Tox Tuesday: Heroin

As abuse of prescription opioids continues, many users often turn to heroin as a cheaper alternative.

Heroin is an opioid, a class of drugs that relieve pain and, in many cases, often are abused. It causes euphoria and decreased mental function, followed by a drowsy state. Repeated heroin use can actually change the way the brain works, and can lead to tolerance, meaning greater amounts of the drug are needed to create the same effect, according to the National Institute on Drug Abuse. About 23 percent of those who use heroin eventually become dependent on the drug, which can lead to a myriad of severe health effects. These include withdrawal (e.g., insomnia, nausea, vomiting, diarrhea, pain, restlessness) if the person stops taking the drug. Overdose also is a huge concern, with one in four heroin users overdosing annually. Heroin is a Schedule I controlled drug in the U.S., meaning it has no currently accepted medical use in the U.S. and a high potential for abuse.

In the U.S., heroin use has almost doubled in recent years, from 373,000 users in 2007 to 620,000 users in 2011, according to the 2011 National Survey on Drug Use and Health. Many new users appear to be young people transitioning from the abuse of prescription drugs to heroin, although the 2011 National Survey on Drug Use and Health notes that outside of the figures on increased usage, much of the evidence is anecdotal. Young adult heroin initiates (first time users) ages 18 to 25 have increased, from 53,000 from 2002 to 2005, to 89,000 a year in 2009-2011.

Recent media reports in the U.S. also have indicated that first time users are looking for a cheaper alternative from prescription drugs, and that heroin use is increasing in suburban and rural areas. In fact, the White House’s National Drug Control Strategy specifically mentions the rise in the number of young people using heroin and its spread into areas outside of cities, noting that the number of 18 to 25 year olds admitted for heroin treatment jumped from about 43,000 in 2000 to about 68,000 in 2010.

In Europe, however, there appears to have been a decrease in heroin users entering treatment for the first time as well as a decrease in the drug’s availability – both indicators of its decline, according to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).  A 2011 report in Drugnet Ireland noted that the United Kingdom had experienced a heroin “drought” in November 2010, as hospitals treated a significant number of people who had overdosed on heroin that was mixed with other things, including sedatives, talcum powder and paracetamol. The drought and poorer drug quality also led users to move from smoking heroin to injecting it, and increasing needle size, which upped the risk for overdose.

Heroin shortages also have led to upticks in the use of fentanyl, a synthetic opiate 80 times stronger than morphine that has similar effects to heroin. Estonia has been hit especially hard by fentanyl use.

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