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Heroin |
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Heroin is an addictive drug, and its use is a serious problem in
America. Recent studies suggest a shift from injecting heroin to
snorting or smoking because of increased purity and the misconception
that these forms are safer.
Heroin is processed from morphine, a naturally occurring substance
extracted from the seed pod of the Asian poppy plant. Heroin usually
appears as a white or brown powder. Street names for heroin include
"smack," "H," "skag," and
"junk." Other names may refer to types of heroin produced
in a specific geographical area, such as "Mexican black tar." |
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Health Hazards |
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Heroin abuse is associated with serious health conditions, including:
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Fatal overdose
- Spontaneous abortion
- Collapsed veins
- Infectious diseases, including HIV / AIDS and hepatitis,
particularly in users who inject the drug.
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Short-term Effects
The short-term effects of heroin abuse appear soon
after a single dose and disappear in a few hours. After an injection
of heroin:
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Long-term Effects
Long-term effects of heroin appear after repeated
use for some period of time. Chronic users may develop:
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Collapsed veins
- Infection of the heart lining and valves
- Abscesses
- Cellulitis
- Liver Disease
- Pulmonary complications, including various
types of pneumonia, may result from the poor health condition of the abuser,
as well as from heroin's depressing effects on respiration |
In addition to the effects of the drug itself, street heroin may
have additives that do not readily dissolve and result in clogging
the blood vessels that lead to the lungs,liver, kidneys, or brain.
This can cause infection or even death of small patches of cells in
vital organs.
The Drug Abuse Warning Network* lists heroin/morphine
among the three most frequently mentioned drugs reported in
drug-related death cases in 2001. Nationwide, heroin emergency
department mentions were statistically unchanged from 2001 to 2002,
but have increased 35 percent since 1995. |
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Tolerance, Addiction, and Withdrawal |
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With regular heroin use, tolerance develops. This means the abuser
must use more heroin to achieve the same intensity of effect. As
higher doses are used over time, physical dependence and addiction
develop. With physical dependence, the body has adapted to the
presence of the drug and withdrawal symptoms may occur if use is
reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few
hours after the last administration, produces drug craving,
restlessness, muscle and bone pain, insomnia, diarrhea and vomiting,
cold flashes with goose bumps ("cold turkey"), kicking
movements ("kicking the habit"), and other symptoms. Major
withdrawal symptoms peak between 48 and 72 hours after the last dose
and subside after about a week. Sudden withdrawal by heavily
dependent users who are in poor health is occasionally fatal,
although heroin withdrawal is considered less dangerous than alcohol
or barbiturate withdrawal. |
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Treatment |
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There is a broad range of treatment options for heroin addiction,
including medication as well as behavioral therapies. Science has
taught us that when medication treatment is integrated with other
supportive services, patients are often able to stop heroin (or other
opiate) use and return to more stable and productive lives.
In November 1991, the National Institutes of Health (NIH) convened
a Consensus Panel on Effective Medical Treatment of Heroin Addiction.
The panel of national experts concluded that opiate drug addictions
are diseases of the brain and medical disorders that indeed can be
treated effectively. The panel strongly recommended (1) broader
access to methadone maintenance treatment programs for people who are
addicted to heroin or other opiate drugs; and (2) the Federal and
State regulations and other barriers impeding this access be
eliminated. This panel also stressed the importance of providing
substance abuse counseling, psychosocial therapies, and other
supportive services to enhance retention and successful outcomes in
methadone maintenance treatment programs.
Methadone, a synthetic opiate medication that blocks the effects
of heroin for about 24 hours, has a proven record of success when
prescribed at a high enough dosage level for people addicted to
heroin. Other approved medications are naioxone, which is used to
treat cases of overdose, and naltrexone, both of which block the
effects of morphine, heroin and other opiates.
Buprenorphine is a recent addition to the array of medications now
available for treating addiction to heroin and other opiates. This
medication is different from methadone in that it offers less risk of
addiction and can be dispensed in the privacy of a doctor's office.
Several other medications for use in heroin treatment programs are
also under study.
There are many effective behavioral treatments available for
heroin addiction. These can include residential and outpatient
approaches. Several new behavioral therapies are showing particular
promise for heroin addiction. Contingency management therapy uses a
voucher-based system, where patients earn "points" based on
negative drug tests, which they can exchange for items that encourage
healthful living. Cognitive-behavioral interventions are designed to
help modify the patient's thinking, expectancies, and behaviors and
to increase skills in coping with various life stressors. |
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Extent of Use |
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Monitoring the Future Survey (MTF)** |
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According to the 2003 MTF, rates of heroin use are almost 50
percent lower than recent peak rates in all three grades surveyed.
However, only use by 10th-graders showed a significant decline in the
past year. |
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Heroin Use by Students, 2003:
Monitoring the Future Survey |
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8th-Graders |
10th-Graders |
12th-Graders |
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Ever Used*** |
1.6 % |
1.5 % |
1.5 % |
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Used in Past Year |
0.9 |
0.7 |
0.8 |
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Used in Past Month |
0.4 |
0.3 |
0.4 |
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Community Epidemiology Work Group (CEWG) † |
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In June 2003, CEWG members reported that heroin indicators were
relatively stable, but maintained high levels in Boston, Chicago,
Detroit, Newark, Philadelphia, and San Francisco. Primary heroin
treatment admissions ranged from 62 to 82 percent of all illicit drug
admissions (excluding alcohol) in Baltimore, Boston, and Newark;
rates of heroin ED mentions exceeded 100 per 100,000 in Chicago and
Newark; and heroin/opiate-related deaths ranged between 275 and 496
in Philadelphia, Baltimore, Chicago and Detroit. |
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National Household Survey on Drug Abuse (NHSDA)†† |
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The 2002 NSDUH study reports that since the mid-1990's, the
prevalence of lifetime heroin use increased for both youth and young
adults. From 1995 to 2002, the rate among youth age 12 to 17
increased from 0.1 to 0.4 percent; among young adults age 18 to 25,
the rate rose from 0.8 to 1.6 percent. In the past year, 404,000
Americans age 12 and older reported using heroin, and 3.7 million
reported using it at least once in their lives. |
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* The Drug Abuse Warning Network survey is funded
by the Substance Abuse and Mental Health Services Administration.
** These data are from the 2003 Monitoring the
Future Survey, funded by the National Institute of Health, DHHS, and
conducted by the University of Michigan's Institute for Social
Research. The survey has tracked 12-th graders' illicit drug use and
related attitudes since 1975; in 1991, 8th and 10th-graders were
added to the study.
*** "Ever used" refers to use at least
once during a respondent's lifetime. "Past year" refers to
an individual's drug use at least once during the year preceding
their response to the survey. "Past month" refers to an
individual's drug use at least once during the month preceding their
response to the survey.
† CEWG is a NIDA-sponsored network
of researchers from 21 major U.S. metropolitan areas and selected
foreign countries who meet semiannually to discuss the current
epidemiology of drug abuse. CEWG's most recent report is
Epidemiologic Trends in Drug Abuse, Volume I, June 2003.
†† NSDUH (formerly known as
the National Household Survey on Drug Abuse) is an annual survey
conducted by the Substance Abuse and Mental Health Services Administration.
Revised 4/04
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Reference: |
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National Institute on Drug Abuse (NIDA), is part of
the National Institutes of Health (NIH), a component of the U.S.
Department of Health and Human Services. |
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