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The Purity of Heroin

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Prior to being banned as a narcotic in 1923 by the Narcotics Division of the US Treasury Department, heroin was a legal narcotic drug and was commonly prescribed as a powerful analgesic to treat symptoms of acute and severe pain (such as that from physical injury or trauma, post-surgery, myocardial infarction, or cancer).1

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.

How Heroin’s Purity Has Decreased

Initially, the heroin available from the street market was supplied primarily from China.1 Over the years, more and more countries began producing the drug for distribution globally.

Afghanistan heroin

Recently, Afghanistan was identified as the leader in world-wide heroin trafficking according to the 2014 UN World Drug Report.2

The hope with the 1923 heroin bans was that they would reduce heroin use risks and prevent from even more individuals from becoming addicted to the drug. However, banning the substance, after it had already been widely distributed across the nation, also brought about many negative consequences.3-5

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Pure heroin is what the majority of addicts strive to acquire. However, it is much more likely that 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 

One of the negative consequences of banning heroin is that heroin continues to be distributed, sold and used illegally – and yet there are no longer regulations on the purity of the drug.

The Danger of Low Heroin Purity

Inconsistencies in product purity can introduce other risks for some chronic heroin abusers – particularly those with markedly increased physiologic tolerance to the drug.

For example, some will suffer from symptoms of withdrawal soon after obtaining and using what was believed to be pure, revealing the product to be more heavily cut with an additive than originally believed.

Given that the strength of the drug being purchased is largely unknown to the vast majority of heroin users, the potential risk for heroin overdose is quite high.

This may lead the heroin addict to seek out more of the drug in order to fend off these uncomfortable symptoms of withdrawal – perpetuating a cycle of dangerous drug-seeking behavior and compulsive use.

Heroin and Fentanyl Mixtures

Similar to heroin, fentanyl is a type of analgesic that belongs to the class of drugs known as opioids. Fentanyl is typically used in the medical field as an anesthesic 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

heroin impurities

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. In 2006, an epidemic of fentanyl-laced heroin spread across the U.S. and caused a number of problems for both paramedics and emergency rooms.7 

The problem became so significant that emergency rooms and paramedics across the country experienced significant reductions in their supply of naloxone, which is the drug used to counteract heroin overdose and restore the victim’s breathing.3, 7 Uniformed police officers were even posted on known drug corners at this time to act as a deterrent toward potential buyers. Substance abuse centers put out a special call in an effort to help addicts steer clear of this dangerous new designer drug combination that had been invading the neighborhood.

The Impurities of Heroin Cutting Agents

Along with the problem of not knowing the strength of the heroin being used, the safety of the additive substance is nearly impossible to account for. An analysis of heroin samples, which have been confiscated by law enforcement, revealed a long list of poisons and household items have been found as cutting agents.8
South China Drug Dealers Add Rat Poison to Heroin (0:54 sec).

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

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.

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  1. Hughes PH, Barker NW, Crawford GA, Jaffe JH. The natural history of a heroin epidemic. Am J Public Health 1972;62(7):995-1001.
  2. United Nations Office on Drugs and Crime: World Drug Report 2014.
  3. Drug Enforcement Administration Heroin Domestic Monitor Program: 2011 Drug Intelligence Report.
  4. 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.
  5. Stephens RC. The street addict role: A theory of heroin addiction. 1991 Suny Press. Albany, NY.
  6. National Institute on Drug Abuse: Heroin.
  7. Kaa E. Impurities, adulterants and diluents of illicit heroin. Changes during a 12-year period. Forensive Sci Int 1994;64(2-3):171-179.
  8. 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.

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