One of the main risks associated with heroin found on the street is that it is rarely pure.
It is estimated that street heroin on average contains approximately 7%-10% pure heroin. The maximum percentage of street heroin that is pure is about 20%, with the remainder consisting of diluents and adulterants.
The content of street heroin varies from region to region.
This is because a wide range of substances can be added for different reasons.
Adulterants, such as powerful synthetic opioids like fentanyl and carfentanil are added to heroin to mimic its effects or increase the potency of the drug.
On the other hand, diluents with similar properties to heroin such as quinine and paracetamol are added to maximise profits or enhance the efficiency of the drug with regard to administration.
Heroin may also contain impurities having been contaminated by substances that are unintentionally added during the manufacturing stage.
Alternatively, heroin may come into contact with contaminating substances during the packaging stage.
This uncertainty regarding specific content is a big part of what makes street heroin so dangerous.
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Heroin, referred to chemically as diacetylmorphine, is an illicit semi-synthetic street drug of the opioid class.
Heroin is considered semi-synthetic as it is partially derived from the naturally occurring opium poppy plant.
Classified as a schedule 1 substance, heroin has no currently accepted medical use and has a high potential for addiction.
Pure heroin, which contains approximately 85-95% diacetylmorphine, comes as a fine white powder.
Street heroin – which is never pure – varies in form and colour due to the presence of diluents and adulterants that alter its chemical structure.
Heroin can be injected, snorted, or smoked depending on the type of heroin it is.
The use of diluents, which are typically relatively harmless, makes a lot of sense financially.
Cutting heroin with these non-pharmacologically active substances allows manufacturers to make higher quantities of the product at a lesser expense.
Also, using diluents that are the same colour as heroin can be an astute way of masking what could be a poor quality product.
Diluents used to cut heroin may include the following:
Most of the time, adulterants are added to intensify the pleasurable sensations typically associated with the heroin “rush”.
Adulterants added to heroin may include the following:
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Heroin comes in three different forms: White heroin, brown heroin, and black tar heroin.
The properties and characteristics of these different types of heroin determine how each is used and where they are distributed.
These properties and characteristics include:
A more comprehensive insight into the three different types of heroin is provided below:
Black tar heroin, which comes from Mexico and Central America, has a sticky consistency and is sold almost exclusively in the United States.
It is estimated that in 2014, 79% of US heroin was sourced from Mexico, which is 15% more than it was 10 years earlier.
Sucrose is often used in the making of black tar heroin in particular and is responsible for its sticky texture.
Because black tar heroin comes in solid form, it weighs heavier and also has a higher volume.
Black tar heroin is distributed mostly by land routes in the U.S. because it is bigger than other forms of heroin.
It is wrapped in plastic and stored in small balloons for sale.
It is thought that black tar heroin may have a purity limit of around 30% based on how it is manufactured.
On average, black tar heroin is approximately 25 to 30% pure.
People who use black tar heroin typically administer it in one of three ways:
Despite the acidity of black tar heroin, it requires heat to go into an aqueous solution so that it can be injected.
Although black tar heroin is vaporisable and smokable, there is little evidence of heroin smoking in the U.S.
It is surmised that the acidity of black tar heroin irritates users’ mucosa that lines various cavities in the body.
Black tar heroin can be insufflated by dissolving in water, and with the aid of a spray bottle, snorting the heroin through the nose.
However, this method of administration is not very popular among users, likely because of the irritation it causes.
The use of black tar heroin, in particular, has been associated with several medical complications, including:
To prevent medical complications such as those outlined above, scientists have made the following recommendations to reduce harm in injectors of black tar heroin:
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Brown heroin comes as a coarse powder from Southwest Asia, particularly the countries of Pakistan and Afghanistan, and is sold predominantly in Europe.
Columbian heroin, which is sold largely in the United States, can also be light brown.
People using brown heroin in Europe for the first time usually smoke it.
This is because brown heroin does not dissolve very easily, and simply placing it into water and heating or shaking it to inject merely produces bubbles which could be very dangerous to inject.
Users of brown heroin often administer it via a method known as “Chasing the Dragon.”
This is a method of smoking whereby heroin is heated on a piece of aluminium foil and the vapour this produces is inhaled.
This is much easier than injecting brown heroin, as it needs to be acidified into its basic form by the addition of one of citric, acetic, or ascorbic acid and heated to aid solubility for injection.
It is suggested that users of brown heroin have may have lower levels of Human Immunodeficiency Disorder (HIV) for several reasons:
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White heroin comes from Southeast Asia in powder form and is mostly sold in Australia and Canada.
Because white heroin comes in powder form, as does most of the world’s heroin, it weighs quite light and has a lower volume.
In its purest form, white powder heroin is a salt form of heroin.
Generally speaking, the whiter the heroin the purer it is likely to be.
White heroin is distributed mostly by air transport over very large distances to destinations in Canada and Australia.
It is placed in folds of glassine paper or sealed in plastic baggies for sale.
White powder heroin can be snorted or misted as a solution.
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A relatively new type of heroin, called cheese heroin, made by mixing black tar heroin and crushed Tylenol PM tablets (sleeping tablets), has emerged in recent years as a significant public health concern.
Cheese heroin comes as a light brown powder that is somewhat granular in texture and gets its name from its similar appearance to grated cheese.
Regarding administration, cheese heroin is usually snorted through the nose.
Cheese heroin is highly addictive.
Its low purity level of approximately 1-3% means that it wears off quite quickly and thus rapidly initiates the onset of withdrawal.
It is estimated that cheese heroin represents over 30% of total drug use among students in the U.S.
Before heroin users experience any long-term mental effects, they first develop a tolerance to the drug.
Tolerance means that people require larger and larger quantities of heroin to bring about the desired euphoric rush
This is because the effectiveness of heroin lessens over time as the body gets used to it.
Eventually, people may become dependent on heroin and suffer challenging withdrawal symptoms if they don’t have access to it.
Withdrawal symptoms take hold because of how heroin renders the brain unable to regulate its functioning and neurochemistry.
After a long period of dependence, heroin users report no longer experiencing pleasure from the drug, so they use it merely to keep withdrawal symptoms at bay.
Addiction to heroin can set in within approximately just two weeks of use, and withdrawal symptoms typically start between 6 and 12 hours after the last dose, are their most severe after 2-3 days, and usually last for about a week.
The severity of withdrawal symptoms depends on several factors, including method of administration, duration of use, level of dependence, and their usual dose.
Heroin withdrawal symptoms typically include:
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Although it can be difficult to recover from heroin addiction, it is possible.
Several options can help to make the detox and recovery process as seamless as possible.
When opting to attend addiction treatment, it is vitally important to be certain that your chosen treatment facility is reputable, safe, and highly successful.
There are two available treatment options for heroin addiction: inpatient treatment and outpatient treatment. Both options are explored in greater detail below:
Inpatient is more popular than outpatient treatment for people addicted to heroin.
Those who opt for inpatient treatment stay in a residential facility for up to 90 days, where they receive 24-hour medical care and any social resources they may require.
Upon admission to the facility, patients are medically screened and supervised by medical professionals for the duration of the detox period.
Medical supervision is vitally important during detox, as this is the most critical period for patients.
A strong advantage of inpatient treatment is that patients can access specialist medications under the guidance and observation of medical experts, which increases the likelihood of full recovery.
Patients will then undergo a range of different therapies during their treatment, often including addiction counselling, cognitive behavioural therapy, motivational interviewing, and holistic therapies.
Patients may also have access to recreational facilities, such as spa and gym facilities.
Although inpatient treatment is quite structured and typically more intensive than outpatient treatment, it is more successful and gives people the best possible chance of making a full recovery.
At the end of inpatient treatment, patients are usually referred to an extensive aftercare program where new, healthy thought patterns and behaviours are reinforced and consolidated.
Outpatient treatment is offered as an effective alternative for people whose addiction is perhaps not too severe.
The decision as to whether an outpatient programme is deemed an appropriate treatment option for the individual is made by medical professionals after careful screening.
The main difference between inpatient and outpatient treatment is that patients do not live at a residential inpatient facility.
Instead, patients continue to live at home and commute to the treatment facility to attend regular appointments.
Those who opt for outpatient treatment can still avail of all the same therapy options and have the same access to medications, however, medications will be taken at home without medical supervision.
Attending therapy sessions can be very important for patients as it trains them to gain control over impulses, and also enables them to effectively regulate challenging emotions that are often experienced in recovery.
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According to addiction experts, medication-assisted treatment is the best way to treat people with an addiction to heroin.
Medications can make the detoxification process significantly easier and safer, diminishing the negative effects of withdrawal symptoms.
Medications used in the treatment of heroin addiction include:
Methadone binds to the same opioid receptors that heroin does.
The effects of methadone are long-lasting, and help to nullify the unwanted side-effects associated with heroin withdrawal.
It is taken orally, meaning that it takes longer to reach the brain, and as a result, does not initiate immediate effects like heroin.
There are many studies displaying the efficacy of methadone to treat heroin addiction
In particular, methadone seems to be especially effective at inducing tolerance to block the immediate pleasurable effects of heroin.
Although methadone-assisted treatment is safe, it should be prescribed as a short-term treatment and does require careful medical supervision due to its addictive potential.
Buprenorphine works similarly to methadone but binds only partially to opioid receptors, and so its opioid-like effects are not as pronounced.
As buprenorphine is not as strong as methadone, it has a lower potential for abuse or overdose.
Despite its relatively weak opioid effects, buprenorphine is still very effective in terms of alleviating withdrawal symptoms and preventing relapse.
It is recommended that buprenorphine be administered as soon as withdrawal symptoms appear if possible, but no less than 6 hours after the patient last used heroin.
Suboxone is a combination of buprenorphine and naloxone, an opioid receptor antagonist that blocks the effects of opioids.
Suboxone can be administered sublingually or orally.
The presence of naloxone in the medicine prevents the onset of the high typically associated with heroin use.
Naltrexone is an opioid receptor antagonist like naloxone that is used to block the effects of opioids.
Naltrexone has no sedative effect and no potential for abuse or dependence.
Unfortunately, the widespread use of naltrexone has been limited due to an unwillingness among patients to comply.
Heroin addiction is a devastating disease to struggle against, regardless of what specific type of heroin an individual is addicted to.
It is one of the most widespread and impactful parts of the worldwide opioid epidemic, supporting an international illegal industry and destroying tens of thousands of lives each year.
Whatever the causes behind your addiction, you deserve to get help.
Our expert team is ready and waiting to guide you towards the best treatment available for your unique needs.
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Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
