| Heroin: Harm Reduction Advice |
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Drug Information - Heroin Heroin (diamorphine) is a derivative of morphine that comes from the opium poppy plant. It is important medically as a powerful painkiller and is used recreationally for the rush of euphoria and the deep relaxation it produces. Just a few doses can lead to the beginning of an addiction. There is a much higher risk of overdose death with heroin compared with other drugs - the majority of drug deaths in the UK involve heroin use. It is injected more than other drugs so its use is linked to the spread of blood-borne diseases like HIV and Hepatitis C through the sharing of needles. Heroin was developed over 100 years ago as a stronger alternative to morphine. Its ‘miraculous’ properties in providing pain relief led it to be marketed as a patient’s ‘heroine’. It has been used recreationally ever since. Patterns of Use Nearly all UK heroin is from Afghanistan although there some produced around Thailand/Laos. It is mainly transported or trafficked by road and the price rises sharply the closer it gets to the user. Its use is very widespread across the world with millions of users in the USA, Europe, Russia and Australia. However, most drug users (taking cannabis, ecstasy, cocaine) would not contemplate taking heroin because of its risks and dangers. It is a grainy powder, mainly brown in colour although it can also be whitish. There are about 300,000 problem heroin users in Britain. Most smoke the drug on foil, known as ‘chasing the dragon’. Only a minority inject. Regular use of heroin will cause dependence. Some can manage their intake but there is a significant number who become chaotic users. They are unable to hold down regular work and may turn to crime to fund their addiction. Heroin costs about £60 a gram. Like most other powder drugs (e.g. cocaine or ecstasy), heroin is heavily mixed with adulterants. Average purity is only about 25 percent. The average age of someone who starts heroin in Britain is 21. Effects Heroin has a powerful effect almost instantly and gives very pleasurable feeling of well-being and imperviousness to the concerns of the world. It lasts for 3 or 4 hours giving a sensation of warmth and lethargy. The first time can make you vomit and some never wish to repeat it, but others continue using despite the nausea. The pleasurable effects and temporary escape from real-world difficulties makes it tempting for many to use again. Once the user starts developing an addiction, cravings become intense and withdrawal becomes very unpleasant or even unbearable. Physical tolerance can build up fairly quickly. For users who have been taking heroin for months or years, coming off it can be very difficult. Sudden abstinence, ‘going cold turkey’ is both mentally and physically very demanding, with withdrawal effects lasting up to a week. Going cold turkey is dangerous and should not be attempted for pregnant women and those with poor health. It causes muscle pain, diarrhoea, shivering, vomiting and insomnia, along with anxiety and extreme cravings. Even when clean of heroin, craving and sleep problems are frequent and relapse is common. Harms Heroin purity is inconsistent so there is an ever-present risk of overdose. About 1,000 people die of heroin and morphine in the UK every year. Mixing with alcohol is especially dangerous as both drugs work to suppress breathing and airway reflexes. There is also a danger of vomiting in your sleep, leading to choking. Injecting heroin, especially when sharing needles, is risky, with a high chance of becoming infected with viruses which may prove fatal in the longer term. Injecting over a prolonged period causes veins to collapse making injection difficult. Prolonged heroin use adversely affects the working of the heart, liver and kidneys. The harms of heroin use are entangled with the harms of poverty and an unstable lifestyle, with cause and effect not always clear. Many health issues arise from the neglect of, or difficulty in meeting, bodily needs aside from the drug. Users may lose weight and suffer the effects of lack of sleep. Heroin’s legal status, its addictiveness and its disruptive influence on employment means that users are often drawn into a dangerous criminal environment including prostitution. Many heroin dealers are users who sell drugs to fund their own habit. The needs of dependents such as children of heroin addicts, are often compromised by the time and money needed to feed an addiction. The associated social harms particularly on crime are considerable. The amount of crime (burglary, shoplifting) derived from feeding heroin addiction is vast – it has been estimated to contribute up to 40% of these crimes. For those who manage to rid themselves of addiction, there is still a significant social stigma over heroin use. They may find it hard to be trusted and many employers will discriminate against them. Treatment and Harm Reduction Problem heroin users when seeking help for addiction will usually be offered methadone as a substitute. It is a synthetic opioid which has its own harms and risks but is preferable to injecting street heroin. It is a green liquid which you drink so reducing the need for intravenous injection. It is less addictive than heroin and as it is prescribed medically, it reduces the need to turn to crime to fund drug use. It is also a consistent dose so allows those dependent to manage their addiction better and reduces the risk of overdose. It is however far from being a safe option; about 350 people die of methadone overdose per year. Maintaining a drug programme on methadone often means the users find it hard to achieve freedom from drugs. Even those who ‘kick the habit’ often take drugs like alcohol, cannabis and valium excessively. Others may be offered buprenorphine (Subutex/suboxone) which is taken under the tongue and stops withdrawal as well as blocking the effects of heroin. It is safer in overdose than methadone. A small number of long-term and stable heroin users are prescribed heroin itself sometimes under supervised injecting regimes (so-called ‘shooting galleries’). The UK was one of the first countries to recognise that simple measures such as providing clean needles and other items for injecting could substantially reduce the harm caused by heroin use, particularly in reducing the spread of HIV/AIDS. Drug centres providing clean needles are also a source of information and advice to users on how to seek treatment and stabilise their lives. The Law Heroin possession is often considered more serious than that of other Class A drugs like cocaine or ecstasy, and users are criminalised despite the behaviour of an addict who takes heroin being recognised by scientists and doctors as a symptom of a health issue over which addicts have limited control, rather than a choice to flout the law. Dealers in heroin can expect a custodial sentence. However there is also a considerable amount of heroin available in many prisons. So for addicts, being sent to prison will not necessarily shut off supply and stop addiction. |