The Purity of Heroin
Once it became illegal to distribute, sell, use or even possess the substance, individuals who had already become addicted turned instead to obtaining heroin from the street. But the purity of heroin on the street can vary widely.
In recent years, heroin purity has increased. But the drug is still cut with a number of substances that can pose harm to users.
How Heroin’s Purity Has Increased
Opium—which is manufactured into heroin—is illicitly produced in around 50 countries worldwide. The main areas of production are Southwest Asia (mainly Afghanistan), Southeast Asia (mainly Myanmar and Laos), and countries in Latin America (mostly Mexico). Southwest Asia supplies markets in neighboring countries and Europe, the Middle East, Africa, and South Asia, with some going to North America and Oceania. Southeast Asia supplies East and Southeast Asia and Oceania. Countries in Latin America supply the United States and South America.2
Analysis by the Drug Enforcement Administration (DEA) shows that the purity of heroin has increased in recent years. Mexican-South American heroin purity slightly declined, from 74% in 2014 to 70% in 2015 (which is still quite high). However, purity in South America-only heroin increased from 61% to 63% over the same time period, purity in Southwest Asian heroin increased from 35% to 54%, and purity in Inconclusive Origin-South American heroin increased from 39% to 51%.9
The Danger of Low Heroin Purity
Pure heroin is what the majority of addicts strive to acquire. However, quite often the drug is cut with an additive substance before being sold on the street.5 Substances typical used as additives can vary widely—from powdered milk or starch to even poisonous substances, such as quinine or strychnine.3, 6
While substances are often added to increase the effectiveness of heroin, some have the potential to be quite toxic, especially with persistent, repeated use. Regular ingestion of some of these contaminants can worsen the already damaging health effects associated with heroin use and ongoing abuse. On their own, these substances are known to cause liver damage, kidney failure or even infection – thereby increasing the user’s overall degree of risk.7
In addition, given that the strength of the drug being purchased is largely unknown to the vast majority of heroin users, the potential risk for overdose is quite high.
Heroin and Fentanyl Mixtures
Similar to heroin, fentanyl is an opioid analgesic. Fentanyl is typically used in the medical field as an anesthetic induction agent in operating rooms or as a potent analgesic for the management of intense chronic pain that hasn’t responded to other forms of treatment, such as morphine. When heroin’s illegally mixed or cut with fentanyl, there’s high potential for the lethal combo to elicit immediate respiratory failure in unsuspecting users.3
In many cases, heroin users are mistakenly exposed to this dangerous combination of drugs, given that it’s all too common to be unaware of the precise composition of the substance purchased. However, for a portion of those struggling with heroin addiction, this lethal combo is taken together purposefully in a desperate search to experience a better high.
The rate of overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, doubled from 2015 to 2016. An estimated 19,400 people died from overdoses involving synthetic opioids other than methadone in 2016.10
How to Find Help for Heroin Addiction
Heron addiction is one of the most challenging drug addictions to break and its use is associated with a wide variety of risks, some of which can be quite serious.1
Addiction to heroin does not have to be a death sentence, however. If you or someone you love is exhibiting the the signs and symptoms of heroin addiction and are ready to admit that you need help, it is not too late to seek help.
- Hughes PH, Barker NW, Crawford GA, Jaffe JH. The natural history of a heroin epidemic. Am J Public Health 1972;62(7):995-1001.
- United Nations Office on Drugs and Crime. (2017). World Drug Report 2017.
- Drug Enforcement Administration Heroin Domestic Monitor Program: 2011 Drug Intelligence Report.
- Ciccarone D. Heroin in brown, black, and white: Structural factors and medical consequences in the US heroin market. Int J Drug Policy 2009;20(3):277-282.
- Stephens RC. The street addict role: A theory of heroin addiction. 1991 Suny Press. Albany, NY.
- National Institute on Drug Abuse: Heroin.
- Kaa E. Impurities, adulterants and diluents of illicit heroin. Changes during a 12-year period. Forensive Sci Int 1994;64(2-3):171-179.
- Lurie IS, Driscoll SE, Cathapermal SS, Panicker S. Determination of heroin and basic impurities for drug profiling by ultra-high-pressure liquid chromatography. Forensic Sci Int 2013;231(1-3):300-305.
- Drug Enforcement Administration. (2017). The 2015 Heroin Signature Program Report.
- Centers for Disease Control and Prevention. (2017). Fentanyl.