Heroin – known chemically as diamorphine – is an extremely addictive drug derived from morphine, an opiate (a drug derived opium, itself obtained from the opium poppy). Usually available in the form of a brown or white powder, heroin can be consumed in a variety of ways – most infamously it is injected, but can also be smoked, snorted, inhaled or even applied vaginally or rectally – and produces feelings of supreme euphoria, relaxation and well-being, as well as, on occasion, hallucinations and incredibly vivid dreams. Like morphine, heroin has anaesthetic qualities and some people begin to use it for that purpose; however, the vast majority of those using heroin do so recreationally (if serving an addiction which can rapidly become all-consuming can be described as “recreational”).
Because of its well-earnt reputation as one of the most addictive substances human beings can abuse, and the huge damage heroin addiction usually does to an addict’s health, lifestyle and relationships, heroin is typically seen in an extremely negative light and users go to great lengths to hide every aspect of their substance abuse from others. Heroin is often associated with poverty, crime and antisocial behaviour, disease and poor hygiene, prostitution and homelessness and the stigma of being a “junkie” (a heroin addict) can remain with someone for many years after they stop using the drug. Intravenous heroin use is a major risk factor for HIV/AIDS (sharing a needle with someone with AIDS is one of the most likely methods of contracting the disease), while using the drug whilst pregnant can result in damage to the foetus and to the baby being born addicted to heroin with many attendant health risks.
Known on the street by a great number of pseudonyms including “smack”, “brown”, “junk”, “horse”, “H”, “dope” and many others, heroin is widely available despite its being viewed internationally as one of the most dangerous of all illicit substances, and despite huge efforts on the part of authorities the world over to restrict its use. In the UK, while it continues to be used medically in certain circumstances, heroin is a Class A controlled substance (the most serious classification) and possession and, especially, supply tend to result in very stiff penalties; nevertheless its broad availability, and comparative affordability, mean it is abused across all age brackets, ethnicities and social strata, and represents a significant challenge to and burden on health and social services in every corner of the country.
Diamorphine was first synthesised in 1874, in London, by an English chemist, but its popularity only began after it was rediscovered in 1897 by an employee of German pharmaceutical company Bayer, which trademarked it as “Heroin” (from the German for “heroic”) – in a grim irony, because it was intended to provide the anaesthetic and euphoric qualities of morphine but without the addictive properties which the latter was already known to possess. For over two decades it was sold in many countries as a medicine (under various levels of control – for example, on a prescription-only basis) but from the 1920s onwards, with its hugely addictive nature becoming increasingly obvious, diamorphine – by then most commonly known as heroin despite Bayer’s trademark having lapsed at the end of WW1 – began to be restricted legally across the world.
Nevertheless, heroin had already established itself as a recreational drug of great potency, used by numerous major figures in music, literature and art (the deaths from heroin overdoses of many of those seemingly only adding to its mystique) and a steadily growing number of “normal” people despite the catastrophic consequences of addiction.
Because of the great stigma associated with heroin abuse, and the serious consequences faced by those caught using the drug, firm data on the number of heroin users in the UK is hard to come by. However, in 2015-16 approximately 150,000 people Britons sought treatment for opiate addiction (implying, logically, a significantly greater overall total user base). The UK has by far the highest number of heroin addicts in Europe, according to the European Monitoring Centre for Drugs & Drug Addiction (EMCDDA): some 31% of all drug overdoses in Europe in 2017 occurred in this country.
As a result of heroin’s profoundly negative reputation and associated stigma, users will usually go to great lengths to conceal their consumption of heroin. Nevertheless, there are a number of signs indicative of heroin use – and many more which could betray actual addiction.
Typically, someone “high” on heroin might display symptoms including:
A heroin addict, rather than someone using the drug casually, might display signs including:
Heroin is extremely addictive both physically and psychologically, and withdrawing from the drug is notoriously unpleasant, with symptoms worsening the longer someone uses the drug (and especially horrendous if they have been taking it intravenously). Withdrawal symptoms include:
Heroin’s effects upon the lives, bodies and minds of long-term users are notoriously profound. Most seriously, of course, people can die from overdosing on the drug – but even apart from such worst-case scenarios, the impact of heroin abuse can be serious and long-lasting, both physically and mentally.
Many of the most serious physical consequences of heroin abuse come about as a result of intravenous use. Injecting heroin can cause great damage to blood vessels including collapsed veins and infections, and can be immediately fatal if the injection itself is not conducted properly (for example if a sufficient quantity of air is injected into the bloodstream). Fatalities can also occur when heroin is “cut” (mixed) with other substances (including much stronger drugs such as fentanyl, responsible for a growing number of deaths worldwide) which may be toxic or damaging in other ways. The heart can be damaged both by the substance itself and by the strain placed on it by the “high” (and poor lifestyle including malnutrition), while blood clots can cause strokes. Arthritis can also result from long-term intravenous abuse. People injecting heroin (or any other drug) are also at a much higher risk of contracting diseases such as HIV/AIDS and hepatitis.
Regardless of the method of consumption, long-term users who have built up a dependency to the drug, leading to the consumption of larger and larger doses, are at risk of fatal overdose if they give up the drug for a while and then relapse, taking a dose to which they may have become accustomed previously but which the body post-detoxification cannot handle.
Other negative physical effects may include respiratory problems, muscular weakness, impotence, anorgasmia, dental/oral problems, skin complaints and a weakened immune system.
Any addiction can prove devastating to the addict’s mental health, as the impact upon their life becomes increasingly profound, leading to feelings of loneliness, worthlessness and hopelessness. Depression is a very common consequence: in the short-term, the brain adjusts to the presence of heroin and alters the rate of production of chemicals (including dopamine and serotonin) relating to happiness and pleasure. In the absence of the drug, until the brain is able to return to “normal” sometime after detoxification, it may, therefore, produce much lower quantities of those chemicals, meaning the addict is unable to feel pleasure to any noticeable degree. Longer-term, when confronted with the consequences of his/her addiction (which may have included the loss of important relationships with loved ones, financial collapse, unemployment, a criminal record, and/or gaining a reputation as a “junkie”) feelings of depression can be profound and may result in suicidal ideation.
Heroin use specifically – especially long-term – can cause structural changes in the brain, leading to a marked decrease in cognitive capabilities (lowered intelligence), decision-making abilities and the ability to regulate one’s behaviour. Short- and long-term memory can also be impacted. An addict can also feel emotionally atrophied and unable to relate even to those hitherto closest to them.
The most obvious immediate factor in the development of heroin addiction is that the experience of being on the drug can be intensely pleasurable – sometimes beyond anything a user has previously felt. As a result, they feel the urge to replicate those feelings by consuming more of the drug. Doing this repeatedly will almost certainly lead to a psychological dependence on heroin – whereby the user feels the need to take the drug all the time, firstly to feel the associated euphoria, but after a while simply to feel anything other than the depression and cravings which result from not taking it. Meanwhile, the body is building up a physical dependence on the drug: some hours after last taking heroin, the user will start feeling the physical symptoms of withdrawal which are typically extremely unpleasant and can only be lessened or removed by taking more heroin.
Because of the many dangers and stigma accompanying heroin use and abuse, those consuming the drug will typically lead quite isolated lives and will often associate primarily or solely with other heroin users (especially if the use is intravenous), and their daily routines will revolve around the acquisition and consumption of the drug. As a result, breaking the habit may prove very difficult quite apart from the actual addiction, since everything and everyone surrounding the addict is connected in some way to their heroin abuse. If the user has broken relationships with family and/or friends as a result of their addiction, they may feel that they have nobody to turn to for help and that they are therefore trapped between addiction and terrifying loneliness.
If you are certain, rather than simply suspecting, that someone you love is a heroin addict, the most important thing you should do is find an appropriate time (when they are not deeply under the influence, nor craving the drug so badly that they can’t focus) to tell them that they are much loved and that you are there to support them and to help them break the addiction. Even though the situation may well be extremely distressing for you, try to stay calm and not to become upset as you explain to them that there are a great number of options for treatment – but that treatment is absolutely vital before the addiction does more damage.
Prior to that discussion, research treatment options in your loved one’s area, including private rehabilitation if this is financially feasible: heroin is extremely physically addictive and going through withdrawal/detoxification without medical assistance is absolutely not recommended, while the various therapy options available in rehab will help your loved one address the root causes of addiction and give him/her the tools necessary to minimise the risk of relapse. Reassure them that it is possible to break free of heroin and to lead a happy, fulfilling life in future and that they will be able to keep their condition confidential – but stress that only they can take the first step on the path to recovery, by reaching out for help.