Heroin may be snorted, smoked, or injected subcutaneously (skin-popping), intramuscularly, or intravenously (mainlining). The initial rush with use is followed by feelings of euphoria that are relatively short-lived. Heroin dependence may be rapid and with increased use comes increased tolerance, leading the user to need more of the drug. The lethality of the drug -- which was first synthesized in 1874, and which in the past has had legitimate medical applications -- depends both upon its purity and means of use. Heroin may be cut with other drugs such as fentanyl, enhancing or diminishing its effect. Deaths by overdose are typically caused by depressed respiration leading to anoxia (oxygen deprivation). Use of needles carries its own risks including skin infections, hepatitis, and HIV/AIDS (the latter often due to sharing of needles, or "works").
Heroin use among children and adolescents appears to be increasing. The New York Daily News (February 10, 2014) reports, for example,
National data from the Substance Abuse and Mental Health Services Administration shows that the number of teens dying from heroin abuse has skyrocketed. In 1999, 198 people between the ages of 15 and 24 died of a heroin overdose, compared to 510 deaths in 2009, the latest year data was taken. More teens are seeking treatment for heroin abuse, too — the figure jumped from 4,414 to more than 21,000 (about 80 percent) between 1999 and 2009. Ninety percent of teen heroin addicts are white, according to the data.
Kids may be blind to the addictive nature of heroin or think heroin use is no big deal. There is also evidence that parental neglect and domestic violence contribute to use. Rejection of conventional values and anomie -- a term coined by sociologist Emile Durkheim which is analogous to social alienation -- have also been offered as explanations for heroin use. Explanations for heroin abuse using the term "addictive personality" are fraught with difficulty, for no reliable individual characteristics have been identified.
After all is said and done: Are we creating a nation of junkies? Probably not, but it does seem that many youth are at increased risk for heroin dependence and the health risks associated with it. Responsible adults need to be alert to signs that a kid has been using, and to take appropriate action if use is suspected. Behaviors of concern (from Healing Addiction in Our Community) include:
- Lack of personal hygiene
- Tendency toward recklessness
- Withdrawal from family and friends
- Items of value being "lost or stolen"
- Burnt foil being present in car, room, or in personal effects
- Mood swings, intense rage, lying, and manipulation
- Sudden drop in grades and excessive ditching at school
- Finding evidence of prescription drugs
- Scratching hands and arms
- Strong craving for sweets, morning, noon, and night.
- Possession of drug paraphernalia (apples, pens, cut-off water bottles, foil)
Foil & toilet paper rolls are commonly used to smoke heroin
Of course, we also need to fight for more and better treatment options for youth who use heroin and other substances. Treatments are outlined by the National Institute on Drug Abuse (NIDA), but at the time of this writing are inadequate to meet anticipated needs. Drug Strategies, a nonprofit research agency, may prove to be a helpful resource.