Heroin

Also known as: smack, skag, gear, h, hammer, dragon, junk.

What is heroin? 

Heroin is an illicit opioid derived from the opium poppy and acts as a powerful painkiller (also called a narcotic analgesic). Other drugs in the opioid class include opium, morphine and codeine, and synthetic opioids like fentanyl and oxycodone. 

All opioids work on the brain’s pain receptors and slow down the messages between your brain and body via the central nervous system, affecting vital functions like your breathing and heart rate and making you feel sleepy or calm. 

This slowing effect is why heroin (along with many other drugs, including alcohol) is considered a depressant. Combining depressants can be very dangerous. 

Appearance and use

In Australia, heroin is sold as:

• white/off-white powder
• small white to light brown rocks
• "Homebake", which is made from morphine extracted from prescription opioids

Heroin is sold in caps (a small amount for injecting) or grams.

Heroin is often cut with other substances which alter its purity, and this can make it hard to predict its effects and to correctly measure each dose.

It can be injected intravenously, smoked, snorted or swallowed. 

While heroin is believed to be used by a small percentage of the Australian population, it is linked to a high number of hospitalisations and overdoses. Heroin was involved in 25 per cent of all drug induced deaths in Australia in 2018. 

Why is heroin addictive? 

People use heroin for a variety of reasons, including to experience a "rush" (feelings of euphoria), calming effects and/or to manage chronic physical and emotional pain. 

Heroin’s effects on the body and brain are felt almost immediately when injecting or smoking, and usually after around 10-15 minutes when snorting. 

Regular use of heroin can easily lead to tolerance, where larger doses are needed to produce the same effects. With increased tolerance, people who use heroin will find they need to keep using in order to function normally and to avoid distressing withdrawal symptoms. As dependence develops the risk of overdose also increases as people increase the amounts they use. 

Dependence is just one aspect of addiction. Even if you are no longer dependent on heroin and have gone a long time without using, you might still experience cravings and fall back into old habits—even the process of "scoring" can feel addictive.

Certain moods/emotions, situations or environments (including social interactions) can act as "triggers" for your heroin use, so it's important to figure out what these are if you want to stop or cut down your use.

Effects of heroin

The effects of heroin can be highly varied and depend on your personal characteristics (e.g. your mood, weight, health), the drug (dose, purity, mixing with other drugs etc) and the place (where you take heroin, who else is around, and whether you feel comfortable there).

Short term effects

• pain relief
• euphoria
• heavy feeling hands and feet 
• feeling calm or relaxed
• dry mouth
• nausea and vomiting
• sleepiness
• slowed heart rate and breathing (can result in death due to overdose/mixing with other depressants).

Long term effects

• severe constipation
• diminished sexual functioning (including sex drive, fertility, menstruation)
• tooth decay
• low appetite/weight loss
• brain changes
• problems with memory
• mental health issues including depression
• physical dependence and withdrawal symptoms
• social problems (e.g. money problems, shame/stigma from family or community).

Risks

Overdose and mixing with other drugs

Heroin depresses the central nervous system, lowering your heart rate and slowing your breathing. This means taking it in high doses and/or with other depressants such as alcohol or benzodiazepines can be very dangerous and even deadly, as your heart and breathing could stop.

Overdose can happen to people who are new to using heroin and to people who have used it for a long time. 

Naloxone is a substance which can be used to reverse heroin overdose and is available in the form of an injection or nasal spray.  Free naloxone programs operate in many cities, and by prescription in other areas. Get in touch with us if you’d like assistance to find naloxone near you. 

Injecting risks

If you inject heroin, it is important not to share needles or other equipment to minimise your risk of contracting blood borne viruses such as:

• Hepatitis C (the most common BBV among people who inject drugs)
• Hepatitis B
• Tetanus
• HIV/AIDS.

Free Hepatitis C tests are available free from bulk billing doctors to Medicare card holders. 

Other injecting risks include:

• damage to veins
• blocked blood vessels
• blood poisoning.

You can minimise risks by learning how to prepare and use your equipment correctly. To learn more, contact a harm reduction service in your state. 

• CAHMA (ACT)
• NUAA (NSW)
• NTAHC (NT)
• QuIHN (QLD)
• Clean Needle Program (SA)
• Needle and Syringe Programs (TAS)
• Harm Reduction Victoria
• Harm Reduction WA

Legal risks

Heroin is an illegal substance. If you are found in possession of heroin you could be arrested or charged with a criminal offence. 

Heroin related arrests have increased by 2 per cent in recent years and people who consume heroin make up the majority of heroin arrests.  

Withdrawal

People who regularly use heroin develop a physical dependence and may start to experience unpleasant withdrawal symptoms if they discontinue use even for short periods. Withdrawal symptoms typically appear between six and 24 hours after the last dose. 

What are symptoms of withdrawal? 

• heroin cravings
• restlessness and irritability
• sadness/crying  
• diarrhea  
• poor sleep and yawning  
• stomach and leg cramps 
• vomiting, low appetite
• goosebumps 
• runny nose  
• racing heartbeat.

Where can I get help with withdrawal?

There are services such as residential detox to help you medically supervise the withdrawal process. To find one that is right for you, contact your GP or have a chat to one of our counsellors about your options. 

Treatment and support services

At Counselling Online, we offer free, confidential 24/7 access to trained counsellors who can help you work through your goals and identify services to help you in your area. Have a chat to one of our counsellors if you’re not sure where you’d like to get started.  

Opioid Substitution/Replacement Treatment (OST/ORT)

In Australia, several medications are registered for long-term maintenance treatment for people experiencing heroin or other opioid dependence. These medications are also opioids but provide more stability while the patient works to manage their use. 

• methadone 
• buprenorphine
  - sublingual pill or film
  - long-acting injectable (LAIB), a monthly injection
• Suboxone (buprenorphine combined with naloxone, an opioid inhibitor). 

These treatments will reduce your heroin cravings while also helping to prevent withdrawals. 

Medically-supervised withdrawal (aka Detox)

Some services offer medical supervision and assistance to make the withdrawal process safer and improve comfort. There are also home-based detoxes although these are significantly rarer. Many rehab programs require prospective clients go through the withdrawal process before they begin rehab treatment to improve the client’s ability to meaningfully engage with the program. 

Rehabilitation 

Rehab programs in Australia take many forms but are typically offered in community-based health services or as inpatient residential programs. Rehab programs typically combine different types of therapy and treatment to help clients deal with the root cause of their struggle with drugs and learn strategies to manage or discontinue their use into the future. 

What can I do next?

• Take a self-assessment to help you decide if you should consider seeking help. 
• Get support from others who have been where you are now, in our community forums.
• Try out some of our tips for making a change — they're simple and suitable no matter your stage in your journey.