What is Heroin?

Heroin is a highly addictive opioid made from morphine. Morphine is a naturally occurring substance that comes from the seed pods of certain varieties of poppies. These poppy varieties are typically grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin was originally produced on a commercial scale in the late 1800s and quickly became known as a “wonder drug”, being that it was more effective than morphine and codeine. Unfortunately, it wasn’t long before people realized how quickly the body built up a tolerance to heroin. At the same time, more people began misusing the drug for its rush of euphoria. Soon enough, heroin was banned and the underground market for the drug surged. Heroin is classified as a Schedule 1 narcotic by the Drug Enforcement Agency (DEA) meaning that there are no medical uses for it and it has a high potential for abuse.

Common street names:

Big H, Black Tar, Chiva, Hell Dust, Horse, Negra, Smack, Thunder

What Does Heroin Look Like?

Heroin typically looks like a white or brown powder or a sticky black substance known as “black tar heroin.” The varieties tend to be geographic and the color change is due to impurities. Powdered heroin is sold in aluminum squares, small plastic baggies, or gelatin capsules that have been emptied and refilled with the heroin. Black heroin, on the other hand, is wrapped in plastic or put into small balloons.

Pure heroin is a white powder and has a bitter taste. It is typically sourced from South America. As heroin travels from smuggler to vendor, it is often cut (diluted) with a variety of substances such as powdered milk, sugar, baking soda, laundry detergent, fentanyl, etc. This white or off-white variety is typically found in the eastern United States, specifically east of the Mississippi River.

Heroin found in the western half of the country (west of the Mississippi River) typically originates from Mexico. Because of the crude processing methods that leave impurities, heroin looks like tar, hence the name “black tar heroin.” It is most commonly a sticky black substance but can also be hard or a dirty brown powder.

Between inferior processing and continuous “cutting”, the end-user is often unsure of exactly what they’re ingesting. The additional chemicals and impurities can cause further short- and long-term side effects on the brain and body.

How is Heroin Used?

Heroin is typically used by injecting, smoking, or sniffing/snorting. Pure heroin is usually snorted, sometimes smoked. Most people who are new to using heroin prefer this variety because it does not have the same negative notions as injection does. Otherwise, particularly the case with black heroin, it is dissolved and injected. Sometimes, people will mix heroin with crack cocaine (called “speedballing”) to get a more intense, longer-lasting high.

Heroin Overdose

Heroin use is especially susceptible to overdose for two reasons. First off, the body easily builds a tolerance, requiring more of the drug to be used for the same effect. Once larger doses are taken, heroin causes slowed heart rate and shallow breathing. This can lead to extreme sleepiness, loss of consciousness, and/or convulsions that can lead to death.

Second, because of the manufacturing and distribution process in which heroin is notoriously known to be cut with a variety of chemicals or other drugs, the end-user isn’t necessarily aware of what they are getting and could end up overdosing because of it. One particular example is the use of Fentanyl, which is a common reason for heroin overdose. Fentanyl is about 25-50 times stronger than heroin and is often used to increase the potency of heroin. Unfortunately, users who don’t realize they are using heroin with fentanyl will typically end up overdosing.

Heroin overdose deaths have been primarily trending up, and at an alarming rate. In 1999, there were only 1,960 heroin overdose deaths. In comparison, there were 15,469 in 2016. There was a slight dip down to 14,019 reported in 2019, but with the rise of drug use during the pandemic in 2020, one can anticipate the rate to climb back up again.

What Can Be Done for Heroin Overdose?

Naloxone, commonly known as the brand name Narcan, reverses the effects of an opioid overdose. It is administered as an injection under the skin or into the muscle. It works very quickly and has been proven to save lives. In 2014 a hand-held auto-injector called Evzio was approved by the U.S. Food and Drug Administration and in 2015 they approved a nasal spray by Narcan. Public health efforts are being made to make naloxone more commonly available and some states have even passed laws allowing pharmacists to dispense it without a prescription. With the auto-injectors and nasal sprays, family members and caregivers are better equipped to help their loved ones in a dire situation.

Why Does the Heroin Epidemic Continue?

In the mid to late 1990s, prescriptions for opioids started to increase substantially. Once dependency and increased tolerance of these prescription drugs took root, it was only a matter of time before experimentation with illegal opioids began. Essentially medical prescriptions led to an increase in nonmedical opioid use. One study reported that about 80 percent of heroin users began with prescription opioids.

The problem is exacerbated by the increased availability of heroin. On top of that, heroin is less expensive than prescription opioids on the black market. Therefore, those who become dependent and addicted to their prescription opioids, seek more, but it’s easier and cheaper to switch to heroin.

Whereas heroin users used to be primarily inner-city minorities, the demographic has now expanded dramatically. Heroin use is now more widespread affecting both men and women, in a variety of age groups and income levels. According to the CDC, some of the greatest increases in heroin use have been seen in groups with historically low rates. This includes women, individuals with private insurance, and those with higher incomes. The majority of users are now white men and women, in their late 20s, living outside of large urban areas, most of whom were introduced to heroin through prescription medications.

As heroin manufacturing, distribution, and usage continues, so does drug-related crime. As such, the criminal justice system has seen a sharp rise due to drug-related activities. Unfortunately, individuals released from incarceration are at the highest risk of opioid overdose deaths. This is due to their exceptionally high relapse rates, low tolerance, and desire for social interaction.

Effects of the COVID-19 Pandemic on the Heroin Epidemic

Sadly, the COVID-19 pandemic is already showing its effects on the heroin epidemic. Full statistics won’t be released until later in the year, but there have already been an extraordinary amount of reports from nearly every state showing outbreaks or sustained increases in drug-related overdose deaths. Preliminary reports from the CDC show as much as a 50% increase in drug overdose deaths in 2020 compared to 2019. This number isn’t specific to heroin use only, but opioids overall are the primary contributing factor to this number, accounting for about 75% of all overdose deaths during the early months of the pandemic.

How Can We Stop the Heroin Epidemic?

There continues to be a strong urge to remove barriers to evidence-based treatments and to increase harm reduction services. The CDC’s response plan for the heroin epidemic is:

  • PREVENT People from Starting Heroin by reducing prescription opioid painkiller abuse, improving prescribing practices, and identifying high-risk individuals.
  • REDUCE Heroin Addiction by guaranteeing access to Medication-Assisted Treatment (MAT) which uses medications such as methadone, buprenorphine, or naltrexone along with counseling and behavioral therapies to help overcome opioid use disorder.
  • REVERSE Heroin Overdose by increasing the availability and use of naloxone.

At St. John’s Recovery Place, our comprehensive treatment center is fully equipped to handle opioid use disorder. From the initial phase of medical detox through recovery therapies and all the way to aftercare services, we believe in setting up each individual for their best chance of life-long recovery. Call our admissions office today at 833-397-3422 to find out more and get yourself or your loved one onto the journey to recovery!

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