Skip Navigation
Random Student Drug Testing Random Student Drug Testing ONDCP Seal Search


RSDT ONDCP
Overview Drug Testing Works Program Development

Heroin

Overview / Extent of Use / Health Effects / Treatment / Arrests & Sentencing / Production & Trafficking / Legislation / Street Terms / Other Links / Sources

Overview

Heroin is a highly addictive drug and is the most widely abused and most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. 1

Pure heroin, which is a white powder with a bitter taste, is rarely sold on the streets. Most illicit heroin is a powder varying in color from white to dark brown. The differences in color are due to impurities left from the manufacturing process or the presence of additives. Another form of heroin, "black tar" heroin, is primarily available in the western and southwestern U.S. This heroin, which is produced in Mexico, may be sticky like roofing tar or hard like coal, with its color varying from dark brown to black. 2

Heroin can be injected, smoked, or sniffed/snorted. Injection is the most efficient way to administer low-purity heroin. The availability of high-purity heroin, however, and the fear of infection by sharing needles has made snorting and smoking the drug more common. National Institute on Drug Abuse (NIDA) researchers have confirmed that all forms of heroin administration are addictive. 3

Top

Extent of Use

According to the 2006 National Survey on Drug Use and Health (NSDUH), approximately 3.8 million Americans aged 12 or older reported trying heroin at least once during their lifetimes, representing 1.5% of the population aged 12 or older. Approximately 560,000 (0.2%) reported past year heroin use and 338,000 (0.1%) reported past month heroin use. 4

The 2006 NSDUH results also indicate that there were 91,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. The average age at first use among recent initiates aged 12 to 49 was 20.7 years in 2006. There were no significant changes in the number of initiates or in the average age at first use from 2005 to 2006. 5

Among students surveyed as part of the 2007 Monitoring the Future study, 1.3% of eighth graders and 1.5% of tenth and twelfth graders reported lifetime use of heroin. 6

Percent of Students Reporting Heroin Use, 2007

8th Grade
10th Grade
12th Grade

Past month use

0.4%

0.4%

0.4%

Past year use

0.8

0.8

0.8

Lifetime use

1.3

1.5

1.5

Approximately 76.4% of eighth graders, 84.2% of tenth graders, and 73.9% of twelfth graders surveyed in 2007 reported that using heroin occasionally without a needle was a “great risk.” Additionally, approximately 87.8% of twelfth graders surveyed in 2007 reported that using heroin regularly was a “great risk.” 7

Percent of Students Reporting Risk of Using Heroin, 2007

Percent Saying “Great Risk”
8th Grade
10th Grade
12th Grade

Try once/twice w/o needle

60.3%

70.5%

60.2%

Use occasionally w/o needle

76.4

84.2

73.9

Regarding the ease by which one can obtain heroin, 12.6% of eighth graders, 17.3% of tenth graders, and 29.7% of twelfth graders surveyed in 2007 reported that heroin was "fairly easy" or "very easy" to obtain. 8

The Centers for Disease Control and Prevention (CDC) also conducts a survey of high school students throughout the United States called the Youth Risk Behavior Surveillance System (YRBSS) . Among students surveyed for the 2007 YRBSS, 2.3% reported using heroin at least one time during their lifetimes. 9

Percent of Students Reporting Lifetime Heroin Use, 2003-2007

2003
2005
2007
9th grade
3.5%
2.8%
2.6%
10th grade
2.9
2.5
1.8
11th grade
3.0
1.8
1.8
12th grade
2.9
2.0
2.6
Total
3.3
2.4
2.3

Approximately 0.7% of college students and 1.9% of young adults (ages 19-28) surveyed in 2006 reported lifetime use of heroin. 10

Percent of College Students/Young Adults Reporting Heroin Use, 2005–2006

College Students
Young Adults
2005
2006
2005
2006
Past month 0.1%
0.2%
0.1%
0.2%
Past year 0.3
0.3
0.4
0.4
Lifetime 0.5
0.7
1.7
1.9

According to data from the Bureau of Justice Statistics, approximately 23.4% of State prisoners and 17.9% of Federal prisoners surveyed in 2004 indicated that they used heroin/opiate at some point in their lives. 11

Percent of Prisoners Reporting Heroin/Opiate Use, 1997 and 2004

State Prisoners
Federal Prisoners
1997
2004
1997
2004
At time of offense 5.6%
4.4%
3.0
3.2
In month before offense 9.2
8.2
5.4
5.8
Regularly* 15.0
13.1
8.9
9.2
Ever in lifetime 24.5
23.4
16.1
17.9
* Used drugs at least once a week for at least a month.

Top

Health Effects

The short-term effects of heroin abuse appear soon after taking the drug. Intravenous injection provides the greatest intensity and most rapid onset of the initial rush that users experience. Intravenous users typically experience the rush within 7 to 8 seconds after injection, while intramuscular injection produces a slower onset of this euphoric feeling, taking 5 to 8 minutes. When heroin is sniffed or smoked, the peak effects of the drug are usually felt within 10 to 15 minutes. 12

In addition to the initial feeling of euphoria, the short-term effects of heroin include a warm flushing of the skin, dry mouth, and heavy extremities. After the initial euphoric feeling, the user experiences an alternately wakeful and drowsy state. Due to the depression of the central nervous system, mental functioning becomes clouded. 13 Additionally, breathing may be slowed to the point of respiratory failure. 14

After repeatedly using heroin for a period of time, the long-term effects of the substance begin to appear in the user. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver disease. Additionally, pulmonary complications, including various types of pneumonia, may also result in the user. 15

One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity or effect that they are seeking. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop. 16

Within a few hours after the last administration of heroin, withdrawal may occur. This withdrawal can produce effects such as drug craving, restlessness, muscle and bone pain, and vomiting. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. 17

In addition to the effects of the drug itself, users who inject heroin also put themselves at risk for contracting HIV, hepatitis C (HCV), and other infectious diseases. Approximately 70–80% of the new HCV infections in the U.S. each year are among injection drug users. 18

Street heroin is often mixed with various substances, including sugar, starch, quinine, and sometimes, strychnine or other poisons, causing an added danger to using heroin. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at a great risk of overdose or death. 19

Of an estimated 108 million emergency department (ED) visits in the U.S. during 2005, the Drug Abuse Warning Network (DAWN) estimates that 1,449,154 were drug-related. DAWN data indicate that heroin was involved in 164,572 ED visits. 20

Treatment

A variety of effective treatments are available for heroin addiction. For example, methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has proven successful for heroin addiction. Additionally, buprenorphine and many behavioral therapies are also used to treat heroin addiction. 21

From 1996 to 2006, the number of admissions to treatment in which heroin was the primary drug of abuse increased from 224,366 in 1996 to 245,984 in 2006. Heroin admissions represented 13.6% of the total drug/alcohol admissions to treatment during 1996 and 13.7% of the treatment admissions in 2006. The average age of those admitted to treatment for heroin during 2006 was 36 years. Those admitted to treatment for heroin during 2006 were primarily male (68%) and white (52%). 22

Top

Arrests & Sentencing

During FY 2004, there were 32,980 Federal arrests for drug law violations, 1,881 of which were for heroin. Additionally, the Drug Enforcement Administration (DEA) reported 2,273 arrests for opiates in FY 2004. 23

During FY 2006, there were 1,576 Federal offenders sentenced for heroin-related charges in U.S. Courts. Approximately 97.8% of the cases involved trafficking. 24

Top

Production & Trafficking

The U.S. heroin market is supplied entirely from foreign sources of opium. Heroin available in the U.S. is produced in four distinct geographical areas: South America (Colombia), Southeast Asia (primarily Burma), Mexico, and Southwest Asia (principally Afghanistan). 25

Afghanistan produced more than 90% of the world's opium poppy during 2006, and is the world's largest heroin producing and trafficking country. However, Mexican processors and growers supply a large share of the heroin distributed in the United States, even though Mexico produces a relatively small percentage of the global supply of opium poppy and heroin. Additional intelligence indicates that Colombia is the primary source of heroin used east of the Mississippi River. 26

According to 2006 Federal-wide Drug Seizure System (FDSS) data, Federal agencies seized 1,774 kilograms of heroin. 27 FDSS contains information about drug seizures made within the jurisdiction of the United States by the DEA, Federal Bureau of Investigation, U.S. Customs Service, U.S. Border Patrol, and U.S. Coast Guard. 28

Top

Legislation

Heroin was first synthesized from morphine in 1874 and became widely used in medicine in the early 1900s. At that time, physicians were unaware of heroin's potential for addiction. The first comprehensive control of heroin in the U.S. occurred with the Harrison Narcotic Act of 1914. Heroin currently falls into Schedule I of the Controlled Substances Act based on its potential for abuse and its lack of accepted medical use. 29

Top

Street Terms 30

Common Terms Associated with Heroin

Term Definition
Term
Definition
A-bomb Marijuana mixed w/heroin
Hell dust
Heroin
Big H Heroin
Nose drops
Liquefied heroin
Dragon rock Heroin mixed w/cocaine
Smack
Heroin

Top

Other Links

A Collection of Articles That Address Research on Heroin
This resource presents links to and full text of National Institute on Drug Abuse (NIDA) research articles concerning heroin.

Breaking Heroin Sources of Supply
This fact sheet provides an overview of efforts to reduce domestic heroin availability.”

Buprenorphine Physician Locator
This on-line resource assists individuals in locating physicians who can prescribe buprenorphine (Suboxone® and Subutex®) for treatment of opioid addiction.

“Cheese” Heroin
This fact sheet provides information about “Cheese” or “starter heroin.” "Cheese" is a street term that refers to the combination of heroin and ground up cold medicine (Tylenol PM) containing acetaminophen and diphenhydramine. The mixture is a tan powder that is snorted.

Heroin Movement Worldwide
This Central Intelligence Agency (CIA) Web site provides information about heroin production, consumption, and trafficking.

Heroin Publications
This site presents a listing of heroin-related publications from various sources.

Methadone Fact Sheet
This fact sheet provides an overview of issues dealing with methadone treatment.

Price and Purity of Illicit Drugs: 1981 Through the Second Quarter of 2003
This report extends, improves, and augments previous estimates of trends in the price and purity of five major illicit drugs, including heroin.

Proceedings from the Fentanyl-Laced Heroin Demand Reduction Forum
On July 28, 2006 ONDCP convened a forum to bring together law enforcement and public health officials, prevention specialists, and treatment providers from Federal, State, and local governments to discuss the public health threat and response techniques arising from the recent deaths related to fentanyl-laced heroin.

Substance Abuse Treatment Facility Locator
This on-line resource can be used to locate drug/alcohol treatment programs throughout the United States.

Top

Sources

1 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report , May 2005

2 Drug Enforcement Administration, Drugs of Abuse , 2005

3 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report , May 2005

4 Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health: National Findings , September 2007

5 Ibid.

6 National Institute on Drug Abuse and University of Michigan, 2007 Monitoring the Future Study Drug Data Tables, December 2007

7 Ibid.

8 Ibid.

9 Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance: Youth Online: Comprehensive Results

10 National Institute on Drug Abuse and University of Michigan, Monitoring the Future National Survey Results on Drug Use, 1975-2006, Volume II: College Students & Adults Ages 19-45 (PDF), 2007

11 Bureau of Justice Statistics, Drug Use and Dependence, State and Federal Prisoners, 2004 , October 2006

12 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report , May 2005

13 National Institute on Drug Abuse, InfoFacts: Heroin , June 2007

14 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report , May 2005

15 National Institute on Drug Abuse, InfoFacts: Heroin , June 2007

16 Ibid.

17 Ibid.

18 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report , May 2005

19 Ibid.

20 Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits , March 2007

21 National Institute on Drug Abuse, Heroin Abuse and Addiction Research Report , May 2005

22 Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Highlights—2006 , February 2008

23 Bureau of Justice Statistics, Compendium of Federal Justice Statistics, 2004, December 2006

24 United States Sentencing Commission, 2006 Sourcebook of Federal Sentencing Statistics , 2007

25 Drug Enforcement Administration, Drugs of Abuse , 2005

26 U.S. Department of State, International Narcotics Control Strategy Report, 2007 , March 2007

27 National Drug Intelligence Center, National Drug Threat Assessment 2008 , October 2007

28 Drug Enforcement Administration, Federal-wide Drug Seizure System, as reported in Sourcebook of Criminal Justice Statistics

29 Drug Enforcement Administration, Drugs of Abuse , 2005

30 Office of National Drug Control Policy, Street Terms: Drugs and the Drug Trade

Top