Heroin is a highly addictive drug, and heroin abuse is a serious problem. It is both the most abused and the most rapidly acting of the opiates. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as “black tar heroin.”
Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to four times a day. Although recent studies into heroin abuse suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction. Although smoking and sniffing heroin do not produce a “rush” as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.
Although purer heroin is becoming more common, most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin abuse also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.
Heroin abuse can lead to a mulitude of potentially serious consequences such as:
- Infectious diseases, for example, HIV/AIDS and hepatitis B and C
- Collapsed veins
- Bacterial infections
- Infection of heart lining and valves
- Arthritis and other rheumatologic problems
One of the most detrimental long-term effects of heroin abuse is addiction itself. Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin abuse also leads to profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse.
As with abusers of any addictive drug, heroin abuse gradually leads to users spending more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers’ primary purpose in life becomes seeking and using drugs. The drugs literally change their brains.
Heroin abuse will lead to physical dependence with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhoea, vomiting, cold sweats with goose bumps (“cold turkey”), and leg movements. Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the foetus of a pregnant addict.
Medical consequences of chronic heroin abuse can include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin’s depressing effects on respiration.
Of course, sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse – infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.
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