Heroin is a drug that comes from the opium poppy. It is one of a group of very strong pain-killing drugs called narcotic analgesics or opioids.

Some opioid drugs are opium, morphine and codeine. There are other human-made opioid drugs, such as pethidine and methadone. These drugs can all be used legally, for medical reasons but heroin is not legal.

Heroin (also called 'smack', 'skag', 'hammer', 'h', or 'horse') is in the class of drugs called 'depressants', because it slows down the brain and the central nervous system.

How is heroin used?

Heroin usually comes in powder form. It can be different colours depending on how refined it is - white powder is usually more refined than brown or pink 'rocks', a lumpy powder.

Heroin is usually injected, smoked or snorted. It is absorbed into the blood and acts on the brain very quickly.

People who sell heroin often mix or 'cut' the powder with other things that look the same, to make the drug go further. Some mixed-in substances may have unpleasant or harmful effects. It is difficult to tell what is actually in the drug.

What are the effects of heroin?

What heroin does to you depends on:

• how much you take
• how pure is the heroin you take.
• your height and weight
• your general health
• your past experience with heroin
• whether you use heroin on its own or with other drugs
• whether you use alone or with others, at home or at a party etc.

Immediate effects

The effects of heroin may last up to a few hours which can:

• make physical pain disappear
• make you feel nauseous or vomit
• make the pupils in your eyes get smaller ('pinpoint pupils')
• make your breathing become shallow
• cause constipation - when it is difficult to defecate ('shit')
• make you feel sleepy ('on the nod').
• make you feel really good

Longer term effects

If you use heroin often for a long time you may:

• overdose (have too much heroin - the longer you use heroin, the more likely you are to overdose)
• have long-term constipation
• get damaged veins from injecting a lot in the same site
• get skin abscesses (sores with pus)
• lose your appetite or get sick from lack of healthy food
• have your menstrual period at the wrong time or not at all (women)
• find it difficult to get pregnant (women)
• find it difficult to get an erection (men)
• get pneumonia - a serious lung disease
• have other heart and lung problems
• get tetanus - a disease caused by infection through the places on your body where you inject
• get hepatitis B, C or HIV (the virus that causes AIDS). This is more likely as you use more often, but can happen even if you share injecting equipment just once.

The way a person uses heroin can also cause some problems:

• Street heroin is usually mixed with other things. Therefore, it is hard to know how strong the heroin is and this can lead to accidental overdose or death.
• Injecting heroin with used or dirty injecting equipment makes you more likely to get infected with HIV, hepatitis B or C, get blood poisoning (septicaemia) and skin abscesses. So that you don't get these problems, DO NOT SHARE fits (needles and syringes), spoons, water, filters, alcohol swabs or tourniquets.

Overdose

Overdose of heroin ('dropping') is very common and can happen to anyone. Even small amounts of heroin may cause some people to overdose - for example, new users or those who started using again. This can happen after even a short time not using.

When a person overdoses, they may have:

• very slow breathing
• cold skin and low body temperature
• slow heartbeat
• muscle twitching
• slow working of the central nervous system
• gurgling sound in the throat from vomit or saliva
• blue tips of fingernails/toenails because of low oxygen

The person may go into a coma or even die. If someone overdoses, other people with them should:

• phone 000 to get an ambulance and tell the operator that the person has overdosed. The police will not come unless someone dies or becomes violent.
• stay with the person
• try not to panic
• try to keep the person awake - walk them around, talk to them, use their name
• if the person is unconscious, put them on their side, in the 'recovery' position.
• check their breathing, clear their airway
• do mouth-to-mouth resuscitation if they stop breathing
• if the person is 'on the nod' and looks like they may overdose, put them on the floor, on their side

Do NOT:

• Do not inject the person with anything. Salt, milk, or speed don't work against the heroin and can cause more harm
• Do not put them under the shower.
• Do not put anything in their mouth — it can cause choking and stop them from breathing. Even if someone fits (has a seizure or convulsions), the best thing to do is move things from around them, so they don't hurt themselves.

Preventing overdose

To help prevent overdose:

• never use heroin alone
• never use heroin at the same time as alcohol, tranquillisers or other drugs
• buy heroin from a regular, trusted dealer to be more sure of how strong it is— if buying from a new dealer, try a small amount first
• try a small amount first to how strong the heroin is, or to your 'tolerance' (see below).

Heroin and Pregnancy

Using heroin when you are pregnant can affect both the mother and the unborn child. Babies can also have problems after they are born.

Heroin-dependent women are more likely than other women to:

• lose the baby during pregnancy, have the baby too early or have the baby born dead
• pass infections such as HIV, hepatitis B and C or blood poisoning on to the baby
• have health and social problems during pregnancy and childbirth.

New babies of heroin-dependent mothers are more likely to:

• be sick in the first few weeks of life and later
• have withdrawal symptoms when they are born (because they are no longer getting heroin from the mother's blood supply)
• die from Sudden Infant Death Syndrome (cot death)

Mixing heroin with other drugs

You are more likely to overdose if you use heroin at the same time as other drugs, especially alcohol or minor tranquillisers. Mixing other drugs with heroin can also cause other physical and mental problems.

Tolerence and dependence

Anyone can develop a 'tolerance' to heroin or other drugs. Tolerance means that you must take more of the drug to feel the same effects you used to have with smaller amounts.

'Dependence' on heroin means that it takes up a lot of your thoughts, emotions and activities. You spend a lot of time thinking about using heroin, looking for heroin, using it and getting over the effects of using it. You also find it difficult to stop using or control how much you use. Dependence can lead to a variety of health, money, legal, work and relationship problems.

Not all people who ever use heroin become dependent. Dependence happens gradually with ongoing use.

Withdrawal

People who are dependent on heroin find it very hard to stop using or cut down because of withdrawal symptoms. These can begin to occur only a few hours after last using heroin. Symptoms include:

• wanting heroin very badly (cravings)
• feeling restless
• yawning
• a runny nose
• crying
• diarrhoea
• stomach and leg cramps
• goosebumps
• low blood pressure

Heroin and the law

Using, keeping, selling or giving heroin to someone else is illegal. Many overseas countries (e.g. Malaysia, Singapore, Thailand) have much harsher penalties - including the death penalty - for people who break their drug laws.

If you are convicted on a drug charge you then have a criminal record. This can cause many other problems such as trouble getting a job, a credit card, or a visa to travel overseas.

Heroin and driving

It is illegal to drive under the influence of drugs, including heroin. Penalties include losing your licence, a fine and/or jail.

Heroin slows down the workings of your brain and your body, so it may make you drive dangerously.

Source: NSW Department of Health