Heroin AUSTRALIAN DRUG FOUNDATION
09 HOW DRUGS AFFECT YOU
This pamphlet is part of the “How Drugs Affect You� series. It aims to provide the facts about heroin for anyone interested in understanding more about this drug. It has been written for the general public, including employees, employers, health professionals and their clients.
Other titles in this series include alcohol, amphetamines, analgesics, benzodiazepines, cannabis, cocaine, drugs and their effects, ecstasy, GHB, hallucinogens, ice, inhalants, ketamine and tobacco.
09 HOW DRUGS AFFECT YOU
What is heroin? Heroin is one of a group of drugs known as opioids. Other opioids include opium, morphine, codeine, pethidine, oxycodone, buprenorphine and methadone. Heroin is made from the opium poppy. Heroin and other opioids are depressant drugs. Depressant drugs do not necessarily make you feel depressed. Rather, they slow down the activity of the central nervous system and messages going between the brain and the body. Alcohol, benzodiazepines, GHB and cannabis are also depressant drugs.
Other names Smack, skag, dope, H, junk, hammer, slow, gear, harry, big harry, horse, black tar, china white, Chinese H, white dynamite, dragon, elephant, homebake, poison.
What it looks like Heroin can range from a fine white powder to off-white granules or pieces of brown “rock”. It has a bitter taste but no smell and is usually packaged in “foils” (aluminium foil) or small, coloured balloons.
How is it used? Heroin is most commonly injected into a vein. It is also smoked (“chasing the dragon”), snorted, or added to cannabis or tobacco cigarettes.
Heroin in Australia According to the National Drug Strategy Household Survey1, in 2010:
»» 1.4 per cent of the Australian population aged 14 years
and older had used heroin at some stage in their lifetime
»» 0.2 per cent had used heroin in the previous 12 months.
Effects of heroin The effects of any drug (including heroin) vary from person to person. How heroin affects a person depends on many things including their size, weight and health, also whether the person is used to taking it and whether other drugs are taken around the same time. The effects of any drug also depend on the amount taken. This can be very hard to judge as the quality and strength of illicit drugs can vary greatly from one batch to another.
Australian Institute of Health and Welfare (AIHW) 2011 2010 National Drug Strategy Household Survey: Report, Canberra: Australian Institute of Health and Welfare.
1
» drowsiness » slurred and slow speech » reduced coordination
Stomach » nausea and vomiting » reduced appetite
Lungs slow breathing rate
Heart decreased heart rate and blood pressure
Mouth dry mouth
Eyes constricted pupils
Brain » lowered cough reflex » pain relief » reduced sexual urges
Psychological effects » feelings of intense pleasure » strong feelings of wellbeing » confusion
Immediate effects
Depending on how heroin is taken, the effects may be felt within 7–8 seconds (injecting) or within 10–15 minutes (snorting or smoking). The effects of heroin can last for approximately 3–5 hours.
Low to moderate doses Some of the effects that may be experienced after taking heroin include:
Low to moderate doses
Higher doses A high dose of heroin can cause a person to overdose. This means that a person has taken more heroin than their body can cope with. The risk of overdose increases if the strength or purity of the heroin is not known. Injecting heroin increases the risk of overdose due to large amounts of the drug entering the blood stream and quickly travelling to the brain. High doses of heroin can intensify some of the effects listed in the diagram. People may also experience:
»» impaired concentration »» going “on the nod”
(falling asleep) »» shallow and slow breathing »» nausea and vomiting »» increased sweating and itching
»» urge to pass urine
but difficulty doing so
»» drop in body temperature »» irregular heartbeat »» unconsciousness »» death.
Naloxone (also known as Narcan®) reverses the effects of heroin, particularly in the case of an overdose. Authorised medical personnel such as ambulance officers can administer naloxone. After an overdose, it is strongly advisable to seek assessment at a hospital or by a medical practitioner. Coming down A person who is coming down from using heroin may feel irritable as the drug leaves their body. They may also feel depressed when coming down.
Long-term effects The long-term effects of heroin use on health can include:
»» dependence »» constipation »» menstrual irregularity »» infertility in women »» loss of sex drive in men
»» intense sadness »» cognitive impairment »» tetanus »» damage to heart, lungs, liver and brain.
Some other long-term effects of heroin are related to the method of use:
»» Repeated snorting damages the nasal lining. »» Frequent injecting in the same place can cause
inflammation, abscesses, vein damage and scarring.
»» Injecting can also result in skin, heart and lung infections. »» The impurities and additives in heroin, if injected can also damage veins. This can also cause thrombosis.
Tolerance and dependence People who use heroin regularly for a prolonged period can develop dependence and tolerance to it. Tolerance means they need to take larger amounts of heroin to get the same effect. Dependence on heroin can be psychological, physical, or both. People who are dependent on heroin find that using the drug becomes far more important than other activities in their life. They crave the drug and find it very difficult to stop using it. People who are psychologically dependent on heroin may find they feel an urge to use it when they are in specific surroundings or socialising with friends. Physical dependence occurs when a person’s body adapts to heroin and gets used to functioning with the heroin present Withdrawal If a dependent person stops taking heroin, or severely cuts down the amount they use, they will experience withdrawal symptoms because their body has to get used to functioning without heroin. Symptoms can start within 6 to 24 hours after the last dose. Heroin withdrawal symptoms usually peak within 1 to 3 days and gradually subside in 5 to 7 days. Some of the withdrawal symptoms that may be experienced include:
»» cravings for heroin »» restlessness »» yawning »» increased irritability »» depression »» crying »» diarrhoea »» low blood pressure
»» stomach and leg
cramps, muscle spasms
»» vomiting »» goose bumps »» runny nose »» insomnia »» loss of appetite »» elevated heart rate.
Heroin and driving It is dangerous to drive after using heroin. The effects of heroin, such as drowsiness and reduced coordination, can affect driving ability. The symptoms of coming down and withdrawal can also affect a person’s ability to drive safely.
Heroin and the workplace Under occupational health and safety legislation, all employees have a responsibility to make sure they look after their own and their co-workers’ safety. The effects of heroin such as drowsiness and confusion can affect a person’s ability to work safely and effectively. The symptoms of coming down and withdrawal can also affect a person’s ability to work safely and effectively.
Pregnancy and breastfeeding Using heroin while pregnant can increase the chances of problems in pregnancy such as miscarriage, or going into labour early, which can mean that babies are born below the normal birth weight. Heroin is often “cut” with other substances that can also cause problems during pregnancy and affect the developing foetus. Heroin can pass through the placenta to the foetus, and after birth the baby can experience heroin withdrawal, known as Neonatal Abstinence Syndrome (NAS). Some of the common symptoms of NAS are:
»» poor feeding »» sleep-wake
abnormalities
»» vomiting
»» dehydration »» poor weight gain »» occasional seizures.
Pregnant women who want to stop taking heroin must seek medical advice and supervision, as sudden withdrawal may harm the baby and increase the risk of miscarriage, premature birth and stillbirth. If a mother uses heroin while breastfeeding, the drug may be present in her breast milk. This may have an effect on the health of the baby.
Check with your doctor or other health professional if you are using or planning to use heroin or any other drugs during pregnancy or while breastfeeding.
Heroin and other drugs The effects of mixing heroin with other drugs, including alcohol, prescription medications and over-the-counter medicines, are often unpredictable. Mixing heroin with other depressant drugs (such as alcohol or benzodiazepines) increases the depressive effects and can result in an increased risk of respiratory depression, coma and death. Combining heroin with stimulant drugs such as amphetamines also places the body under great stress.
Heroin and social problems All areas of a person’s life can be affected by drug use.
»» Disagreements and frustration over drug use can cause family arguments and affect personal relationships.
»» Legal and health problems can also add to the strain on personal, financial and work relationships.
Heroin and the law Heroin is illegal in Australia. Federal and state laws provide penalties for possessing, using, making, selling or driving under the influence of heroin. Penalties can include fines, imprisonment and disqualification from driving. Some states and territories have programs that refer people with a drug problem to treatment and/or education programs where they can receive help rather than going through the criminal justice system. For more information contact a legal aid service in your state or territory.
Treatment options In Australia, there are many different treatment options for drug problems. Some aim to help a person to stop using a drug, while others aim to reduce the risks and harm related to their drug use. Treatment is more effective if adapted to suit each person’s situation. Some of the different options include individual counselling, group therapy, medication (pharmacotherapy), residential therapy and supervised/home withdrawal. Some pharmacotherapy based treatments for heroin dependence include: Methadone—a synthetic opioid that can be used as a substitute for heroin. Buprenorphine—prevents withdrawal symptoms and blocks the effects of heroin. Naltrexone—blocks the effects of heroin and other opioids.
Preventing and reducing harms Many Australians take at least one psychoactive drug on a regular basis—they might take medication (i.e. over-the-counter or via a prescription), drink alcohol, smoke tobacco or use an illegal drug. All drugs have the potential to cause harm. As use increases, so does the potential for harm. Australia’s national drug policy is based on harm minimisation. Strategies to minimise harm include encouraging people to avoid using a drug through to helping people to reduce the risk of harm if they do use a drug. It aims to reduce all types of drug-related harm to both the individual and the community.
Heroin, hepatitis and HIV Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood borne viruses such as hepatitis B, hepatitis C and HIV (human immunodeficiency virus—the virus that causes AIDS). The alcohol and drug service in your state or territory can provide information on where to obtain clean needles and syringes. Their telephone numbers are listed on the back of this pamphlet.
There is no safe level of drug use Use of any drug always carries some risk—even medications can produce unwanted side effects. It is important to be careful when taking any type of drug.
What to do if you are concerned about someone’s drug use If you are concerned about someone’s drug use, there is confidential help available. Contact the alcohol and drug information service in your state or territory. The telephone numbers are listed on the back of this pamphlet.
What to do in a crisis If someone overdoses or has an adverse reaction while using heroin, it is very important that they receive professional help as soon as possible. A quick response can save their life.
»» Call an ambulance. Dial 000. Ambulance officers are not obliged to involve the police.
»» Stay with the person until the ambulance arrives.
Find out if anyone at the scene knows cardiopulmonary resuscitation (CPR). »» Ensure that the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing. »» If the person is unconscious, don’t leave them on their back—they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway. »» If breathing has stopped, apply CPR. »» Provide the ambulance officers with as much information as you can—such as how much heroin was taken, how long ago and any pre-existing medical conditions. For further tips on how to reduce the risks of using heroin, call the alcohol and drug information service in your state or territory. The telephone numbers are listed on the back of this pamphlet.
For information, counselling or other assistance, contact the alcohol and other drug service in your state or territory.
ACT (02) 6207 9977
Tas. 1800 811 994
NSW (02) 9361 8000 (Sydney) 1800 422 599 (NSW)
Vic. 1300 85 85 84 (information)
NT 1800 131 350
QLD 1800 177 833 SA
1300 131 340
1800 888 236 (counselling)
WA (08) 9442 5000 (Perth) 1800 198 024 (WA)
Produced by the Australian Drug Foundation Š 2011. Celebrating more than 50 years of service to the community, the Australian Drug Foundation is Australia’s leading body committed to preventing alcohol and other drug problems in communities around the nation. www.adf.org.au For further copies of this pamphlet: Post: PO Box 818 North Melbourne Vic 3051 Street: 409 King Street West Melbourne Vic 3003 Email: druginfo@adf.org.au Web: www.druginfo.adf.org.au