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Heroin Abuse and Addiction Research Report

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Heroin Abuse and Addiction Research Report N A TIONAL INSTITUTE ON DRUG ABUSE ResearchReport S E R I E S Although heroin abuse has tr ended downward during the past couple of years, its prevalence is still higher than in the early 1990s. HHEE RR OO II NN AbuseAbuse andand These relatively high rates of abuse, together with the significant he r oin abuse we are now seeing AAdd dd ii cc tt ii oo nn among school-age youth, the glam- orization of heroin in music and What is heroin? or other poisons. Because heroi n films, changing patterns of drug er oin is an illegal, highly abusers do not know the actual use, and heroin’s increased purity st r ength of the drug or its true and decreased prices, make it addictive drug. It is both imperative that the public have the the most abused and the contents, they are at risk of over- H dose or death. Heroin also poses latest scientific information on this most rapidly acting of the opi- to p i c . ates. Heroin is processed from special problems because of the The National Institute on Drug transmission of HIV and other Abuse (NIDA) has developed this morphine, a naturally occurring substance extracted from the diseases that can occur from publication to provide an overview sharing needles or other injection of the latest res e a r ch findings on seed pod of certain varieties of equipment. he r oin abuse and addiction. poppy plants. It is typically sold He r oin is a highly addictive drug, as a white or brownish powder and its abuse has rep e r cussions that or as the black sticky substance What is the scope extend far beyond the individual known on the streets as “black us e r . The health and social conse- of heroin use in quences of drug abuse–HIV/AIDS, tar heroin.” Although purer hero- the United States? violence, tuberculosis, fetal effe c t s , in is becoming more common, crime, and disruptions in family, most street heroin is “cut” with ccording to the 1998 workplace, and educational other drugs or with substances National Household Survey en v i r onments–have a devastating such as sugar, starch, powdered on Drug Abuse, which may impact on society and cost billions A milk, or quinine. Street heroi n actually underestimate illicit opi- of dollars each year. Fortunately, the availability can also be cut with strychnine ate (heroin) use, an estimated of treatments to manage opiate 2.4 million peo- addiction and the promise of new ple had used treatments from research provide he r oin at some hope for individuals who suffer time in their from addiction and for those lives, and nearly around them. 130,000 of them We hope this compilation of scientific information on heroin reported using it will help to inform readers about within the month the harmful effects of heroin abuse pr eceding the and addiction and will assist in survey. The sur- pr evention and treatment effo r t s . vey report esti- Alan I. Leshner, Ph.D. mates that there Di re c t o r we r e 81,000 National Institute on Drug Abuse new heroi n U . S . D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s • N a t i o n a l I n s t i t u t e s o f H e a l t h 2NIDA RESEARCH REPORT SERIES users in 1997. A large prop o r t i o n of these recent new users were smoking, snorting, or sniffi n g he r oin, and most (87 perce n t ) How is heroin used? we r e under age 26. In 1992, er oin is usually injected, ing treatment; however, only 61 percent were younger sn i f fed/snorted, or smoked. researchers have observed a than 26. HTypically, a heroin abuser shift in heroin use patterns, The 1998 Drug Abuse may inject up to four times a day. from injection to sniffing and War ning Network (DAWN), Intravenous injection provides the smoking. In fact, sniffi n g / s n o r t i n g which collects data on drug- gr eatest intensity and most rapid he r oin is now the most widely related hospital emerge n c y onset of euphoria (7 to 8 sec- reported means of taking heroi n department (ED) episodes from onds), while intramuscular injec- among users admitted for drug 21 metropolitan areas, estimates tion produces a relatively slow tr eatment in Newark, Chicago, that 14 percent of all drug-rel a t e d onset of euphoria (5 to 8 min- and New York. ED episodes involved heroi n . utes). When heroin is sniffed or With the shift in heroin abuse Even more alarming is the fact smoked, peak effects are usually pa t t e r ns comes an even more that between 1991 and 1996, felt within 10 to 15 minutes. diverse group of users. Older he ro i n - r elated ED episodes more Although smoking and sniffi n g users (over 30) continue to be than doubled (from 35,898 to he r oin do not produce a “rush” one of the largest user groups in 73,846). Among youths aged as quickly or as intensely as most national data. However, the 12 to 17, heroi n - r elated episodes intravenous injection, NIDA in c r ease continues in new, young nearly quadrupled. researchers have confirmed users across the country who are NIDA’s Community that all three forms of heroin being lured by inexpensive, high- administration are addictive. purity heroin that can be sniffe d Epidemiology Work Grou p Injection continues to be the or smoked instead of injected. (CEWG), which provides infor- pr edominant method of heroi n He r oin has also been appearing mation about the nature and use among addicted users seek- in more affluent communities. pa t t e r ns of drug use in 21 cities, reported in its December 1999 Route of Administration Among publication that heroin was Heroin Treatment Admissions in Selected Areas mentioned most often as the primary drug of abuse in drug Percentage abuse treatment admissions in 100% Ba l t i m o r e, Boston, Los Angeles, 90 Newark, New York, and San 80 Fr a n c i s c o . 70 60 Injecting 50 40 30 Sniffing/ 20 snorting 10 Smoking 0 and other Baltimore Boston L.A. Newark New York St. Louis Source: Community Epidemiology Work Group, NIDA, December 1999 NIDA RESEARCH REPORT SERIES 3 What are the Opiates Act on Many Places in the Brain and Nervous System long-term effects of heroin use? ne of the most detrimental lo n g - t e r m effects of heroi n Ois addiction itself. Addiction is a chronic, rel a p s i n g disease, characterized by compul- sive drug seeking and use, and by ne u r ochemical and molecular changes in the brain. Heroin also Opiates can change the pr oduces profound degrees of tol- limbic system, which erance and physical dependence, Opiates can which are also powerful motivat- de p r ess brea t h i n g controls emotions, to ing factors for compulsive use and by changing increase feelings of ne u ro c h e m i c a l pleasure. abuse. As with abusers of any activity in addictive drug, heroin abusers the brain Opiates can block pain gradually spend more and more stem, where messages transmitted time and energy obtaining and automatic by the spinal cord from using the drug. Once they are body the body. addicted, the heroin abusers’ pri- functions mary purpose in life becomes ar e control l e d . seeking and using drugs. The drugs literally change their brains. Physical dependence develops with higher doses of the drug. brain so rapidly. With heroin, With physical dependence, the What are the the rush is usually accompanied body adapts to the presence of immediate by a warm flushing of the skin, the drug and withdrawal symp- (short-term) effects dry mouth, and a heavy feeling toms occur if use is red u c e d in the extremities, which may abruptly. Withdrawal may occur of heroin use? be accompanied by nausea, within a few hours after the last oon after injection (or inhala- vomiting, and severe itching. time the drug is taken. Symptoms tion), heroin crosses the After the initial effects, of withdrawal include res t l e s s - Sblood-brain barrier. In the abusers usually will be drow s y ness, muscle and bone pain, brain, heroin is converted to mor- for several hours. Mental function insomnia, diarrhea, vomiting, cold phine and binds rapidly to opioid is clouded by heroin’s effect on flashes with goose bumps (“cold receptors. Abusers typically rep o r t the central nervous system. turkey”), and leg movements. feeling a surge of pleasurable Cardiac function slows. Brea t h i n g Major withdrawal symptoms peak sensation, a “rush.” The intensity is also severely slowed, some- between 24 and 48 hours after the of the rush is a function of how times to the point of death. last dose of heroin and subside much drug is taken and how He r oin overdose is a particular after about a week. However, rapidly the drug enters the brain risk on the street, where the some people have shown persis- and binds to the natural opioid amount and purity of the drug tent withdrawal signs for many receptors.
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