The How and Who Behind Heroin Use

Last week, I was reading celebrity gossip, as is my wont, and I came across a blind item dealing with drug abuse and addiction. The topic sparked some interest (doesn’t the taboo always, though?) and off I was to Google the whole thing. As it turns out, it’s surprisingly hard to get unbiased information about how drugs work and what physiological effects they have. This series of posts is my attempt to do so (though as the eagle-eyed readers will notice, one of the links does come from ““ I am limited by what the Internet gives me).

Initially, I tried to shove all the most popular drugs into one post, but that quickly became entirely too long. So I’ve decided to break it up, for everyone’s convenience. This post ““ heroin, or as the Department of Justice tells me it’s called, Big H.

How is heroin produced?

The most important ingredient in heroin is morphine derived from the milky white sap of the opium poppy (scientific name Papaver somniferum). But while the opium poppy has been cultivated for literally thousands of years, heroin itself is a relative newcomer on the drug scene: in 1874, C. R. Alder Wright, an English chemist, created heroin for the first time. He tested its effects on lab mammals, but nothing much happened until Felix Hoffman created heroin 23 years later, completely independently of Wright’s discovery. Hoffman worked for a company that is now Bayer, hoping to develop a less addictive and less potent form of morphine. Ironically enough, he discovered the exact opposite.

See, heroin is basically morphine chemically bonded with a common industrial acid, acetic anhydride. This addition makes the morphine more potent. Basically, as someone uses heroin, the heroin becomes metabolized into morphine, creating all the same effects, just magnified manifold. It took Bayer over a decade to realize its mistake, and in the meantime, heroin was being sold as a non-addictive alternative to morphine and a cough suppressant. By 1925, heroin was banned everywhere.

What does heroin do short-term?

Once heroin gets into the system, usually either through snorting or injections, it heads to the brain where it gets broken down into morphine. From there, it binds to opioid receptors.  Receptors are specialized areas attached to cells that can pick up chemical information sent by other neighboring cells. Opioid receptors are found in the brain and spinal cord, and when they get hit by a bunch of morphine, they change the way in which they send information about pain and pleasure. So once the heroin hits, there’s this rush, a big feeling of euphoria, that while fleeting, is intense. This is followed by a stage that the Internet assures me is called “on the nod,” a drowsy, dreamlike state that can last several hours. This is due to a depression of the central nervous system, and can lead to slurred speech, slowed movement, and constricted pupils.

Like with most things, it’s possible to build up a tolerance to heroin, which would require an increase in the dosage to get the same feelings of euphoria and pleasure.

What does heroin do long-term?                 

The answer to this really depends in part on how the heroin is consumed. People who inject put themselves at risk for infectious diseases like HIV/AIDS and hepatitis ““ in fact, heroin use is one of the reasons Eastern Europe is experiencing and explosion in the number of new cases of HIV/AIDS. But even with clean needles, extensive drug use can lead to collapsed veins. Other physical effects are infection of the heart lining and values, the formation of abscesses, and liver and kidney problems.  If the heroin is impure or cut with a toxin, those additives can clog blood vessels, reducing blood flow and causing permanent damage to vital organs.

Approximately 23% of people who use heroin develop an addiction and kicking that addiction is extremely, extremely difficult. I cannot emphasize enough that it is a difficult, physically trying process. Withdrawal symptoms can kick in after just a few hours without use, but generally subside after a week, though some people may experience symptoms for months and may crave the drug for years. The first two to three days are the worst, and can lead to physical pain, nausea, vomiting, diarrhea, craving for the drug, insomnia, and cold flashes. Because of the severity of the symptoms (and risk– heavy users may find that going cold turkey is fatal), few people who are addicted to heroin quit cold turkey, and there are a series of programs that use drugs like methadone, a synthetic opiate which affects the same receptors as heroin, to sort of wean the person off of heroin.

Who uses heroin?

This is a surprisingly tricky question to find the answer to. Heroin used to be predominantly used by poor, urban youth, but in recent years, it’s grown more popular in middle class, suburban people of all ages.  Men and women seek treatment for heroin addiction at equal rates, but it is possible that men are slightly more likely to use heroin in general.

A small study published in the American Journal of Drug and Alcohol Abuse in 2004 by Cindy S. Eaves suggests that women are generally introduced to heroin by a male friend or a boyfriend. While men say that they purchased the heroin they used the first time, women generally receive their first heroin dose as a gift.  Women are also twice as likely to inject heroin than men, leaving them more vulnerable to a whole range of physical complications, as well as to diseases like HIV/AIDS  and hepatitis.

That said, and though this does not diminish the personal impact at all, relatively few people actually use heroin. While 3.8 million Americans aged 12 or older have reported using heroin at some point in their lives, according to the 2008 National Survey on Drug Use and Health, only 453,000 or 0.2% of all Americans age 12 or older used heroin in the past year. That same study found that 13.3% of 8th graders, 17.2% of 10th graders, and 25.4% of 12th graders said that finding heroin was “fairly easy” or “very easy,” suggesting a gap between actual use and potential use.

10 replies on “The How and Who Behind Heroin Use”

I’ll admit I am a bit fascinated with drugs and the drug trade. Have you ever heard of the TV documentary series Vanguard? They did a great expose two years ago called “The Oxycontin Express,” which was about prescription painkillers being dispensed freely in FL years before anyone acknowledged the problem or mainstream news decided to report on it.

Also another little-reported fact I learned while doing a research project on HIV/AIDS in Latin America in grad school was this: lots of addicts know not to share needles, and needle exchange programs are effective. However, if you keep using one needle and use it as yours multiple times, but you share your works with another person who has HIV you can still contract the virus by sharing the same works. Of course it’s more likely if you share works more than once. Yikes.

I haven’t seen that series, but it sounds very interesting. I remember hearing local news reports in Kentucky on a lot of prescription drug abuse, especially in Eastern Kentucky, but I don’t know much about how the issue looks in other states. The economic and class differences in which drugs are used fascinate me.

And thank you so much for sharing that information about HIV/AIDS and needles – I was aware that needle exchange programs were effective, but I had no idea about the rest of it.

I’m so looking forward to the rest of this series. So much of our drug “education” consists of saying, “Don’t do them,” without any clear explanation as to why. I think that if more people (especially young people) were aware of the actual physical effects of drugs, that would be a far more effective approach to discouraging drug use.

The drug education is severely lacking – it provides no context for the drug use, no information about how to stop using the drugs, and no information on what the drugs are actually doing. It really is a bunch “don’t do them” type of slogans tossed around at teenagers.

Many places in the US use the same tactic when it comes to premarital sex, which is a neat little parallel (and we all know how well that works).

That I think would be much more effective. Kids like visual aids too, it would be pretty interesting to show some kids in middle and early high school what drugs do to certain organs. Then there could be a reminder of all kinds of famous folks who succumbed to drugs one way or another, laid out in detail for older kids. The idea that telling kids they’ll be addicts after one hit or one joint is absurd, to the point where they have no reason to believe it if they know anyone who uses drugs. Kids should also be taught about prescription drugs.

I wish drug education programs would stop with all the scare tactics and admit that people drink and do drugs because they feel really fucking good. People try it out and enjoy it and decide that what they learned in school was hyperbolic because all they tell us is that it’s poison and that users are miserable right from the start.

A major problem is that so much of the (anti-) drug discourse is controlled by people who’ve never used drugs. Would we take relationship advice from someone who’s never dated? Would we ask someone who doesn’t cook for a good recipe? I wish there was a way to insert actual drug users into the conversation about drug use without turning it into a defensive shouting match on both sides.

Thank you for a very informative post. Once I was given morphine in the ER. I had a very bad GI infection and was suffering from dehydration. Let me tell you, serious dehydration hurts like hell! I thought my bones were going to explode. But the effects of the morphine were exactly as you described. Instantly the pain was gone. I felt wonderful for a bit, but then after I felt sluggish and sleepy… almost like being drunk, but much more mellow. At the time it was a good thing, because I needed to rest and heal, but I could not imagine what it would feel like if that effect was magnified.

Leave a Reply