A powerful illegal drug that has the fastest onset of all the opioids, as published by the Drug Enforcement Administration (DEA), heroin is usually sold as a brownish or white powder or as “black tar,” a black sticky form of the drug
The National Survey on Drug Use and Health (NSDUH) publishes that as of 2015 around 5 million Americans aged 12 and older had tried heroin at least once.
Heroin is often “cut” with other substances like sugar, starch, or powdered milk. It may also be mixed with other drugs. The National Institute on Drug Abuse (NIDA) reports that higher-purity heroin (heroin with fewer impurities and other substances contained within it, generally whitish in color) is more often smoked or snorted. Darker-colored heroin, either black or brown, tends to have more impurities, often due to the way the drug was harvested or processed. This darker heroin is regularly dissolved in liquid to dilute it and then injected directly into the muscles, veins, or under the skin.
Heroin is very potent and its abuse results in a large number of unintentional and fatal overdoses. Smoking, snorting, and injecting the drug all send it rapidly into the brain, which can cause a toxic buildup that may suppress breathing and deprive the brain of oxygen, leading to permanent brain damage, coma, or even death. NIDA reports that about 14,000 people in the United States died from a heroin overdose in 2015.
Snorting, or inhaling or sniffing, heroin is commonly thought to be the easiest way to take the drug as it doesn’t require much paraphernalia. Heroin powder can be lined up on a flat surface, like a mirror or table, and then snorted into the nose using a straw, stem of a ballpoint pen, or rolled-up paper (like a dollar bill). Credit cards are often used to scrape heroin powder into “lines” to be snorted. Heroin may also be dissolved in water to “shoot” it into the nose with a syringe.
When a person snorts heroin regularly, they can damage nasal and sinus cavities and may suffer from chronic nosebleeds. Damage to the lungs may occur as well.
Black tar heroin is regularly smoked, often called “chasing the dragon,” by heating it on a square of foil. Generally, the heat source is a lighter under the foil. The user then inhales the resulting fumes through a straw or ballpoint pen stem. Heroin can also be smoked in a pipe, or the powder can be rolled into cigarettes to be smoked.
Heroin acts on respiration rates, and smoking the drug can cause respiratory issues, lung damage, and chronic cough.
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Heroin powder can be heated on a spoon and then dissolved into liquid to be injected with a syringe and needle into a vein, called “shooting up.” The vein is often exposed by tying off areas around it with a rubber tube, string, or shoelace. When veins are blown, heroin may be injected directly into the muscle. Intramuscular and intravenous (IV) heroin use are common methods of taking the drug. IV drug users may get creative on where they inject the drug so as not to create “track marks” or scars in noticeable locations on the body. Heroin may be injected between the toes, for example. It can also be injected just under the skin, in a practice known as “skin popping.”
Injecting heroin sends the drug straight into the bloodstream, creating a swift and intense “high.” It often causes users to go “on the nod” and become drowsy and mellow. IV drug use can lead to fatal overdose, and it can also increase the risk for skin infections, collapsed veins, and the contraction and spread of infectious diseases like HIV/AIDS and hepatitis through sharing unclean needles.
Heroin is often mixed with other drugs, both intentionally and unintentionally, when the user doesn’t realize the heroin has been cut with another drug. For instance, heroin may be cut with fentanyl, an extremely potent opioid, to make a batch stretch further, and the buyer may not even realize this.
Heroin is also taken with other drugs on purpose to amplify or enhance the effects of the drugs or to counteract effects of one drug. For example, cocaine is a stimulant drug; since heroin is a depressant, users may take these two together in a “speedball,” in an attempt to counteract the negative effects of each drug. Heroin may be added to marijuana cigarettes, often called “atom bombs,” and smoked in an effort to enhance the effects of both drugs. Heroin may also be combined with prescription opioids.
Mixing heroin with other mind-altering substances increases all associated risks for all the substances and increases the likelihood of complications and overdose.