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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 can be a white or brown powder, or a black sticky substance known as black tar heroin.
Prescription opioid pain medicines such as OxyContin® and Vicodin® have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use. Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin1-3 and about 80 percent of people who used heroin first misused prescription opioids.1-3 More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.4
People who inject drugs such as heroin are at high risk of contracting the HIV and hepatitis C (HCV) virus. These diseases are transmitted through contact with blood or other bodily fluids, which can occur when sharing needles or other injection drug use equipment. HCV is the most common bloodborne infection in the Unites States. HIV (and less often HCV) can also be contracted during unprotected sex, which drug use makes more likely.
When people overdose on heroin, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage.
Heroin is highly addictive. People who regularly use heroin often develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. A substance use disorder (SUD) is when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home. An SUD can range from mild to severe, the most severe form being addiction.
Pain relievers with an origin similar to that of heroin. Opioids can cause euphoria and are often used nonmedically, leading to overdose deaths. For more information, see the Misuse of Prescription Drugs Research Report.
Internationally, overdose is the primary cause of death among people injecting drugs. However, since 2001, heroin-related overdose deaths in the United States (US) have risen sixfold, paralleled by a rise in the death rate attributed to synthetic opioids, particularly the fentanyls. This paper considers the adaptations some US heroin injectors are making to protect themselves from these risks.
The use of drug sampling as a means of preventing an overdose from injection drug use reduces the quantity absorbed at any one time allowing users to monitor drug strength and titrate their dose accordingly. Given the highly unpredictable potency of the drugs currently being sold as heroin in the US, universal precautions should be adopted more widely. Further research is needed into facilitators and barriers to the uptake of these drug sampling methods.
For many decades, overdose has been the primary cause of deaths among people injecting drugs [6, 9, 29,30,31,32], but since 2001, heroin-related overdose deaths have risen sixfold in the United States [33]. Heroin-related overdose intensified after 2010, with overdose mortality rates tripling between 2010 and 2014 from 1.0 to 3.4 per 100,000 [34]. The increase in heroin-related deaths has been paralleled by a rise in the death rate attributed to synthetic opioids other than methadone. The age-adjusted rate of overdose deaths attributed to synthetic opioids other than methadone, which includes fentanyl and its analogs, doubled between 2015 and 2016, rising to 6.2 per 100,000 [35]. Evidence from the US Drug Enforcement Agency indicates this i

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