Heroin is an illegal opioid drug that is produced from morphine. Morphine is a natural substance taken from the seed's pods of opium poppy plants—the poppy plants grow in Southeast and Southwest Asia, Mexico, and Columbia. When heroin is produced, it could look like white or brown powder or a sticky black tar substance. Heroin is illegal and highly addictive and sold in different regions of the United States. Pure heroin is a white powder and has a slightly bitter taste and mainly originates from regions of South America and some parts of Southeast Asia. Pure heroin is appealing to first-time heroin users because it is smoked or snorted and does not have to be injected.
The black tar heroin found in the United States is primarily produced in Mexico—the black color comes from a crude form of processing that leaves behind impurities, which increases the danger for injection drug users. Initially, heroin begins with the opium poppies, and when the plant blooms, it reveals a pod that produces a milky sap that is then extracted. The sap from the opium pod is pure opium that is then extracted and refined.
Producing Heroin from Morphine
The production of morphine, from which heroin is produced, involves the opium sap mixed with lime that is then boiled. The boiling process separates the organic materials that sink to the bottom, and the morphine floats to the top, such as how oil separates in water.
It is at this point, the separated material (morphine) is collected and heated again with ammonia, which is then filtered and boiled again and eventually produces a brown paste. The brown paste is then dried, producing a brown powder. The process of making heroin begins with morphine that is mixed with acetic anhydride and heated for around 6 hours. When these two substances are combined, it forms diacetylmorphine—the product is then mixed with hot water and chloroform.
The mixture of diacetylmorphine, hot water, and chloroform is drained, and sodium carbonate is added, which produces the heroin solidify. The next step of the process involves filtering the carbonate solution with activated charcoal, and it is then purified with alcohol. Heat is then added to this mixture so that the alcohol evaporates, and the product is then purified with hydrochloric acid, which results in fluffy white powder. The pure form of heroin is then transported and sold across the globe.
Adulterants and Diluents - Modifying the Purity of Heroin
However, when it is then distributed to the drug user, it would have already been cut or chopped up with adulterants and diluents. An adulterant is an ingredient that has pharmacological effects, which is added to modify the effects of heroin. A diluent does not do this, and it is used to add bulk to heroin increasing the batch.
Overall, the purpose of doing this is to increase the yield, lowering the potency or increasing it, but also ensuring the addict remains addicted to the drug. Although this is not always the case, and there are have been countless cases of heroin being cut with fentanyl and people overdosing because of a pure form of heroin.
Powdered heroin is cut with a variety of products, and most are toxic and deadly. However, dealers use these substances for different reasons. Heroin could be cut with procaine, which is an anesthetic, or fentanyl, acetaminophen, or tramadol, which are pain medications. Sometimes sugars or caffeine are used along with diuretics or drugs used to treat heart conditions. Sugar, for example, is used to add bulk and dilute heroin. Caffeine is used to help the drug vaporize at a lower temperature when it is smoked. Other pain medications are used because it has similar effects to heroin.
According to a PBS article with Frontline, titled The Opium Kings, it states, "by the time heroin is peddled on city streets in small bags, at $5 to $100, its value has ballooned more than ten-fold—not many years ago virtually all the heroin sold on America's streets was heavily diluted that is was rarely more than 10% pure". The article goes on to mention that the heroin found today across America has seen a drastic increase in purity and being adulterated with drugs like fentanyl.
Street Names for Heroin and its Current Accessibility in the United States
Heroin has numerous street names, which include:
Black, Black Tar, Black Peral, Boy, Brown, Brown Crystal, Brown Rhine, Brown Sugar, China White, Dope, Dragon, H, Horse, Junk, Mexican Brown, Mexican Mud, Smack, Tar, White Nurse, White Lady, Skag, Skunk, and Snow, among many others.
The availability of heroin remains high across the United States. According to a Drug Enforcement Administration National Drug Threat Assessment, the regions of the Great Lakes, Midwest, and the Northeast United States have the largest white powder heroin markets. The largest amounts of heroin seized by federal authorities were in Arizona, California, and Texas. The cities included were Phoenix, Los Angeles, and Houston.
The retail heroin market is changing, and more of the retail heroin being analyzed contains fentanyl. Drug traffickers mix fentanyl into local heroin supplies and charge a higher price. What is occurring is the demand for high-quality heroin is being met with heroin that is adulterated with fentanyl, and most drug users are never the wiser. Drug traffickers satisfy the demand for a pure product by disguising it with fentanyl, which has increased the rate of drug-related overdose. The Drug Enforcement Administration has also observed the spread of heroin into more rural markets, with a higher price tag when compared to inner cities.
A Brief History of Heroin and How it Emerged within the United States
Heroin or diacetylmorphine gained popularity as a wonder drug by the medical profession. Despite hundreds of thousands becoming addicted to it when it was legal, the market for it continued to flourish. Originally, the drug was not overly prescribed as medicine before 1900, although there are reports of its preparation, dating back to 1874, by C.R. Wright in London, England. Originally, there was not much interest within the medical community for a morphine derivative because of how it was being produced and how the morphine molecule was isolated. It was not until 1890 when a German scientist W. Dankwortt created the morphine derivative through a different process—because of the nature of the compounds he isolated, other scientists began to study the physiological effects of heroin.
In the last decade of the 19th century, the medical profession began to take an interest in heroin, and it was the Bayer Company in Elberfeld, Germany, that began production on a commercial scale in 1898. Diacetylmorphine was marketed under the name heroin, and it received widespread acceptance within the medical community. Heroin was prescribed for almost every illness, and it was also used to treat addiction to codeine or morphine.
There was tremendous confidence with the drug despite warnings that heroin might be a dangerous poison. Other studies were discovering that heroin created physical tolerances resulting in the user increase the dose. A study was done in 1899 by Horatio C. Wood Jr, as cited by the United Nations Office on Drugs and Crime, it found that the dosage of heroin had to be increased to remain effective. However, at the turn of the century, anyone recommending heroin within the medical community failed to refer to how addictive it becomes. Gradually, more and more people were becoming addicted to heroin, but the medical profession was still in favor of its use.
Heroin Addiction in the United States
During the early 1900s, heroin was used medically across the United States. However, the first place where heroin addiction became newsworthy within the USA was in the city of New York, were approximately 98% of all addicts were addicted to heroin. To this day, heroin is still widely abused. In 1916, The Public Health Service Hospitals in the United States discontinued dispensing heroin, and by 1924, the legitimate production of heroin practically ceased. However, the addict's demand for the drug continued to be supplied, and the drug continued to be connected to murder, crime, and addiction across many parts of the country. All that had changed over the decades was the purity and supply of heroin, but the problem with addiction continued and remains to this day.
Fast forward to 2019, Mexico-sourced heroin continues to dominate the heroin market in the United States. However, heroin comes from three source areas—Mexico, South America, and Southwest Asia. According to the Drug Enforcement Administration, Mexico-sourced heroin represents the majority of heroin seized, followed by South American heroin. The majority of heroin smuggled into the United States is brought overland across the southwestern border. Mexican traffickers continue to widen their heroin trafficking operations within the regions of the Great Lakes, Midwest, and the Northeast United States. White powder pure heroin continues to dominate the market and is also the biggest fentanyl market.
The Scope of Heroin Addiction in the United States
According to the 2018 National Survey on Drug Use and Health, over 800,000 Americans aged 12 and older used heroin in the past year. Per the Centers for Disease Control, in 2018, nearly 15,000 people died from a drug overdose involving heroin—a rate of almost five deaths for every 100,000 Americans. However, from 2017 to 2018, heroin involved overdose deaths showed a decline, decreasing 4.1%, until 2019 and 2020 when they began to rise again. The 2016 National Survey on Drug Use and Health reported over 940,000 Americans used heroin in the past year, which was on the rise since 2007. Statistically, people who are addicted to alcohol are two times more likely to be addicted to heroin. Also, anyone addicted to prescription pain medication is forty-times more likely to be addicted to heroin.
What Does Heroin Look Like?
BLACK TAR HEROIN
COOKED HEROIN WITH SYRINGE
What are the Effects of Heroin?
Many people who use heroin smoke or snort the drug, while most heroin users use the drug intravenously. However, all methods of using heroin travel to the brain quickly, which is why the drug is highly addictive. Even after using the drug once or twice, the average person could become addicted to it. The immediate effects of heroin involve a rush of euphoria and happiness, and everything feels as if it is slowing down. Heroin, like any other opioid, blocks the body from getting pain messages, slows down the heart rate, and causes respiratory depression. Short-term effects include the following:
- Warm flushing skin
- Dry mouth
- A heavy feeling in the extremities
- Severe itching
The repeated use of heroin causes a change in the physical structure and physiology of the brain. The drug causes long-term imbalances in neuronal and hormonal systems that cannot be reversed. Some studies have shown a deterioration of the brain's white matter, which affects decision-making abilities, regulation of behavior, and responses to stressful situations. A tolerance for heroin occurs when more of the drug is required to achieve the same effects. Long-term heroin use leads to the following problems:
- Collapsed veins
- Infections of your heart lining and valves
- Skin infections
- An increased risk of contracting HIV/AIDS, hepatitis B, and hepatitis C
- Liver and kidney disease
- Lung disease
Overall, opioid tolerance, dependence, and addiction are caused by changes in the brain from chronic use of opioids like heroin. Much of the problem with overcoming heroin addiction is the struggle to overcome the effects of these changes, per Addiction Science and Clinical Practice
Heroin Overdose - How Does it Happen?
Overdose is a dangerous and deadly consequence of heroin use. Large or even small amounts of heroin depresses heart rate and breathing to a point where the person will not survive without medical help. An overdose occurs when a person has excessive unopposed stimulation of the opiate pathways within the brain, slowing down the function of the central nervous system. Drug overdose is one of the leading causes of accidental death in the United States. The signs of heroin overdose include the following:
- Pupils contract and appear small
- Muscles are slack and droopy
- The person is nodding out of consciousness
- Slurred speech
- Slow and shallow breathing
- The face is pale and clammy skin
- Fingernails and lips turn purple
- Heartbeat is slow and erratic
According to the Centers for Disease Control and Prevention, in 2017, over 70,000 people died of a drug-related overdose, and approximately two-thirds involved opioids. The CDC also predicts that by the end of 2020, the number of overdose deaths will reach over 72,000. Per the 2018 National Survey on Drug Use and Health, over 117,000 people used heroin for the first time in 2018. Not all heroin overdose results in death, and most are preventable if the person receives help immediately.
Heroin Addiction and How it Happens
Most drugs affect the brain's reward circuit, which causes euphoria flooding it with dopamine. The surges of dopamine in the reward circuit causes the reinforcement of pleasurable but unhealthy behaviors, such as using heroin. When someone continues to use heroin, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. Eventually, this creates tolerance and dependence to heroin. Every other time someone uses heroin after their first use, it will never be the same experience within the body. Gradually, more of the drug is needed to achieve the desired results. The brain adapts to the drug leading the person to become less and less able to derive pleasure from other things they once enjoyed. Along with the physical dependence on heroin, the drug user also develops a psychological dependence on the drug, resulting in an endless cycle of addiction.
The cycle of addiction is similar for each individual, but each person has different reasons why they started to abuse heroin. When a person becomes addicted to heroin, it becomes a physical and psychological need to use the drug. The body experiences painful withdrawal symptoms when it does not have heroin, and the mind requires the effects of heroin to function. The urge to use the drug causes a person to ignore the consequences of their drug use—for example, the decline of your physical and psychological health. Also, most addicts become caught up in the criminal justice system because of heroin use. Drug addiction becomes an expensive habit forcing many addicts to do what it takes to get the drug.
There are many reasons why people use drugs, and this could be because of physical or emotional pain or the environment they are in. Whichever the motivating factor, once it stops, it becomes difficult to stop without proper treatment and help. A person does not have to live with addiction their entire life—with the proper rehabilitation, aftercare, and support, anyone can overcome their substance abuse and move on with a productive, healthy life. Heroin is a highly addictive drug, and in 2018, less than 0.1% of adolescents aged 12 and older were past-year heroin users. Also, approximately 0.5% of young adults aged 18 to 25 were past-year heroin users. Additionally, 0.3% of adults aged 26 and older were past-year heroin users, per the National Survey on Drug Use and Health.
Heroin Addiction Treatment, Detox, Rehabilitation, and Aftercare Support
Heroin addiction can be treated, but it is not easy. Someone who has been abusing drugs for many years cannot simply stop using heroin without help. Most heroin addicts require long-term drug treatment or repeated care to ensure life-long sobriety. Overall, rehabilitation should help a person stop using drugs, stay drug-free, and become a productive contributing member of society, family, and work. Rehabilitation is not a one size fits all. Effective drug rehabilitation addresses all of the patient's needs, not just their drug use.
Counseling and other behavioral therapies are the most commonly used forms of treatment. Also, remaining in treatment long enough is critical because treatment plans must be reviewed often and even modified to fit the patients changing needs. Families must understand that treatment does not need to be voluntary to be effective.
Treatment for heroin addiction begins with detox, and typically this is medical detox. Withdrawal symptoms caused by the cessation of heroin use are often painful and difficult to manage. Withdrawal management is a process of using medication to control withdrawal symptoms and easing a heroin addict into counseling, so they are entirely drug-free. Medical detox requires a different length of time for each person. Generally, the rehabilitation process could last one week or more before counseling begins.
Behavioral therapies are the most commonly used and the most effective. However, other forms of therapy, such as holistic programs, adventure and wilderness centers, and other non-traditional forms, are also commonly used. Per the National Institute on Drug Abuse, behavioral therapy modifies a person's attitudes and behaviors related to drug use, while increasing healthy life skills and applying other forms of treatment. Heroin addicts can receive treatment at various locations offering inpatient or outpatient services. Former heroin addicts also benefit from aftercare support, such as remaining connected to 12-step support groups or transitioning back to society through a sober living home.
Inpatient and Outpatient Drug Rehabilitation for Heroin Addiction
Outpatient behavioral treatment offers a wide variety of programs and counseling modalities for patients at most stages of addiction. Many of these programs involve group or individual counseling and other approaches. Common therapies are cognitive behavioral therapy, multidimensional family therapy, motivational interviewing, and motivational incentives. Outpatient programs can last a few weeks or upwards of one year if needed. However, a heroin addict with a lengthy history of addiction may not benefit from an outpatient program.
Residential programs are also effective, especially for a heroin addict with a lengthy history of addiction and substance use. There are licensed treatment centers across the nation, providing effective resources for anyone addicted to heroin. Residential drug rehabilitation could occur within therapeutic communities, short-term programs, long-term treatment centers, and recovery housing. Typically, the extent and severity of addiction determine what method rehabilitation is required. According to Treatment Episode Data from 2005 to 2015, the treatment admission rate for heroin abuse was 40% lower in 2005 at 104 per 100,000 population than in 2015. Heroin treatment admission rates were between 8 and 833% lower in 2005 than in 2015.
Heroin Addiction and Abuse Statistics
According to the 2018 National Survey on Drug Use and Health, over 526,000 people aged 12 or older in 2018 had a heroin use disorder. The number of people struggling with a heroin addict corresponds with 0.2% of the population. The percentage of people in 2018 with a heroin use disorder was higher than the percentages from 2002 to 2008 and from 2009 to 2017.
Per the Centers for Disease Control and Prevention, those who are using heroin are also using multiple other substances, such as cocaine and prescription pain medication. Between 2010 and 2018, heroin involved overdose deaths have increased nearly five times. However, from 2017 to 2018, the number of deaths decreased by about 4%. The decrease in the number of deaths is connected to the shift from heroin to fentanyl. Although, heroin in the United States as of 2019 and 2020 is cut with fentanyl resulting in an increase in overdose deaths.
In 2019, U.S. Customs and Border Protection seized 5,427 pounds of heroin, which was a small increase from 2018. At the end of August 2020, U.S. Customs and Border Protection seized 4,552 pounds of heroin. Year after year, heroin is smuggled into the United States through the southwestern border.
According to the 2019 Drug Enforcement Administration National Drug Threat Assessment, the domestic heroin, and fentanyl markets intertwine, with both substances affecting the Great Lakes, Northeast regions of the United States. Traffickers within these regions at the retail levels are mixing fentanyl in white powder heroin or pressing the powders into counterfeit pills to stretch supplies. The products are addictive, high quality, and extremely potent.
Common Terminology Surrounding Heroin Defined
Black Tar Heroin—it is a sticky, gooey version of heroin, and 70 to 75% of it contains toxic contaminants and additives, giving the drug its sticky tar-like consistency and appearance.
Speedball—is the combination of heroin and cocaine being used intravenously or snorted simultaneously, and it produces a more intense long-lasting high.
White Powder Heroin—is the purest form of heroin and is a salt form of the drug known as diacetylmorphine hydrochloride, which is also mixed or cut with other white powders.
Brown Powder Heroin—the further process of black tar heroin and cutting it with lactose usually produces heroin that is brown in color.
Viral Infections—intravenous drug use causes viral infection and increases the risk of transmitting these infections, such as HIV/Aids and hepatitis.
Smack—is a slang term used primarily in the 1960s to refer to heroin.
Heroin Detox—is a process of utilizing withdrawal management to help a heroin addict control and manage withdrawal symptoms before counseling and therapy.
Heroin Overdose—occurs with a large or small amount of heroin affecting the central nervous system causing respiratory depression and heart failure resulting in death or coma.
Opium Poppy—commonly known as the opium poppy or breadseed poppy, is a species of plant from which both opium and poppy seeds are derived. Morphine is made from opium, and heroin is derived from morphine.
Opiate—these are substances derived from the opium poppy plant that vary in structure and effects on the body.