Due to the variations in quality and purity of heroin batches at street level (2-3% - 98%*), estimating a mean dosage is at best an approximation, and at worse dangerous. Many users new to the heroin experience will initially share with a more experienced user, either by
snorting or smoking, and titrate the dose according to the initial effects.
Added to this the often unscrupulous drug dealers attempts to increase profitability by adding adulterants, or "cutting" the heroin with a variety of other pharmaceuticals, and/or inactive or dangerous substances, the issues of suggested doses for first time users becomes almost impossible.
Experienced users will also need to titrate their doses as tolerance increases, and more heroin is needed to produce euphoric effects.
[top]Ways of administration
The onset of the effects of heroin is dependent on route of administration determined by bioavailability- or the percentage of the unchanged drug that enters the bloodstream. When a drug is injected intravenously, bioavailability is 100%. Other methods of administration decrease the amount of the drug which enters the systemic circulation due to incomplete absorption or first-pass metabolism via the liver. Studies have shown users subjective experience of the pleasure of heroin use is in part determined by the speed at which the blood level of the drug increases [1a].
[top]Intravenous (I.V) Injection
Heroin can be injected directly into a vein, a practice colloquially termed ‘digging’ or ‘shooting up’. Users report the onset of an intense rush within 7 to 8 seconds of administration, as heroin rapidly passes the blood-brain barrier. Bioavailability is 100%.
[top]Intramuscular (I.M) Injection
An injection directly into the muscle, with an onset within 5-10 minutes. Bioavailability is 85%.
[top]Subcutaneous Injection
This method refers to injecting under the outer layer of the hypodermis, often referred to as ‘skin-popping’.
[top]Insufflation
Heroin can be administered through nasal
insufflation, commonly referred to as ‘snorting’, ‘railing’ or ‘banging’. Peak effects can be felt within 10-15 minutes, as the heroin is quickly absorbed into the bloodstream through the soft tissue in the mucous membrane.
[top]Smoking or Inhaling
This method is also referred to as ‘chasing the dragon’ and involves gently heating the heroin on aluminum foil and inhaling the smoke and vapours through a tube. Heroin can also be smoked with
tobacco in a rolled cigarette. Onset times are similar to insufflation, and similarly, bioavailability is around 52%.
[top]Rectal Administration
A lesser-used method also known as "
plugging", considered by users a safer alternative to injecting. Heroin is absorbed through the rectal membrane, and effects can be felt within 10-15 minutes and peak at around 30-50 minutes.
[top]Oral Administration
Heroin is rarely taken orally, as onset of effects can take a minimum of 30 minutes, and users often report the absence of a intense ‘rush’ with this route of administration. Bioavailability decreases to 35%.
Although most first time users will smoke heroin, this can often progress to intravenous use when heroin purity or tolerance reduces the effect of the drug when smoked, forcing users to switch to IV use; where the least amount of drug can be used for maximum effects.
[top]Effects of Heroin
The effects of heroin include
euphoria, a sense of warmth and well-being, a feeling of being disconnected from the real world, drowsiness, relaxation, drooping eyelids, somnolence. These effects can last for several hours. Following the initial rush of euphoria, the user may become very drowsy and relaxed, slipping in and out of consciousness in an alternately wakeful and drowsy state. This is known as “nodding” or “gouching”. Mental functioning becomes clouded, and the ability to complete simple tasks may be compromised. Other effects include slowed and slurred speech, a dry mouth, itchiness, constricted (or “pinned”) pupils, nausea, vomiting and constipation. Paradoxically to the common sedative effects, some new heroin users report that the drug gives them a feeling of increased energy. Some artists and writers have claimed that their heroin use provided them with bursts of creativity, but many other users firmly believe that the drug stems artistic and creative talent.
If a withdrawing
addict uses heroin, on administration they will feel a rush of instant relief, euphoria, happiness, analgesia and lack of worry. When addiction, tolerance and dependence develop, an addict will require heroin to be able to even function properly in normal, day to day life. In this situation, using heroin serves mainly to restore normality, and to ease the pain of
withdrawal. As dependence develops, as does a tolerance to some of the effects of heroin, such as its sedative effects, itching and nausea. It seems that tolerance does not have a great bearing on constipation, however, and many long term addicts report ongoing problems with constipation.
Heroin is a central nervous system depressant. This accounts for its sedative effects, as well as lowered blood pressure, depressed respiration and slowed, shallow breathing. The drug also works as a very effective analgesic, acting as a strong pain killer.
It may be difficult to rouse someone who is nodding as a result of taking heroin, but they should be responsive to
audio and physical stimuli. If it is not possible to gain a reaction from a heroin user, and they are unresponsive to their name being called or to physical stimuli, then medical help is required, as it is likely that they have overdosed.
Negative effects associated with heroin use include a high risk of dependence, addiction and withdrawal. There is a high risk of overdose if one injects, this is the most dangerous route of administration. It must also be noted that it is still very possible to overdose through snorting heroin, but is less likely than if one injects. Smoking heroin is the least dangerous route of administration, but for non tolerant users there is still a small risk of overdose, although it is less likely that an overdose via this method of administration would be deadly.
If a heroin user injects, a wide range of injection-related health risks must also be taken into account. Although much safer than injecting, smoking and snorting are by no means harmless. The normal risks connected to these route of administration exist, such as respiratory problems for smoking, and sinus infections for snorting. For a more comprehensive explanation of the risks associated with heroin use, please see 'The Dangers of Heroin'.
[top]Combinations with Heroin
Ideally, heroin should not be combined with any other psychoactive drug, but realistically it is understandable that many users will do so, thereby increasing the risk of complications and death. Research by the Drug Abuse Warning Network reported an average of 2.7
drugs were present in fatal overdose cases, and although no single drug was found at a lethal dose, the synergistic effects of combination can themselves be lethal. [5] Some of the drugs more commonly used in combination with heroin include:
Usually injected intravenously with heroin- a practice known as "
speedballing"- this combination is incredibly euphoric and has been described by many users as a full body/mind orgasm. Speedballing has a reputation for inducing an intense and powerful high. However, it is a very dangerous combination, as the use of a depressant (heroin) and a stimulant (
cocaine) concurrently can cause major cardiac problems, up to and including heart attack and fatal overdose. In recent years, Hollywood actors John Belushi and River Phoenix died as a result of abusing this combination.
[top]Alcohol and benzodiazepines
The other most common combination among users who want to get really intoxicated, and are unaware of the dangers. Heroin, benzodiazepines and
alcohol are all central nervous system (CNS)
depressants. Mixing CNS depressants can be incredibly dangerous due to combined depression effects on the circulatory and respiratory systems. The user's breathing and circulation can slow to a stop, leading to respiratory and/ or cardiac arrest. Additionally, many benzodiazepines cause retrograde amnesia, meaning the user will forget they already took three pills, and soon a bottle of fifteen will be gone when the user still thinks they only took three. The majority of "heroin overdose" deaths are actually polydrug overdoses, and the additional drugs are usually benzodiazepines and/or alcohol, and sometimes cocaine.
[top]Various Psychedelics, etc.
The
psychedelic experience tends to overpower most aspects of heroin. If an addict is starting to get sick from lack of heroin during a trip, a dose should be administered (often, even long-time injectors will need help in this situation) or else there is a risk of the trip going bad, but recreationally mixing psychedelics or
empathogens with heroin is generally considered a waste of heroin.
Can add a pleasant floating feeling and euphoria to the already floaty and euphoric heroin high, but only in users that enjoy
marijuana. Many a comfortable, nodding heroin addict has had his/her high ruined by an
anxiety attack brought on by a few hits of marijuana.
[top]Different Uses for Heroin
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