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1. SOURCE

Heroin is a powerful semi-synthetic narcotic analgesic (C.N.S depressant) produced by the chemical modification of morphine.

2. MODE OF ADMINISTRATION

Heroin can be injected subcutaneously or intravenously, sniffed, smoked or swallowed.

The commonest route of administration is by injection, (mainlining" or "skin popping"). Nowadays, many heroin users initially try to confine their habit to smoking or sniffing, hoping in this way to evade the dangers of "needle infections".

3. APPEARANCE

Street heroin occurs as a crystalline white power with a characteristic bitter taste. "Brown" heroin powder (due to impurities) is sold in East Africa and the Mauritian islands, where it is known as "brown sugar". Street heroin varies in purity from 5% to 20%. Recently, a large quantity of heroin mixed with methaqualone powder was confiscated in South Africa.

Self-administered dosage varies from 3-4 milligrams per day by chronic heroin dependents.

4. SIGNS AND SYMPTOMS OF INTOXICATION

Because of its potency, both its analgesic and euphoric effect, heroin has the greatest dependence potential of all narcotic analgesics.

a. Short Term Effects

Suppression of sensation of pain, euphoria, mental clouding and feelings of well being.

Shortly after administration there is a drowsy, dreary, mild dozing state referred to as "nod" (characteristic lolling of the head).

There is decreased physical activity, inability to concentrate, and constriction of the eye pupils and drooping eyelids.
There is a lowered body temperature and sweating. Respiration state is slow. Initially there is nausea and vomiting, reduced appetite constipation.
Itching and burning skin sensations are common. There is a reduced libido.

b. Long Term Effects

As tolerance develops and larger doses are taken, these signs and symptoms become accentuated, with an ever-increasing impairment of concentration and slowing of speech.
The heroin dependent will show maladaptive behavioral effects such as impaired judgment and gross interference with social and occupational functions.

NB: One of the most desired effects is the "heroin rush", often referred to as an abdominal orgasmic sensation immediately following the intravenous injection.

5. SIGNS AND SYMPTOMS OF HEROIN WITHDRAWAL

These commence characteristically in the heroin dependent between 8- 12 hours after the last dose.

Early symptoms include watering eyes, running nose, yawning and sweating.

This is often followed by an agitated, restless sleep called the "yen", which may last several hours.

The withdrawal peak occurs 36-72 hours after the last dose and is marked by: - bouts of shivering, "goose flesh" ("cold turkey"), excessive sweating, irritability, insomnia, loss of appetite, vomiting, intestinal spasms, diarrhea, rapid pulse, aches and pains, muscle spasms and uncontrollable kicking movements.
General weakness, severe agitation and depression make up the emotional component of withdrawal.

Secondary complications due to loss of fluids frequently occurs (weight loss, dehydration and disturbance of the blood electrolyte balance).
Observable withdrawal signs and symptoms gradually diminish 7-10 days after onset.

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