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Heroin is a semisynthetic substance derived from the resin of opium poppies, which are grown widely in South America, the Middle East, and Asia. Heroin can be injected, smoked, or sniffed. Reported effects include vomiting and nausea for first-time users, followed by intense euphoria ("rush") accompanied by flushed skin, dry mouth, and impaired mental functioning.

Heroin was first manufactured in 1898 by the Bayer pharmaceutical company and marketed heavily as a treatment for respiratory ailments. Heroin was originally believed to cure morphine addiction, but doctors soon realized it was more potent and addictive than morphine. Its addictive potential was an important factor in U.S. restriction under the Harrison Narcotics Act in 1914 and in its full criminalization in 1919. Presently, the U.S. Drug Enforcement Agency classifies heroin as a Schedule I narcotic, with high abuse potential and no accepted medical utility.

Most U.S. heroin comes from Mexico and Colombia, with New York, Chicago, and Los Angeles being the primary market areas for domestic heroin distribution. Abuse rates are highest in East Coast metropolitan areas, where higher-purity powder is available. For many years, injection was the dominant method of use, due in part to low purity levels. In the early 1990s higher-quality heroin entered the United States, making snorting and smoking more attractive routes of administration. The result has been an overall increase in heroin consumption rates in the latter years of the 20th century. New use methods also helped combat the social stigma associated with injection and helped broaden heroin's appeal to new and more affluent groups, such as suburban whites.

Despite an increase in overall rates of use, heroin remains one of the least used illegal drugs in the United States. Adolescent use has remained relatively stable over the past 25 years, with use by high school seniors fluctuating between 1 and 2 percent. However, emergency room admissions for heroin have increased 35 percent since 1995, mostly among youth. Drug treatment admissions have also increased steadily since 1992, mostly among middle-aged white males.

Heroin became associated with criminality in the 1970s based on the reasoning that users will turn to burglary, fraud, shoplifting, and prostitution to obtain money to maintain their addictions. Such reports emerged during the Nixon administration and still remain popular in anti-drug campaigns. Heroin use is also associated with violent crime. Research indicates that episodes of prostitutes assaulting and robbing clients are connected to the withdrawal experience. There is also substantial violence associated with heroin trafficking, although this is attributed to the inherent violence associated with drug markets rather than the pharmacological effects of heroin.

Health risks associated with heroin include fatal overdose, addiction, collapsed veins, and withdrawal sickness. An addict typically begins experiencing withdrawal symptoms within 8 hours after discontinuation of use. Withdrawal symptoms are similar to a severe flu, include sweating, anxiety, cold sweats, vomiting, diarrhea, and fever. Another significant problem with heroin use is the high risk of contracting blood-borne diseases, such as hepatitis and HIV/AIDS, from injection and needle sharing. Nationally, roughly 75 percent of new AIDS cases among women and children stem from the injection of illegal drugs such as heroin. Many countries have instituted programs supplying sterile needles to injectors to combat these diseases. The U.S. federal government does not currently support needle exchange programs, although some city and local governments do.

Bibliography:

1) National Institute on Drug Abuse, Community Epidemiology Work Group. 2005. "Epidemiologic Trends in Drug Abuse, Advance Report." Bethesda, MD: National Institute on Drug Abuse.

2) Substance Abuse and Mental Health Services Administration. 2007. "Results from the 2006 National Survey on Drug Use and Health: National Findings." Rockville, MD: Substance Abuse and Mental Health Services Administration.

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