Heroin

Smack, H, horse, Harry, boy, junk, shit, skag, brown

Heroin is a drug manufactured from morphine, which is obtained from the opium poppy. Its effects are similar to those of morphine. Both are central nervous system depressants, and very effective painkillers.

heroin powder

Heroin can come in several forms, but the two most common in Australia are white powder and brown rock. The powder form is dissolved and injected. Dealers normally cut it with other substances, typically caffeine, paracetamol, sugars or starch. The 'brown rock' form of heroin is less pure; it is usually heated and the vapours inhaled. Unrefined heroin (heroin base) is rarely found in Australia.

Heroin and the law

Heroin was banned from legal prescription in Australia in 1953. Bans were brought about through international pressure. The use of heroin for any purpose is illegal in all states and territories in Australia. Supply is much more severely punished than other activities associated with heroin use.

How heroin is used

Heroin can be injected, smoked, swallowed or snorted, or its fumes inhaled (this is called 'chasing'). It is usually injected. Smoking heroin is becoming more popular, but it has been found that people who smoke heroin usually end up injecting it.

Australian research has found that people can die from smoking, snorting or swallowing heroin, as well as injecting it.

How common is heroin use?

The 2016 National Drug Strategy Household Survey found that 0.2% of Australians aged 14 and over had used heroin in the preceding year and 1.3% had ever tried it. 

Short term effects

Heroin suppresses nerves that signal pain, making it an especially effective painkilling medication. It also suppresses the centres in the brain that control breathing and coughing. The initial effect of heroin, when injected, inhaled or smoked, is a surge of pleasurable feeling called 'the rush', which is usually accompanied by warm flushing of the skin, a dry mouth and a heavy feeling in the hands and feet. Other immediate symptoms can include nausea, vomiting and a severe itch. The effects are almost immediate following injection or inhaling. After the initial rush, users become drowsy for several hours, with slowing of the heart and breathing, as well as reduced mental alertness and response to pain.

Long term effects

Many of the physically damaging effects of heroin are associated with injecting, rather than with the drug itself. Constant injection can lead to collapsed veins, bacterial infection and abscesses (boils) at injection sites. If a person shares needles or uses dirty equipment they are also vulnerable to blood-borne viruses such as HIV and hepatitis B and C.

Heroin itself can cause:

  • severe constipation
  • tooth decay (from lack of saliva)
  • difficulty getting and staying pregnant
  • impotence in males
  • loss of appetite and weight.

Heroin users are often in poor general health, which, along with suppression of the respiratory system, makes them vulnerable to lung

Heroin use and psychological problems

Heroin users suffer high levels of depression and anxiety, and are more likely to have an antisocial personality disorder. Suicide rates amongst heroin users are estimated at 14 times that in the general population. They are also found to have high rates of post-traumatic stress disorder (PTSD) and borderline personality disorder. The 2007 National Drug Strategy Household Surveyfound that around 65% of heroin users reported high or very high psychological distress, as measured by the Kessler 10 Scale. This compared with 20% of other drug users, and around 9% of those who did not use illegal drugs in the preceding month.

Heroin and driving

Heroin causes drowsiness and impairs alertness, concentration and reaction times. It is dangerous, as well as illegal, to drive under the influence of heroin. If heroin is used with alcohol, the risk is greatly increased.

Heroin and pregnancy

Heroin taken by a pregnant woman crosses the placenta, and can affect foetal development. It increases the risk of miscarriage, premature birth, low birth weight and sudden infant death syndrome (SIDS). The baby of a heroin-dependent mother may also be born dependent, and have to go through a withdrawal following birth (this is called neonatal abstinence syndrome). In severe cases, medication may be necessary. If the mother has a blood-borne virus such as hepatitis B or C, or HIV, the baby may become infected pre delivery or at childbirth. Heroin passes into breast milk, and can cause further adverse effects on a breast-fed baby.

Using heroin with other drugs

Heroin users frequently use other depressant drugs such as alcohol and tranquillisers at the same time. Combining heroin with these drugs greatly increases the risk of overdose.

Dependence

Research suggests that around one in four of those people who ever try heroin actually become dependent on it. Daily heroin use over several weeks is probably necessary to develop dependence. Daily use typically occurs after a one or two-year period from first use.Australian research has found that people can develop a dependence

Withdrawal

Within the first 12 hours after their last dose a dependent user can experience withdrawal symptoms, including:

  • runny eyes and nose
  • excessive sneezing and yawning
  • sweating.

These symptoms may be followed by:

  • agitation and irritability
  • goose bumps
  • hot and cold flushes
  • loss of appetite.

After about 24 hours very strong cravings develop, which may be accompanied by:

  • stomach cramps
  • diarrhoea
  • nausea and vomiting
  • headaches
  • poor sleep
  • lethargy
  • pains in the back, joints and/or legs and arms
  • continuation of the earlier symptoms.

Symptoms reach their peak in two to four days; by the fifth to seventh day most physical symptoms have begun to settle down. Over the following weeks, general health and mood improve, but the former user may experience ongoing problems related to sleep and appetite, as well as drug cravings.

Overdose

The risks of overdose and death are high. Heroin is a very effective nervous system depressant. It can be difficult for a person to control the dose they are taking, since purity cannot be measured directly when the drug is purchased on the illegal drug market. A person returning to heroin after a break or a significant reduction in their use is at particular risk. They will have lost their tolerance to the drug; if they then take the amounts that they used before stopping, they can overdose. The risk of death is increased if other depressants such as alcohol or when heroin has been mixed with another depressant.

Heroin, opiates and opioids

The term opiate is used to describe naturally occurring drugs obtained from opium poppies.

Opium is the resin taken from the poppies, from which the opiates morphine and codeine are extracted. Opiates act on nerve cells in the brain called opioid receptors to depress the activity of the nervous system and act as very effective pain killers.

Heroin is not derived directly from the opium poppy—it is manufactured from morphine. It is called an opioid agonist because it activates the brain in the same way as the opiates.

Methadone is a synthetic opioid agonist that affects the brain in the same way as morphine and heroin. While the opioid agonists activate the opioid receptors, naltrexone acts to block these receptors (so drugs like heroin cannot activate them); it is an opioid antagonist. Buprenorphine is a mixed opioid agonist-antagonist. It activates the opioid receptors to a lesser extent than heroin, methadone and morphine, but it acts at the same time to block the receptors, preventing heroin and other opioids from having much effect.

Treatment

The most effective treatments for heroin dependence are substitution therapies. These involve substituting other less harmful drugs for heroin, usually on a long-term basis. Doses must be high enough to prevent withdrawal symptoms. People in treatment also need good psychological and social support, addressing motivation and coping skills, if they are to succeed in giving up heroin.

Methadone

Methadone maintenance treatment is the most commonly used substitution therapy. The methadone is typically swallowed as a syrup. While its effects on the brain are similar to those of heroin, methadone lacks many of the negative side effects associated with heroin use. Because it is swallowed, the risks associated with injecting drug use are removed. When stabilised on methadone, a person is able to undertake usual life activities, including driving. Since the methadone is prescribed by a doctor, problems associated with controlling dosage and using the illegal market are less than with heroin. Methadone can be injected, and overdose is still possible. However, the evidence suggests that methadone maintenance treatment reduces the risk of death to one-third of the risk for users not in treatment. It also reduces heroin use, other criminal activity associated with the illegal market, and obstetric and foetal complications, while leading to an increase in users' legitimate earnings Because methadone is not effective for all heroin users, other drug therapies have been developed, including buprenorphine and naltrexone.

Buprenorphine

Buprenorphine is taken by dissolving a tablet of the drug under the tongue. Because of its action on the brain, the risk of overdose with buprenorphine is lower than with methadone. It must be prescribed at doses high enough to maintain people in treatment, and should be accompanied by appropriate psychological and social support. It has a similar effectiveness to methadone in terms of retention in treatment and reducing illegal drug use.

Naltrexone

Another treatment that is less common in Australia is use of the blocking agent naltrexone. In high enough doses, naltrexone blocks the sites in the brain activated by heroin, so that any heroin taken will have no effect. Naltrexone brings on a severe withdrawal reaction. Because of this, people planning to enter naltrexone treatment are often required to go through withdrawal before entering treatment. The treatment has a high drop-out rate, and appears to be best suited to highly motivated people with good social support.