Heroin

Pharmaceutically manufactured heroin is a pure white powder, which can be made into tablets and ampoules, or as a linctus. Street heroin is usually a brown or beige powder. Or more rarely as a white powder (Chinese no. 4, or 'China White').

Desired Effects:

• Intense rush
• Euphoria
• Exhilaration
• Relaxation and decreased anxiety
• Feelings of warmth and wellbeing.

Side Effects:

• Nausea and vomiting
• Drowsiness
• Decreased heartrate.
• Shallow breathing
• Coma sometimes fatal.

You can never be sure of the purity of heroin or what it is cut with. While the purity of street heron has always fluctuated, heroin has recently been adulterated synthetic opioids called ‘nitazenes’, which increases the risk of overdose.

• Smoking heroin is safer than injecting intravenously; chasing heroin gives the user a hit like injecting as it gets into the bloodstream quickly, and it is far safer.
• If you do inject, always use clean needles and injecting equipment (heroin cookers, water pots, swabs etc). You can access these from needle exchanges, drug agencies and pharmacies; this can protect you from blood borne viruses like Hepatitis B & C and HIV.
• Use test strips to check for adulteration with ‘nitazenes’, fentanyl or other drugs (available from your local drug service).
• Never share your needles or works with anyone else, no matter how well you know them.
• If you inject, learn how to inject yourself using the safest technique. Injecting with poor technique is one of the riskiest things you could ever do and can be extremely damaging to your body causing problems such as abscesses, infections, blood clots & deep vein thrombosis (DVT), or hitting an artery. You can contact drug services and needle exchanges for advice on safer injecting.
• If you are going to inject, use sterile vitamin C or citric acid acid rather than lemon juice or vinegar as these can damage veins and cause other health problems. Sachets of citric and Vitamin C are available for needle exchanges.
• Mixing heroin with other drugs can increase the risk of overdose, especially drugs like alcohol, benzo's, pregabalin and gabapentin and methadone.
• Speed balling (using heroin and crack together) can lead to an extreme decline in your health and lifestyle.
• Avoid using alone as there is nobody around to help if you overdose.
• If you have had a break from using, your tolerance will be significantly lower and you are at a greater risk of overdose.
• If you suspect someone has overdosed, put them in the recovery position and call for emergency help immediately.
• Always carry Naloxone. Naloxone temporary reverses the effects of heroin (and other opioids) overdose – Naloxone Saves Lives.

Long term risks:

Dependence and effects of long term use.

Most heroin deaths involve one or more drugs and among people over 40 with long-term poor physical and mental health who have been using for decades or more.

Short term risks:

• Overdose. Opioid deaths make up the largest proportion of drug-related deaths and have more than doubled since 2012. In England and Wales in 2024, 2,621 deaths involved opioids, 1,415 of these involved heroin, although most heroin deaths involve more than one drug.
• While there are risks involved in smoking heroin, injecting can damage circulatory system, leading to abscesses, ulcers, thrombosis.
• Sharing injection equipment can lead to contracting blood borne viruses like Hep B, Hep C and HIV.

Central nervous system depressant, analgesic.

Class A under the Misuse of Drugs Act.

Smoked on foil ('tooting', 'chasing' or 'chasing the dragon'), Injected, snorted up the nose.

If snorted:
Razor blade, hard level surface (such as a mirror or glass), tube or rolled banknote.

If smoked:
Tinfoil, matches or lighter, cigarette papers, tobacco.

If injected:
Needle and syringe, water, citric acid, matches or lighter, spoon, tourniquet, swabs.

In its pharmaceutical form as Diamorphine to treat extreme pain eg. terminal cancer.

Heroin is derived from the opium poppy, which grows in many parts of the world. The main centres of illicit production include the border regions of Iran, Afghanistan, and Pakistan (known as the Golden Crescent), and around the borders of Thailand, Burma and Laos (known as the Golden Triangle). Most heroin in the UK came from Afghanistan, but since a crackdown on production by the Taliban regime in 2022, heroin is increasingly coming from surrounding countries.

Heroin users can access support from ‘street agencies’ or projects, sometimes called community drug services or community drug teams, which offer a range of services including information and advice, counselling, detoxification and prescribing for opiate users, needle exchanges and sometimes support groups and other services such as acupuncture. Some may have extended opening hours and may be open at weekends. GPs and hospitals can make referrals to specialist drug services like Drug Dependency Units (DDUs). These are usually located in or adjacent to a hospital and specialise in helping problem drug users, especially people who are dependent on drugs like heroin. They provide counselling, detoxification, substitute prescribing and other treatments. Residential services offer treatment programmes for heavily dependent drug users who are trying to give up. Residents must usually be drug free on admission which means they usually have to undergo detoxification before entry. Programmes usually last 3-6 months, but some 12 steps programmes last longer. The types of programmes vary. Self help groups like Narcotics Anonymous (NA) co-ordinate local support groups for problem drug users around the country. Families Anonymous run similar groups for the families of drug users. Many heroin users are referred for treatment through the criminal justice system.

Parents & other relatives

Drug agencies also provide lots of advice and support to parents of people using these drugs. Many street agencies can provide relative support groups or counselling for family members, partners etc.