What is heroin?

Heroin is a synthetic opiate (medicine containing opium). Opiates are effective painkillers. Heroin in its pure form is a white powder that can be swallowed or dissolved in water and injected into a vein. Heroin can also be sniffed or inhaled when heated (this is sometimes called 'chasing the dragon').

Most heroin is illegally manufactured and imported. When sold on the street it is likely to have been mixed with a variety of similar powders. It may cost between 15 and 40 for a wrap.

Its use in Ireland is almost completely restricted to inner city areas in Dublin. However, this may change in the future as drug barons attempt to expand their markets. Its use in adolescents is associated with poverty, unemployment, social deprivation and early school leaving.

Common nicknames for heroin include Smack, junk, horse, china white, chiva, H, tar, black, fix, speed-balling, dope, brown, dog, food, negra, nod, white horse, and stuff.

What are the effects of heroin?

Opiates such as heroin have a depressant and calming effect on the user. They reduce the effects of anxiety, fear and discomfort. They give a feeling of being ‘wrapped up in cotton wool’. Injecting heroin results in an intense and immediate effect, smoking results in an immediate but less intense response. Smoking heroin has become popular amongst users of the drug as it avoids the need for injection and the risk of HIV infection from shared ‘works’ (needles and syringes).

Heroin when injected produces a very rapid ‘rush’ lasting about a minute involving warm flushing of the skin and sexual excitement followed by a pleasant dreamlike state of peacefulness and contentment. Pain is reduced as are aggressive tendencies and sexual drives. Euphoria is particularly prominent with early use of heroin; habituated users experience little euphoria. Constipation and palpitations can occur with rashes and itching, often of the nose.

First time use can result in nausea and vomiting. This may be sufficient to deter further use of the drug. Not all heroin users are addicted users, some may continue with occasional or regular use while others may go on to compulsive use. Repeated use of heroin does not automatically mean a person goes on to daily use and becomes an addict.

Prolonged use can result in diseases such as hepatitis B, AIDS and tetanus, especially when sharing needles. There is also a risk of using impure drugs that have been mixed with unknown substances. Repeated sniffing of heroin damages the lining of the nose.

How addictive is heroin?

The addictive potential of heroin is high. It was originally designed as an alternative to the habit-forming morphine but is actually four times more addictive. Heroin is not available for medical use in Ireland. Tolerance develops rapidly so that a regular user can tolerate large amounts of the drug that would be fatal in a non-user.

Long-term use of heroin can cause the user to become almost immune to its effects, so that they need to take more of the drug to achieve the same effect. Overdoses can occur in users who have been detoxified either voluntarily on a programme or involuntarily in prison and who then inject their ‘usual’ dose and cannot tolerate it.

Dependence, while not inevitable, is common with frequent opiate use, particularly if injected. How quickly this develops will depend on the individual and the amount of the drug used. It can be as little as a few days to months. Withdrawal begins about 4-12 hours after the last dose of the drug. Effects can vary from minor flu like symptoms to full blown ‘cold turkey’ where the user experiences severe physical and psychological effects of nausea, diarrhoea, cramps, muscle spasms and insomnia.

Some of the psychological effects of withdrawal - a sense of discomfort and loss of wellbeing - can take months to settle and result in high relapse rates from detoxification. The high relapse rate after withdrawal effects have subsided suggests that psychological dependence is more of a problem than physical dependence as a cause of compulsion to continue use.

It is thought that ‘once an addict always an addict’ need not be true if the psychosocial causes of the original abuse are addressed. Physical dependence is easier to overcome than the psychological dependence.

Physical damage from long-term heroin use is usually associated with the way the drug is taken. Problems include blood poisoning. abscesses, inflammation of the heart and veins, clots, and viral infection spread by needle sharing such as hepatitis A, B and C and HIV. Suppression of cough reflex can cause chest complaints. Brain damage has been reported in chronic users in the US.

What is heroin withdrawal?

The sudden withdrawal of heroin after use for some weeks or more causes symptoms similar to flu which usually commence between 8 and 24 hours after the last dose of heroin. These effects usually diminish within 7 to 10 days. However, the person may continue to feel generally unwell for several months after their withdrawal.

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