B, hepatitis C and HIV (Human Immunodeficiency Virus – the virus that causes AIDS).
Heroin users may also put themselves at risk through unsafe sex. HIV is also transmitted through unsafe vaginal and anal sex. The correct use of a condom can prevent infection.
Heroin and other drugs
Combining heroin with other depressant drugs (such as alcohol, benzodiazepines or other opiates) greatly increases the effects. A relatively low quantity of heroin can quickly become equivalent to a higher quantity (or an overdose) if it is combined with other drugs.
Tolerance and dependence
People who are physically dependent on heroin usually develop tolerance to the drug, making it necessary to take more and more to get the desired effects. Eventually, a usage plateau is reached, at which no amount of the drug is sufficient. When this level is achieved, dependent users continue to administer the drug, but largely for the purpose of delaying withdrawal sickness.
Dependence on heroin can be psychological, physical, or both.
Psychological dependence: People who are psychologically dependent on heroin find that using it becomes far more important than other activities in their lives. They crave the drug and will find it very difficult to stop using it, or even to cut down on the amount they use.
Physical dependence: Physical dependence occurs when a person’s body adapts to heroin and the body gets used to functioning with the drug present. For some people this dependence leads to bad eating habits, poor hygiene and housing problems. Poor nutrition and living conditions increase the risk of infections and other health problems. Maintaining the ‘habit’ can sometimes lead to users turning to crime to get enough money to pay for it.
If a dependent person suddenly stops taking heroin, or severely cuts down the amount they use, they will experience physical withdrawal symptoms because their body has to readjust to functioning without the drug. This usually occurs within a few hours after last use.
Withdrawal symptoms from heroin include a craving for the drug, restlessness, yawning, tears, diarrhoea, low blood pressure, stomach and leg cramps, vomiting, goose bumps, and a runny nose.
These withdrawal symptoms get stronger and usually peak around 2 to 4 days after last use. They also include increased irritability, insomnia, loss of appetite, vomiting, elevated heart rate, muscle spasms and emotional depression. Then they begin to get weaker and usually subside after 6 to 7 days. But some symptoms, such as chronic depression, anxiety, insomnia, loss of appetite, periods of agitation and a continued craving for the drug, may last for periods of months and even years. Sudden withdrawal from heroin never causes direct death, unless the user is also using other drugs and is in poor health. Withdrawal from heroin or other narcotic analgesics is much less dangerous than withdrawal from some other drugs like alcohol or benzodiazepines.
In Australia, there are a number of drug treatment options. Some aim solely for the user to achieve a drug-free lifestyle. Others recognise abstinence as one option, however, due to individual circumstances, may not be possible in certain situations. The overall aim of these programs is to reduce the harm/risks related to a person’s drug use.
Treatment is more effective if tailored to suit a person’s specific situation and usually involves a combination of methods. The different options include individual counselling, group therapy, medication and supervised/home withdrawal.
A synthetic opiate, methadone, is used as a substitute for heroin to treat heroin dependent people. The intention is to reduce the impact that heroin has on their lives by removing:
- the dangers of injecting drugs, as methadone is taken orally
- the risk of unclean street drugs of unknown strength
- the need to support an expensive habit.
Naltrexone is a drug prescribed to help people stay off heroin once they have successfully withdrawn from heroin and other opiates. Using heroin or other opiates while on naltrexone will have little or no effect. This drug does not cause physical or psychological dependence. Naltrexone is on trial in Australia.
Ultra Rapid Opiate Detox (UROD)
UROD is a quick method of withdrawing or detoxifying from opiates. It involves high doses of naltrexone given over a 48-hour period or less along with heavy sedation. By the end of the process, the patient should be physically withdrawn from opiates. UROD is under trial in Australia at present.
Many health professionals recommend that those on maintenance medications (e.g. methadone and naltrexone) undergo counselling during and after withdrawal.
Support during treatment
Support from a friend or family member while undergoing treatment will help to provide the emotional and practical support needed. If the supporting role is taken on then a clear agreement needs to be established with your friend/family member about the role.
Support may include:
- being committed to supervising the treatment dose for the duration of treatment
- knowing what to do in the event of an overdose
- encouraging the friend/family member to develop their friendships and support networks and to get involved in positive, healthy activities
- going with them to appointments (e.g. doctors and counsellors)
- attending couple or family counselling.
Using heroin while pregnant can harm an unborn child. These babies are often born underdeveloped and suffer from breathing problems and infections in the first few weeks of life. Heroin can also cause premature labour; babies may be born so early that they need intensive care. The baby’s poor health can also be associated with the poor health and nutrition of their mothers.
Heroin can cross the placenta and an unborn baby can become dependent on the drug. Babies of heroin-dependent mothers can suffer withdrawal symptoms after they are born. They often need special care in hospital.
Injecting heroin also increases the risk of HIV infection and other disease for both mother and baby.
Pregnant women who want to stop taking heroin need to be very careful. Sudden withdrawal from heroin may harm the baby and cause poor growth, miscarriage or premature labour.
It is recommended that you check with your doctor, or other health professional, if you are taking or planning to take any substances during pregnancy, including prescribed and over-the-counter medications.
Heroin and driving
It is illegal to drive while under the influence of any drug (including heroin). Breaking this law carries heavy penalties including disqualification, fines and even imprisonment.
It is also unsafe to drive after using heroin. Heroin causes drowsiness, reduces coordination, slows down reaction time and may also affect vision. These effects can impair driving.
Heroin and the law
Heroin is illegal. Federal and state laws provide penalties for possessing, using, making or selling heroin. Drug laws in Australia distinguish between those who use drugs and those who supply or traffic drugs.
At present in Victoria, penalties range from a $2,000 fine and/or one year imprisonment for cultivation (if the court is satisfied that the offence is not related to trafficking), $3,000 and/or one year’s imprisonment for possession/use (not related to trafficking) to fines of up to $250,000 and/or 25 years imprisonment for commercial trafficking.
In Victoria, the police and courts have recently introduced a number of new schemes in relation to drug offences. Some of these aim to divert people from the criminal justice system, others involve referring people with a drug problem to treatment programs.
Reducing the risks
Australian drug policy is based on harm minimisation. This is about reducing drug-related harm to both the community and individual drug users.
Harm minimisation strategies range from encouraging ‘non- use’ through to providing the means for drug users to use drugs with less risks.
For more tips on how to reduce the risks of using heroin call the alcohol and drug information service in your state or territory.
Remember: there is no safe level of drug use.
What to do in a crisis
If someone is suspected of having overdosed while using heroin, it is very important that they receive professional help as soon as possible. Quick responses can save lives.
- Call an ambulance. Dial 000. Don’t delay because you think you or your friend might get into trouble. Ambulance officers are not obliged to involve the police.
- Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
- Ensure adequate air by keeping crowds back and opening windows. Loosen tight clothing.
- If the person is unconscious, don’t leave them on their back â€” they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
- If breathing has stopped, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
- Provide the ambulance officers with as much information as you can â€” how much heroin was taken, how long ago, and any pre-existing medical conditions.
- Before using heroin, make sure you and your friends know what to do in a crisis.