Heroin: History, Effects, and Treatment of Addiction

Introduction: Heroin Across Social Boundaries

Heroin, like all drugs, knows no social, ethnic, or economic barriers. Although most people think of a heroin addict as some "junkie" shooting up in an urban back alley, he or she is just as likely to be a corporate CEO or a high school student. Heroin users can be found throughout the world; they include all ages and races, rural and urban alike. Once prescribed for common respiratory ailments, heroin today is used as a potent painkiller in certain medical contexts, but when used illegally as a street drug, it can prove lethal.

Historical Origins and Early Medical Use

In 1898, a German chemical company founded by Friedrich Bayer marketed a new cough medicine called "Heroin" — a drug that now floods illegally throughout the world in record amounts. During the early nineteenth century, medicines were derived from natural materials such as opium, the dried milky substance of poppy seed pods. Friedrich Sertürner first applied chemical analysis to plant drugs by purifying the main active ingredient of opium, calling it "morphium" after the Greek god of dreams, Morpheus (Scott). In the late 1890s, Heinrich Dreser, head of Bayer's pharmacological laboratory, adopted this strategy to produce one of the world's most famous drugs — heroin — which was made by adding two acetyl groups to the morphine molecule (Scott). Heroin gets its name from the adjective heroisch (meaning "heroic"), which was often used by nineteenth-century German doctors to describe a powerful medicine (Scott).

In 1898, Dreser presented this new drug to the Congress of German Naturalists and Physicians as a cough, chest, and lung medicine, and it was rapidly adopted in medical establishments throughout Europe as an alternative to morphine and codeine (Scott). Even today, heroin is known to be more potent and faster acting than morphine because it travels more readily from the bloodstream into the brain (Scott).

Although hailed as a wonder drug, by the early twentieth century reports began to surface that heroin dosages had to be increased with usage to remain effective and that withdrawal symptoms were worse than those of morphine (Scott). In 1903, G.E. Pettey wrote in the Alabama Medical Journal that of the last 150 people he had treated for drug addiction, eight were dependent on heroin, yet most physicians were reluctant to abandon the drug (Scott). In 1911, J.D. Trawick wrote in the Kentucky Medical Journal, "I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend. I have used it with good results" (Scott).

Not surprisingly, the first generation of heroin addicts were middle-aged or older, typically suffering from chronic diseases such as tuberculosis or asthma (Simon). Moreover, they were middle-class or higher, since only those in the upper social circles could afford to be under a physician's care for such ailments, and only those under a doctor's care were exposed to heroin (Simon).

Regulation, Criminalization, and the Black Market

By the late nineteenth century, many European countries had enacted pharmacy laws to control dangerous drugs; however, under the United States Constitution, individual states were responsible for medical regulation (Scott). Although some state laws required morphine and/or cocaine to be physician-prescribed, the drugs could be easily obtained in bordering states. Moreover, many over-the-counter medicines still contained these drugs, including "soothing syrups" for crying babies (Scott). It is estimated that by the beginning of the twentieth century, there were over a quarter of a million Americans — from a population of 76 million — addicted to opium, morphine, or cocaine (Scott). President Woodrow Wilson signed the Harrison Narcotic Act in 1914, which allowed federal regulation of medical transactions in opium derivatives or cocaine (Scott).

In 1910, New York's Bellevue Hospital made its first admission for heroin addiction, and in 1915 it admitted 425 addicts, who were described in the Psychiatric Bulletin of the New York State Hospitals as gang members between seventeen and twenty-five years of age who took the drug by sniffing (Scott). After 1919, when the legal interpretation of the Harrison Act outlawed medical prescriptions of narcotics to maintain addicts, American drug abusers became totally dependent on black market sources. It was at this stage that heroin gained popularity among drug dealers, who recognized its potential as a compact and powerful substance that could be adulterated easily (Scott).

Also during this era, addicts discovered the enhanced euphoric effects of heroin when injected with a hypodermic syringe. By the early 1920s, many New York addicts supported their habit by collecting scrap metal from industrial dumps — hence the term "junkies" (Scott). In 1922, heroin was blamed for 260 murders in New York, leading the United States Congress to ban all domestic manufacture of heroin in 1924. Yet two years later, S.L. Rakusin, the U.S. Narcotic Inspector, declared that heroin seemed "more plentiful than it ever was before" (Scott). Organized crime syndicates were still buying heroin through legitimate pharmaceutical manufacturers in Western Europe, Turkey, and Bulgaria. By the early 1930s, restrictive policies of the League of Nations had driven many heroin manufacturers underground; however, Japan and its occupied territories continued to produce heroin on a massive scale until the end of World War II (Scott). Since that time, heroin has effectively belonged to the international crime market (Scott).

Patterns of Use and Physiological Effects

In 1992, the New York Times carried a front-page story about a successful businessman who was a regular heroin user (Sullum). The story began: "He is an executive in a company in New York, lives in a condo on the Upper East Side of Manhattan, drives an expensive car, plays tennis in the Hamptons and vacations with his wife in Europe and the Caribbean. But unknown to office colleagues, friends, and most of his family, the man is also a longtime heroin user." The man described heroin as relaxing and pleasurable, comparing it to a drink of alcohol: "The drug is an enhancement of my life. I see it as similar to a guy coming home and having a drink of alcohol. Only alcohol has never done it for me" (Sullum).

The National Household Survey on Drug Abuse reports that approximately three million Americans have used heroin during their lifetimes; of this number, 15% used it within the past year, while 4% used it in the previous thirty days (Sullum). A survey of high school seniors indicated that 1% had used heroin during the previous year, while 0.1% had used it on twenty or more days during the previous month (Sullum). According to the Drug Abuse Warning Network, 8% of drug-related emergency department visits during the last six months of 2003 involved heroin abuse (NIDA).

The National Institute on Drug Abuse (NIDA) reports that the short-term effects of heroin abuse appear shortly after a single dose and disappear within a few hours. An injection of heroin causes a surge of euphoria — typically called a "rush" — accompanied by a flushing of the skin, dry mouth, and a sensation of heavy extremities (NIDA). This initial euphoria is followed by an "on the nod" state, in which the user alternates between wakefulness and drowsiness as mental function is affected by depression of the central nervous system (NIDA).

Long-term effects of heroin use include collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease, while pulmonary complications may include various types of pneumonia, general poor health, and depressed respiration (NIDA). Research indicates that heroin abuse during pregnancy is associated with adverse consequences such as low birth weight and an increased risk for developmental delay (NIDA). Moreover, street heroin may contain additives that do not readily dissolve, which can result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain, potentially causing infection or destruction of small patches of cells in vital organs (NIDA).

Generally, heroin withdrawal symptoms include flu-like symptoms such as chills, sweating, runny nose and eyes, muscular aches, stomach cramps, nausea, diarrhea, and headaches (Sullum). Addicts who have developed a tolerance to the drug — and therefore require higher doses to achieve the desired effect — are known to actually volunteer to undergo withdrawal so that they can begin using again at a lower dose, thereby reducing the cost of their habit (Sullum). Heroin users commonly go through periods of abstinence and then return to drug use long after physical discomforts have subsided; therefore, the fear of withdrawal symptoms is not the essence of addiction (Sullum). In fact, it is a well-documented observation in drug treatment that detoxification is not equivalent to overcoming an addiction, and heroin addicts typically repeat detoxification programs before successfully ending their habit (Sullum).

Works Cited

From Flowers to Heroin. The Central Intelligence Agency. Retrieved July 07, 2006 at

Gupta, B.S. (1997, January 01). Personality characteristics of persons addicted to heroin. The Journal of Psychology. Retrieved July 07, 2006 from HighBeam Research Library.

Heroin. Street Drugs. Retrieved July 07, 2006 at http://www.streetdrugs.org/heroin.htm

NIDA InfoFacts: Heroin. (2006, April). National Institute on Drug Abuse. Retrieved July 07, 2006 at http://www.nida.nih.gov/Infofacts/heroin.html

Patalano, Frank. (1998, November 01). Cross-cultural similarities in the personality dimensions of heroin users. The Journal of Psychology. Retrieved July 07, 2006 from HighBeam Research Library.

Scott, Ian. (1998, June 01). A hundred-year habit (centenary of Bayer's chemical medicinal — heroin). History Today. Retrieved July 07, 2006 from HighBeam Research Library.

Simon, Scott. (1998, September 19). When heroin was legal. Weekend Saturday: National Public Radio (NPR). Retrieved July 07, 2006 from HighBeam Research Library.

Sullum, Jacob. (2003, June 01). H: the surprising truth about heroin and addiction. Reason. Retrieved July 07, 2006 from HighBeam Research Library.