Heroin is one of the leading causes of overdose death in the United States. It’s also a common source of substance use disorders and addiction. Heroin is a widely known illicit drug that’s often portrayed in the media, but there may be a lot you don’t know about it.
Learn more about heroin and the statistics that surround this dangerous substance.
Heroin is an opioid drug that’s similar to morphine, oxycodone, and hydrocodone. Heroin is considered a semi-synthetic opioid, which means it is made by modifying another existing opioid, but it’s not fully lab-made. Morphine is a naturally occurring opiate that you can find in opium poppy plants along with codeine. Milk from poppy plants has been used for thousands of years for various purposes, but it wasn’t until 1804 that morphine was discovered to be an active alkaloid in the poppy plant.
Heroin was first synthesized in 1874 by an English chemist named C. R. Alder Wright. He discovered it by combining morphine with other chemicals through experimentation. He sent it to be tested, but it wasn’t used until it was independently discovered by Felix Hoffman, who was working for the pharmaceutical company Bayer.
Heroin’s origins are as a medication. Hoffman discovered heroin when he was trying to add chemicals to it to make codeine. Instead, they got heroin, which can be as much as twice as strong as morphine. The drug was first used by the Bayer company and marketed as a substitute for morphine. Though heroin was found to be stronger, it was sold as an alternative to morphine that didn’t have some of its adverse side effects. It was sold as an over-the-counter cough suppressant that wasn’t as addictive as morphine. However, heroin soon proved to be just as addictive as morphine through the late 19th and 20th centuries. It was used in the United States until non-medical sales and manufacturing were banned in 1924. The League of Nations banned it in the following year.
Heroin isn’t a scientific name or even a street name; it’s the brand name that was first assigned to the drug by the German Bayer company. The drug is actually called diamorphine or diacetylmorphine, which shows its morphine-derivative roots. Heroin has become so commonly associated with diamorphine that the term is genericized. That’s when a trademark becomes so common that it’s used as a generic name, like Kleenex or Jell-O. In fact, Aspirin is also a brand name introduced by Bayer that is used as a generic name. If you’ve ever confused heroin for a female hero by leaving off the E, you’ve stumbled onto the brand’s intended association. Heroin was derived from the German word heroisch, which means heroic or strong.
Your brain produces a chemical that’s remarkably similar to opioids like heroin. The chemical is called endorphin, and it’s why opioids work on humans. Endorphins are a chemical in your brain and body that helps to mitigate your response to pain. You can often feel the effects of endorphins after a strenuous workout or after completing something stressful. Endorphins may also be used as a rewarding chemical and may be released after sex or eating.
Endorphins were actually discovered in humans after morphine was discovered in plants. Endorphins were found to be so similar to morphine that they were named “endogenous morphine” or endorphin, which means morphine that comes from inside the body. Endorphin receptors exist all over the body in your brain, spine, and muscles. These receptors bind with endorphins to produce pain-relieving and relaxing effects. Heroin, morphine, and other opioids can bind to these receptors for even more potent effects.
When a medical examiner is investigating an overdose death in which heroin is expected, they might find morphine in the person’s system. That’s because heroin is broken down quickly and leaves morphine behind as an active metabolite. This causes you to feel the opioid effects longer when you take heroin than when you take morphine. However, it also means it can be difficult to determine accurate heroin overdose statistics. Heroin was involved in 14,019 overdose deaths in 2019. However, that number could be under-reported because the drug is found as morphine in a person’s system.
Opioids are a useful medication when it comes to treating pain. Drugs like oxycodone can stop pain signals from being sent and received throughout the body, facilitating pain relief and relaxation. However, opioid medications can also be addictive, especially when they’re abused. According to the National Institute on Drug Abuse, around 80% of heroin users report that they started by using prescription opioids. Developing a substance use disorder involving prescription opioids can become expensive. Maintaining your addiction would involve doctor-shopping, or finding new doctors to prescribe opioids to avoid suspicion of misuse. Since prescriptions are difficult and expensive to obtain, you may resort to using heroin instead.
Heroin, like other opioids, offers a few side effects, even if you don’t use enough to cause an overdose or addiction. Heroin can cause an itchy feeling on your skin, dry mouth, and drowsiness. However, it can also cause constipation. Some opioid receptors are located in your intestines. As heroin binds to these receptors and slows down activity all over your body, it can inhibit your ability to pass your stool normally. This can happen with opioid prescription use too. Doctors mitigate this by prescribing medications to help you go. Chronic heroin use can lead to long-term gastrointestinal discomfort. It may also cause other digestive problems if it’s ignored for too long.
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Heroin that’s sold on the streets often has other additives in it besides heroin. This is true for other illicit drugs as well. One of the most dangerous aspects of illegal drug use is the fact that it’s unpredictable. Heroin dealers may cut the drug with cheaper substances in order to increase profits. If you can charge full price for half the heroin, you can make more money. They may cut the heroin with inert substances that aren’t active in the body. However, even inert substances can be dangerous. Powdered additives like cornstarch that are heated and injected along with heroin can coagulate and cause clotting in blood vessels. This can cause collapsed veins, deep-vein thrombosis, heart attacks, and strokes.
Heroin is also mixed with active substances. Sometimes it’s mixed with caffeine to counteract drowsiness. Less common, it may be mixed with random toxic chemicals like detergent or rat poison. In the past few years, the powerful opioid fentanyl has been found in heroin and other illicit drugs. Fentanyl is a synthetic drug that can be as much as 100 times stronger than morphine. It’s enough to kill the average adult with a dose as small as 2 mg (milligrams).
Track marks or scars are commonly associated with heroin use, especially in popular media depictions of heroin addiction. But these marks around injection sights are caused by the needle and contaminants, not heroin itself. Injected drug use can mean repeatedly using needles on the same veins. Unskilled injectors may inject the drug in a way that does more damage than your average phlebotomist or nurse. This can lead to scars around the injection sites. Impure drugs can also cause inflammation and scarring around the injection site. Repeated injections can lead to more damage, such as collapsed veins.
Heroin misuse is associated with other consequences besides scarring. It can increase your risk of contracting an infectious disease. According to NIDA, heroin use is associated with diseases like HIV, hepatitis, and other infectious diseases. Active addiction is also associated with risky sexual practices and sexual assault, which can also increase your risk of infectious disease. These diseases can be deadly, especially if they aren’t addressed quickly.
In 2019, the majority of heroin-related overdose deaths also involved another drug like alcohol or other depressants. Alcohol and other depressants like benzodiazepines can potentiate heroin. Potentiation is when two or more drugs combine their similar effects to create a more intense reaction. In this case, heroin and alcohol can both slow down your nervous system, causing oxygen deprivation in smaller doses of each individual drug than it would normally take to be dangerous.
A heroin overdose can be deadly, leading to respiratory depression, unconsciousness, and a slowed heart rate. In many fatal overdose cases, heroin causes breathing to slow to the point of oxygen deprivation, causing brain damage and death. A heroin overdose is a serious medical emergency, but it can be treated if help arrives in time.
A drug called naloxone, which is sold under the name Narcan, can effectively reverse an opioid overdose. Naloxone is an opioid receptor antagonist, which means it binds to opioid receptors and stops them from being activated. It can also kick heroin off the body’s opioid receptors, halting their effects. Many first responders carry naloxone, which can be bought over the counter in some states.
DEA. (n.d.). Fentanyl. Retrieved from https://www.dea.gov/factsheets/fentanyl
National Institute on Drug Abuse. (2020, May 15). HIV, hepatitis, and other infectious diseases. Retrieved from https://www.drugabuse.gov/drug-topics/health-consequences-drug-misuse/hiv-hepatitis-other-infectious-diseases
National Institute on Drug Abuse. (2018, January). Prescription opioid use is a risk factor for heroin use. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use
National Institute on Drug Abuse. (2021, January 29). Overdose death rates. Retrieved from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
Raypole, C. (2019, September 27). How to increase Endorphins: 13 TIPS. Retrieved from https://www.healthline.com/health/how-to-increase-endorphins