Heroin abuse is much more pervasive in the US than many people realize. A recent report from the Office of National Drug Control Policy estimates that there are around 1.5 million chronic users of heroin in the US – and that number does not include users who are not classified as chronic (people who use heroin fewer than four days per month). The number of people who have tried heroin has been continually on the rise over the last few years. Heroin accounted for 14.1 percent of all admissions to publicly funded substance abuse treatment programs in 2008. The majority of people seeking treatment from this pool were Caucasian – 59.8 percent and nearly a third of all admissions were for people between ages 20-29.

The kind of heroin that is referred to as “black tar” usually comes from Mexico and is often sold in the western part of the US, though it has been showing up in states like Ohio, where drug-related deaths from overdose outnumbered traffic-related fatalities in the year 2008. The dark color of this kind of heroin comes from processing that yields impurities. Sometimes referred to as “smack,” “tar,” “H” or one of many other street names, the morphine component of heroin is derived from the opium poppy.

Although heroin is often injected straight into the veins of the user, it can also be smoked when it is in its freebase form, which has a lower boiling point, or snorted. Most countries in the world have laws that punish those who create, distribute or even possess heroin. There are a few countries that allow for the prescription of the drug as an opioid replacement therapy – Germany, Denmark, United Kingdom, Switzerland and Netherlands. In these cases, heroin is used similarly to how methadone is used in the United States.

Heroin is converted to morphine once it enters the body. The drug binds to the opioid receptors in the brain and body, particularly affecting the opioid receptors that regulate both pain and reward. Once heroin is activated inside the body, the user is overcome with a sensation of euphoria. This is usually accompanied by physical sensations, like a feeling of heaviness in the extremities, a dry mouth or flushed skin. If a person uses heroin regularly, the drug will begin to change the brain and how it functions over time. This will result in an elevated tolerance level as well as dependence. Long-term use can also alter both hormonal and neuronal systems permanently.

There are many inherent risks to using heroin, one of which is associated with the intravenous injection of the drug – HIV. HIV can easily and quickly be spread between users who share needles. In 2009, nine percent of new HIV infections were among those who injected drugs.

Who Uses Heroin?

The National Survey on Drug Use and Health (NSDUH) found that approximately 669,000 Americans reported having tried heroin in 2012. In 2011, 4.2 million Americans reported having used heroin at least once during their lifetime. The number of Americans who report having tried heroin has been rising every year since 2007. These rising numbers are largely attributed to young adults between ages 18-25 who are trying the drug. It is estimated that 156,000 people tried heroin for the first time in 2012. To put this in perspective, only 90,000 people tried heroin for the first time in 2006.

Once seen as a drug confined to urban areas, heroin use is no longer restricted to location. Swells of heroin availability and use are now popping up in suburban and rural parts of the US from coast to coast. Although young adults are leading contributors to the rising numbers behind heroin use, people of all ages, races and economic backgrounds use heroin. As The Daily Beast reported earlier this year, the drug is as much of a “white collar” problem as anything else.

Side Effects and Signs of Heroin

There are many effects involved with using heroin. Some of the desired effects of using the drug are:

  • Euphoria. Users feel an immediate euphoric rush. This effect typically only lasts for the first couple of minutes that follow heroin use. What follows is a high that can last for hours and is usually described as a cozy or warm overall feeling. The temporary pleasure derived from heroin use is typically the prime effect that makes people want to use the drug again.
  • Pain relief. Users often feel as though their physical pain has been alleviated greatly after using heroin. The pain relief capabilities of heroin often diminish over time as a person’s tolerance begins to build.
  • Thrill.A recent study from Roosevelt University found that a majority of heroin users demonstrate “sensation-seeking behaviors” and are drawn to the drug, in part, because of the thrill they experience when procuring the drug and preparing to use it.

Many side effects are associated with heroin use. Some of the most common side effects of heroin use include:

  • Skin that is flushed
  • A mouth that is dry
  • Extremities that feel heavy
  • Itching that is severe
  • Nausea
  • Vomiting
  • Drowsiness and mental cloudiness
  • Impaired cognitive function
  • Slowed heart function
  • Slowed breathing, sometimes decreased to a life-threatening point
  • Painful constipation, which is associated with the use of all opiates
  • Miscarriage
  • Decreased cough reflex
  • Decreased libido
  • Slowed or slurred speech
  • Lowered tone of voice
  • Nodding off
  • Pupils that are constricted
  • Appetite that is reduced
  • Impaired coordination
  • Increased sweating
  • Difficulty urinating
  • Lowered body temperature
  • Irritability or depression when the drug effects begin to fade