Heroin (Junior Drug Awareness)

Heroin

alcohol amphetamines and other stimulants cocaine and crack diet pills

Marijuana

ecstasy and other club drugs

nicotine

heroin

over-the-counter drugs

how to say no to drugs

prozac and other antidepressants

inhalants and solvents

steroids and other performance-enhancing drugs Vicodin, oxycontin, and other pain relievers

Heroin Allan b. Cobb

Junior Drug Awareness: Heroin

Copyright © 2009 by Infobase Publishing All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval systems, without permission in writing from the publisher. For information, contact: Chelsea House An imprint of Infobase Publishing 132 West 31st Street New York NY 10001 Library of Congress Cataloging-in-Publication Data Cobb, Allan B. Heroin / Allan B. Cobb. p. cm. — (Junior drug awareness) Includes bibliographical references and index. ISBN 978-0-7910-9749-6 (hardcover) 1. Heroin—Juvenile literature. 2. Heroin abuse—Juvenile literature. I. Title. II. Series. RM666.H35C63 2008 615'.32335—dc22

­2007043662

Chelsea House books are available at special discounts when purchased in bulk quantities for businesses, associations, institutions, or sales promotions. Please call our Special Sales Department in New York at (212) 967-8800 or (800) 322-8755. You can find Chelsea House on the World Wide Web at http://www.chelseahouse.com Text design ­by Erik Lindstrom Cover design by Jooyoung ­An Printed in the United States Bang NMSG 10 9 8 7 6 5 4 3 2 ­1 This book is printed on ­acid-­free ­paper. All links and web addresses were checked and verified to be correct at the time of publication. Because of the dynamic nature of the web, some addresses and links may have changed since publication and may no longer be valid.

contents iNTRODuCTiON Battling a Pandemic: A History of Drugs in the United States by Ronald J. brogan,  Regional Director of D.A.R.E. America

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What is heroin? 

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heroin use Throughout history 

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how heroin is used 

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Who uses heroin 

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how heroin Affects the body 

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Tolerance, Addiction, and Withdrawal 

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Detox and Treatment 

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Glossary

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Bibliography

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Further Reading

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Photo Credits

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Index

104

About the Authors

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introduction

battling a pandemic: a history of drugs in the united states

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hen Johnny came marching home again after the Civil War, he probably wasn’t marching in a very straight line. This is because Johnny, like 400,000 of his fellow drug-addled soldiers, was addicted to morphine. With the advent of morphine and the invention of the hypodermic needle, drug addiction became a prominent problem during the nineteenth century. It was the first time such widespread drug dependence was documented in history. Things didn’t get much better in the later decades of the nineteenth century. Cocaine and opiates were used as over-the-counter “medicines.” Of course, the most famous was Coca-Cola, which actually did contain cocaine in its early days.

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battling a pandemic: a history of drugs in the united states After the turn of the twentieth century, drug abuse was spiraling out of control, and the United States government stepped in with the first regulatory controls. In 1906, the Pure Food and Drug Act became a law. It required the labeling of product ingredients. Next came the Harrison Narcotics Tax Act of 1914, which outlawed illegal importation or distribution of cocaine and opiates. During this time, neither the medical community nor the general population was aware of the principles of addiction. After the passage of the Harrison Act, drug addiction was not a major issue in the United States until the 1960s, when drug abuse became a much bigger social problem. During this time, the federal government’s drug enforcement agencies were found to be ineffective. Organizations often worked against one another, causing counterproductive effects. By 1973, things had gotten so bad that President Richard Nixon, by executive order, created the Drug Enforcement Administration (DEA), which became the lead agency in all federal narcotics investigations. It continues in that role to this day. The effectiveness of enforcement and the socalled “Drug War” are open to debate. Cocaine use has been reduced by 75% since its peak in 1985. However, its replacement might be methamphetamine (speed, crank, crystal), which is arguably more dangerous and is now plaguing the country. Also, illicit drugs tend to be cyclical, with various drugs, such as LSD, appearing, disappearing, and then reappearing again. It is probably closest to the truth to say that a war on drugs can never be won, just managed. Fighting drugs involves a three-pronged battle. Enforcement is one prong. Education and prevention is the second. Treatment is the third.

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introduction Although pandemics of drug abuse have been with us for more than 150 years, education and prevention were not seriously considered until the 1970s. In 1982, former First Lady Betty Ford made drug treatment socially acceptable with the opening of the Betty Ford Center. This followed her own battle with addiction. Other treatment centers—including Hazelden, Fair Oaks, and Smithers (now called the Addiction Institute of New York)—added to the growing number of clinics, and soon detox facilities were in almost every city. The cost of a single day in one of these facilities is often more than $1,000, and the effectiveness of treatment centers is often debated. To this day, there is little regulation over who can practice counseling. It soon became apparent that the most effective way to deal with the drug problem was prevention by education. By some estimates, the overall cost of drug abuse to society exceeds $250 billion per year; preventive education is certainly the most cost-effective way to deal with the problem. Drug education can save people from misery, pain, and ultimately even jail time or death. In the early 1980s, First Lady Nancy Reagan started the “Just Say No” program. Although many scoffed at the program, its promotion of total abstinence from drugs has been effective with many adolescents. In the late 1980s, drug education was not science-based, and people essentially were throwing mud at the wall to see what would stick. Motivations of all types spawned hundreds, if not thousands, of drug-education programs. Promoters of some programs used whatever political clout they could muster to get on various government agencies’ lists of most effective programs. The bottom line, however, is that prevention is very difficult to quantify. It’s difficult to prove that drug use would have occurred if it were not prevented from happening.

battling a pandemic: a history of drugs in the united states In 1983, the Los Angeles Unified School District, in conjunction with the Los Angeles Police Department, started what was considered at that time to be the gold standard of school-based drug education programs. The program was called Drug Abuse Resistance Education, otherwise known as D.A.R.E. The program called for specially trained police officers to deliver drugeducation programs in schools. This was an era in which community-oriented policing was all the rage. The logic was that kids would give street credibility to a police officer who spoke to them about drugs. The popularity of the program was unprecedented. It spread all across the country and around the world. Ultimately, 80% of American school districts would utilize the program. Parents, police officers, and kids all loved it. Unexpectedly, a special bond was formed between the kids who took the program and the police officers who ran it. Even in adulthood, many kids remember the name of their D.A.R.E. officer. By 1991, national drug use had been halved. In any other medical-oriented field, this figure would be astonishing. The number of people in the United States using drugs went from about 25 million in the early 1980s to 11 million in 1991. All three prongs of the battle against drugs vied for government dollars, with each prong claiming credit for the reduction in drug use. There is no doubt that each contributed to the decline in drug use, but most people agreed that preventing drug abuse before it started had proved to be the most effective strategy. The National Institute on Drug Abuse (NIDA), which was established in 1974, defines its mandate in this way: “NIDA’s mission is to lead the Nation in bringing the power of science to bear on drug abuse and addiction.” NIDA leaders were the experts in prevention and treatment, and they had enormous resources. In

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introduction 1986, the nonprofit Partnership for a Drug-Free America was founded. The organization defined its mission as, “Putting to use all major media outlets, including TV, radio, print advertisements and the Internet, along with the pro bono work of the country’s best advertising agencies.” The Partnership for a Drug-Free America is responsible for the popular campaign that compared “your brain on drugs” to fried eggs. The American drug problem was front-page news for years up until 1990—1991. Then the Gulf War took over the news, and drugs never again regained the headlines. Most likely, this lack of media coverage has led to some peaks and valleys in the number of people using drugs, but there has not been a return to anything near the high percentage of use recorded in 1985. According to the University of Michigan’s 2006 “Monitoring the Future” study, which measured adolescent drug use, there were 840,000 fewer American kids using drugs in 2006 than in 2001. This represents a 23% reduction in drug use. With the exception of prescription drugs, drug use continues to decline. In 2000, the Robert Wood Johnson Foundation recognized that the D.A.R.E. Program, with its tens of thousands of trained police officers, had the top state-of-the-art delivery system of drug education in the world. The foundation dedicated $15 million to develop a cutting-edge prevention curriculum to be delivered by D.A.R.E. The new D.A.R.E. program incorporates the latest in prevention and education, including high-tech, interactive, and decision-model-based approaches. D.A.R.E. officers are trained as “coaches” who support kids as they practice research-based refusal strategies in high-stakes peer-pressure environments. Through stunning magnetic resonance imaging (MRI)

battling a pandemic: a history of drugs in the united states images, students get to see tangible proof of how various substances diminish brain activity. Will this program be the solution to the drug problem in the United States? By itself, probably not. It is simply an integral part of a larger equation that everyone involved hopes will prevent kids from ever starting to use drugs. The equation also requires guidance in the home, without which no program can be effective. Ronald J. Brogan Regional Director D.A.R.E. America

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What is heroin?

h

eroin is a very powerful and dangerous drug made from the opium poppy flower. Heroin is one of the most widely abused of all the drugs made from opium poppies. It acts very quickly in the body by affecting how the human brain feels pleasure and pain. It creates a sense of intense well being, euphoria, relaxation, and sleepiness. Heroin is also a drug that causes addiction with repeated use. Frequent users of heroin require more and more of the drug because their bodies develop a tolerance. This means that the users will need more of the drug to feel its effects. Once someone has developed a tolerance to a drug, it is difficult to stop using it without treatment.

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What is heroin?

Heroin is made from the opium poppy flower. Above is a poppy field in Northern Moravia, Czech Republic.

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heroin

WHAT IT LOOKS LIKE Pure heroin is a white powder with a bitter taste. It is almost never sold on the streets. Instead, heroin sold on the streets may be white, tan, red, or dark brown. Street heroin comes in these different colors either because of substances in it that are left over from when it was made or from other substances purposely mixed in with the pure heroin. Heroin is commonly mixed with other substances or drugs. Powdered milk, powdered vitamins, caffeine, sugar, and certain chemicals are often used. Coffee, chocolate milk powder, cocoa mix, and brown sugar are what might give some powdered heroin a tan or brown color. Heroin can also be mixed with dangerous substances such as poisons. The substances mixed in with heroin are often selected by what is easily and cheaply available. This is done partly to reduce the strength of the heroin and also to make it cheaper to produce, and therefore cheaper to buy. By mixing heroin with other substances, drug dealers can double or triple the amount of heroin they sell, since more people will be able to afford it. One type of heroin available mostly in the western and southwestern United States is called “black tar.” It varies in color from dark brown to black and can be either a sticky, tar-like substance or hard like coal. Black tar heroin is difficult to mix with other substances. Dealers do mix it, though, by heating it up until it is soft and kneading in a substance such as starch, molasses, cocoa mix, coffee, or brown sugar. When someone buys heroin on the street, he or she never knows how strong the drug is or what was added to it. In movies showing heroin use, someone is often shown tasting a small amount of heroin to see if it is

What is heroin?

Though heroin is typically a white powder, it is sold on the streets in shades of red, brown, and tan. This is caused by the substances that are mixed with it—such as brown sugar—which dealers use to cheapen the cost of producing it and the price it costs to buy it. Dealers hope a lower cost will attract more customers.

bitter. Because of this strong, noticeable taste, it is easy to tell if the heroin has been mixed with something with a different taste. Heroin bought on the street is usually packaged in paper bundles or small, zippered plastic bags. It is also often sold in glass vials, capsules, plastic wrap, aluminum foil, or small balloons. (The heroin is funneled into the bottom of the balloon, which is then securely tied. The tied end containing the heroin is folded back into the mouth of the balloon for added protection.) Black tar heroin, because it is sticky, is normally packaged in cellophane, plastic wrap, waxed paper, aluminum

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heroin

Black tar is a type of heroin that comes from Mexico. It varies in color from shades of dark brown to black. Unlike the powdered forms of heroin that come from South Asia or South America, black tar heroin is solid. It can be either sticky like tar or hard like coal.

foil, or small balloons. In some areas of the world, it is common for heroin to be sold in packages stamped with brand names or logos. Dealers use these to create a name for themselves, in order to get customers to come back again and again.

STREET NAMES Street names are nicknames that drug users use to identify illegal drugs. On the street, heroin goes by many different names: Lady, white girl, China White, horse, black tar, brown sugar, Mexican Brown, smack, skag, mud, goods, H, junk, and Harry. There are literally hundreds of other slang names for heroin, and they vary from region to region. Some names such as H, junk,

What is heroin? Harry, horse, and smack refer to heroin in general. Other names, including black tar, Mexican Brown, and China White, refer to specific types of heroin. Black tar, as already mentioned, is either sticky and tar-like or a coallike lump of heroin. Mexican Brown is a heroin from Mexico containing substances that give it a brown color. China White is a high purity, white, powdered form of heroin. On the street, slang is also used to describe an amount of heroin. For example, a “nickel bag” is sold for $5 and a “dime bag” is sold for $10. A “deuce” is $2 worth of heroin. A “bindle” is a small packet, and a “deck” is a bag weighing 1 to 15 grams. A “half load” is 15 bags or decks and a “load” is 25 bags or decks. As with

CHEESE HEROIN “Cheese heroin,” or simply “cheese,” became famous in 2005 after it caused a string of deaths. Cheese is a brownish powder and is usually snorted or inhaled. It contains 2% to 8% heroin mixed with a common cold medicine, and sells cheaply at $2 for a tenth of a gram, and $5 for a quarter of a gram. It is widely available and widely used among children and teens, and children as young as nine years old have reportedly used it. This is extremely dangerous, because cheese—despite its innocent sounding name—is highly addictive. Many users end up going to special medical centers, called rehabilitation clinics, to try to get off the drug. Unfortunately, though, it has killed some users: 21 of them between 2005 and 2007.

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heroin slang names for heroin, the slang terms for amounts of heroin vary widely from place to place.

OPIUM POPPIES Opium is a drug that oozes from the young seedpod of the opium poppy. Up to 16% of this ooze is a drug called morphine, which is made into heroin. The scientific name of the opium poppy, Papaver somniferum, means “sleep-bringing poppy.” It was given this name because the drug it contains make people feel drowsy. The species has many different varieties. Some varieties are “low morphine” because they lack enough opium for making drugs. Other varieties are “high morphine” and are specially grown for their drug content. Opium poppies are tall plants that grow up to 5 feet (1.5 m) tall. The flower color varies and may be white, pink, violet, blue, or red. The seedpod, where the drug is made, is a bulb-like capsule filled with tiny seeds. The seed color also varies, and may be black, gray, blue, or white. Opium poppies grow well in nutrient-rich soils in warm or hot areas. They have traditionally been grown in India, Iran, Turkey, Afghanistan, Eastern Europe, China, Manchuria, and other parts of Asia. Today, they are still grown in these areas as well as in Mexico, Central America, and South America. The seeds from some poppies are widely used for food and are found in and on foods such as bagels, muffins, and cakes. These poppy seeds are from the low-morphine varieties of opium poppies and may also be pressed to make cooking oil and oil-based paints. Although these poppy seeds are supposed to be free from the drug opium, they do contain tiny amounts of opium and related substances. The amount of opium in poppy seeds is too small to have a drug effect, but it may still show up in drug tests.

What is heroin?

Opium poppies are tall plants from which the drug opium can be extracted. The opium is found in the plant’s seedpod, which is full of tiny capsules of seeds. Poppy seeds are often used for food, such as bagels. They contain small traces of opium that have no effect but can still show up in drug tests.

OPIATES Opium is a combination of several different types of chemicals. These related chemicals are together called

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heroin opiates because they are made from opium. All of these opiates are in a group of chemicals called alkaloids. Alkaloids are natural substances made up of carbon, hydrogen, and nitrogen. Some alkaloids are poisonous, while others have medical uses as pain relievers or drugs to block pain and other sensations. Opium contains two main groups of alkaloids. The group with sleep-causing effects is called phenanthrenes. The main narcotics found in this group include morphine, codeine, and thebaine. The other group of alkaloids is called isoquinolines. This group has no narcotic characteristics, so heroin users typically ignore it. Heroin is considered an opiate, but it is not found naturally ready-made in opium (it is made from morphine). Opium has been used as a narcotic for more than 6,000 years, once as part of early medicine as well as in ritual practices. Ancient doctors used it as a pain reliever. The use of opium as a recreational drug seems to have occurred in China in the late 1400s. From there, its use and abuse spread slowly throughout the world. Laws against opium were put in place as early as 1729 to try to control its abuse. In efforts to uphold these laws, the government battled the growers, refiners, and distributors of the drug. These battles continue today.

MORPHINE AND CODEINE Morphine is the most plentiful alkaloid in opium. The sap of the opium poppy seedpod usually contains 10% to 16% morphine. Morphine is a strong pain reliever, used to treat both acute and chronic pain. Acute pain is pain from specific recent causes, such as pain from an injury or pain after surgery. Chronic pain, such as back pain from an old injury or pain from severe diseases, is pain that lasts for a long time.

What is heroin? An unusual fact about morphine is that it is very similar to substances that are created naturally in the human body. These substances are known as endorphins. The word endorphins is a contraction for endog-­ enous morphine, meaning “morphine created in” the body naturally. The job of endorphins is to kill pain, and so they are produced in the body in response to pain. Endorphins work by fitting into special spots in the body, like keys into a lock, in order to “turn off” feelings of pain. Morphine works much like this because it is built in a similar way to endorphins—like a fake copy of the endorphin key. As a result, morphine has the same pain-relieving effects as endorphins. It has been discovered that endorphins occur in large amounts in women during childbirth, long distance runners, and others who are involved in physically stressful or painful activities. Codeine, a substance similar to morphine, is the other alkaloid found in the opium poppy. Opium contains anywhere from 0.3% to about 3% codeine. In opium with a higher percentage of codeine, the morphine content is lower. Codeine is used in medicine for its pain-relieving, anti-cough, and anti-diarrhea effects. Most codeine for medical use is made from morphine, rather than from opium. Codeine is a controlled substance, meaning that the U.S. government regulates its sale and use. Some common medicines available at drugstores contain small amounts of codeine, but medicines with stronger doses require a special note from a doctor. Because so many doctors prescribe codeine for their patients, the drug is easily available and is widely abused. In some countries, codeine is sold in pharmacies to anyone, even people without prescriptions. Heroin addicts will sometimes buy codeine if they cannot find heroin.

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heroin

HEROIN Heroin is another drug that can be made from morphine. The chemical name for heroin is diacetylmorphine or diamorphine. It was first made in the laboratory in 1874 by an English chemist named C.R. Alder Wright. He was experimenting with morphine to find a better painkiller. His work received little attention. In 1897, a German chemist named Felix Hoffman, working for the company Bayer Pharmaceutical, made this substance again. Since morphine was known to be highly addictive, he was trying to find a less addictive but stronger form of the drug. His experiments showed that this new substance was three times stronger than morphine. Bayer Pharmaceutical named the new drug heroin. It was advertised as a painkiller that would not cause addiction like morphine did. The new drug was used in cough syrup and to cure morphine addiction. Within a few years, however, a terrible mistake was discovered: Heroin was found to be much more addictive than morphine. Studies on heroin have now shown that its effects are very similar to those of morphine. Plus, as with morphine use, regular heroin use causes the user to build up a physical tolerance. The result is that both drugs are very addictive.

FROM POPPIES TO HEROIN Heroin follows a long journey from the poppy fields to the street. The journey begins as growers plant poppy seeds in their fields. After about three months, the poppies bloom into brightly colored flowers. Eventually the flower petals fall away, leaving the seedpod. The seedpod is filled with tiny poppy seeds and a thick, milky sap that contains opium. The sap is extracted from the seedpods by cutting parallel slits in them with a knife. The sap that oozes out

What is heroin?

After a poppy flower’s petals have fallen off, opium can be collected from the seedpod, which contains seeds as well as a thick, milky sap that contains the opium. The milky fluid seeps out and hardens into a gummy substance upon exposure to air. This is the raw opium. It can then be scraped off and collected. Above, a man in Kandahar, Afghanistan removes raw opium from a poppy flower.

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heroin of the pod eventually becomes a thick, brownish-black gum. This gum—actually raw opium—is then scraped off the seedpods and collected. An acre of opium poppies produces about 23 pounds of raw opium (13 kg raw opium). Raw opium contains more than 35 different alkaloids. Because morphine only makes up about 10% of the opium, the people who grow the opium poppies often remove the morphine close to the fields. The morphine is the important part to them anyway, and removing it near the fields lessens the material they need to smuggle to drug-making laboratories. For example, if a poppy field produces 220 pounds (100 kg) of opium, only 22 pounds (10 kg) is morphine. Smaller loads of morphine are less likely to be caught by law enforcement. The raw opium from the fields is dissolved in boiling water and filtered to remove foreign substances. The liquid is then heated over a low flame until most of the water is evaporated, and a thick paste forms. This paste is called processed opium and is ready to be eaten or smoked by opium users. It is also ready to be sold to illegal morphine or heroin laboratories, which are usually located close to the opium source. These illegal laboratories are usually very simple buildings. Most of the work takes place in huge metal pots under thatched-roofed, open-air buildings in jungles or other places easily hidden from drug police. Twenty to 35 pounds (10 to 15 kg) of processed opium is mixed in a large pot with boiling water and a chemical called lime. The natural waste products of the cooking sink to the bottom of the pot while the morphine forms a layer on the surface of the water. The morphine layer is carefully removed and mixed with the chemical ammonium chloride. This mixture is then filtered and boiled until a brown paste is formed; this is finished morphine.

What is heroin?

Afghanistan is the largest opium-producing country in the world. Many of its farmers are dependent on the crops to feed their families and will work 12 hours each day scraping opium milk from the bulbs for up to two weeks, depending on field size. In 2005, field workers were making 200 Afghani (equivalent to $4.00 U.S.) a day or would sometimes get 50% of the proceeds. Above, Afghan workers collect opium in a field.

It usually takes all day to process a batch of opium. After processing, the opium is then poured into molds and dried in the sun. The morphine paste, called morphine base, resembles modeling clay. It is a mixture of morphine and codeine. Morphine base may be either sold as is directly to users or sold to another laboratory for making heroin. Processing morphine base into heroin is a four-step process. First, the morphine base is mixed with a chemical called acetic anhydride, and then heated for six hours. This produces a new chemical, diacetylmorphine. Next,

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heroin water and another chemical, chloroform, are added to the solution. This causes many of the impure substances to sink to the bottom of the liquid mixture. The liquid is poured into a new container and sodium carbonate is added. This causes the heroin to sink to the bottom of the container, appearing as whitish crystals. The heroin is filtered out of the liquid and purified with charcoal and alcohol. Then the mixture of heroin, charcoal, and alcohol is heated again. This final heating causes the alcohol to evaporate, leaving behind pure heroin. The heroin is further refined to remove any impurities. The refining process uses many different chemicals, such as hydrochloric acid and ether. (Ether is dangerous to work with and is highly flammable. Many illegal laboratories have blown up because of careless handling of some of the chemicals.) The refined heroin powder is pressed into bricks of equal size and wrapped in plastic. Bricks are called units or half units, depending on their weight: Units weigh 1.5 pounds (700 g) and half units weigh 0.75 pounds (350 g). A unit measures 5.5 inches long, 4 inches wide, and 2 inches deep (14 cm long, 10 cm wide, and 5 cm deep). Many heroin laboratories are located in cities in Southeast Asia, such as Bangkok or Hong Kong. The heroin produced by these laboratories is about 85% to 95% pure. Finished, pure heroin is then smuggled to other countries. Once the shipments arrive in a country, dealers begin to plan how to distribute them. Top dealers usually handle large shipments of 44 to 220 pounds (20 to 100 kgs). A dealer in a major city such as New York might divide a large shipment into smaller ones of 2.2 to 22 pounds (1 to 10 kgs) for sale to other dealers. Those dealers then repackage the heroin and distribute it to dealers on the street. It is at this stage of the distribution that the heroin is mixed with other substances.

What is heroin?

HEROIN USE Heroin is used throughout the United States and around the world. All kinds of people use heroin for the feelings of intense happiness and relaxation it gives. But repeated use leads to addiction, and continued use can seriously hurt a person’s health, and even kill him or her.

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heroin use throughout history

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pium poppies have been grown since before recorded history. Artifacts from 6,000 years ago in ancient Sumer (present-day Iraq) contain images of opium poppies. The Sumerians called the opium poppy Hul Gil, which means “joy plant.” The Sumerians later passed the art of poppy growing on to the Assyrians, another culture in the ancient Middle East. The Assyrians then passed the knowledge of poppy growing and use to the Babylonians, who, in turn, passed it on to the Egyptians. By 1300 B.C., the ancient Egyptians were growing opium poppies and using the opium in trade with other peoples. In the capital city of Thebes, Egyptians began growing opium poppies in their fields. During the reigns of Thutmose IV, Akhenaton, and King Tutankhamen

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heroin use throughout history (Tut), the opium trade flourished. The Phoenicians and Minoans set up profitable trade routes to move opium from Egypt into Greece, Carthage, and Europe. Around 1100 B.C., a major advance was made in opium harvesting. On the island of Cyprus, craftsmen began making special knives with sharp, curved blades to slit the seedpod of the opium poppy. Similar knives are still used today to obtain the resin from the pods. The name opium comes from the ancient Greek word opion, meaning “poppy juice.” Even though opium was widely known to the ancient Greeks, there is little evidence that it was abused. The Greeks recognized it as a medicine for treating various diseases. The Greek doctor Hippocrates reported that opium was useful for treating conditions such as chronic headaches, dizziness, deafness, seizures, dimness of sight, loss of voice, asthma, coughs, and fever. The Greek physicians also applied opium directly to wounds as a pain reliever. The ancient Greeks also mentioned opium in their literature. The poet Hesiod was the first to write about poppy growing and opium production in eighth century B.C. The poet Homer mentioned the effects of opium in his epic poem The Odyssey. He described it as “a drug that had the power of robbing grief and anger of their sting and banishing all painful memories.” The conqueror Alexander the Great later introduced opium to India and Persia in 330 B.C. In India, the practice of eating opium for recreation became widespread. Opium spread slowly throughout the rest of the Middle East under the influence of the Roman Empire. Then the power of the Roman Empire declined, and these lands became part of the Islamic Empire. The role of opium in the Middle East returned to being medical, instead of recreational. Part of the reason for this was that many

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Alexander the Great, shown in a mosaic from 333 B.C., helped spread the use of opium as he traveled through India and modern-day Iraq.

heroin use throughout history Muslims believe that the use of intoxicating substances is prohibited by their religion. The only acceptable use for opium, therefore, was as a pain reliever. While Europe entered into what was known as the Dark Ages (a period of little to no cultural growth and development), medical knowledge flourished in the Middle East. The value of opium as a pain reliever was well documented, and it was used throughout that region to treat migraine headaches and other painful ailments. Opium was also used to treat depression. Some time between A.D. 400 and 1200, the Muslims introduced opium to China. By A.D. 1400, opium was used in China as a recreational drug. It was smoked throughout the country, but mainly by the rich and the elite. “Opium dens” sprung up, and people went to them to smoke the drug socially with others. Over time, opium became cheaper and easier to get, and opium dens became places not only for the rich, but also for the middle and working classes. Then, in the 1800s, the United States began rapidly building railroads across the unsettled West. Chinese laborers moved to the United States to get work on railroad construction, and they brought with them the practice of smoking opium. Opium dens began to spread across the West, too. Later, during the U.S. Civil War, opium was used medically, to treat the pain of wounded soldiers.

REINTRODUCTION TO EUROPE The extremely strict and powerful Spanish government was responsible for keeping opium out of Europe from about 1300 to 1500. The Catholic Church, which controlled Spain at that time, considered anything from the Middle East to be linked to the devil. And since opium was widely used throughout the Middle East—even

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heroin though it was only used for medical reasons—it was banned in Europe. Then, in 1527, the Swiss scientist Paracelsus returned to Europe from his travels in Arabia. He brought back a sword, and hidden in its handle he kept what he called “Stones of Immortality.” The “stones” were actually a mixture of opium and citrus juice. The drug was used as a painkiller and given the name laudanum, a combination of the Latin words for “to praise” and “plant extract.” That began opium’s reintroduction into Europe. Opium was not widely accepted in Europe at first, but it eventually became accepted. It was used to treat pain, sleeplessness, and diarrhea. Opium became part of the normal medical treatment for many ailments. But it also became a recreational drug. Sailors traveling to China discovered the habit of smoking opium. They brought this back to Europe, and soon opium abuse became a problem. The opium trade between Europe and Asia grew, and the recreational use of opium increased even more. In 1729, China banned the practice of smoking opium and any other nonmedical use.

THE OPIUM TRADE Trade directly between Europe and China began in the 1500s when the Portuguese started settlements in India. They then began a settlement in Macau, and another in China a short time later. When the Spanish took over the Philippines, trade increased even more between the two areas. Ships also made trade easier. Before that, merchants crossed back and forth along an overland trade route known as the Silk Road. Ships enabled traders to carry much greater amounts of silver and other precious items to China.

heroin use throughout history But the Chinese government made trading difficult for other countries. Chinese emperor Qing tried to control trade by allowing it only at the port of Canton (now Guangzhou). The demand for foreign goods in China was high, but the supply was low due to Qing’s control. The prices of these goods became very high because shopkeepers could charge a lot, knowing how much people wanted certain items. Spain was unhappy with this situation, because it meant less money for them since fewer people could afford to buy Spanish products. To make more money, Spain began selling opium to China. Great Britain later replaced Spain as the main country dealing with China. Great Britain was buying huge amounts of tea, silk, and porcelain, but could not sell many of its own goods to China. In an attempt to fix this unbalanced trade, the British began exporting opium to China from their colonies in India. The opium trade with China took off, and China was flooded with opium. The balance of trade shifted from being in China’s favor to being in Great Britain’s favor. The Chinese government banned the use of opium in 1729 because of the growing number of opium addicts. It estimated that it had 13.5 million addicts consuming 39,000 tons of opium each year. But the British continued exporting opium to China. In 1839, China began to enforce its laws against opium. The Chinese destroyed the port of Canton, and British opium shipments were confiscated. Great Britain responded by sending gunboats to attack several Chinese coastal cities. China was not prepared for that type of warfare and was defeated by 1842. The country was forced to sign the Treaty of Nanjing and the Treaty of Bogue. These treaties opened China up to trade by

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heroin the British, and gave Hong Kong over to the British Empire. In 1856, a second war broke out. British and French troops moved into China and took over the port cities of Canton and Tianjin. In 1858, the Chinese signed a treaty to end the war, in which it agreed to open 11 more ports, permit foreign diplomats in Beijing, allow Christian missionaries to come to the country, and legalize the importation of opium. (China later attempted to block the entry of diplomats into Beijing.) When Great Britain tried to enforce the treaty, the war started in 1859. British and French troops occupied the capital of Beijing and burned the royal summer palace. The Convention of Peking of 1860 forced China again to sign the terms of the Treaty of Tianjin.

BANNING OPIATES The abuse of opium and opiates continued in China until 1906. The Chinese government then started a program to wipe out opium use within 10 years. The program aimed to turn peoples’ opinions against heroin use and to make them think of foreigners (who were strongly disliked) when they thought of the drug trade. The program required opium smokers to register with the government and to begin a program to cut down their use gradually until they quit. Former addicts were used as examples and teachers to reach out to other addicts and help them quit. The program was largely successful; however, when the leader of the country died in 1916, opium abuse rose again under the new government. In the United States, there were no laws restricting the use of opium or other opiates until 1875. In 1875, San Francisco passed city laws aimed at closing opium dens in town. This was followed in 1891 by a California state law requiring narcotics to be given warning labels,

heroin use throughout history and their sales to be recorded in a log. More rules were added in 1907 to this law, called the California Pharmacy and Poison Act. The act made it a crime to sell opiates to someone who did not have a doctor’s note. Finally, in 1909, the state government passed a ban on the possession of opium. The U.S. government put a tax on opium importation, starting in 1893. The Opium Exclusion Act of 1909 prohibited importing opium used for smoking. The Harrison Narcotics Tax Act of 1914 placed a tax on the distribution of all opiates, which, in turn, served as a deterrent against buying and selling the drugs.

TRAFFICKING Heroin is the most commonly available illegal opiate. Other opiates, such as codeine and oxycodone (both available at a pharmacy, but only with a doctor’s prescription), often show up on the street, too. But opium and morphine are now uncommon recreational drugs. Today, drug trafficking has made heroin available in many parts of the United States. Most of the heroin available in the United States comes from one of four sources: Mexico, South America (mostly Colombia), Southeast Asia (mostly Myanmar), and Southwest Asia and the Middle East (mostly Afghanistan). Even though almost all the heroin produced in South America and Mexico is sent to the United States, other regions of the world have been a big part of heroin production and sales in the past 30 years. In the 1980s and early 1990s, law enforcement targeted heroin production in the Middle East. The success by law enforcement allowed Colombia to become a major supplier of heroin to the United States since 1993. South American heroin is commonly available in cities in the Northeast and along the East Coast. Independent

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heroin traffickers often smuggle the heroin into the United States by traveling over the border as passengers on an airline. A delivery person will usually carry about 1 to 2 pounds (500 grams to 1 kg) of heroin per trip. These traffickers increased their influence in the moneymaking heroin market in the Northeast—the area with the largest demand in the United States. They have done this by aggressively working to sell their product, distributing high-quality heroin for a lower price than their competitors. Since the mid-1990s, Colombian heroin traffickers have started using other methods for smuggling heroin. Delivery people enter the United States through Miami, New York City, San Juan (Puerto Rico), and other U.S. cities on flights from Colombia. But because drug police are now watching flights from Colombia more closely, traffickers are smuggling Colombian heroin into the United States through other countries first. They might go through Costa Rica, the Dominican Republic, Ecuador, Panama, Mexico, Argentina, or Venezuela. They also smuggle larger amounts of the drug on ships traveling to the United States. Sometimes a shipment of heroin travels on the same boat as larger shipments of cocaine. Within the United States, criminal groups from the Dominican Republic have played a major role in heroin distribution on the street. The groups rule the heroin markets in northeastern cities, such as New York City, Boston, and Philadelphia. The Colombian traffickers deal directly with Dominican trafficking groups responsible for selling heroin on the street. Mexican heroin has been imported into the United States for decades, too. It is produced, smuggled, and distributed by groups that traffic all different drugs. Many of these groups, called cartels, have been in operation for more than 20 years. Organized crime groups in Mexico

heroin use throughout history

Former Peruvian Interior Minister Fernando Rospigliosi walks among bags full of drugs on the outskirts of the country’s capital, Lima, in 2003. These seized drugs had originally been intended for trafficking, or smuggling. Officials said they had found approximately nine metric tons of cocaine, heroin, and marijuana, which would have been worth about $69 million if sold in the United States.

produce, smuggle, and distribute the black tar heroin sold in the western and southwestern United States. Traditionally, trafficking groups operating from Mexico have succeeded by keeping shipments small. This lessens the risk of losing a large amount of the drug if caught by police. Mexican traffickers usually send just between 2 and 7 pounds (1 to 3 kg) of heroin in a single shipment. Illegal immigrants and migrant workers

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heroin occasionally smuggle heroin for the major trafficking groups across the U.S.–Mexico border in small amounts. There is also evidence that drug trafficking groups are sending larger shipments across the border in cars and trucks. During the late 1980s and early 1990s, most of the heroin in the United States was of high purity and came from Southeast Asia. Recently, however, there has been a big decrease in the amount of heroin coming into the United States from that area. Drug police in Thailand have arrested more than a dozen big-time drug traffickers. These people played a major role in sending heroin shipments to the United States. After their arrests, the amount of drugs sent to the United States fell. But shipments of heroin from Southeast Asia didn’t stop entirely. Now they are sent through China, Japan, Malaysia, the Philippines, Singapore, Taiwan, or South Korea in order to cover criminals’ tracks. Chinese traffickers distribute heroin within the United States, too, mainly in the Northeast and along the East Coast. The groups rely upon American criminal organizations to sell their heroin. Even though the amount of heroin they sell has declined, these groups remain the most sophisticated heroin trafficking organizations in the world. Trafficking groups made up of West African criminals also smuggle heroin to the United States from Southeast Asia. Nigerian criminal groups in particular have been active in cities and areas with large Nigerian populations. These include Atlanta, Baltimore, Dallas, Houston, New York City, Newark, and Washington, D.C. Chicago recently has become the center for heroin trafficking controlled by Nigerian criminals. Traffickers operating from Middle Eastern locations also smuggle heroin to the United States. Most of the

heroin use throughout history

Myanmar security officers prepare to burn drugs they collected in the capital city of Yangon in 2006. The military government torched hundreds of kilos of narcotics worth about $148 million in an effort to convince the world it is cracking down on drug production. Myanmar is the world’s second largest producer of opium, which flows easily through the country’s largely uncontrolled border regions.

Southwest Asian and Middle Eastern heroin is first sent through Western Europe, Pakistan, and Iran. Criminal groups of Lebanese, Pakistani, Turkish, and Afghani people are all involved in supplying heroin to the United States. Heroin traffickers and dealers operate as a close group and rarely conduct business with people of other ethnic groups. Therefore, heroin from Southwest Asia and the Middle East is more common in areas in the United States with large populations of people from those regions.

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how heroin is used

h

eroin users have many different ways of taking the drug. Each of the different methods produces a similar effect. The differences lie in how intense the effect is and how long it takes to reach its peak (when the effect is the strongest). The most common ways of taking heroin are by injection, inhaling or snorting, and smoking.

INJECTION Most heroin users inject the drug. According to some studies, heroin injection is becoming more common and inhaling it is becoming less common. However, in some groups, such as whites living in wealthier areas, smoking or inhaling heroin remains common. This is

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how heroin is used because users there believe this method is less likely to lead to addiction. This is not true. Regardless of the method of using heroin, the risk of addiction and death from overdose is real. Injecting heroin is also called shooting up or mainlin-­ ing. This can be done in several ways. Injecting it into a blood vein is called intravenous use. This produces the effects in as little as seven to eight seconds. Injecting heroin into a muscle is called intramuscular use, and injecting it under the skin is called subcutaneous use. Intramuscular or subcutaneous use can produce effects in about five to eight minutes. Most heroin users inject

TOOLS FOR HEROIN USE For injecting heroin: • • • •

injection needles small cotton balls used to strain the drug spoons or bottle caps for “cooking” (liquefying) the heroin a “tie-off” that the user wraps around his or her arm to make his or her veins stick out

For sniffing or smoking heroin: • • •

razor blades straws or rolled dollar bills pipes

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heroin

A needle and spoon are among the tools people use to inject heroin. People often inject the needle directly into their veins to get the quickest high.

how heroin is used heroin directly into a vein to get the quickest high. They might do this several times in one day. Many heroin users inject heroin because the rush it provides is much quicker and more intense than with any other method. Users often develop a high level of dependence on the drug and very quickly need to increase their doses to get the same effect they had the first time. This results in the need to use more and more heroin over time. This is what causes addiction to heroin. People who are addicted to heroin, often called “junkies,” reach the point where they will do just about anything to get heroin to get high. The addiction to heroin is both physical and mental. A person’s body will crave the drug, and so will his or her mind.

SMOKING Smoking heroin originated in the 1950s in Hong Kong. The practice is similar to smoking opium, which has a very long tradition. In Chinese, smoking heroin is called chui lung, which means “chasing the dragon.” The name brings to mind a vision of the rippling smoke coming off the heroin, resembling a dragon’s tail. “Chasing the dragon” involves inhaling the smoke that comes from the heroin being heated on tin foil above a flame. The wispy, white smoke is then inhaled or “chased” through a tube. Smoking heroin is actually the fastest way to get heroin into the body. Injecting heroin into the bloodstream causes a quick high, but smoking heroin gets the drug to the brain almost immediately. An injection of heroin takes a long path to the brain. The drug passes through the veins to the liver and heart before delivery to the brain. Smoked heroin is absorbed by the lungs, where it is transferred to the bloodstream and delivered directly to the brain in about seven seconds. The high from

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heroin smoking heroin is not as intense as that from injecting heroin because the dose is much smaller when smoked. It is more difficult to overdose from smoking heroin, but this does not mean that it is safe. The risk of addiction from smoking heroin is real. Aside from addiction, smoking brings plenty of other health risks. One of the most troubling risks is difficulty breathing. Smoking heroin causes the passages in the lungs to get smaller. One effect of heroin on the body is slowed breathing. This plus the shrinking of lung passages can be a deadly combination for some users. People with any kind of breathing difficulty, such as asthma, risk suffocating due to inhaling heroin smoke. Heroin may also be sprinkled onto tobacco or marijuana and smoked that way. Some users will put heroin in cigarettes because it cannot be detected while the cigarette is smoked. This means users can get a heroin high and people around them think they are only smoking a cigarette. Most users consider this to be a waste of heroin, though, since it is difficult to get its full effect.

INHALING When people snort or inhale heroin, they will likely feel nauseous, their noses will run, and they will get stomach cramps. Snorting heroin does not provide as intense a high as other methods. Because of this, many people believe it is less addictive. Unfortunately, snorting heroin actually leads to addiction for many people. Users who once snorted the drug often move to the injection method because their bodies become used to the drug and the effects become less intense. They turn to injecting heroin to get the more intense effects they experienced when they began using the drug. Many serious

how heroin is used addicts started out snorting heroin without knowing they would become addicts.

MIXING HEROIN AND OTHER DRUGS Mixing drugs is becoming more and more common, and it is extremely dangerous. There have been a few scientific studies on exactly how a user reacts to taking heroin with other drugs. Most of the researchers’ information is based on records from hospital emergency rooms and from friends of victims. One study in Australia showed that just 21% of heroin overdoses resulted from using heroin alone, and the rest came from a mix of heroin and another drug. Illegal drugs are sometimes mixed with legal drugs such as painkillers or cold medicine or with other illegal drugs. Mixing heroin with other drugs—whether legal or illegal—is very dangerous. Using more than one drug at a time can have unpredictable and dangerous effects. Mixing heroin with other drugs increases the risk of harm. For example, heroin mixed with alcohol increases the risk of heart failure, a fatal consequence. Some users mix heroin with cocaine, a combination called a speedball or snowball. Several well-known actors, comedians, musicians, and sports stars have died in the past after taking this deadly combination of drugs. A speedball is usually injected into the bloodstream, but can also be smoked or dissolved in water and snorted. When injected, cocaine can kill the cells around the injection site and cause sores, which can become infected. A mixture of heroin and cocaine or another stimulant (a drug that speeds up the body) causes a more intense high than heroin alone, but it is more dangerous because of the combination of drugs. Cocaine speeds up the body for a short period of time, while heroin slows down the body for a longer period of time. Cocaine and

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heroin

Actor and comedian Chris Farley is well known for his work on Saturday Night Live and in popular big-screen comedies such as 1995’s Tommy Boy and 1996’s Black Sheep. As Farley’s star rose, however, so did his problems with drugs and alcohol. He was found dead of an accidental overdose in his apartment in late 1997 at age 33. Morphine—a painkiller derived from opium—as well as cocaine were found in his blood.

how heroin is used other stimulants, such as Ecstasy or speed, cover up the effects of the heroin. This may lead the user to take more heroin, greatly increasing the risk of overdose. Taking heroin with anything that speeds up body functions creates a serious risk of death.

HEROIN USE OUTSIDE OF LARGE URBAN AREAS There is a misconception that heroin is mainly a problem in inner-city urban areas. This is far from true. Heroin use also takes place in many smaller cities throughout the United States and even in rural areas. As more heroin reaches the United States, the price of heroin decreases while the quality stays high. Middle school and high school students are susceptible to heroin use because they have the income to buy low-cost heroin and may face peer pressure to use drugs. These factors make it easy for students to get hooked on heroin. A 2006 Arizona Youth Survey showed a decrease in heroin use among Arizona students between 2002 and 2006. Nearly 3% of teens in Grades 8 through 12 surveyed in 2002 reported having used heroin. Four years later, it was 2%, according to the 2006 survey. While this sounds good, authorities are hearing stories that heroin use is on the rise again. Heroin is cheap and easy to conceal. Heroin use is common among troubled teens who commit crimes. Throughout the United States, about 87% of teens entering the criminal justice system are drug users. Drug treatment is becoming a standard part of the juvenile criminal justice system.

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heroin

RISKS OF USE All methods of heroin use—whether injection, smoking, or snorting—create a serious risk of addiction. Individuals who abuse heroin over time develop a tolerance for the drug. This means that they must use increasingly larger doses of it to achieve the same effect or intensity they experienced when they first began using the drug. And over time, heroin lessens a user’s ability to feel pleasure, so he or she must take the drug simply to feel normal. Addicted individuals who stop using heroin will also experience the intense and painful symptoms of withdrawal, which include heroin cravings, restlessness, muscle and bone pain, and vomiting. The biggest risk from using heroin is death by overdose. Heroin overdose can also cause weak breathing, intense fits of shaking, and coma. Both new and experienced users risk overdosing on heroin because it is impossible for them to know the purity of the heroin they are using. Whenever a batch of high-purity heroin is released on the streets, many overdoses occur since users are often used to taking weaker heroin. There are other risks, too, aside from death and addiction. Women who use heroin regularly often experience irregular or even absent menstrual cycles, which can result in bone loss and an inability to get pregnant. Women who do get pregnant and use heroin will often deliver babies who are addicted to the drug at birth. These babies suffer from the same issues of addiction and treatment as adults. In addition, a small percentage of users—male and female—who smoke heroin develop a disease called heroin-induced leukoencephalopathy. This disease affects certain delicate parts of the brain and leads to slurred speech, difficulty walking, and eventually the loss of many brain functions, coma, and death. A popular rumor is that the aluminum foil used to heat

how heroin is used heroin for smoking causes this disease. There have been no studies that show this to be true. Heroin users who inject the drug expose themselves to additional risks, which are increased when they share needles or do not take the time to clean their equipment. Injecting heroin increases a person’s risk of getting HIV (which can lead to AIDS), hepatitis B and C, and other viruses carried in blood. Long-time users who inject heroin also risk scarred or collapsed veins, heart infections, abscesses (pockets of skin filled with pus), pneumonia, tuberculosis, and liver and kidney disease. Many of these conditions can be fatal.

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Who uses heroin

i

ndividuals of all ages use heroin. The 2005 National Survey on Drug Use and Health (NSDUH) reported that approximately 3.5 million Americans ages 12 and older reported trying heroin at least once during their lifetimes. This is 1.5% of that age group. The study also showed that in the same age group, about 379,000 (0.2%) reported heroin use in the past year, and 136,000 (0.1%) reported heroin use in the past month. The study also indicated that there were 108,000 people in this age group who had used heroin for the first time within the past 12 months. This is, in fact, a drop from the previous year, when 118,000 people reported using heroin for the first time in the previous 12 months. Statistics also indicate that males are more likely than females to use heroin. In the United States, about 50

Who uses heroin 2% of males use heroin, compared to 1.3% of females. Among adolescents, the number of males and females using heroin is roughly equal.

HEROIN USE AMONG TEENS High-purity heroin that can be snorted is becoming more available. This has given rise to a new, younger user population. This user group is taking in larger amounts of the drug and, according to drug treatment specialists, heading quickly down the road toward addiction. Teens turn to drugs for many different reasons. Some do it because they want to fit in with friends or certain groups. Some may also take drugs or drink alcohol because they enjoy the high. Still others believe that taking drugs makes them more impressive and adult-like. They might feel they need excitement in their lives or an escape from what they consider dull lives. Taking drugs or drinking alcohol might seem exciting compared to other activities. Teens from families with alcohol or drug problems are more likely to have serious substance abuse problems themselves. Teens who do not feel appreciated by their parents or connected to them are at greater risk for drug

PERCENT OF STUDENTS REPORTING HEROIN USE, 2006 8TH GRADE

10TH GRADE

12TH GRADE

Past month use

0.3%

0.5%

0.4%

Past year use

0.8%

0.9%

0.8%

Lifetime use

1.4%

1.4%

1.4%

Source: National Institute on Drug Abuse and the University of Michigan. 2006 “Monitoring the Future” study, Drug Data Tables. December 2006.

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heroin use; so are teens with poor self-esteem, or emotional or mental health problems, such as depression. They might turn to drugs or alcohol just to be part of a social network of others with a similar desire for drugs. While the use of drugs does not necessarily cause people to become violent, people with a violent streak in their personality who use illegal drugs tend to engage in violent behavior more frequently. Furthermore, violent teenagers who use drugs continue to engage in violence much longer than violent teens who do not use them. Studies show that almost 90% of the teens who use drugs also engage in other behaviors that put them or those around them at risk for serious harm. These behaviors include drinking heavily, fighting, carrying weapons, and having unsafe sex. Life can be difficult for young people. They face stress at school, with friends, and in daily life. For many,

STUDENTS DESCRIBING RISK OF HEROIN USE, 2006 8TH GRADE

10TH GRADE

12TH GRADE

Trying heroin once or twice, without using a needle, is a “great risk.”

60.4%

70.0%

62.6%

Using heroin occasionally, but not with a needle, is a “great risk.”

75.3%

83.6%

76.2%

Source: National Institute on Drug Abuse and the University of Michigan. 2006 “Monitoring the Future” study, Drug Data Tables. December 2006.

Who uses heroin

PERCENT OF STUDENTS WHO SAY THEY HAVE EVER TRIED HEROIN, 2001 TO 2005 2001

2003

2005

9th grade

3.2%

3.5%

2.8%

10th grade

3.3%

2.9%

2.5%

11th grade

2.8%

3.0%

1.8%

12th grade

3.0%

2.9%

2.0%

Total

3.1%

3.3%

2.4%

Source: Centers for Disease Control and Prevention. “Youth Risk Behavior Surveillance System”: United States, 2005.

heroin is an escape from reality. According to the 2006 “Monitoring the Future” study, 1.4% of eighth, tenth, and twelfth graders said they had used heroin at some time in their lives. In the same survey, students were asked about the risks associated with the use of heroin by injection and by other means. Almost all students rated any heroin use as a “great risk.” At the same time, students reported that it was not difficult to obtain the drug: 13.0% of eighth graders, 17.4% of tenth graders, and 27.4% of twelfth graders said that heroin was “fairly easy” or “very easy” to obtain. The Centers for Disease Control and Prevention (CDC) also conducts a survey of high school students throughout the United States. The survey is called the “Youth Risk Behavior Surveillance System.” The results of this study show that fewer high school students than in the past are reporting ever having tried heroin in their lives.

HEROIN USE AMONG ADULTS Studies show that heroin use among adults is slightly lower than heroin use among teenagers. This decrease is

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heroin likely due to young people quitting heroin before they reach adulthood, or perhaps from deaths resulting from drug use. Some teenagers who are heroin users never reach the fully addicted stage, so quitting heroin is easier for them. Others are convicted of crimes and sentenced to jail, where heroin is more difficult to obtain, so they must end their habit. Statistics on heroin use among college students and young adults also show a slight decline in use between 2004 and 2005. About 0.5% of college students and 1.7% of all young adults ages 19 to 28 reported ever having tried heroin. The Bureau of Justice Statistics performed its own studies of heroin use among prisoners in state and federal prisons. The studies showed that about 23.4% of state prisoners and 17.9% of federal prisoners surveyed in 2004 said they had used heroin in their lifetimes. Heroin use among older adults is a growing problem. A survey in 2000 showed that more than half a million people over the age of 55 in the United States had used illegal drugs within the last month. Alcohol and opiate

PERCENT OF COLLEGE STUDENTS AND YOUNG ADULTS REPORTING HEROIN USE, 2004 TO 2005 COLLEGE STUDENTS 2004

2005

YOUNG ADULTS 2004

2005

Past month

0.1%

0.1%

0.1%

0.1%

Past year

0.4%

0.3%

0.3%

0.4%

Lifetime

0.9%

0.5%

1.9%

1.7%

Source: National Institute on Drug Abuse and the University of Michigan. “Monitoring the Future,” National Survey Results on Drug Use, 1975–2005, Volume II: College Students & Adults Ages 19–45.

Who uses heroin abuse were the top two reasons for persons over 55 to enter drug treatment. Opiate abuse accounted for 14% of all drug treatment center admissions in this age group. The study also showed that heroin was the drug of choice for 9 out of 10 opiate users. There are many reasons why some older adults turn to heroin. Some of the common reasons are physical pain management with opiates, loss of friends or loved ones, and decreasing independence. Older adults turn to heroin to relieve these problems in their daily lives. But there is also another group of older heroin users: the lifetime abusers. In the baby boomer population (people born between 1946 and 1964), there are a number of people who have used heroin and other drugs for their entire adult lives. The baby boomers lived through a time when drug use began to be much more common, and even accepted by some, and so many people of this generation started using drugs and never stopped. As

PERCENT OF PRISONERS REPORTING HEROIN/OPIATE USE, 1997 AND 2004 STATE PRISONERS 1997

2004

FEDERAL PRISONERS 1997

2004

At time of offense

5.6%

4.4%

3.0%

3.2%

In month before offense

9.2%

8.2%

5.4%

5.8%

Regularly*

15.0%

13.1%

8.9%

9.2%

Ever in

24.5%

23.4%

16.1%

17.9%

lifetime * Used drugs at least once a week for at least a month. Source: Bureau of Justice Statistics. Drug Use and Dependence, State and Federal Prisoners, 2004. October 2006.

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heroin they get older, the health problems that come from drug abuse get worse. These older adults sometimes seek out heroin as a replacement for other opiates that they use for pain management. Heroin and other drugs are hard on the bodies of older adults. For example, the kidneys and liver must work harder to process heroin. As the body ages, the ability of these organs to process heroin decreases. In older people who have used heroin for a long time, the risk of overdose is greater because their bodies cannot process the heroin. The availability of higher-purity heroin today also increases those risks for older users. Studies have suggested that more people over the age of 55 are entering drug treatment. It is predicted that by 2020, the percentage of people age 50 and older who need treatment for illegal drug use will be five times higher than it is today. In the coming years, the drugabusing baby boomer population are likely to create a burden on the healthcare industry.

HEROIN USE AND ECONOMIC STATUS Heroin use and its effects are found in all parts of society. It is found in inner cities, wealthy suburbs, and rural communities. Heroin use is found among the poor, the working class, and the rich. It shows up in both educated and uneducated populations. It is found among blue-collar workers, professionals, and even the unemployed. The stereotype of the typical heroin user being a street person robbing and stealing to feed his or her addiction is inaccurate. This is not to say that there are not people who fit that stereotype, but few heroin users are immediately recognizable. Heroin use, like any drug use, is something people start because they want to, but few do it for their entire lives. Even though heroin is an addictive drug, many

Who uses heroin people who try it once or even a couple of times do not continue. Some of those who continue using heroin only do so until they get to an age at which they “grow out of it.” According to most studies, people reach this stage at about 35 to 40 years old. Most heroin users are employed in either full-time or part-time jobs. Statistics show that 1.3% of those employed full-time and 1.2% of those employed parttime use heroin. About 3.1% of unemployed people use heroin. Those numbers might make it seem that more unemployed people than employed people use heroin, but that is not the case. Even though the percentage of unemployed who use heroin is much higher than employed heroin users, it is important to look at the total number of people in each group. There are more employed people than unemployed people in the United States. This means that the majority of heroin users are employed either full- or part-time.

MAKING HEROIN USE “GLAMOROUS” Even though heroin use has been declining over the past several years, it is still higher than it was in the early 1990s. School-age youths remain the main group that uses heroin. It is argued that one of the reasons behind the increase in heroin use is the glamorization of the drug in music and films. This, along with an increase in purity and a decrease in price, makes it attractive to young people. Music and movies usually emphasize the euphoria created by the use of heroin, and only sometimes show how hard it is to quit. The grim realities of the life of an addict are not often shown. Some movies do depict the life of an addict and the problems of addiction, but they rarely show a happy ending in which the heroin addict overcomes addiction and goes straight. All too often,

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Actor Brad Renfro was 12 when he was cast in the hit 1994 film The Client, starring Susan Sarandon. Critical acclaim as well as major roles in films such as 1995’s Tom and Huck followed. The young actor, however, began to abuse drugs, and in 2005, he was part of a large bust in Los Angeles, where he was arrested for attempting to buy heroin. He died in 2008 at age 25 of an accidental heroin overdose.

Who uses heroin the addict in the movies ends up overdosing. Although overdosing is not unusual among heroin addicts, there are also success stories of breaking the addiction. Some music and movies stars publicly admit to heroin use and addiction after they get out of successful rehab. This—the reality of addicts getting help and recovering—is in sharp contrast to what is shown in music and movies. What happens in the movies differs from the reality of people going through rehab. Stories of celebrities who overdose on heroin often overshadow successful rehab stories. Heroin use among musicians, actors, artists, and writers has existed for a long time. Even though many creative people have used or been addicted to heroin, how much the drug affected their creativity is debated. Few artists with great talent have said that using heroin helped them achieve anything. There have been several books and movies specifically about heroin abuse that don’t glamorize the issue. The 1996 film Trainspotting, based on the book by Irvine Welsh, follows the lives of a group of heroin users in Scotland. The 1995 film The Basketball Diaries is based on the diary written by famous author, poet, and musician Jim Carroll during his heroin addiction. The actor Leonardo DiCaprio stars as Jim Carroll. The 2000 film Requiem for a Dream was based on a book by Hubert Selby Jr. The film looks at addiction and the way it overtakes reality. The 1998 television movie Gia starring Angelina Jolie is about the heroin-addicted supermodel Gia Carangi, who contracted HIV from a dirty needle and died at age 26. The fashion world has at times glamorized drug use. In 1993, Calvin Klein ads began using very thin, bony models with pale skin and dark circles beneath their eyes. This was quickly dubbed the “heroin chic” look.

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Actors Mark Wahlberg (left) and Leonardo DiCaprio starred in the 1995 film The Basketball Diaries, which chronicled the early life of author, poet, and musician Jim Carroll during his heroin addiction. In the film, DiCaprio plays a basketball-playing teen who descends into drugs and violence. Here, the two actors attend the film’s premiere.

The look drew criticism from many anti-drug groups for glamorizing heroin use. In 1997, President Bill Clinton even took time to criticize the trend. The “druggie” look eventually faded away in the late 1990s, possibly due in part to the death of David Sorrenti, the fashion photographer who popularized the look. Sorrenti died from a heroin overdose.

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eroin causes a sensation of pleasure and euphoria in users. These feelings are a result of how heroin interacts with the brain. Soon after a person injects, smokes, or snorts heroin, the drug moves from the blood into the brain. There, heroin is converted into morphine. The morphine binds to sensitive regions in the brain that cause the feelings of euphoria along with pain relief. Heroin users describe it as a surge of pleasurable sensation. The short-term effects of heroin include a warm flushing of the skin, dry mouth, and arms and legs that feel heavy. It relaxes muscles, causing users to nod their head. Their eyelids droop, their walking slows, and their speech becomes slow and slurred. Nausea, vomiting, and severe itching may also accompany this. Heroin also will make a person’s pupils become very tiny. 61

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heroin The intensity of these feelings depends on how much of the drug is taken and how rapidly it enters and binds to the brain. Heroin is addictive because it enters the brain so rapidly. Some of the effects are short-term, but there are long-term effects from continued use. Read on to discover those effects.

HOW HEROIN AFFECTS THE BRAIN The effects of opiates such as opium, morphine, codeine, and heroin have been known for a long time. However, it was not until 1972 that scientists found out how opiates affect the brain specifically. Researchers from Johns Hopkins University discovered the sensitive parts of the human brain to which opiates would attach themselves. When opiates bound themselves to these sites, they caused the euphoria and the painkilling effects. The sensitive spots are found in three clusters in different parts of the brain: the “pleasure center,” the respiratory center, and the digestive center. The discovery of these sensitive areas in the brain sparked an interesting question: Why does the human brain have spots to which plant substances such as opium can attach? The answer to that question must be that the sites have another function. The scientists soon figured out that the active ingredient in all these opiates is morphine. When they looked at the structure of morphine, they found that it was similar to another group of compounds found in the brain. These compounds, called endorphins, are chemicals made in the brain when the body experiences pain or stress. Endorphins bind to neurons in the brain and cause a relaxing sensation that calms the body and eases pain. Endorphins are also called the natural opiates of the body.

how heroin affects the body When the human body is stressed or injured, endorphins flood the spaces between nerve cells. The endorphins bind with neurons and stop the release

THE PLEASURE CENTER Scientists James Olds and Peter Milner discovered the pleasure center of the brain in 1954. They were studying a part of the brain called the reticular formation. During experiments with animals, Olds and Milner noticed that sending an electric current into this part of the animals’ brains would cause the animals to stop whatever they were doing. This portion of the brain was considered to be a “pain center,” since the animals stopped what they were doing because they felt pain. But by accident, the scientists missed the reticular formation in one animal and sent electricity into another area of the animal’s brain instead. The animal behaved in an unexpected way: When its brain was mildly shocked with electricity, the animal repeated what it had been doing. Olds and Milner concluded that this was a “pleasure center.” When stimulated with electricity, it brought the animal an immediate feeling of pleasure. The researchers concluded that the pleasure center of the brain developed to guide people’s actions toward what makes them feel good. Unfortunately, heroin stimulates this part of the brain, too. Since the pleasurable rewards are great, a person is at great risk of developing a psychological addiction to heroin.

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heroin of the chemicals that cause neurons to be stimulated. Stopping neurons from firing creates a pain-relieving effect. Moreover, endorphins can excite other neurons leading to other parts of the brain, thus creating euphoria. Endorphin levels rise during exercise, after a painful injury, or at times of high stress. Because morphine attaches itself to the same spots in the brain as endorphins do, the two substances have a similar effect. However, morphine’s effect is much more powerful than that of endorphins.

THE BRAIN–BODY CONNECTION Heroin affects the part of the brain known as the autonomic nervous system, which is responsible for most functions in the body that are automatic. These include digestion, heartbeat, and organ functions. So by affecting the brain, heroin also affects the body. One part of the brain affected by heroin is the part that controls breathing. When heroin stimulates this part of the brain, it causes a person’s breathing to become slower and weaker. This likely contributes to the feeling of well-being, since slowed breathing can give a relaxed feeling. It is also likely that this contributes to the drowsy feeling associated with heroin use, because breathing slows when a person is asleep. Shortly after using heroin, the user starts “nodding off.” This condition, also called “going on the nod,” is associated with the pain-relieving characteristics of heroin. Heroin also affects the part of the brain that controls the digestive system. In fact, one of the early uses of opium was to stop diarrhea. Today, the most common anti-diarrhea drugs contain loperamide, one of the other opiates found in poppies. Most opiates have a similar effect on the digestive system.

how heroin affects the body Heroin users often experience digestion problems. These can include nausea and vomiting. Tolerance to these effects builds up quickly with continued use. Heroin causes the brain to stop sending signals to the intestines, thus stopping the muscles that move digested food. This causes heroin users to experience constipation. The small intestines are part of the autonomic nervous system and seldom work well in heroin addicts. The drug slows movement of feces along the small intestines, which leads to constipation. As the dose of heroin increases, the effect it has on the autonomic nervous system increases. An overdose of heroin will actually weaken the functions of different parts of the autonomic nervous system until they stop functioning. During an overdose, the victim will stop breathing and his or her heart will stop beating. Once this occurs, death follows very quickly.

LONG-TERM EFFECTS The long-term effects of heroin use are very serious. Heroin can damage various organs in the body, such as the heart, and also the reproductive and immune systems. Heroin also slows the production of some hormones. In women, it delays the menstrual period. In men, it reduces the production of testosterone, causing a lack of sexual desire and other problems. One of the most serious long-term effects of heroin is addiction itself. Repeated heroin use also produces a tolerance to and physical dependence on the drug. These are powerful motivating factors contributing to the use and abuse. Heroin addicts, like those addicted to any other drug, begin spending more and more time and energy obtaining and using the drug. Once they become addicted, heroin addicts’ primary concern in life

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Recovering addicts are treated in Poland in 2004 at the detox ward of Nowowiejska Hospital, which was one of only two recovery wards in Warsaw. Poland faced a crisis in 1990 after inexpensive “kompot”—a locally produced form of heroin—became popular. Many Polish addicts suffered from HIV-AIDS, adding to the drain on medical resources in the post-Communist Polish society.

becomes seeking and using drugs. The drug use literally changes the way their brains work. Psychological addiction to heroin takes place in two stages: acquisition and maintenance. In the acquisition stage, euphoria and positive effects occur. These good feelings encourage continued use to repeat the same feelings again. Maintenance is the continued use of heroin to get that feeling again. The heroin addict is then compelled to continue taking the drug to avoid severe withdrawal effects. Physical dependence develops when higher and higher doses of the drug are required to create the same effect. The body adapts to the presence of

how heroin affects the body the drug, and withdrawal symptoms occur if use is suddenly reduced or stopped. Withdrawal is another problem associated with long-term heroin use. Withdrawal refers to the physical symptoms that appear in the body about 8 to 12 hours after the last heroin dose. It begins as addicts’ eyes tear. Then, they yawn, feel anxious, and become irritable. After several hours, they begin to sweat excessively and experience fever, stomach and muscle cramps, diarrhea, and chills. These symptoms can continue for 1 to 3 days after the last dose and can last as long as 7 to 10 days. In some cases, full recovery can take even longer.

ORGAN DAMAGE The long-term use of heroin can have serious effects on the body’s organs. The damage to the organs comes from both the effects of heroin in the body and the effects of other substances that are mixed with the heroin. Because heroin is mixed with many different substances, a range of damage can occur. Of all the methods of use, injecting heroin probably carries the greatest risk to the body’s organs. When heroin is injected, the body is exposed not only to the impurities in the heroin, but also to harmful bacteria, fungi, and diseases from dirty needles. If the injection site is not thoroughly cleaned, bacteria can enter the body and cause a variety of infections. One of the most severe infections is called endocarditis. The inside of the heart and parts of it are lined with a very thin skin called the endocardium. If bacteria enter the bloodstream from a heroin injection, they can travel through the bloodstream to the heart. These bacteria attach to the endocardium and begin to grow, leading to an infection. Endocarditis may cause symptoms suddenly, or they may develop slowly. The symptoms

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heroin of endocarditis include fever, chills, fatigue, shortness of breath, cough, and night sweats. Many of these symptoms are similar to heroin withdrawal symptoms, so the heroin user may ignore them. Left untreated, endocarditis can damage the heart and permanently destroy its inner lining. This can cause the heart to work harder to pump blood, eventually causing heart failure. Many different bacteria cause endocarditis, and different bacteria act at different speeds. One kind of endocarditis is caused by a bacterium called Streptococcus viridans. This is a common kind of bacteria that also causes strep throat. Left untreated, this form of endocarditis is fatal within a year. Other forms of endocarditis are caused by Staphylococcus aureus and Streptococcus hemolyticus. Left untreated, these are fatal in about a month. Injecting heroin into veins also damages the veins themselves. Scarring is an obvious sign of repeated injections. The scars along injection sites are called “track marks.” The scarring is much worse when addicts use dull needles. Many heroin addicts reuse disposable syringes over and over, sometimes hundreds of times. This dulls the needles and increases the scarring. Injecting heroin repeatedly for extended periods may also result in collapsed veins. Some heroin addicts rotate the injection among different sites on their body. This gives the veins in different places on the body time to heal before reuse, and may decrease the likelihood of their collapsing. Another problem with injecting heroin comes from the nature of the substances mixed with it. Some of these may be injected into the bloodstream as solids rather than liquids. This clogs blood vessels leading to vital organs such as the lungs, liver, brain, and kidneys. When these blood vessels become clogged, the organs

how heroin affects the body

The arm of a heroin addict shows track marks caused by intravenous drug abuse.

are at risk for infection or cell damage. As a result, heroin addicts often have serious, long-term illnesses in addition to their heroin addiction. Heroin addicts are

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heroin often plagued with ailments such as pneumonia and tuberculosis. Another disease that may affect heroin users is called pulmonary edema. This is the swelling of lung tissue. As the lung tissue swells, a person can only breathe in about 50% of what they might breathe normally. This condition can lead to a serious case of pneumonia, and sometimes to death. Pulmonary edema is often the cause of the sudden death of some heroin addicts. Leukoencephalopathy is a disease that harms parts of the brain and spinal cord. This condition was first noted in the 1930s in children suffering from leukemia. The first case associated with heroin use was documented in 1982. The earliest symptoms of leukoencephalopathy are slurred speech and difficulty walking. These symptoms may start in as little as a few days after using heroin. Any heroin user showing these signs should see a doctor immediately. If treated quickly, recovery is possible. Later symptoms include vision loss, speech difficulty, loss of coordination, paralysis, and, ultimately, coma. Death occurs in as many as 25% of those with the disease. Heroin users with weak immune systems due to AIDS are most at risk for getting the disease. Yet, scientists still do not understand how people get this disease. Research suggests that substances mixed with heroin may cause it. Heroin users also tend to have problems with their livers. The liver is an important organ because it regulates blood sugar levels, creates bile for digestion, and filters toxins from the blood. The liver is on the right side of the abdomen, next to the stomach. The liver receives blood from two large vessels called the hepatic artery and the portal vein. The hepatic artery carries oxygenrich blood from the heart. The portal vein carries blood containing digested food from the small intestine. These

how heroin affects the body blood vessels repeatedly split off into branches, like tree branches, and end in very small vessels called capillaries. Each capillary leads to tiny parts of the liver that filter toxins out of the blood and regulate blood sugar levels. When there is an excess of blood sugar, the liver removes and stores it. When blood sugar is low, the liver releases extra blood sugar. In this way, the liver regulates blood sugar levels so that they never get too high or too low. Another function of the liver is to filter toxins from the blood. This includes any drugs in the blood. When the liver removes toxins, it must work harder and can become damaged doing so. Alcohol is another toxic substance that leads to liver damage. When the liver has to work especially hard over a long period of time to remove toxins, a condition called cirrhosis can occur. Cirrhosis is caused by the destruction of liver cells over a long period of time. When liver cells are damaged, they are replaced with scar tissue. This causes an enlargement of the liver, which prevents the organ from working well, since scar tissue cannot do the work of liver cells.

OTHER EFFECTS Using heroin, regardless of the method, exposes the user to many different diseases. The most common among these are hepatitis and AIDS. Both of these conditions can cause life-long problems—and death—for the heroin user. Hepatitis is the swelling of the liver. There are many different types of hepatitis but the most common are hepatitis A, hepatitis B, and hepatitis C. A different virus causes each type of hepatitis. The disease has a strong link to heroin injection, since unclean needles can spread it. However, any heroin user is at risk for hepatitis, which is also spread from person to person

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heroin through body fluids. A sneeze or a cough, for example, can propel particles 10 or more feet. These particles can contaminate syringes or other heroin tools and expose the user to hepatitis. Hepatitis A is the least serious type of hepatitis. It usually comes from contaminated water or food and is spread in unclean conditions. The symptoms of hepatitis A show up in two to six weeks from contact and include loss of appetite, nausea, mild fever, dark urine, and sometimes jaundice, a yellowish coloring of the skin and eyes. Hepatitis A causes an enlarged liver, too, but usually leaves no permanent damage. Hepatitis B can lead to long-term hepatitis or cirrhosis of the liver. Hepatitis B is generally passed from person to person by shared or dirty syringes and unprotected sex. The symptoms for hepatitis B are similar to those for hepatitis A, but it may take much longer for the symptoms of hepatitis B to appear. Hepatitis C is similar to hepatitis B, but symptoms may not show up for two weeks to six months, or even many years. Hepatitis C is passed between people in a similar way as hepatitis B. There is currently no cure for Hepatitis C, but some therapies have shown promise. Another condition that can result from heroin use is HIV, the virus that causes AIDS (acquired immunodeficiency syndrome). AIDS was first reported in the United States in 1981. Since that time, it has become a major worldwide epidemic. HIV attacks the body by killing or damaging the cells of the immune system. By weakening the body’s immune system, HIV gradually destroys the body’s ability to fight infections and certain cancers. AIDS is the most advanced stage of HIV infection. HIV can be passed from person to person in several ways. The two most common ways of getting HIV are by

how heroin affects the body having unprotected sex with someone who is infected, or using needles or syringes from people who are infected. (In the past, it was possible for infected blood to slip into hospital supplies to be used in blood transfusions. Since 1985, the United States has been actively testing all donated blood for HIV. Therefore, the risk of getting HIV in this way in the United States is now extremely low.) There is no evidence that HIV is spread by contact with saliva or through casual contact such as shaking hands or hugging, or the sharing of food utensils, towels and bedding, swimming pools, telephones, toilet seats, or biting insects. Sharing needles is the most common way that HIV is spread among heroin users. When AIDS first appeared, there were few treatments for it. Researchers today have developed drugs that can help fight HIV and the related infections and cancers. These treatment advances have improved victims’ chances of survival. They have also slowed the spread of HIV in developed countries such as the United States, where anti-AIDS drugs are available. There is no cure for HIV or AIDS yet, but scientists are working on it.

HEROIN USE BY PREGNANT WOMEN Using heroin while pregnant can severely harm an unborn child. It can cause premature birth, which results in babies who are not fully developed and therefore require intensive care. Once they are born, these babies often suffer from breathing problems and infections in their first few weeks of life. Most babies born to heroin abusers have poor health because of the poor health and nutrition of their mothers. An unborn baby also can become dependent on heroin if its mother uses it. Babies of heroin-using mothers can suffer withdrawal symptoms after they are born. These babies require special treatment for addiction.

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heroin Even if a woman stops taking heroin when she finds out she is pregnant, the baby may still be harmed. Withdrawal in the mother can contribute to miscarriage, poor growth, or premature birth. Heroin has many effects on the body, from physical difficulties to dependence and addiction. The physical and mental parts of heroin addiction can be overwhelming. The addiction combined with the withdrawal symptoms make breaking the addiction cycle very difficult.

SIGNS OF HEROIN ABUSE Some possible physical signs of heroin abuse are: • • • • • • • •

Tiny pupils Vomiting Constipation and use of laxatives Track marks on arms Itching and scratching Becoming energetic and then all of a sudden nodding out Extreme weight loss Loss of menstrual period

Some behaviors that could indicate heroin abuse are: • •

Unexplained time away from home, along with a sudden change in behavior Frequent, secret phone calls

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IS SOMEONE YOU KNOW USING HEROIN? Sometimes it is difficult to tell if someone you know has started using drugs. One of the first signs is when that person starts spending more time with other people who use drugs. Another sign is if this person starts having unusual mood swings or stops doing things he or she once liked doing. He or she also may have less motivation to do ordinary things such as taking part in healthy activities or school. People who use heroin may start

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Letting go of strong friendships and forming new friendships with people who use drugs Depression Bringing bought items back to stores for a cash refund Stealing credit cards or checks

Some other signals of heroin abuse are: • •

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Slips from pawnshops left lying around The presence of tools for shooting up, such as bottles of vinegar and bleach (used to clean needles), cotton balls, shoelaces or belts, aluminum foil or gum wrappers with burn marks, and spoons with burn marks The theft of household valuables, tools, appliances, and jewelry, or items used for cooking heroin, such as spoons

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heroin wearing long-sleeved shirts all the time to hide the track marks left by shooting up. If you find out that someone you know is using heroin, you need to carefully plan what to do next. Your immediate reaction might be to beg, plead, or threaten this person to go to rehab. The reality is that those actions are not the best approach. Remember that someone will not quit using heroin until he or she is ready to admit to addiction and expresses a desire to quit. The best thing to do is to encourage loved ones to stop using by gently pushing them in the right direction. Explain that you see they have a problem and it is affecting not only them but also their family and friends. Remind them that you care for them and want nothing bad to happen to them. If you realize that a friend your age is using heroin, it is important to tell a trusted adult. Your friend will probably be taken to rehab for medical and psychological treatment. After loved ones get out of rehab, they will need all the support you are able to give. You need to talk honestly to them, listen to their story, and be sympathetic. Let them know that you are concerned, and encourage conversations about rehab experiences. Ask how they are feeling now and about any problems they’re having. Suggest going out to different places with you to take part in fun activities. Getting your loved ones comfortable talking is very important, since he or she will probably feel some embarrassment and shame about being addicted. Most heroin addicts eventually get and stay drug-free. The most successful ones are those with many caring friends.

6 tolerance, addiction, and Withdrawal

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hen a person regularly uses heroin, he or she finds that more and more heroin is needed to achieve the same intensity of effects. This increased need is known as tolerance. When higher doses of heroin are used over time, physical dependence and addiction develop. Physical dependence develops when the body gets used to the presence of heroin. When the heroin user quits taking drugs, he or she has withdrawal symptoms. To counteract these withdrawal symptoms, he or she takes more heroin. This continues the vicious cycle of heroin addiction.

TOLERANCE Developing a tolerance for heroin begins with the first use. Tolerance occurs as the body adapts to the presence of heroin. The body does this in many different 77

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HEROIN ways. First, it can speed up how quickly it breaks down and gets rid of substances such as drugs. Sweating also helps get drugs out of the body. Moreover, the brain also becomes resistant to the stimulation from certain drugs over time and may change how it works in reaction to the drug. The body’s ability to adapt to the effects of a drug can change the brain’s chemistry—sometimes permanently. When a heroin addict quits using heroin, his or her body is unable to produce the chemicals that used to make that person feel normal. This explains why recovering heroin addicts have a desire to use the drug again just to feel normal, even long after they become free from their addiction with treatment. Each individual is slightly different in how rapidly his or her tolerance builds up. The speed at which tolerance builds up also depends on how often heroin is used. Someone who is an occasional user will build up a tolerance at a slower rate than someone who injects heroin several times a day. A person can also develop a different level of tolerance to different parts of his or her reaction to the drug. He or she may slowly become resistant to the euphoria and pain relief, or to vomiting and slowed breathing. Users don’t develop tolerance to certain other reactions to heroin use, such as shrinking pupils and constipation.

PHYSICAL ADDICTION Users develop physical addiction when their body, rather than their mind, is dependent on a substance. (But, as stated, physical addiction and psychological addiction often occur together.) Physical addiction is a medical problem that affects users when they stop using heroin. Suddenly stopping the use of heroin creates physical withdrawal symptoms because the body needs

tolerance, addiction, and Withdrawal the drug to function. For a heroin addict, physical addiction is easily treated. A person can go through treatment to remove the drug from his or her system in only a matter of days. This will break the physical addiction, but does not address the psychological addiction. Once the physical addiction to heroin has been overcome, the psychological issues must be brought under control. This should be done in a program that specifically deals with heroin, since this drug is different than most. Heroin addiction is complex and different from other addictions such as alcohol. Most addicts do the drug for the sole purpose of feeling good, and this is what traps addicts in addiction. The euphoria usually lasts for hours at a time, but it eventually begins to wear off. When the withdrawal symptoms begin, the addict craves heroin again, and using it progresses to physical addiction. Successfully breaking free from heroin addiction requires major lifestyle changes. A person needs to look at his or her entire life to discover what has led him or her to addiction. Until this is done, a heroin addict will continue to use. A physical addiction to heroin is very powerful and can make an addict sacrifice everything to obtain more of the drugs. Heroin addicts often resort to crime to feed their addiction. They may begin by stealing from family and friends before turning to stealing from strangers. Often, heroin addicts will distance themselves from family and friends because they are ashamed of their actions. This often has the effect of hurting family and friends more than the addict knows.

PSYCHOLOGICAL ADDICTION Psychological addiction is when the mind, rather than the body, is dependent on something. Heroin is definitely psychologically addictive. When someone stops

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heroin using heroin, part of what he or she goes through is psychological withdrawal. This is called a craving. A heroin addict usually has cravings for more heroin before he or she begins having symptoms of physical withdrawal. These cravings may be for the euphoria, or they may be caused by fear of how withdrawal symptoms will feel. Regardless of why, cravings are one of the things that drive heroin addicts to continue using heroin. When heroin addicts are treated for their addiction, some of the best treatment methods include therapy to address why they became addicted. This often happens alongside treatment for physical addiction. It is possible—and common—to be both psychologically and physically dependent on heroin at the same time. Many doctors don’t consider these two kinds of addiction to be different, especially with a highly addictive drug like heroin. But the causes and characteristics of each type are quite different, as are the types of treatment preferred.

WITHDRAWAL Withdrawal is a sign of physical addiction to heroin. It strikes users in as little as four hours after their last use of the drug. The initial symptoms are uncomfortable yet are often enough to prompt an addict to use more heroin. The symptoms usually peak after two or three days, and finally get weaker within a week. Few heroin addicts reach the point where they allow the symptoms of withdrawal to fade away, unless they are undergoing treatment for their addiction. Withdrawal happens in two phases: acute and pro-­ tracted. Acute withdrawal occurs when physical addiction has developed and the heroin addict suddenly stops using. Then the body quickly tries to return to normal after the heroin high. The symptoms of acute

tolerance, addiction, and Withdrawal withdrawal can occur within 8 to 12 hours after stopping heroin use, and reach a peak of intensity within 48 hours. They then gradually get weaker over 5 to 7 days. In some addicts, however, the symptoms can last for months. Symptoms of acute withdrawal include muscle and stomach cramps, diarrhea, leg spasms, vomiting, sweats, delirium, and sleeping problems. It is important to note that even though acute heroin withdrawal feels terrible, like a horrible case of the flu, it is almost never life-threatening. Sudden withdrawal is usually only fatal for heroin users who are already in poor health. But because acute heroin withdrawal symptoms can be extremely painful and seem so frightening, many addicts return to heroin use just to avoid them. The symptoms create anxiety for the addict, and the fear of withdrawal becomes a motivation for continued use of the drug. Often, the fear of withdrawal symptoms is stronger than the desire for a heroin rush. Protracted withdrawal has symptoms that last for months after quitting heroin. The symptoms begin about four weeks after quitting and last for six or eight weeks. The symptoms include slight increases in blood pressure, body temperature, breathing, and pupil size. After that, for about the next seven months, the second part of protracted withdrawal symptoms begins. During this part of protracted withdrawal, there are decreases in blood pressure, body temperature, and breathing. The recovering addict will also have a general feeling of unease, anxiety, and trouble sleeping. Throughout the entire withdrawal period, physical and mental discomfort makes it difficult for an addict to resist using heroin again. During protracted withdrawal, it is common for the patient to have occasional acute withdrawal symptoms. These are usually brought on by environmental factors, such as seeing something

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heroin associated with heroin, a particular odor, or being in the neighborhood where the person once used heroin. All of these can stimulate past memories and bring about a craving for heroin. A recovering addict can be haunted by these memories and cravings for several decades after quitting.

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eroin addiction is one of the most difficult addictions to overcome. A heroin addict’s body becomes used to the constant exposure to heroin and its effects. Withdrawal symptoms are so unpleasant and powerful that the addict uses whatever means necessary to get more heroin to stop the symptoms. To break this cycle of continued use, the addict must undergo a rehabilitation (or rehab) program. This involves detoxification, or detox, as a treatment for physical addiction. The goal of detox is to get the patient’s body to a point at which he or she does not have withdrawal symptoms and can function without heroin. The current medical treatment and detox procedures are a major improvement over what was available in the

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HOW DO YOU KNOW YOU ARE ADDICTED TO HEROIN? Users should answer the following questions to think about their heroin use. 1. Do you isolate when using heroin? 2. Have you ever used more heroin than you planned? 3. Has your heroin usage interfered with your job or school? 4. Do you find yourself concealing your heroin usage from others? 5. Are you experiencing financial difficulties due to your heroin usage? 6. Has your heroin usage caused problems with your partner/spouse or family? 7. Do you wish you could stop using heroin and find that you are unable to quit? 8. Have you experienced legal difficulties from your heroin usage and yet you continue to use? 9. Do you consume the entire amount of heroin you have and then immediately desire to get more? 10. Have you failed to cut down or quit heroin entirely? 11. Do you wish you had never taken that first hit, line, or injection of heroin? 12. Have you continued to use heroin even after you experienced an overdose?

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13. Do you fear other people will find out about your heroin usage? 14. Are you preoccupied with getting heroin when you do not have it? 15. Do you have to use larger amounts of heroin to get the same high you once experienced? 16. Has anyone ever told you that you may have a problem? 17. Have you ever lied or misled those around you about how much or how often you use heroin? 18. Do you use heroin at work or in the bathroom in public facilities? 19. Have you ever pawned something in order to buy heroin? 20. Are you afraid that if you stop using heroin you will not be able to function? 21. Do you find yourself doing things that you are ashamed of so you can purchase heroin? 22. Have you ever stolen drugs or money from family or friends in order to buy heroin? If you answered yes to one or more of these questions, you have a serious problem with heroin. Copyright © 2004 Heroin Anonymous World Services. Heroin Anonymous is not affiliated with this publication, other than to grant permission for use of this information.

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heroin past. Then, heroin users were offered other drugs that had a similar effect as heroin. These drugs were addictive but not as strongly as heroin. Once the patients’ addiction to heroin was replaced with a different addiction, they were then slowly taken off the other drug. The traditional treatment practices used today require a strong commitment from the addict. Because of the pain and discomfort of withdrawal, the dropout rate is high. The first step toward treating heroin addiction is the hardest. Before any detox or treatment can begin, the addict must admit to having an addiction. The addict must be willing and committed to undergo treatment and detox. This is a tough process that requires the full commitment of the addict before it can be successful. Most detox programs use a combination of different methods for breaking the heroin addiction. This chapter will discuss several of those methods.

GOING COLD TURKEY Going “cold turkey” is when a drug addict just stops using a drug rather than gradually using less and less before stopping completely. Going cold turkey off heroin is difficult because of the effects of the physical and psychological addiction. Some addicts try to do this on their own, but most are not as successful as addicts who get professional medical care. Between 8 and 24 hours after the last use of heroin, the cold-turkey withdrawal begins. Most addicts have similar symptoms, such as diarrhea, aches and pains, stomach cramps, vomiting, sweats, and chills. A person going through withdrawal often feels as though he or she is dying. This feeling is often so strong that the addict goes straight back to using heroin. But if an addict makes it through 4 to 8 days, he or she is on the

detox and treatment way to breaking the addiction. For many addicts, the only way to get through this part of the process is to take pain pills and anti-diarrhea pills. After the cold-turkey stage, the addict still has a long road to recovery. The addict’s body is still used to having the stimulation from heroin. This is a powerful part of addiction and it needs to be controlled. At this stage, addicts usually need counseling and special drugs to help make it through each day. It is important to keep occupied. Many addicts committed to recovery will take up a healthy hobby or develop an interest in something that makes the time pass quickly. The simple action of doing something helps keep the addict from turning back to heroin. If the recovering addict does not have a job, this is a good time to get one. It will help make him or her feel like he or she is part of the world again. For a recovering addict, one of the worst things to do is hang around with other heroin addicts. This often leads back to using heroin because the addict’s body still has urges to feel the euphoria of a heroin high. Going cold turkey on one’s own is a difficult path to follow, and can cause enormous emotional strains on family and friends. It can be a traumatic experience. The best, and usually most successful, method of breaking heroin addiction is going to a rehab clinic with a good reputation.

BEHAVIORAL TREATMENT There are many good behavioral treatments available for heroin addiction. These treatments include therapy with a person who has been trained in drug counseling. Behavioral therapy uses rewards and punishments to achieve more good behavior (such as taking part in activities meant to aid recovery) and to reduce negative

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heroin behavior (going back to heroin use or resisting recovery). Rewards might include a night out at the movies, going out for dinner, or a day off from work. Punishments could be losing the privilege of having visitors come to the rehab center, getting no extra treats, and not being allowed to go home for the weekend. Behavioral treatments are divided into two types: con-­ tingency management treatments and cognitive-­behavioral interventions. They sound complicated, but they’re easy to explain. Contingency management treatments are based on the idea that if a behavior is rewarded, it is more likely to be repeated in the future. This kind of therapy for heroin addiction uses a system in which patients “earn points” for staying drug-free. The points can be exchanged for treats that encourage healthy living, such as visits from family and friends. Cognitive-behavioral interventions help change how patients think, act, and cope in various stressful situations in life. Cognitive-behavioral therapies encourage patients to examine what they are doing and why they are doing it, so they can realize a better alternative. Although behavioral treatment can work well in helping with heroin addiction and preventing relapse after treatment, it works better when combined with other types of treatment. The use of various medical drugs together with behavioral treatment has the highest success rate.

DRUG TREATMENT Many heroin detox programs use medical drugs that are similar to heroin but do not have all the euphoric effects. These drugs help the addict’s body adapt to not having the stimulation of heroin. It is a gradual stepping-down process in which a patient uses smaller and smaller amounts of the medical drug. This helps

detox and treatment lessen the withdrawal effects of heroin, since the drugs are not taken out of the person’s body all at once. In some cases, though, the addict becomes addicted to the detox drugs. If this happens, the person’s addiction to those drugs must be broken, too.

Naltrexone Treatment Naltrexone is one medicine for opiate addiction treatment. It works by blocking the effect of heroin on the body. After detox, the heroin addict is given naltrexone three times per week. At this dose, if the patient returns to using heroin, he or she doesn’t feel its euphoric effects. Thus, naltrexone helps discourage the addict’s return to heroin use, which is important since it is common for recovering addicts to go back to old behaviors. Naltrexone is often given alongside behavioral therapy. The advantages of naltrexone are that it is not addictive and has few bad side effects. In addition, it can be given to a recovering addict without concerns that it will end up being sold on the street; some of the drugs used to treat heroin addiction are taken and illegally sold on the street as a substitute for heroin. Finally, unlike other addiction treatment drugs, the government does not restrict when and where naltrexone can be given to a recovering addict. Because of this, naltrexone can be given out in many settings, such as in a private doctor’s office. This privacy can be attractive to people who are reluctant to enter clinics. Naltrexone is most successful in patients who are highly motivated to stop using heroin. It is less effective in patients who lack strong motivation to quit, because it does not mimic heroin in the body. This means that it does not make withdrawal easier. For patients with less motivation to quit heroin, other medicines are usually more helpful.

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The medicine naltrexone blocks the effects of heroin and other opium-derived drugs by binding to the same receptors in the brain as the illegal drugs would do. This prevents patients from feeling the effects of heroin if they return to the drug within two months after quitting—when the temptation is typically greatest—and helps discourage further drug use. Dr. Lance Gooberman (above), pictured in his Merchantville, N.J. clinic in 2000, holds up an inch-long syringe of the medicine.

Methadone and LAAM Treatment Methadone is a human-made opiate that is similar to heroin. Like heroin, it is a potent pain reliever. Methadone is usually given for the treatment of heroin addiction,

detox and treatment but it may sometimes be used as a pain reliever, as well. During heroin addiction treatment, addicts are given regular doses of methadone to lessen the cravings associated with heroin and to make withdrawal easier. To treat heroin addiction, the addict is put on a methadone maintenance treatment (MMT). The goal of the MMT is to get the addict to stop using heroin and to get him or her away from the crime and diseases associated with heroin addiction. Methadone creates a high similar to that of heroin. After the detox process and during the MMT, patients lose their addiction to heroin because they develop an addiction to methadone. Methadone is given to the addict in the form of a pill or liquid to be swallowed. This helps remove the user from the dangers of injecting heroin. Once the addict has been successfully detoxified from heroin, the MMT continues until all the cravings for heroin are gone. The main benefit of this treatment is that, in hundreds of scientific studies, it has been shown to have almost no negative health effects. This is the case even with patients who are on the treatment for years at a time, as long as 20 or 30 years in some cases. MMT is one of the most widely used methods of breaking heroin addiction. It is safe and effective at replacing heroin and keeping addicts from returning to heroin. MMT is also a rather inexpensive, long-term treatment option for heroin addiction. But even this successful treatment has its problems. One drawback is that methadone has become a valuable drug on the street. Users can substitute methadone for heroin if they cannot find heroin. Some patients on MMT will sell their methadone on the street and make enough money to live on. The biggest drawback of MMT, however, is that the patient becomes addicted to methadone. When it has been determined that the patient has finally gotten over his or her addiction to heroin, he or she then must

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Methadone is a manufactured opiate that, when given to heroin addicts in regular doses, helps curb cravings and make withdrawal easier. Here, a daily dose of the drug is dispensed by computerized measurement into a cup at a California clinic. Though new medicines have become available, methadone has remained the standard drug treatment for heroin addiction since the 1960s.

detox and treatment undergo detox and treatment for methadone dependence. Methadone detox requires that the addict use less methadone over a long period of time, sometimes even years. Levomethadyl acetate hydrochloride (LAAM) is another human-made opiate similar to methadone. However, unlike methadone, which addicts must use daily, LAAM can be taken three times per week. This makes it far more convenient and possibly less expensive than methadone. It can be addictive, though, just like methadone. In 1993, the U.S. government approved LAAM for medical use. But because of methadone’s high success rate and its widespread use around the world, LAAM is often overlooked. This remains the case even though studies have shown that LAAM is as effective as methadone.

Buprenorphine Treatment Buprenorphine is another opiate, but it is not as strong a pain reliever as morphine or heroin. The U.S. government approved buprenorphine for the treatment of heroin addiction in 2002. This medicine works by allowing a heroin addict to get off heroin gradually while avoiding most of the withdrawal symptoms. One big advantage of buprenorphine is that it is much less addictive than either methadone or LAAM. This means that there is no need for an additional detox period to break the addiction from the treatment drug. When a heroin addict undergoes detox, he or she is given buprenorphine in a drug called Subatex. This medicine serves as a replacement for heroin and prevents most of the symptoms of withdrawal, while not producing the same pain relief of heroin. Subatex is a pill that is put in the mouth and left to dissolve under the tongue. It only needs to be taken once per day.

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heroin Because buprenorphine is an opiate, it has the potential of being abused like other opiates. To prevent abuse, Subatex is given to an addict only during the detox phase of treatment. After about a week, the patient is changed to a drug called Suboxone. This drug is used during the maintenance phase of treatment for heroin addiction. Suboxone affects the body and brain in much the same way as heroin except that the euphoria created is not as strong. Its use prevents withdrawal symptoms. It is given to recovering addicts to prevent them from going back to using heroin. Suboxone contains buprenorphine as its main active ingredient, too, and like Subatex it is left to dissolve under the tongue. However, Suboxone also contains a second drug called naloxone. Naloxone is a drug that blocks the effects of opiates in the body and brain when injected. Naloxone prevents the opiates from binding with neurons in the brain so they have no effect on the brain. Naloxone is only effective when injected, though, so this prevents Suboxone from being ground up and injected by addicts on the street. One of the problems with treatment of heroin addiction is that many of the drugs used to treat the addition create effects similar to those of heroin. Sometimes recovering addicts will sell their drugs to addicts or these drugs will be stolen and sold to addicts when heroin is not available. Because injecting heroin produces a strong sensation on a small amount of drug, adding chemicals that block the effects when injected help prevent illegal use of treatment drugs.

NEW TRENDS IN TREATMENT A new type of so-called “rapid detox” shows promise for addicts. Rapid detox is a fast and fairly painless method. First the addict is given a medicine to make him or her go numb and go to sleep. Then he or she is given various

detox and treatment detox medicines. Because the patient is in a deep sleep, there is no pain and discomfort from withdrawal. Studies have shown, however, that this procedure has a risk of death, psychosis, increased stress, delirium, attempted suicide, and abnormal heart rhythm. Another drawback of this method is its costs: as much as $15,000. Furthermore, because this is a treatment for illegal drug addiction, medical insurance companies view it as something that is the fault of the patient. Because of this, insurance companies do not usually pay any of this cost. After the heroin addict has been put to sleep, he or she is given the drug naltrexone to block the effects of heroin in the body. This begins the heroin withdrawal symptoms in a matter of hours rather than days. The heroin addict remains asleep for this withdrawal period and must stay under a doctor’s care for 24 to 48 hours during the procedure. Doctors monitor the patient while he or she is asleep, and then continue to monitor him or her after he or she is awakened. When the patient wakes up, he or she will not remember any of the withdrawal symptoms. The detox from heroin is complete, but the patient usually spends at least 10 more months taking naltrexone to prevent going back to heroin use. Although this procedure has gained some popularity, studies have shown that it is no more effective than other treatment methods. And the risks to the patient during this procedure are much greater than with other treatment options. Because of this, many doctors are reluctant to use this procedure. But some people are embarrassed to go into long-term detox programs and, if they can afford it, may choose a rapid detox program instead.

LONG-TERM SUCCESS Withdrawal symptoms are the greatest obstacle in heroin detox and addiction treatment. Almost all studies

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heroin show that different detox and treatment methods share similar success rates, and none stands out as better than the others. Statistics show that the average heroin addict

BASIS FOR EFFECTIVE TREATMENT Scientific research since the mid 1970s shows that treatment can help many people change destructive behaviors, avoid returning to drug use, and successfully remove themselves from a life of substance abuse and addiction. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. Based on this research, key principles have been identified that should form the basis of any effective treatment program: • • •

•

• •

•

No single treatment is appropriate for all individuals. Treatment needs to be easily available. Effective treatment addresses the multiple needs of the individual, not just his or her drug addiction. An individual’s treatment plan must be reviewed often and changed to meet the person’s changing needs. Remaining in treatment for a sufficient time is critical. Counseling and other behavioral therapies are critical pieces of nearly all effective addiction treatments. For certain types of disorders, medications are an important part of treatment, especially when

detox and treatment will start and stop detox many times during his or her lifetime. Relapses to heroin use several times over a lifetime are common among heroin addicts.

•

•

• • •

•

combined with counseling and other behavioral therapies. Addicted or drug-abusing individuals who also have mental disorders should have both disorders treated in a combined way. Medical treatment of withdrawal is only the first stage of addiction treatment and, by itself, does little to change long-term drug use. A person does not need to volunteer for treatment in order for it to be effective, but it helps. Patients must be constantly watched to make sure they are not using drugs during treatment. Treatment programs should provide tests for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients change behaviors that place themselves or others at risk of infection. As is the case with other long-term diseases, recovery from drug addiction can be a long process and usually requires several episodes of treatment, including “booster” sessions and other forms of continuing care.

Source: National Institute on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide (1999).

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heroin Heroin addicts go back to heroin use for many different reasons. Some former heroin users may respond to stress by using heroin again since it relieves stress. This begins the addiction cycle again. Some former users return to heroin if they become depressed. They might find it easier to turn to heroin than to seek proper help for their depression. Some former addicts return to heroin use simply because they have poor coping skills to deal with regular obstacles in life. Many times, this can all be prevented by therapy and support. How likely is it that a former addict will return to heroin? There is no way of telling. When a recovering heroin addict faces a tough situation, there is an increased risk of slipping back into drug use. After that, the outcome for each individual varies. Some people are able to enter detox and treatment before their addiction becomes too strong. But because heroin causes such a strong psychological addiction, the cravings for it may continue throughout the former addict’s lifetime. Staying off heroin can be a lifelong fight.

glossary Addiction  A ­long-­term disease characterized by constant drug seeking and abuse and by ­long-­lasting chemical changes in the brain

Craving  A powerful, often uncontrollable desire for a substance

Detox  (Detoxification) A process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal. This is often the first step in a drug treatment program.

Endorphin  One of the body’s own natural painkillers Euphoria  A feeling of intense pleasure and ­well-­being Narcotic  An addictive drug that reduces pain, alters mood and behavior, and usually causes sleep or stupor

Opiate  Any drug made from opium Opium  An addictive narcotic taken from the seedpods of the opium poppy

Overdose  The accidental or intentional use of a drug or medicine in an amount that is higher than what is recommended. Overdose may result in death.

Physical addiction  A state that occurs when the body needs a substance in order to function. This can happen with regular drug use and results in withdrawal when the drug use is stopped. Physical addiction usually occurs alongside physical tolerance.

Psychological addiction  A condition in which a person requires a substance in order to feel mentally stable

Recreational drug  A drug used for personal enjoyment rather than medical reasons

Rehab  (Rehabilitation) Treatment that helps addicts break their addiction

Tolerance  A condition in which even higher doses of a drug are required to produce the same effect that was felt during the first use. Tolerance often leads to physical addiction.

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Glossary Smuggle  To secretly transport items from one place to another

Trafficking  The smuggling of drugs from one area to another for sale

Withdrawal  A variety of symptoms that occur after the use of an addictive drug is reduced or stopped

bibliography Dinkes, R., E.F. Cataldi, G. Kena, and K. Baum, (2006). Indicators of School Crime and Safety: 2006 (NCES2007–003/ NCJ 214262). U.S. Departments of Education and Justice. Washington, D.C.: U.S. Government Printing Office. Fernandez, Humberto. Heroin. Center City, Minn.: Hazelden, 1998. Johnston, L. D., P. M. O’Malley, J. G. Bachman & J. E. Schulenberg (2006). Monitoring the Future: National Results on Adolescent Drug Use: Overview of Key Findings, 2005. (NIH Publication No. 06–5882). Bethesda, Md.: National Institute on Drug Abuse. Monitoring the Future: National Survey Results on Drug Use, 1975–2005, Volume II: College Students and Adults Ages 19–45, 2005. University of Michigan, 2006. Moraes, Francis. The Heroin User’s Handbook. Port Townsend, Wa.: Loompanics Unlimited, 2004. Moraes, Francis. The Little Book of Heroin. Berkeley, Calif.: Ronin Publishing, 2000. Moraes, Debra, and Francis Moraes. The Little Book of Opium. Berkeley, Calif.: Ronin Publishing, 2003. National Institute on Drug Abuse. Heroin Use and Addiction. Research Report, NIH Publication No. 05–4165. National Institute of Health, Rockville, Md. May 2005. U.S. Department of Health and Human Services, SAMHSA, Office of Applied Studies. Drug Abuse Warning Network, 2003: Area Profiles of ­Drug-­Related Mortality. DAWN Series D-27, DHHS Publication No. (SMA) 05–4023. Department of Health and Human Services, Rockville, Md., 2005. U.S. Department of Health and Human Services, SAMHSA, Office of Applied Studies. Drug Abuse Warning Network, 2005: National Estimates of ­Drug-­Related Emergency Depart-­ ment Visits. DAWN Series D-29, DHHS Publication No. (SMA) 07–4256. Department of Health and Human Services, Rockville, Md., 2007.

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further reading Cobb, Allan B. Heroin And Your Veins: The Incredibly Disgusting Story. New York: Rosen Publishing, 2006. Ferreiro, Carmen. Heroin. Philadelphia: Chelsea House Publishers, 2003. Hager, Holly J. Heroin = Busted! Berkeley Heights, N.J.: Enslow Publishers, 2005. Howard, Todd. Heroin. Drug Education Library. San Diego, Calif.: Lucent Books, 2002. LeVert, Suzanne. The Facts About Heroin. New York: Benchmark Books, 2006.

Web Sites Drug Policy Information Clearinghouse http://www.whitehousedrugpolicy.gov This site contains a variety of reports and other information about drug abuse throughout the United States and what is being done to combat it. Heroin Anonymous http://www.­heroin-­anonymous.org People can find out more information on heroin abuse and how to get help on the Web site of this addiction recovery organization.

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photo credits Page

13: Vova Pomortzeff/ Shutterstock 15: Courtesy of the DEA 16: Courtesy of the DEA 19: Nigel Cattlin/ Alamy 23: AP Images 25: Getty Images 30: Getty Images 37: AFP/Getty Images 39: AP Images

42: 46: 58: 60: 66: 69: 90: 92:

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Shutterstock AP Images Kurt Krieger/Corbis Time & Life Pictures/ Getty Images Ed Kashi/Corbis SPL/Photo Researchers AP Images AP Images

index A

C

abscesses, 49 acetic anhydride, 25 acquisition, 66 acute withdrawal, 80–81 addiction, 48, 63, 65–66, 73–74, 78–80, 84–85 Addiction Institutes of New York, 8 adults, heroin use among, 53–56 Afghanistan, 35 AIDS, 49, 59, 70, 72–73 alcohol, 71 Alexander the Great, 29 alkaloids, 20, 24 appearance of heroin, 14 Arabia, 32 Argentina, 36 Arizona Youth Survey, 47 Assyrians, 28 autonomic nervous system, 65

California, 34–35 California Pharmacy and Poison Act, 35 Canton, 33–34 Carangi, Gia, 59 Carroll, Jim, 59 Catholic Church, 31–32 cheese heroin, 17 chemical name of morphine, 22 chi lung, 43 China, 20, 31, 32–34, 38, 43 China White, 17 chloroform, 26 cirrhosis, 71 Civil War, 6, 31 Clinton, William, 60 Coca-­Cola, 6 cocaine, 45–46 codeine, 20, 21 cognitive-­behavioral ­interventions, 88 cold medicines, 17, 45 cold-­turkey, 86–87 college students, 54 Colombia, 35–36 color of heroin, 14 constipation, 65 contingency management treatments, 88 controlled substances, defined, 21 Costa Rica, 36 cravings, 43, 48, 80, 82 crime, 47, 52, 54, 79 Cyprus, 29

B babies, 48 baby boomers, 55 balloons, 15–16 Bangkok, 26 banning of opiates, 34–35 Basketball Diaries, 59 Bayer Pharmaceuticals, 22 behavioral treatments, 87–88 Betty Ford Center, 8 bindles, 17 black tar heroin, 14, 15–16, 17 Bogue, Treaty of, 33–34 brain, effects on, 62–64, 78 brain-­body connection, 64–65 breathing rates, 64 bricks, 26 buprenorphine treatment, 93–94

D D.A.R.E., 8, 10 Dark Ages, 31 decks, 17 definition of heroin, 22

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Index detoxification. See also treatment programs behavioral treatment, 87–88 buprenorphine treatment, 93–94 cold-­turkey, 86–87 drug treatment, 88–89 LAAM treatment, 93 long-­term success and, 95–98 methadone treatment, 90–93 naltrexone treatment, 89–90 new trends in, 94–95 overview of, 83–86 deuces, 17 diacetylmorphine, 22, 25 diarrhea, 64, 67, 87 DiCaprio, Leonardo, 59 digestive system, 64–65, 67 dime bags, 17 diseases, 49, 59, 67, 70–73 Dominican Republic, 36 Drug Abuse Resistance Education (D.A.R.E.), 8, 10 Drug Enforcement Agency (DEA), 7 “Drug War,” 7

E economic status, 56–57 Ecstasy, 47 Ecuador, 36 education, importance of, 7 effects of heroin brain and, 62–64, 78 brain-­body connection and, 64–65 diseases and, 71–73 long-­term, 65–67 organ damage as, 65, 67–71 overview of, 61–62 pleasure center and, 62, 63

pregnancy and, 73–74 signs of use and, 73–74 Egyptians, 28–29 endocarditis, 67–68 endorphins, 21, 62–64 enforcement, importance of, 7 euphoria, 61

F Fair Oaks, 8 Ford, Betty, 8

G Gia, 59 glamorization, 57–60 going on the nod, 64 Great Britain, 33–34 Gulf War, 10 gum, 24

H half loads, 17 half-­units, 26 Harrison Narcotics Act, 7, 35 Hazelden, 8 heart, effect on, 67–68 hepatic arteries, 70–71 hepatitis, 49, 71–72 heroin chic look, 59–60 Hesiod, 29 Hippocrates, 29 history of heroin use, 28–39 HIV, 49, 59, 72–73 Homer, 29 Hong Kong, 26, 34, 43 hormones, 65 Hul Gil, 28

I infants, 73–74 inhalation, overview of, 44–45 injection, 40–43, 67–68

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Index intramuscular use, 41 intravenous use, 41 Islamic Empire, 29–31 isoquinolines, 20

J Johnson Foundation, 10 Jolie, Angelina, 59 junkies, 43 “Just Say No” program, 8

K kidney disease, 49 Klein, Calvin, 59–60

L LAAM treatment, 93 laudanum, 32 Leukoencephalopathy, 70 Levomethadyl acetate ­hydrochloride (LAAM) ­treatment, 93 liver disease, 49, 70–72 loads, 17 lungs, effects on, 70

M Macau, 32 magnetic resonance imaging (MRI), 10–11 mainlining, defined, 41 maintenance, 66–67 manufacturing process, 22–26 menstruation, 48, 65 methadone maintenance treatment (MMT), 91–93 methadone treatment, 90–93 methods of use, 40–49 Mexican Brown, 17 Mexico, 35, 36–38 Miami, 36 Middle East, 35, 38–39

migrant workers, 37–38 Milner, Peter, 63 Minoans, 29 miscarriages, 74 mixing of drugs, 45–46, 68 MMT (methadone maintenance treatment), 91–93 “Monitoring the Future” study, 10 morphine, 6, 20–21, 24–26, 62 movies, 57–59 music, 57–59 Muslims, 29–31 Myanmar, 35

N naloxone, 94 naltrexone treatment, 89–90, 95 Nanjing, Treaty of, 33–34 National Institute on Drug Abuse (NIDA), 9–10 nausea, 65 neurons, 64 nickel bags, 17 nicknames, 16–18, 41, 45, 64 Nigeria, 38 Nixon, Richard, 7 nodding off, 64

O Odyssey, The (Homer), 29 Olds, James, 63 opiates, 19–20, 62 opium dens, 31 Opium Exclusion Act, 35 opium poppies, 18, 22–26 opium trade, 32–34 organ damage, 65, 67–71 organized crime, 36–37 overdoses, 41, 44, 48, 65

Index P packaging of heroin, 15–16 pain center, 63 Panama, 36 Paracelsus, 32 Partnership for a ­Drug-­Free America, 10 phenanthrenes, 20 Philippines, 32 Phoenicians, 29 physical addiction, 78–79. See also addiction pleasure center, 62, 63 pneumonia, 49, 70 poppies, 18, 22–26 portal veins, 70–71 Portuguese, 32 pregnancy, 48, 73–74 premature births, 73 prevention, importance of, 8–9 protracted withdrawal, 81–82 psychological addiction, 63, 66–67, 79–80. See also ­addiction Puerto Rico, 36 pulmonary edema, 70 pupils, 61 Pure Food and Drug Act, 7

Q Qing (Chinese emperor), 33

R rapid detox, 94–95 Reagan, Nancy, 8 Requiem for a Dream, 59 reticular formation, 63 risks of use, overview of, 48–49 Robert Wood Johnson Foundation, 10

Roman Empire, 29 rural areas, heroin use in, 47

S San Francisco, 34 sap, 22–24 scarring, 68 seeds, poppies and, 18 Selby, Hubert. Jr., 59 shooting up, defined, 41 signs of abuse, 74–76 Silk Road, 32–35 small intestines, 65, 70–71 Smithers, 8 smoking, overview of, 41, 43–44 smuggling, 24 snowballs, 45 Sorrenti, David, 60 Southeast Asia, 35, 38 Spain, 32–33 speech, slurred, 70 speed, 47 speedballs, 45 spinal cord disease, 70 Staphylococcus aureus, 68 “Stones of Immortality,” 32 street names, 16–18, 41, 45, 64 Streptococcus hemolyticus, 68 Streptococcus viridans, 68 students, 47, 50–53 Subatex, 93–94 subcutaneous use, 41 Suboxone, 94 Sumerians, 28

T taxation, 35 teenagers, 47, 50–53 testosterone, 65 Thailand, 38 thebaine, 20 Tianjin, Treaty of, 34

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Index tolerance, 12, 22, 65–66, 77–78 tools, overview of, 41 trafficking, overview of, 35–39 Trainspotting, 59 transfusions, 73 treatment programs, 7, 56, 79–80, 94–98. See also ­detoxification Treaty of Bogue, 33–34 Treaty of Nanjing, 33–34 Treaty of Tianjin, 34 tuberculosis, 49, 70 Tutankhamen (King of Egypt), 28–29

U units, 26

V veins, collapsed, 49, 68 Venezuela, 36 violence, 52 viruses, 49. See also hepatitis vomiting, 65

W Welsh, Irvine, 59 West Africa, 38 withdrawal, 48, 67, 68, 73–74, 80–82 Wright, C.R., 22

Y Youth Risk Behavior ­Surveillance System, 53

about the authors Allan B. Cobb is a ­ full-­time, freelance writer living in Central Texas. He writes on many different topics and specializes in nonfiction topics for young adults and science educational materials. When not writing or practicing photography, he enjoys many different outdoor activities such as camping, hiking, canoeing, sailing, and caving. His educational background is in biology, chemistry, geology, and education.

Series introduction author Ronald J. Brogan is the Bureau Chief for the New York City office of D.A.R.E. (Drug Abuse Resistance Education) America, where he trains and coordinates more than 100 New York City police officers in ­program-­related activities. He also serves as a D.A.R.E. regional director for Oregon, Connecticut, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont. In 1997, Brogan retired from the U.S. Drug Enforcement Administration (DEA), where he served as a special agent for 26 years. He holds bachelor’s and master’s degrees in criminal justice from the City University of New York.

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