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Heroin, also known as diamorphine among other names, is an opioid most commonly used as a recreational drug for its euphoric effects. It is used medically in several countries to relieve pain or in opioid replacement therapy. It is typically injected, usually into a vein, but it can also be smoked, snorted, or inhaled. The onset of effects is usually rapid and lasts for a few hours.
Common side effects include respiratory depression (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and addiction. Side effects of use by injection can include abscesses, infected heart valves, blood-borne infections, and pneumonia. After a history of long-term use, opioid withdrawal symptoms can begin within hours of the last use. When given by injection into a vein, heroin has two to three times the effect of a similar dose of morphine. It typically comes as a white or brown powder.
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In the United States, heroin is not accepted as medically useful.
Under the generic name diamorphine, heroin is prescribed as a strong pain medication in the United Kingdom, where it is administered via subcutaneous, intramuscular, intrathecal or intravenous routes. It may be prescribed for the treatment of acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain and chronic pain, including end-stage terminal illnesses. In other countries it is more common to use morphine or other strong opioids in these situations. In 2004 the National Institute for Health and Clinical Excellence produced guidance on the management of caesarean section, which recommended the use of intrathecal or epidural diamorphine for post-operative pain relief.
Diamorphine continues to be widely used in palliative care in the UK, where it is commonly given by the subcutaneous route, often via a syringe driver, if patients cannot easily swallow morphine solution. The advantage of diamorphine over morphine is that diamorphine is more fat soluble and therefore more potent by injection, so smaller doses of it are needed for the same effect on pain. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care.
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Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin is manufactured from opium poppies cultivated in four primary source areas: South America, Southeast and Southwest Asia, and Mexico. Although Afghanistan produces the majority of the world’s heroin, South American heroin has become the most prevalent type available in the U.S., particularly in the Northeast, South and Midwest. The particular form known as “black tar” from Mexico, a less pure form of heroin, is more commonly found in the western and southwestern United States. This heroin may be sticky like roofing tar or hard like coal, with its color varying from dark brown to black.