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The Dangers of Black Tar Heroin

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Heroin is a powerful, potentially deadly opioid manufactured from morphine, a natural substance extracted from poppy plants. There are several forms of heroin, ranging from white and brown powders to black tar heroin.

Afghanistan heroin
U.S. Marine Corps Sgt. Adam Bala hauling back black tar heroin discovered in Afghanistan during a 2012 raid.

In recent years, the United States has been the target market for black tar heroin.

Black tar heroin tends to look like a black, sticky goo resembling black tar.

Unlike most forms of heroin, which come in the powdered form, black tar heroin is the only exception in that it comes in the solid form.

Several regions around the globe produce black tar heroin, but black tar heroin in the U.S. tends to be primarily exported from Mexico.

While the dangers of black tar heroin have several overlaps with those of white heroin, there are also a couple of detrimental health consequences that are unique to black tar heroin.

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Where Does Black Tar Heroin Come From?

Mexico is currently the main supplier of black tar heroin in the U.S. Formerly, Mexico was a primary supplier of brown heroin powder, an impure, low-quality form of heroin.

Mexico heroin

However, the popularity of Afghanistan's higher-quality white heroin began to shove brown heroin further away from U.S. demand. Mexican cartels then began to shift their heroin production focus to black tar heroin, a higher quality heroin than the brown heroin they had previously been making.

At purity levels typically no higher than 25-30%, however, black tar heroin is still traditionally less pure than white heroin powder.2, 3 Consequently, one street user appeal of black tar heroin has been its cheaper cost, relative to white heroin.

Health Risks of Black Tar Heroin

Black tar heroin abuse is associated with serious health consequences – some of which are unique to black tar heroin, and some of which are shared with other types of heroin.

Special Health Risks of Black Tar Heroin

Since black tar heroin is, on average, only 25-30% pure heroin, as much as 70-75% of the black, tar-like substance contains potentially toxic contaminants and additives. These contaminants, combined with the consistency of the tar-like substance, have made black tar heroin known for clogging needles and blood vessels, and increasing the risk for permanent damage to vital organs, the brain, lungs, kidneys and liver.4

Some health risks that are particularly high when specifically using black tar heroin include 5-7:

1. Wound botulism: Wound botulism is a paralyzing disease that develops from a nerve toxin. Black tar heroin users can develop wounds from injection sites where the bacteria Clostridium botulinum can be introduced and cause infection.

2. Venous sclerosis: Injection of black tar heroin can make the user vulnerable to venous sclerosis, a condition where one’s veins gradually narrow, decreasing blood flow throughout the body – which can lead to a variety of other organ consequences.

3. Abscesses: Injecting black tar heroin can make one more prone to developing abscess, which are walled-off pockets of bacteria and pus that lie underneath the skin’s surface.

4. Tetanus: Tetanus is another toxic bacterial infection that can develop from injecting black tar heroin contaminated with Clostridium tetani "spores." It can result in stiffness in the neck, jaw, back spasms, rigid body spasms, contortions and ultimately death.

5. Gas gangrene: Injection of black tar heroin can also make one vulnerable to becoming infected with Clostridium perfringens, a bacteria that causes life-threatening death of body tissue.

6. Necrotizing fasciitis: Necrotizing fasciitis is a flesh-eating tissue disease also caused by bacteria that can be introduced to the skin when injecting black tar heroin.

7. Overdose: Heroin overdose may be more likely with black tar heroin than with white heroin since black tar heroin tends to have lower, more unknown purity levels, making precise dosing nearly impossible.

Health Risks Common to Most Types of Heroin

The following are black tar heroin health risks that are also risks with other types of heroin:

  • Suppressed breathing. The brain and body are deprived of oxygen, lips and fingernails turn blue and skin becomes clammy. Eventually, convulsions, coma and death may result.8
  • Infectious diseases from needle-sharing, such as hepatitis B and C, and HIV/AIDS.
  • Collapsed veins from scarring and destruction of blood vessels.
  • Infections in the heart. Bacterial endocarditis (infection of valves) and pericarditis (infection of the membrane around the heart) are both life-threatening conditions that can result from heroin use.

  • Abscesses in the skin, muscle and other tissues into which heroin was injected.
  • Pneumonia, a lung infection that can result in coughing, fever, chills, phlegm and difficulty breathing.
  • Gastrointestinal disease, ranging from constipation and cramping to bowel obstruction, perforation, impaired arterial blood flow to the GI tract and resultant necrotic bowel tissue.
  • Spontaneous abortion. Pregnant users often have poor nutrition and inadequate prenatal care. Maternal heroin use has been associated with miscarriage, low birth weight and delays in development. The infant may be born physically dependent on heroin and suffer withdrawal.

Black Tar Heroin: The User Experience

Users of black tar heroin first heat it up, then mix it with water and inject it using a needle.8 The euphoric rush that comes from black tar heroin is similar to that of white heroin, and addiction can also similarly develop quickly.

To see a bit further inside the lives of black tar heroin users, check out HBO's hour-long documentary on black tar heroin.

Similar to other types of heroin, when black tar heroin enters the brain, it gets converted back into morphine and attaches to opioid receptors involved in the perceptions of pain and reward. Heroin also attaches to opioid receptors in the brain stem, which control functions critical to life, such as blood pressure, breathing and staying awake and alert.4

After an injection, black tar heroin users may experience:

  • A "rush" of euphoria.
  • Dry mouth.
  • Constricted pupils.
  • Warm flushing of the skin.
  • Heaviness of the arms and legs.
  • Clouded mental functioning.
  • Alternating wakeful and drowsy states, a condition called "on the nod."
  • Severe itching.
  • Nausea and vomiting.9

Similar to users of other heroin types, black tar heroin users develop tolerance, needing more and more of the drug to get the same intensity of effect.

Users also develop dependence – they need to continue the drug to avoid withdrawal symptoms such as low mood, nausea or vomiting, muscle and bone aches, diarrhea, fever and kicking movements ("kicking the habit"). If the user abruptly reduces or stops heroin intake, withdrawal symptoms can begin as early as 6 hours after the last use.

Does Your Loved One Use Heroin?

Physical Signs of Heroin Abuse

  • Changes in appetite and sleep.
  • Runny nose and eyes.
  • Sudden weight loss or gain.
  • Deterioration in appearance or grooming.
  • Injuries, bruises or accidents they can't explain.
  • Shakes, slurred or incoherent speech.

Psychological Signs of Heroin Abuse

  • Confusing changes in attitude or personality.
  • Sudden mood changes - angry outbursts or sudden laughter.
  • Unusual hyperactivity or agitation.
  • Lack of motivation or being "spaced-out."
  • Seeming fearful, anxious or paranoid.

Behavioral Signs of Heroin Abuse

  • Absence from or poor performance at work or school.
  • Missing money or valuables; borrowing and stealing money.
  • Complaints at work or school about the person of concern.
  • Being isolated, withdrawn or secretive.
  • Clashes with family or friends.
  • Demanding more privacy, avoiding eye contact.
  • Sudden changes in friends, activities or hangouts.
  • Frequently getting into trouble.

It Takes You to Help Someone with a Heroin Problem

It is possible for those who struggle with black tar heroin addiction to still have a chance of turning around their lives. But without the full support of family and friends behind them, recovery from addiction becomes a much more difficult and overwhelming undertaking. Individuals who have an addiction to heroin are unlikely to reach out for help on their own accord. The deeper and deeper they fall into the cycle of addiction, the more isolated and “in denial” they will become. Often, the responsibility falls to family and friends to reach out and lend a helping hand if signs of heroin use are observed in a loved one.

Connect with Help

Call today to speak with one of our caring recovery advisors. Learn about your many recovery options or how to best intervene to get help for your loved one.

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  1. Ciccarone D. Heroin in brown, black and white: Structural factors and medical consequences in the U.S. heroin market. Int J Drug Policy. 2009 May; 20(3):277-282
  2. Middle America waking up to a Mexican Cartel Heroin Nightmare. Breibart News, 27 Sept 2015.
  3. National Drug Intelligence Center. Interagency Domestic Heroin Threat Assessment, February 2000. Johnstown, PA: National Drug Intelligence Center; 2000.
  4. DrugFacts, Heroin. National Institute on Drug Abuse.
  5. Anderson MW, Sharma K, Feeney CM. Wound botuslism associated with black tar heroin. Acad Emerg Med. 1997 Aug;4(8):805-9
  6. Sheehy, J. Black tar heroin use explains lower HIV levels among injection drug users in the Western U.S. UCSF News Center. 26 January 2004.
  7. Iqbal N. Tetanus in i.v. heroin users. Ann Saudi Med. 2001 Sep-Nov;21(5-6):296-9.
  8. Opioids. Substance Abuse and Mental Health Services Administration.
  9. Real Teens Ask About Effects of Heroin. Teens drugabuse.gov.

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