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Heroin is a highly addictive drug, and its use is a serious
problem in America. Recent studies suggest a shift from injecting
heroin to snorting or smoking because of increased purity and
the misconception that these forms of use will not lead to addiction.
In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.
Reports from SAMHSA's 1995 Drug Abuse Warning Network (DAWN), which collects data on drug-related hospital emergency room episodes and drug-related deaths from 21 metropolitan areas, rank heroin second as the most frequently mentioned drug in overall drug-related deaths. From 1990 through 1995, the number of heroin-related episodes doubled. Between 1994 and 1995, there was a 19 percent increase in heroin-related emergency department episodes.
Tolerance, Addiction and WithdrawalsWith regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.
Extent of Use
Monitoring the Future Study (MTF)
According to the 1999 MTF, rates of heroin use remained relatively stable and low since the late 1970s. After 1991, however, use began to rise among 10th- and 12th-graders, and after 1993, among 8th-graders. In 1999, prevalence of heroin use was comparable for all three grade levels. Although past year prevalence rates for heroin use remained relatively low in 1999, these rates are about two to three times higher than those reported in 1991.
Monitoring the Future Study
Community Epidemiology Work Group (CEWG)
In June 2000, CEWG members reported that heroin indicators showed mixed trends. Mortality figures were mixed, with deaths increasing notably in Austin, Detroit, Minneapolis/St. Paul, and Phoenix, and declining in Miami, Philadelphia, St. Louis, San Diego, and Seattle. Emergency room admissions were also mixed, with 10 cities showing decreases (significant in San Francisco and Washington, D.C.), and 10 showing increases (particularly Baltimore and Miami). Heroin continues to account for a substantial proportion of treatment admissions in some CEWG areas (e.g., 47.8 percent in Baltimore, 43 percent in New York City, and 32 percent in Detroit). Heroin injection characterizes a large proportion of primary heroin treatment admissions (e.g., 90 percent in Texas). During the second quarter of 1999, the highest purity levels were found in Philadelphia (71 percent); New York (63.6 percent); Boston (61.4 percent); Newark (60.7 percent); Atlanta (57.8 percent); and San Diego (57.6 percent). Purity levels in other CEWG areas ranged from 11.8 percent in Dallas to 46.7 percent in Detroit. Injecting is on an upward trend among younger users in Baltimore, Boston, Minneapolis/St. Paul, Newark, New York City, and Seattle. In Boston, Chicago, Denver, Miami, and Washington, D.C., snorting seems to be increasing and is often the starting route for new users.
National Household Survey on Drug Abuse (NHSDA)ý
The 1999 NHSDA study reports the use of illicit drugs by those people age 12 and older. The lifetime prevalence (at least one use in a persons lifetime) for heroin for those people age 12 and older was 1.4 percent.
By age category, 0.4 percent were in the 12-17 range; 1.8 percent were 18-25; and 1.4 percent were users age 26 and older.
"Lifetime" refers to use at least once during a respondent's lifetime. "Past year" refers to an individual's drug use at least once during the year preceding their response to the survey. "Past month" refers to an individual's drug use at least once during the month preceding their response to the survey.
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