is a cellular equation that teaches the user facts of general
validity. I have learned a great deal from using junk: I have
seen life measured out in eye-droppers of morphine solution.
I experienced the agonizing deprivation of junk sickness, and
the pleasure of relief when junk-thirsty cells drank from the
needle....I have learned the cellular stoicism that junk teaches
the user. I have seen a cell full of sick junkies silent and
immobile in a separate misery. They knew the pointlessness of
complaining or moving. They knew that basically no one can help
anyone else. There is no key, no secret someone else has that
he can give you.
I have learned the junk equation. Junk is not...a means to increased
enjoyment of life. Junk is not a kick. It is a way of life.
William S. Burroughs, Junkie
The "way of life" Burroughs
was talking about is more tightly tied to junk, or heroin, than
any similar lifestyle is linked to any other drug.
Because heroin isn't just a drug
to users; it's an abiding personal passion and an all-consuming
concern, a soothing balm of oblivion to calm the dull ache of
It's the reason some people get
up in the morning and the reason they fall asleep at night.
It's the first thought they think
of when they realize they're awake, alive, or alone. It's an
identity, vocation, and pastime, a lover, master, and friend.
In fact, heroin is just about everything to every addict, all
Everything, that is, except legal,
safe, and free.
So what is heroin and why does
it have the total grip it has over so many people?
That's a good question. But it's
not an easy one to answer.
The drug heroin is a semi-synthetic
narcotic that's been around for a long time.
First synthesized in 1898 in
the German labs of the Bayer Company, heroin (or diacetylmorphine)
was the brainchild of Heinrich Dreser, the same chemist who'd
distinguished himself a decade earlier by developing Bayer's
other popular new painkiller, aspirin.
When heroin first hit the market,
it was prescribed as a pain reliever and treatment for a range
of other ailments, including bronchitis, emphysema, asthma, and
even tuberculosis, due to its ability to really turn off a cough.
In its earliest years, the drug
was also touted as a cure for morphine addiction.
It also "cured" a range
of other addictions, from opium addiction to alcoholism, but
only if you consider it a "cure" when addicts end up
strung out on a drug way more potent than the drug they were
addicted to in the first place.
And if you accept that definition,
heroin is a surefire cure for morphinism and alcoholism and just
about every other -ism you can think of -- in the same way that
death is a cure for chicken-pox and laryngitis is a cure for
Still, most of the medical community
requires a higher level of proof than that, and as time went
by and heroin began to be recognized as the super-addictive drug
that it is, it gradually fell from favor as an opiate "cure."
Eventually, it was even withdrawn
as a medicine altogether (at least in the United States) due
to legislation that grew out of the perceived risks -- addiction,
most notably -- associated with the drug.
Today, heroin is recognized by
the U.S. government as having no legitimate medical uses, although
it's still prescribed as a treatment for pain in Great Britain
and a number of other countries.
As a result of the federal ban,
all heroin available in the United States is illicitly made and
distributed, which poses a double threat -- in the form of both
questionable quality and unknown contaminants -- that can seriously
affect the health and lives of users.
And street heroin does just that,
Heroin is the end product in
an intricate chain of manufacture that spans continents and involves
dozens of separate operations and uncounted greedy middlemen.
The drug is derived from the
opium poppy, which is mainly grown in three areas of the world:
Southwest Asia (in the so-called "Golden Crescent"
of Afghanistan, Pakistan, and Iran), Southeast Asia (in the "Golden
Triangle" states of Laos, Thailand, and Burma), and increasingly
(starting in the the late-'90s and continuing into the present),
in Mexico and Colombia, as Latin American drug cartels diversify
from cocaine to higher-profit heroin.
After a simple sequence of steps
(in which the juices of opium poppies are dried, filtered into
a morphine base, then synthesized into heroin), the drug finds
its way into this country, where it winds its way into the hearts,
minds, and veins of an estimated million-and-a-half U.S. addicts
and weekend "chippers," as "Mexican mud,"
"China white," or "black tar."
And even though color is a standard
means of identifying heroin, color itself is a pretty unreliable
indicator of anything -- except for the cuts and extenders that
go into any particular batch of the drug.
Because heroin, which is gray
in solid form, becomes sparkly white or coffee brown as a result
of the various junk (suppose that's where the nickname came from?)
that dealers drop in to beef up profits.
Common heroin cuts include dextrose,
talcum powder, mannitol, quinine, cocoa, powdered soap, and brown
When it gets to America it's
usually sold on the street in twenty-five or fifty dollar bags,
spoons, or balloons under any number of nicknames and aliases,
including H, horse, stuff, shit, skag, and smack.
But by whatever name and in whichever
package, heroin has definitely regained its title as king of
the street drugs in recent years. Potency has soared and prices
have dropped -- partly due to the influx of Colombian and Mexican
cartels into the heroin marketplace and the price wars their
entry has inspired.
And the collective intelligence,
guile, and plain-old street smarts of its followers say it stays
that way -- at least for a while longer.
Heroin can be used in a number
of ways, depending on user preference and the quality of the
Inhalation, or "snorting," is the most basic way of
getting the drug from "out there" to "in here,"
although it tends to be favored only by occasional or novice
users, since the bitter, unpleasant taste of heroin becomes all
the more distasteful when slowly draining from the nose to the
mouth and throat.
The most common way of using
heroin is through injection -- either subcutaneously ("skin-popping")
or intravenously ("mainlining"). The effects of mainlining
are more immediate and more pronounced than other means of using
the drug, as are the dangers it poses to users -- in the form
of infections, abscesses, and other injection-related problems,
as well as the increased risk of needle-borne HIV infection.
Another way of using heroin that's
become increasingly popular -- trendy, even -- in recent years
is smoking, in a practice sometimes known as "chasing the
Here, a user burns a small amount
of the drug on foil and "chases" a fine spiral smoke
"dragon" deep into the lungs. Chasing the dragon is
particularly popular among younger and more upscale users of
the drug, and those with an aversion to needles and a healthy
fear of AIDS (but not of heroin).
And although a lot of dragon-chasers
incorrectly guess that smoking is somehow less addictive than
injection, it isn't -- since higher quality dope is typically
smoked, the percentage of actual drug that reaches the bloodstream
is roughly the same.
Regardless of how it's administered,
effects of heroin are almost immediate and last from 3-4 hours.
They typically begin with a mild-to-intense
nausea. (Vomiting is common, but as at least one user has remarked:
"You don't mind vomiting behind smack.") That gives
way to a giant, rolling wave of euphoria which is often compared
It's this intense rush of pleasure
that brings users back (and back and back) to heroin, until they
nearly forget there was a time and a way without the drug. But
there was and there is.
And when they're hooked, many
can't tell you whether they keep shooting to feel the pleasure
or to avoid the pain that comes with not getting a fix every
few hours, or if somehow, the distinction between the two has
gotten so blurred that they can't tell any more where one begins
and the other ends.
The amount of heroin a user uses
is linked to a number of key variables, particularly the purity
of the heroin and the duration of the habit.
The length of time a person's
been using is important because tolerance to the drug is largely
a function of time. Tolerance refers to the need for users to
continually increase their dosage in order to produce similar
Tolerance to heroin is hard and
fast; while first-time users may need as little as 2-5 mg. to
get high, long-term addicts may fire up hundreds of milligrams
a day just to take the edge off their habits.
Addiction is another serious
danger associated with heroin use and one that follows inevitably
from regular use of increasing amounts of the drug.
And while addiction to heroin
is physiological -- involving the central nervous system and
other body systems affected by the drug -- it also involves a
strong psychological component, which can continue to make life
difficult for an ex-user months or years after the physical craving
for the drug has gone.
Precisely why heroin and other
narcotics work the way they do -- and create addiction the way
they do -- has fascinated researchers for decades.
For years, the best medical wisdom
of the day just supposed that the drugs did something
to a person -- what, exactly, wasn't clear -- and that abusers
suffered from "character disorders" that somehow predestined
And if that theory didn't always
fit, others guessed that addicts might even inherit the tendency
towards addictions, the way that some people inherit red hair
or brown eyes or freckles. But the longer that researchers looked,
the less it looked like these early theories were true.
Then, in 1975, researchers in
Scotland and American made a discovery that overturned the way
we look at drugs, the body, and the brain, when they found biological
circuits in the brain built around chemical transmitters and
receptors virtually identical to heroin and other narcotics.
Dubbed enkephalins and
endorphins by researchers ("enkephalin" is a
Greek term for "in the head" and "endorphin"
is a contraction of the words endogenous, or internal, and morphine),
the discovery also changed our ideas about addiction in general,
and heroin in particular.
In short, the reason that heroin
works in the body is because it so closely resembles bits of
protein in the brain and central nervous system that plug into
internal receptors, the biochemical triggers that help regulate
pain, pleasure, and emotion, and which otherwise produce effects
identical to narcotics.
At this cellular level, opiate-drug
molecules are like perfectly shaped "keys" to a system
of internal "locks" that activate the endorphin system.
And with endorphins, when the key fits, the body turns itself
What endorphin research may mean
in the future is still unclear, but hopefully, a greater understanding
of how the brain's pleasure-reward system works will lead to
painkillers without the addictive properties of heroin, morphine,
And when that happens, development
of a chemical to "turn off" the craving for heroin
and "turn on" positive feelings in its place might
not be that far behind.
..Why Not: Addiction...
All the talk about tolerance
and endorphins and withdrawal has a point in human terms and
it's that people who get strung out on junk get sick if it's
unavailable -- or if they're unavailable because they're
in jail or some other place where it's difficult or impossible
to get a fix.
And when the drug is unavailable
to the user, or vice versa, bad things start to happen in a process
Withdrawal refers to the changes
the body puts itself through to reset its equilibrium after a
period of heroin abuse. It can begin as early as four hours after
a fix, although many users report no ill effects for eight hours
As we pointed out earlier, the
degree of difficulty involved in withdrawing from smack really
depends on the quality and dosage of the drug and the duration
of the habit.
If a person uses poor-quality
heroin for a short time, he or she has a fairly mild habit, but
a habit nonetheless. With purer heroin, expect a habit that will
be tougher to kick.
There are a couple of ways to
kick a heroin habit -- none of them fun or pretty, but none truly
Kicking takes about a week (at
least the physical part of kicking takes about a week), with
peak discomfort occurring at 48-72 hours.
Symptoms include dilated pupils,
irritability, insomnia, and elevated blood pressure and pulse
rate, in addition to symptoms that are similar to those of a
mild case of the flu: runny nose, weakness, diarrhea, hot and
cold flashes, sweating, abdominal cramps, and nausea and vomiting.
The skin takes on the clammy
feel and the bumpy texture of a plucked turkey -- a situation
that is so pronounced it long ago gave rise to the term "cold
turkey" in describing the process of a sudden, complete
withdrawal from narcotics.
In addition, involuntary muscle
twitches cause a spastic jerky motion in the legs and feet, which
probably explains the origin of the phrase "kicking the
As we mentioned earlier, physical
symptoms begin to abate following the second or third day of
withdrawal, but the psychological symptoms and the huge empty
feeling in the gut that a junk habit leaves can last for years.
In fact, learning to handle recurrent
flashes of junk-hunger is something that a good many ex-junkies
get to handle for the rest of their lives. But considering the
alternative, most think it's not a bad trade-off.
..Why Not, Part 2: Overdose...
One of the other serious risks
of heroin is the danger of overdose, a risk made all the more
real -- and that much more frequent -- as a result of the wide
fluctuations in quality that plague the street heroin market.
Example: Typical purity of U.S.
heroin a decade ago averaged less than 10 percent, but today
potency's up -- and in some cases and places, way up.
Variations in potency can be
extreme, too. In fact, the purity of street heroin can range
all the way from zero on the low end to 90-plus percent on the
Still, the gap between an intoxicating
dose and an overdose can be so small that OD's sometimes result
from slight changes (usually due, ironically, to increases in
quality) in the street market.
For this reason, most experienced users exercise caution when
using a different "brand" of heroin -- or junk obtained
from a new or unfamiliar source.
Symptoms of a heroin OD or other
narcotic overdose are both similar to and different from other
drug overdose emergencies.
While a heroin OD involves the
same respiratory depression (from slow to near-nonexistent breathing)
and coma as any other depressant drug OD, one tip-off to a narcotics
overdose is a constriction of the pupils of the eyes to near-pinpoint
Due to the serious depressant
action of narcotics in general and heroin in particular, a heroin
OD is a major medical emergency and should be treated as such.
Old-line junkie quick-fix remedies
(such as injecting an OD victim with milk or salt water) are
not reliable and should not be used in place of medical treatment.
A new breed of narcotic antagonists
(which fit endorphin locks even better than heroin, and thus
displace heroin from its binding sites) are available now, and
each can reverse the effects of an OD almost instantly. Such
drugs, including naloxone and naltrexone, are only available
through legitimate medical channels.
That's the reason it's so important
to get help as quickly as possible in the event of an overdose.
Because all the wonder drugs in the world aren't going to help
if you don't get the victim to the hospital in time.
Any number of different approaches
and programs are available to help addicts retire their junk
habits, including client-oriented outpatient clinics and inpatient
Drug-oriented programs have traditionally
dispensed methadone, a synthetic heroin-like drug that replaces
the craving for junk, to either detoxify or maintain addicts.
In detox, an addict is gradually
weaned off heroin by progressively decreasing doses of methadone.
In maintenance programs, long-term users are supplied with daily
doses of methadone, with no real attempt made to withdraw them
from the drug.
Since 2003, a new drug, buprenorphine
(combined with naloxone and sold under the tradename Suboxone®),
has also been used to treat addicts, both to relieve craving
and withdrawal and to block the effects of illicit opiate use.
Maintenance is obviously one
approach to solving the problem, but if experience has taught
us nothing else about drugs, it's that "curing" drug
addiction with more drugs is often more claim than cure.
Okay, so which way do you go
from here? That depends, as the caterpillar told Alice when she
turned up in her own private Wonderland, on where you really
want to go.
If heroin is a problem for you,
probably the best advice is to just give it up. The unpredictability
of the heroin that's available on the street these days makes
staying alive a tricky proposition, at best.
When you add in the risk of exposure
to the AIDS virus that comes with sharing needles and syringes,
you may just come to the realization that getting straight is
the smartest thing you can possibly do.
If you're not a heroin user, but have thought about giving it
a shot (or a sniff or a chase of the dragon's tail), think again.
And remember, it isn't called
junk for nothing.
That's what it's called because
that's what it makes out of people's lives.
..Sidebar | Bottom
Lines: Even More Reasons Why Not...
Although heroin usually causes
little or no tissue damage to the body (aside from injury at
the site of the injection), there are a lot of reasons why experimenting
with junk isn't a safe bet -- or a great idea. Here are just
- Variability in the quality of
street heroin can range from zero to 90 percent, greatly raising
the risk of accidental overdose and death.
- Dangers linked to shooting heroin
involve the same risk to the brain, lungs, liver, and eyes associated
with shooting other drugs. And sharing needles is one of the
primary routes for the spread of AIDS.
- Addiction -- the painful process
of physical and psychological dependence on the drug -- can begin
in a relatively short time, especially when higher-quality heroin
is being used.
- Heroin's potent pain-relieving
properties may actually conceal symptoms of real physical illness
or such diseases as pneumonia, and delay treatment.