This booklet provides information for people who use heroinThe National Drug and Alcohol Research Centre (NDARC) has conducted many interviews

with heroin users, many of whom have requested more information on heroin.

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WHAT IS HEROIN?

Heroin is an opiate, first manufactured in 1874.Opiates are drugs manufactured from the opiumpoppy, and include opium, morphine and codeine.Heroin may come in powder form, or in small rocks.Heroin is a strong pain killer, which suppressescoughing and causes sleepiness and constipation.Like all opiate drugs, heroin suppresses the volumeand rate of breathing, which is what kills people in anoverdose. It is illegal to possess, use, manufacture orsell heroin in Australia.

HOW DOES HEROIN WORK?

Heroin mimics the naturally occurring chemicals inthe brain and body which are produced in responseto pain and which modify the effects of the pain-killing,pleasure-producing neurotransmitters called ‘endorphins’.

When heroin enters the bloodstream it releases aflood of endorphins which results in an initial rush ofeuphoria. This is followed by a relaxed warm feelingand the disappearance of fear and worry.

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HOW IS HEROIN USED?

Heroin may be used by injection, smoking or inhalingthe fumes (“chasing”), snorting or swallowing. InAustralia, heroin is mostly injected. However, thesmoking of heroin has become common in recentyears, usually by heating heroin on aluminium foiland inhaling the vapours through a straw. RecentAustralian research hasshown that people havedied from using heroinby smoking, snortingand swallowing heroin.There is no safe way touse heroin. Each routeof administration carriesrisks. Research has alsoshown that most peoplewho smoke heroin endup injecting it if theycontinue to use.

WHAT IS HEROIN USED FOR?

As heroin is illegal, it is not currently used inmedicine. Other opiate drugs, such as morphine,are used in medicine for the relief of pain, thesuppression of coughing and to control diarrhoea.

There is no safe wayto use heroin.

Each route of administrationcarries risks. Research

has also shown thatmost people who

smoke heroin end up

injecting it if they continueto use.

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WHY DO PEOPLE USE HEROIN?

The main reason people use heroin is for its euphoriceffect. When it is used regularly many people becomedependent on the drug and find it extremely difficultto stop using it. They may need to use heroin to stopgoing into withdrawal.

Many people use heroin to deal with psychologicaldistress. Psychological problems are common amongheroin users, particularly depression and anxiety.Heroin is used as a way of blocking out bad feelings.

WHAT IS IN ‘STREET HEROIN’?

The main additives found in heroin in Australia aresugar, caffeine and paracetamol. It is rare for othersubstances to be found in street heroin. There is noevidence that the impurities in heroin cause death.

Pure heroin does not produce the extensive organdamage that drugs such as alcohol do. However,

the margin for error in theamount that is safe to useis far smaller with heroin. Itusually takes a substantialamount of alcohol to killsomeone. It does not takea large amount of herointo cause death fromoverdose.

It does not takea large

amount ofheroin to

cause death from

overdose

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WHAT ARE THE HARMS ASSOCIATEDWITH HEROIN USE?

The major harm associated withheroin use is overdose, which isthe single biggest killer ofheroin users. Research showsthat two thirds of regular heroinusers have had an overdose,and 85% have seen someoneelse overdose. Most overdosesoccur when the person hasused other drugs as well as

heroin, most commonly alcohol, benzodiazepines(e.g. Valium, Rohypnol) and tricyclic antidepressants(e.g. Tryptanol). The risk of an overdose is notrestricted to young, inexperienced users. Mostpeople who die from anoverdose are experiencedusers, around 30 years old.

Regular use of heroin is likely toresult in dependence on thedrug. This means that theperson loses control over theiruse of the drug, and is likely toexperience flu-like withdrawalsymptoms if they stop using heroin (e.g. aches andpains, sweating, diarrhoea and muscle spasms). Our best guess is that a third of people who haveever use heroin will become dependent on it, with

The majorharmassociated withheroin use is

overdose,which

is the single biggestkiller of

heroin users.

Most people who

die from anoverdose are

experiencedusers, around

30years old.

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people who use regularly atgreater risk. It is not just injectingthat can lead to dependence.Regular smokers of heroin candevelop dependence on thedrug, and this is one of thereasons so many move on toinjecting. Many people whoinject heroin believe that it ismore economical. However,because tolerance increasesrapidly they soon use heroinmore often, and spend more

money than when they smoked.

Heroin injectors are exposed to injection-relatedproblems. These include the risk of HIV, hepatitis B and hepatitis C from the sharing of injectingequipment. Injecting also causes damage to the veins,even if clean needles are used.

Finally, heroin is expensive.This means that many userswith low or average incomescommit crime to supporttheir use. The amount ofcrime heroin users commithas been shown to go upand down, depending onhow much heroin they are using. About a half ofregular heroin users have a prison record.

Injecting also causes

damage to theveins, even if

clean needlesare used.

Our best guess isthat a third of

people who have

ever used heroin will

become

dependenton it, with people

who use regularlyat greater

risk. It is not just

injecting that can

lead todependence.

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IS IT MORE ECONOMICAL TO INJECTHEROIN?

Many users find that that injecting heroin gives arush and provides a ‘bigger bang for the buck’ thansmoking or snorting the drug. However, injectingheroin results in higherlevels of dependence onthe drug. Injectors usemore often, and quicklydevelop a tolerance (whenyou need more of the drugto get the same effect) toheroin. Many injectorshave to use more of thedrug and use it more often. While injecting may givea bigger short-term effect, it costs substantiallymore financially and healthwise in the long-term.

WHAT DOES ‘OVERDOSE’ MEAN?

An overdose occurs as a resultof the drug’s effect on thecentral nervous system. Toomuch heroin causes bloodpressure to drop to such lowlevels that oxygen does not getto vital organs. As a result, thebody shuts down, breathingslows and stops.

While injecting maygivea bigger short-term

effect, it costssubstantially more

financially and

healthwise in the

long-term.

Too muchheroin causes

blood pressure todrop to such low

levels that oxygendoes not get to

vital organs.

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WHAT DO I DO IF SOMEBODYOVERDOSES ON HEROIN?

If a person has overdosed do the following:

• Call Emergency 000 for an ambulance

• Check that the person’s airway is clear. If not remove anything from the person’s mouth and extend the neckto open the airway

• Check breathing. If the person is not breathing be prepared to immediately start mouth to mouth resuscitation

• Check circulation by feeling for a pulse in the person’s neck. If there is no pulse then immediately commence heart massage

• If airway, breathing and circulation are OK, put the person in the recovery position

• Loosen any tight clothing that might restrict breathing

• Keep the person comfortably warm with blankets or a coat

• Do not give the person fluids

• Explain to the ambulance crew what has happened and what you have done

• Do not leave the person alone until professional help arrives

Learning basic first aid, or even better,

completing a recognised first aid course,

could save a life.

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recovery position

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HOW MANY OVERDOSES ARE THEREIN AUSTRALIA

In 1998 there were 737 opiate (e.g. heroin, methadoneand codeine) overdose deaths recorded in Australia, a23% increase from 1997. The number of overdosedeaths has been steadily increasing, with 347 deathsrecorded in 1988. The overwhelming majority ofthese overdose fatalities are due to heroin. Mostdeaths (about 85%) occur among males, and theaverage age at death is in the early thirties.

WHY HAVE HEROIN OVERDOSEDEATHS INCREASED?

We are not sure why the number of overdose deathshas increased so greatly, and there appears to be no one cause. Firstly, there are more heroin usersthan before, but the increase in overdoses isprobably greater than theincrease in heroin users.Secondly, the use of otherdrugs with heroin, particularlyalcohol and benzodiazepines,is known to increase the riskof an overdose. Polydrug usemay have increased among heroin users. Finally, thepurity of heroin has increased. However, while purityplays a role in overdose, it is not the only factor involved.

the use of other drugswith heroin,

particularly alcohol andbenzodiazepines, is

known to increase the

risk of an overdose.

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WHAT CAN BE DONE TO REDUCEHEROIN OVERDOSE DEATHS?

It is rare for a person to die ofa heroin overdose while theyare in drug treatment. It isolder users who are not intreatment who are at greatestrisk. A recent study indicatesthat many of these older usersare using less heroin thanpreviously, so their tolerance is

reduced. Enrolment in treatment would dramaticallyreduce the risk of overdose. Secondly, the use of otherdrugs with heroin, most importantly alcohol andbenzodiazepines, greatly increase the risk of overdose.Reducing the use of other drugs with heroin wouldreduce a person’s risk of overdose. Finally, responses atoverdoses are poor. Improving these responses, such ascalling an ambulance immediately, would reduce thenumber of deaths that occur.

It is rare for a

person to dieof a heroin

overdose while

they are in drugtreatment.

calling an ambulance

immediately, would reduce the number of

deaths that occur.

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HOW CAN I GET OFF HEROIN?

There are a variety of treatment choices for peoplewho wish to give up heroin use. Some of thesetreatments involve giving the person a substitute drugthat is like heroin. The most common form of treatmentin Australia is methadone maintenance, where theperson is dosed daily on methadone, a synthetic formof heroin.

Not all treatments use drugs.Rehabilitation services such as WeHelp Ourselves and OdysseyHouse run 3-6 month programmes,that require the person to live as apart of a community of recoveringdrug users.

Detoxification services offer short-term in-patient or at homedetoxification from the drug.Detoxification itself, however, is not a treatment. Mostpeople who undergo detoxification, with no other formof treatment, start using heroin again very quickly.

Finally, naltrexone maintenance is now being practicedin Australia. Naltrexone is a drug that counteracts theeffects of heroin. It is important to continue to take thedrug every day. Many people stop using naltrexoneand overdose after taking heroin again. You shouldalso not attempt to use a large amount of heroin to “getover the naltrexone”, as the risk of overdose is high.

There are a varietyof treatment

choices for

people who

wish to give

up heroinuse.

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