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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.
What is the scope of heroin use in the United States?
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.
NIDA's Community
Epidemiology Work Group (CEWG), which provides information about the
nature and patterns of drug use in 21 cities, reported in its December 1999
publication that heroin was mentioned most often as the primary drug of abuse
in drug abuse treatment admissions in Baltimore, Boston, Los Angeles, Newark,
New York, and San Francisco.
Route of Administration Among Heroin Treatment
Admissions in Selected Areas
Source: Community Epidemiology Work
Group, NIDA, December 1999
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 in Newark, Chicago, and New
York.
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.
Source: National Institutes of
Health; The National Institute on Drug Abuse
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