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Overview
Heroin, a highly addictive drug, is the most abused and the most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of certain varieties of poppy plants.1
Pure heroin, which is a white powder with a bitter taste, is rarely sold on the streets. Most illicit heroin is a powder varying in color from white to dark brown. The differences in color are due to impurities that have been left from the manufacturing process or the presence of additives. Another form of heroin known as "black tar" heroin is available most often in the western and southwestern U.S. This heroin, which is only produced in Mexico, may be sticky like roofing tar or hard like coal, and its color may vary from dark brown to black. The color and consistency of this type of heroin result from the crude processing methods used to illicitly manufacture this substance.2
Heroin can be injected, smoked, or snorted. Injection is the most efficient way to administer low-purity heroin. The availability of high-purity heroin, however, and the fear of infection by sharing needles has made snorting and smoking the drug more common.3 There is also the misconception by users that snorting or smoking heroin will not lead to addiction as injection does.4
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Extent of Use
According to the 2003 National Survey on Drug Use and Health, approximately 3.7 million Americans ages 12 and older reported trying heroin at least once during their lifetimes, representing 1.6% of the population ages 12 and older. Approximately 314,000 (0.1%) reported past year heroin use and 119,000 (0.1%) reported past month heroin use.5
Among high school students surveyed as part of the 2003 Monitoring the Future Study, 1.6% of eighth graders, 1.5% of tenth graders, and 1.5% of twelfth graders reported using heroin at least once during their lifetimes. In 2002, these percentages were 1.6%, 1.8%, and 1.7%, respectively.6
Percent of Students Reporting Heroin Use, 2003
Regarding the ease by which one can obtain heroin, 15.6% of eighth graders, 18.8% of tenth graders, and 27.9% of twelfth graders surveyed in 2003 reported that heroin was "fairly easy" or "very easy" to obtain.7
Nearly 63% of eighth graders, 71% of tenth graders, and 59% of twelfth graders reported that using heroin once or twice without a needle was a "great risk."8
Percent of Students Reporting Risk of Using Heroin, 2003
Nationwide, 3.3% of high school students surveyed in 2003 as part of the Youth Risk Behavior Surveillance System (YRBSS) reported using heroin during their lifetimes. Male students (4.3%) were significantly more likely than female students (2.0%) to report lifetime heroin use. Hispanic students (3.9%) were more likely to report heroin use within their lifetime than white (2.6%) or black (2.6%) students.9
During 2003, 1.0% of college students and 1.9% of young adults (ages 19-28) reported using heroin at least once during their lifetimes. Approximately 0.2% of college students and 0.4% of young adults reported past year use of heroin, and less than 0.05% of college students and 0.1% of young adults reported past month use of heroin.10
According to data from the Arrestee Drug Abuse Monitoring (ADAM) Program, a median of 5.8% of adult male arrestees and 6.6% of adult female arrestees tested positive for opiates at arrest in 2003. The adult male samples were compiled from 39 U.S. sites and the adult female samples were compiled from 25 sites. A median of 5.1% of adult male arrestees and 7.1% of adult female arrestees reported using heroin at least once in the year before being arrested.11
Past Heroin Use by Arrestees, 2003
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Health Effects
The short-term effects of heroin abuse appear soon after taking the drug. Intravenous injection provides the greatest intensity and most rapid onset of the initial rush that users experience. Intravenous users typically experience the rush within 7 to 8 seconds after injecting heroin, while intramuscular injection produces a relatively slow onset of this euphoric feeling, taking 5 to 8 minutes. When heroin is sniffed or smoked, the peak effects of the drug are usually felt within 10 to 15 minutes.12
In addition to the initial feeling of euphoria, the short-term effects of heroin include a warm flushing of the skin, a dry mouth, and heavy extremities. After the initial euphoric feeling, the user experiences an alternately wakeful and drowsy state, often feeling drowsy for several hours. Due to the depression of the central nervous system, mental functioning becomes clouded.13 Additionally, breathing may be slowed to the point of respiratory failure.14
After repeatedly using heroin for a period of time, the long-term effects of the substance begin to appear in the user. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver disease. In addition to this, pulmonary complications, including various types of pneumonia, may also result in the user.15
A heroin overdose may cause slow and shallow breathing, convulsions, coma, and possibly death.16 One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity or effect that they are seeking. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop.17
Within a few hours after the last administration of heroin, withdrawal may occur. This withdrawal can produce effects such as drug craving, restlessness, muscle and bone pain, and vomiting. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week.18
In addition to the effects of the drug itself, users who inject heroin also put themselves at risk for contracting HIV, hepatitis B and C, and other blood-borne viruses. In 2003, 1% of eighth graders, 0.9% of tenth graders, and 0.7% of twelfth graders reported that they have injected heroin at least once during their lifetimes.19 Among college students and young adults surveyed in 2002, 0.3% and 0.4%, respectively, reported injecting heroin at least once during their lifetimes.20
Street heroin is often mixed with various substances, including sugar, starch, quinine, and sometimes, strychnine or other poisons, causing an added danger to using heroin. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at a great risk of overdose or death.21
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Drug Episode: A drug-related
ED episode is an ED visit that
was induced by or related to the
use of drug(s).
Drug Mention: A drug mention
refers to a substance that was
recorded during an ED episode. Because up to 4 drugs can be reported for each drug abuse episode, there are more mentions than episodes.
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During 2002, heroin was the third most frequently mentioned illicit drug reported to the Drug Abuse Warning Network (after cocaine and marijuana) by emergency departments (ED) nationwide. There were 93,519 heroin ED mentions during the year, up slightly from 93,064 in 2001. Between 1995 and 2002, the number of heroin ED mentions increased 34.5%. More than half of the heroin ED mentions in 2002 involved individuals 35 years of age and older.22
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Treatment
Opioid agonist medications are used to treat addiction to opiates, primarily heroin. Approximately 97% of the clients being treated with such medications receive methadone, while the remaining clients being treated with opioid agonist medications receive LAAM. Methadone is used by treatment clients on a daily basis, while LAAM is taken three times a week. Of 13,428 treatment facilities surveyed in 2000, nine percent (1,215) reported that they dispense methadone or LAAM for opiate addiction.23
From 1992 to 2002, the number of admissions to treatment in which heroin was the primary substance of abuse increased from 168,321 in 1992 to 285,667 in 2002. The heroin admissions represented 11% of the total drug/alcohol treatment admissions during 1992 and 15.2% of the admissions in 2002. Those admitted to treatment for heroin during 2002 were primarily male (68.5%) and white (47.7%). The average age of those admitted to treatment for heroin during 2002 was 36 years.24
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Arrests & Sentencing
The Drug Enforcement Administration (DEA) made 2,329 heroin-related arrests during FY 2003, representing 8.6% of the total arrests made by the DEA during the year.25
During FY 2002, 25,609 of the Federally-sentenced defendants nationwide were charged with drug offenses. Heroin was involved in 1,806 (7%) of the drug offenses.26
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Production & Trafficking
The U.S. heroin market is supplied entirely from foreign sources of opium. Heroin available in the U.S. is produced in four distinct geographical areas: South America, Southeast Asia (primarily Burma), Mexico, and Southwest Asia (principally Afghanistan).27
In 2003, worldwide potential illicit opium production increased to approximately 3,549 metric tons. During 2002, the potential illicit opium production was 2,159 metric tons. The potential production in Southwest Asia in 2003 accounted for 2,865 metric tons and production in Southeast Asia accounted for 684 metric tons.28
According to the DEA, South American produced heroin dominates the white-powder heroin market east of the Mississippi River, while Mexican black tar and brown powder heroin dominate the market west of the Mississippi. Nationwide in 2002, DEA Domestic Monitor Program (DMP) samples of South American (SA) heroin had the highest average purity (46%) and Southeast Asian (SEA) heroin samples had the lowest (23.9%). Mexican (MEX) heroin samples averaged 27.3% and Southwest Asian (SWA) heroin averaged 29.8% pure in 2002.29
Purity of DMP Samples, 2000–2002
During FY 2003, Federal agencies seized 5,643 pounds of heroin under the Federal-wide Drug Seizure System (FDSS). FDSS contains information about drug seizures made within the jurisdiction of the United States by the DEA, Federal Bureau of Investigation, U.S. Customs Service, U.S. Border Patrol, and U.S. Coast Guard.30
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Legislation
Heroin was first synthesized from morphine in 1874 and became widely used in medicine in the early 1900s. At that time, physicians were unaware of heroin's potential for addiction. The first comprehensive control of heroin in the U.S. occurred with the Harrison Narcotic Act of 1914. Heroin currently falls into Schedule I of the Controlled Substances Act based on its potential for abuse and its lack of accepted medical use.31
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Street Terms32
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Other Links
Breaking Heroin Sources of Supply
This fact sheet provides an overview of efforts to reduce domestic heroin availability.
Heroin Fact Sheet
This resource provides a concise summary of available research on heroin effects, use, availability, treatment, and related enforcement activities.
Heroin Movement Worldwide
This CIA site provides information about heroin production, consumption, and trafficking.
Heroin Publications
A listing of heroin-related publications from various sources.
Methadone Fact Sheet
An overview of issues dealing with methadone treatment.
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Sources
1 National Institute on Drug Abuse, Research Report: Heroin Abuse and Addiction, 1999
2 Drug Enforcement Administration Web site, Drugs of Abuse, February 2003
3 Drug Enforcement Administration Web site, Drug Descriptions: Heroin
4 National Institute on Drug Abuse, Infofax: Heroin, 2000
5 Substance Abuse and Mental Health Services Administration, Results from the 2003 National Survey on Drug Use and Health: National Findings, September 2004
6 National Institute on Drug Abuse and University of Michigan, Monitoring the Future 2003 Data from In-School Surveys of 8th-, 10th-, and 12th- Grade Students, December 2003.
7 Ibid.
8 Ibid.
9 Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance—United States, 2003, May 2004
10 National Institute on Drug Abuse and University of Michigan, Monitoring the Future National Survey Results on Drug Use, 1975–2003, Volume II: College Students & Adults Ages 19–45 (PDF), 2004
11 National Institute of Justice, Drug and Alcohol Use and Related Matters Among Arrestees, 2003 (PDF), 2004
12 National Institute on Drug Abuse, Research Report: Heroin Abuse and Addiction, 1999
13 National Institute on Drug Abuse, Infofax: Heroin, 2000
14 National Institute on Drug Abuse, Research Report: Heroin Abuse and Addiction, 1999
15 National Institute on Drug Abuse, Infofax: Heroin, 2000
16 Drug Enforcement Administration Web site, Drug Descriptions: Heroin
17 National Institute on Drug Abuse, Infofax: Heroin, 2000
18 Ibid.
19 National Institute on Drug Abuse and University of Michigan, Monitoring the Future: Overview of Key Findings, 2003 (PDF), June 2004.
20 National Institute on Drug Abuse and University of Michigan, Monitoring the Future National Survey Results on Drug Use, 1975–2002, Volume II: College Students & Adults Ages 19–40 (PDF), 2003
21 National Institute on Drug Abuse, Research Report: Heroin Abuse and Addiction, 1999
22 Substance Abuse and Mental Health Services Administration, Emergency Department Trends from the Drug Abuse Warning Network, Final Estimates 1995–2002, July 2003
23 Substance Abuse and Mental Health Services Administration, Facilities Providing Methadone/LAAM Treatment to Clients with Opiate Addiction, December 2002
24 Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Highlights—2002 (PDF), May 2004
25 Drug Enforcement Administration, Defendant Statistical System, as reported in Sourcebook of Criminal Justice Statistics
26 U.S. Sentencing Commission, 2002 Sourcebook of Federal Sentencing Statistics, 2004
27 Drug Enforcement Administration Web site, Drug Descriptions: Heroin
28 Department of State, International Narcotics Control Strategy Report, 2003, March 2004
29 Drug Enforcement Administration, 2002 Domestic Monitor Program, October 2003
30 Drug Enforcement Administration, Federal-wide Drug Seizure System, as reported in Sourcebook of Criminal Justice Statistics
31 Drug Enforcement Administration Web site, Drugs of Abuse, February 2003
32 Office of National Drug Control Policy, Drug Policy Information Clearinghouse, Street Terms: Drugs and the Drug Trade
Heroin section
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Last Updated: September 21, 2004
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