fact sheet - heroin use in South Africa
Fact sheet by:
Alcohol & Drug Abuse Research Group
Medical Research Council

What is heroin?

• Heroin (diacetylmorphine) is a semi-synthetic opiate which acts as a central nervous system (CNS) depressant and an analgesic.
• It is produced from morphine, which is extracted from the Asian poppy (Papaver somniferum)
• Heroin has the appearance of a white or brownish powder.

Modes of administration

• Historically, the main mode of heroin use has been through injection.
• Improvements in the purity of heroin and the fear of HIV have resulted in more new users snorting or smoking heroin.
• There is little culture of injection use in SA, with heroin users preferring to smoke heroin with dagga or inhale the vapours ("chasing the dragon").

Short-term effects

• Heroin acts on the opioid receptor sites in the brain, resulting in feelings of intense pleasure and a dulling of pain. This rush includes a flushing of the skin, a dry mouth, heaviness in the limbs, and may involve nausea, vomiting, and severe itching.
• These initial effects are accompanied by feelings of relaxation and drowsiness, dulling of mental functions, and slowed breathing and cardiac functions.
• The rush occurs within 7 to 8 seconds of intravenous heroin use and within a couple of minutes of snorting or smoking heroin.

Long-term effects

• With chronic use, psychological and physical addiction occurs and tolerance and craving for the effects of heroin develop. If heroin is not used regularly, the addicted user will experience withdrawal symptoms, for example hypothermia, stomach cramps, insomnia, diarrhoea, and vomiting.
• In large doses, heroin toxicity (overdose) may occur due to the depressant action of heroin on the CNS, which may lead to coma and potentially, death. The risk of overdosing increases with the concurrent use of other CNS depressants (such as alcohol), greater heroin dependence, and a longer history of heroin consumption.
• Injection drug users risk developing bacterial infections of the blood vessels, heart valves, and heart lining; collapsed veins; skin abscesses, wound botulism, and tetanus, from the use of unsterile or blunt needles.
• When used intravenously, contaminants in heroin may clog the blood vessels of vital organs, resulting in infection, loss of cell patches, or immune reactions (eg arthritis).
• Respiratory problems (eg pneumonia and tuberculosis).
• Reduction of body's ability to resist and fight infection.
• Use during pregnancy may place a child at risk for developmental difficulties. There is an increased risk of miscarriage, low birth weight, and foetal abnormalities.
• Indirect and direct sharing of injection equipment places the user at high risk for contracting HIV and other blood-borne viruses such as Hepatitis B, C, and G.
• There is a link between heroin use and trauma unit visits in the USA, with heroin being the primary drug involved in drug-related emergency room visits and mortality.
• There a link exists between heroin use and criminal activity in the USA and Europe, with heroin use being linked to property crime and crimes of violence. These crimes are often committed to support the heroin addiction.
• Adverse psychological consequences: impaired concentration, attention, and memory; impaired psychological development (especially for adolescents); together with impaired social and occupational functioning.

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