Street Heroin

Since heroin has no approved medical indications in the United States, it is only available and used illicitly. The marked variability of its purity and the use of a wide variety of other substances and drugs to "cut" street heroin poses a major problem. This inability to know what is included in each drug sale makes the street drug more than doubly dangerous. Typically, heroin is administered intravenously, which provides a rapid "rush," a euphoria, which is thought to be the important component of heroin s addictive properties. It can be injected under the skin (subcutane-ously, SC) or deep into the muscle (intramuscularly, IM). Multiple intravenous injections leave marks, called tracks, in a much-used injection site, which often indicate that a person is abusing drugs; but heroin can also be heated and the vapors inhaled through a straw (called "chasing the dragon''). It can also be smoked in a cigarette. While the heat tends to destroy some of the drug, if the preparation is pure enough, a sufficient amount can be inhaled to produce the typical opiate effect.

Heroin use is associated with TOLERANCE AND Dependence. Chronic use of the drug leads to a decreased sensitivity toward its euphoric and analgesic actions, as well as to dependence. Like morphine, the duration of action of heroin is approximately 4 to 6 hours. Thus, addicts must take the drug several times a day to prevent the appearance of WITHDRAWAL signs. Many believe that the need to continue taking the drug to avoid withdrawal enhances its addictive potential.

Patients taking opiates medicinally can be taken off them gradually, without problems. Lowering the opiate dose by 20 to 25 percent daily for two or three days will prevent severe withdrawal discomfort and still permit rapid taper off the drug. Abrupt withdrawal of all of the drug is very different—and leads to a well-defined abstinence syndrome that is very similar for both heroin and morphine. It includes eye tearing, yawning, and sweating after about eight to twelve hours past the last dose. As time goes on, people develop restlessness, dilated pupils, irritability, diarrhea, abdominal cramps, and periodic waves of gooseflesh. The term cold turkey is now used to describe abrupt withdrawal with the associated gooseflesh. The heroin withdrawal syndrome peaks between two and three days after stopping the drug, and symptoms usually disappear within seven to ten days, although some low-level symptoms may persist for many weeks. Babies of mothers dependent on opiates are born dependent, and special care must be taken to help them withdraw during their first weeks. Medically, although miserable, heroin withdrawal is seldom life threatening—unlike withdrawal from alcohol, which can sometimes be fatal.

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