Associated names
Smack, Brown, 'H', Shit, Gear, Skag.

 

Legal status
Class A.

 

Appearance
Usually sold as white, yellowish or most commonly a reddish brown powder. A version known as China-White is occasionally available and is very pure and dangerous.

 

Cost
Heroin is sold in small quantities typically in £10 bags. The cost varies from region to region but will cost anything from £40 - £90 a gram. It is getting cheaper.

 

Quality
Heroin is often heavily adulterated (between 40 per cent to 70 per cent) with other substances such as Paracetamol, talcum powder or powdered glucose. Very occasionally adulterations may be toxic to the system but this tends to be rare.

 

Methods of use
Usually smoked or injected - can be snorted or swallowed. Smoking is known as 'chasing the dragon' and involves the heroin being lined onto a piece of foil, heated from below and inhaled through a paper tube. To inject heroin is first dissolved into water- usually by being heated on a spoon.

 

Effects
Heroin is a powerful painkiller and this combines with a certain euphoric quality creating a sense of warm wellbeing. Heavy use results in sedation, sleepiness and slurring incoherence. First time users often report nausea and vomiting.

 

Health implications
Numerous and complex. Pure heroin itself is not a particularly health-threatening substance (except for overdose) and most risks are around the lifestyle and self-neglect that go with habitual use and with the dangers of infection from needles.

Some of the impurities are also of obvious risk to health. Often a user's cough reflex is suppressed for long periods of time leaving the user open to chest infection, and constipation is common among regular users.

Heroin is very physically addictive and though withdrawal is not fatal it is nonetheless unpleasant and the fear of it can often keep most dependent users using. Tolerance can build quickly, meaning that more heroin is needed to regain the high and eventually to just feel something like normal and stave off withdrawal.

After a period of abstinence tolerance drops and the risk of suppressed breathing and overdose is more real. Death from overdose remains a significant cause of mortality among the heroin-using population.