What is heroin, and why is it considered so much more dangerous than other opiates/opioids?
Heroin is a semi-synthetic opiate. It is derived from morphine, and is 2-3x more potent (source 1, source 2). Heroin is actually innactive itself, but it is quickly metabolized into 6-monoacetylmorphine as well as morphine, both of which are potent mu-opiate agonists, which results in effective analgesia as well as euphoria.
When injected heroin is known to have a more intense rush than morphine, due to the fact that it crosses the blood brain barrier much quicker, and is also more soluble in water than it's precursor.
In pure form, heroin is no more dangerous than any other opiate, yet it is either incredibly controlled, or flat out illegal in most country's, so it is often bought from black market sources. Street heroin is dangerous as one can never know the purity of it, nor can they know what adulterants were used to cut it, though here is a process for purifying street heroin. (note: As the article explains, this procedure should not be used with heroin that is possibly cut with other opiates/opioids such as fentanyl. The resulting extraction could be highly dangerous. Always test your dope in small ammounts through insufflation to note whether your heroin has similar symptoms of fentanyl;i.e. strong sedation, short lived duration, little euphoria)
I am thinking of switching from oxycodone to heroin due to costs or other reasons. How much heroin do I need to use?
This is a question that gets asked a lot, and from a harm reduction point of view, it's very hard to say. However, their are ways to ensure that you will not die from your first time using heroin (assuming that your dope is not cut with another super potent opiate, which is always a risk.)
- As was mentioned earlier, Heroin is 2-3x more potent than morphine. The easiest wayb to get an estimate as to how much heroin you would need (assuming that your gear is 100% pure- which it is not), is to first calculate it by converting your oral oxycodone dosage (which has a very high BA, around 80% ) and multiply it by .8.
- (This step is unnecessary if you are injecting your oxycodone, since then you would already know pretty much exactly the amount you were consuming given the 100% BA)
Okay, so now you know that it takes 48 mg to catch a nice buzz off of oxycodone. Now the next step is to equate 48mg to an IV morphine dosage. IV morphine is approximately 2x more potent than oxycodone. Therefore, and equipotent dose would be 24mg of I.V. Morphine.
- Now the final step.. Heroin is 2-3x stronger than morphine. To be on the safe side, we'll assume that its 3x more potent. Therefore, we'll divide the equipotent dose of morphine (24mg) by 3, which would result in 8 mg. So assuming that your heroin is pure, it would take roughly 8mg of I.V diacetylmorphine to achieve the same buzz that 60 mg of oral oxycodone would give you. However, we also must take into account the different bioavailability's of heroin, as most people are not going to be jumping straight to the needle.
So depending on how you plan on using the heroin, you multiply the dose by the BA's %, and weigh that out on a scale.
You will almost certainly need to use more than whatever calculated dosage you are getting, but given the rare chance that you obtain some highly pure heroin, following this calculation method should keep you from overdosing, and allowing you to gauge safely how much you need to use, and how pure your heroin is.
What is the safest way to use heroin?
There is no safe way to use heroin. You never know how your body will react to the substance if you're naive, and you never know how pure your heroin is, unless you're lucky enough to get pharmaceutical grade smack. However, I.V is by far the most dangerous and holds the highest risk for overdose. Insufflation and Inhalation are safer alternatives, and inhalation will give a more similar "rush" to the IV ROA. Oral is not a common ROA for heroin, as it is pretty pointless, since you might as well just take some morphine, since heroin acts as a prodrug for only morphine, as opposed to morphine and 6-monoacetylmorphine.
What are the risks of using heroin?
The risks of heroin, are similar to pretty much every other opiate:
- respiratory depression
Other risks are often associated with I.V drug use and are not particular to heroin, or opiates. These are:
- Cotton Fever
- Bacterial Infections
I'm addicted to heroin and want to stop, but don't know how!
(Note: This can apply to all opiates/opioids)
Many people become sick of being dependent on heroin and other narcotics and at one point want to get out of the vicious cycle of addiction. Unlike stimulants though, quitting heroin is made more difficult as in addition to a psychological dependance, there is also a physical dependence. Luckily, there are a number of different drugs, some of them prescribed for the treatment of opiate withdrawal or maintenance, and others which are used off label that are very helpful in fighting withdrawal symptoms.
A thread of interest for those facing withdrawal can be found here
Different Types of Heroin
Powder Heroin (HCl):
- Powdered Heroin is usually found on the East Coast of the United States, and is sold commonly in "bags" (small wax envelopes), or grams. Powdered Heroin HCl (hydrochloride salt) is freely soluble in water, meaning that heating it is unnecessary, and in fact more harmful than not, as it can melt insoluble cuts into the solution, which can later solidify in your blood stream.
Black Tar Heroin:
- Black Tar Heroin is prevalent on the West Coast of the United States
According to the experience of many, and the science that back's it up, under most circumstances in the USA you do not heat heroin. Especially not powder heroin, but not tar either.
The reason you don't apply heat is, when you do apply heat tar, you introduce all the contaminates, cuts, and probably degrade the active ingredient a little bit while allowing all the precipitate matter to join the solution. YOU ARE SUPPOSED TO BE LEFT WITH VISIBLE "TAR" IN YOUR SPOON, ALL THE HEROIN HAS GONE INTO THE WATER. THE VISIBLE "TAR" IS INACTIVE INGREDIENT, LIKELY THE SUBSTANCE THAT YOUR HEROIN HAS BEEN CUT WITH. This is only difference between a hot shot and cold shot of heroin, hot shots DO NOT get you higher.
Don't be fooled by what you see, your eyes cannot see milligrams, but all the heroin has all gone into the cold water. Many people's eyes play tricks on them when they heat the solution and no longer cannot see the particulate matter, but it's is still there, but melted in with solution.
When you run a solution that was heated/cooked and not allowed to completely cool down in time, when you run it through the filter, the adulterants/contaminates/inactive ingredients slip right through the filter and into your syringe. Even though it may look clear to you, it is almost as dangerous as IVing without a filter, since the filter couldn't effectively filter out the particulate matter from the cooked/hot solution of heroin/water/melted cut.
Another common myth is that cooking your shots kills all bacteria eliminating risk of bacterial infection. This is false because bacteria thrive in wet, warm/hot environments, and if you actually applied enough heat to kill all bacteria, you would have degraded the active ingredient, heroin, significantly. So another reason to do cold shots: No added degradation of heroin. To minimize risk of bacterial infection, practice proper injection technique, absolutely EVERYTHING that comes in contact with the drug, your solution, your rigs, etc, must be sterile. When mashing the heroin with a plunger in cold water in your cooker or spoon, be EXTRA sure that you've sterilized the plunger, and have washed your hands with isopropyl alcohol, or even better use non-latex gloves. There are more germs on your fingers than most other parts of your body so it is VITAL that you maintain a sterile environment every step of the preparation and injection procedure.
How to prepare Black Tar Heroin:
- WASH YOUR HANDS AND INJECTION SITE, first for 60 seconds with soap in the sink, then apply isopropyl (minimum 70%, 91 or 99% is preferred) alcohol to your hands and injection site. Do not touch anything that is not sterile while prepping your shot, do not touch your face, nose, eyes, mouth, do not touch ANYTHING that is not sterile or you raise risks of bacterial infection.
- You never use heat to prep tar heroin, you remove the end of your sterile syringe's plunger (the whole rig rinsed first in isopropyl to re-sterilize, then flushing it out thoroughly with clean water to flush out the isopropyl. This is something you should do if you are re-using one of your own syringes, re-using syringes can lead to serious infections like endocarditis and MSRA staph infections, all of which can be fatal.
- Mash the tar for 30 seconds to a minute tops in the coldest clean water you can get, (ideally bacteriostatic saline or water stored properly in the refrigerator will be cold enough). You only need to mash it once or twice, to release 99% of the active ingredient; heroin. The <1% loss is negligible. A 0.2um Micron Filter will filter out the inactive ingredients and also most bacteria. Swab w/ isopropyl both your injection site and its good injection practice to dip the needle tip again in a fresh isopropyl alcohol source, as an extra precaution, then follow proper injection technique for administration of parenteral heroin.
Heroin freebase (brown, gear, smack, skag and many other colloquial names) is the main type of heroin seen in the UK and other European countries, especially the Netherlands. It is usually a light brown powder but colour can vary from dark brown to grey to off-white. As it is in the freebase form instead of the salt it is not freely water soluble. The commonest way to take it is to smoke it on foil (known as “chasing”). Most of the heroin in the UK is cut with caffeine to aid chasing and is made with smoking in mind. It usually comes in bags (varying weight, usually around 0.2g, wrapped in plastic) or is sold as weight in wraps or baggies.
There was a drought in 2010/2011 which is still not fully resolved in 2012, and the purity of heroin on the streets has dropped dramatically – by a third between late 2009 and late 2010 according to a government report (source). There are reports from local police forces of dangerous cuts being used, including barbituates and fentanyl, as well as inactive substances which might cause harm if smoked/IV’d. There is also a danger that as the drought resolves people will come into contact with unexpectedly strong heroin and overdose when they take the same dose they have been used to doing. Remember you have no idea how strong your heroin is until you try it, so always start by smoking a small amount – appearance/smell/taste is no indication of purity. The regional heroin thread in EADD is used to spread information about reports of dangerous cuts.
This is the commonest and safest way to take heroin freebase. It hits you almost instantly but you don’t do the whole dose in one go so you can titrate it carefully to prevent OD. Overdoses via this ROA, while rarer than IV, do still occur however especially when taken concurrently with other CNS depressants such as alcohol or benzos. Chasing instead of IVing also reduces the risk of blood-bourne diseases and other risks associated with IV use.
Chasing can be a difficult skill to master but the concept is simple. You are vaporising the heroin rather than burning it, and you run it along the foil heating it from below and inhaling the vapour through a tube.
How to chase:
Start with a rectangle of foil approx. 10cm by 15cm, shiny side down. There is a debate about whether you need to “burn off” the foil first – some aluminium foil in the UK has a thin layer of vegetable oil coating it and holding a lighter to it burns this off, but there is currently no evidence that this is necessary or that the vegetable oil harms you. A paper produced by the government's Advisory Council on the Misuse of Drugs looking at promoting chasing heroin off foil makes no reference to this. It also states that “the evidence provided to date does not indicate that the levels of aluminium derived from the use of foil constitute a risk to the individual.” (source) Booklets of foil designed specifically for chasing are available from some online suppliers.
You also want a tube to use to inhale the heroin. The best way to do this is to take a small rectangle of foil, fold over the edges and wrap it around something like a biro. Either crinkling it slightly or wrapping a rizla around it will keep it rolled up. The advantage of this is that some of the vaporised heroin collects on the inside of the tube, and you can smoke it afterwards. There are various ways of folding the tube so it collects more heroin and these can be found through a google search.
You next place your heroin onto the foil in a corner and heat gently from below to melt it on (so you can’t lose it!) Place the tube in your mouth and hold the foil with the small edge towards you and the heroin in the right hand corner nearest you (if you are right handed). It can help to make a slight crease down the length of the foil, along path you want the heroin to run.
Put the tube in your mouth and hold the lighter in your right hand under the heroin – you want a medium flame and it to melt but not burn the heroin – experiment with flame size and distance from foil. When you are ready, melt the heroin again and tip the foil away from you slightly. Run the heroin down the foil with the lighter slightly in front of the blob of heroin (“beetle”) and the tube (“tooter” or “toot”) just behind it. You are aiming to run the heroin smoothly along the long edge, inhaling the vapour as you go – it’s all about coordination. This takes a bit of practice so it’s best to be shown by someone who is experienced. Make sure you don’t frazzle the heroin – it’s often easier to run a whole bag than tiny bits as it is less likely to burn. When you reach the end rotate the foil and run the heroin along a new path. Remember to stop and gauge how much the heroin has affected you from time to time.
As heroin freebase is insoluble, an additional step needs to be taken when prepping it for IV - you need to convert it to a soluble salt. This is an extra opportunity to contaminate your shot so be very careful. Citric or ascorbic acid is commonly used; it is important to use pure powder and not crushed Vitamin C tablets or other acids such as vinegar, as they can contain substances which can cause harm if IV’d and are not sterile. Needle exchanges often give out sachets of citric acid or they are available online.
The citric/ascorbic acid is added when the heroin is in the spoon or (ideally) sterile cooker/stericup and the water has been added. A common mistake is to use too much, leaving an acidic solution which can damage veins. You don’t need to use the whole sachet – just add a little, apply gentle heat and see if it has dissolved. There is an excellent video produced by ExchangeSupplies showing how to add the right amount of acid to your heroin available here.
Applying heat is not advised when prepping most things as it can lead to poorly soluble cuts dissolving into the shot, but it is usually necessary with heroin freebase to cause it to react with the acid. Try to keep it to a minimum however. Don't forget to take the usual precautions when IVing, use fresh equipment for each shot and keep everything as sterile as possible.
Sterile needles and other IV equipment is available from needle exchanges and many pharmacies across the UK, as well as online.
Insufflating heroin freebase does work to some degree as it is lipid soluble but it is not an effective ROA compared to chasing, and certainly not as effective as insufflating a soluble heroin salt. It is safer than IVing but unlike chasing you can’t titrate your dose, so there is a greater risk of misjudging it and overdosing.
IV Related Risks
What is Cotton Fever?
Cotton fever is a syndrome that is often associated with intravenous drug use, specifically the use of cotton to filter drugs like heroin. The cause of the condition has been established to be the endotoxin shed by the bacteria Enterobacter agglomerans which colonizes cotton plants. A condition very similar to cotton fever was described in the early 1940s among cotton-farm workers. The term cotton fever was coined in 1975 after the syndrome was recognized in intravenous drug users. However, some sources have attributed the symptoms of cotton fever with simple sepsis occasioned by unsafe and unsanitary drug injection practices. This is borne out by the fact cotton fever occurs in equal spread with all injectable drug users, with various filter materials utilized (Wikipedia Cotton Fever Page).
- Shortness of Breath
- Cotton Fever can be treated with anti-biotics if the symptoms persist, though this is usually unnecessary. If the Fever lasts for more than a couple hours, it is possible that it can turn into something worse, like pneumonia, in which case you should seek medical attention as soon as possible. (Sources:Heroin Helper, Journals.lww.com)
- An abscess is a very ugly type of infection which exhibits itself as a collection of pus on any part of the body, surrounded by redness and swelling. Abscesses occur when a certain part of the body becomes infected, resulting in White Blood Cells moving through the walls of blood vessels and into the infected region, causing pus to form. (PubMed Health)
- Swelling/Hardening of Tissue
- Warm and Tender at the site of infection.
DO NOT PUSH ON AN ABSCESS OR TRY TO DRAIN IT YOURSELF! THIS CAN CAUSE THE INFECTION TO SPREAD. Warm Compresses can help drain and speed up the healing of an abscess. In some cases a doctor will need to create an incision and drain the infection. Anti-biotics are usually given as well. If you develop an abscess, please do not wait to go to a doctor. Letting an abscess go unattended can lead to gangreene, Endocarditis, Osteomyelitis as well as new abscesses
Detox and Maintenance Drugs: Suboxone and Methadone
When a heroin/opiate addict wants to quit, there best course of action is usually to taper using a longer acting opioid. The golden standards for detox and ORT (Opiate Replacement Therapy) are Buprenorphine and methadone.
- Methadone is a synthetic opioid used for the treatment of chronic pain, as well as for detox and maintenance in heroin/opiate users. It is beneficial in that it is very strong (nearly 3x stronger than morphine with acute dosing), and has a very long half life (15-60 hours). This means that people can dose once a day, and at the appropriate dose, get relief from withdrawal for 24 hours. Methadone can be used for detox purposes, with short term detoxes lasting 1-2 weeks, and long term detoxes lasting from 1-3 months.
As a maintenance drug, Methadone works to help reduce physical and psychological cravings. At dosages of around 60 mg and up, Methadone also works effectively to block the euphoric effects of opiates such as heroin. However it is not a blocker in the sense that an antagonist like Naltrexone is. Instead, at high enough dosages, methadone pushes an individuals tolerance up so high, that other opiates cannot compete with it. At the same time, Methadone also saturates the opiate receptors to the point where even taking more Methadone will not create euphoria, but rather just suppress breathing (which is needless to say, very dangerous).
- Buprenorphine is a potent partial agonist opioid which is also used for maintenance and detox. Like Methadone, Buprenorphine has a very long half life (36 hours), which means that once, daily dosing is possible in order to achieve effective relief from withdrawal. Unlike Methadone however, Buprenorphine has the advantage in that it is available by prescription, allowing patients to medicate themselves at home, without having to pick up their dosage at a clinic every day like methadone maintenance requires.
Buprenorphine also has the advantage in that it has a ceiling effect, meaning that past a certain dosage (different for everyone, but the pharmaceutical company's seem to have decided upon 32mg), there are no increase in opioid agonist effects, making respiratory depression much harder to achieve. This makes Buprenorphine containing drugs like Suboxone/Subutex safer than Methadone, as well as overdose is far less likely.
At dosages above 4 mg, Buprenorphine also works to block other opiates. Unlike Methadone however, Buprenorphine blocks in a similar fashion as antagonists such as Naltrexone do. It has an extremely high affinity to the mu opiate receptor, so that it sticks to it like a piece of gum, clogging it up. If someone on a high dosage of Buprenorphine attempts to shoot heroin, the dope will not be strong enough to push the Buprenorphine off the receptor, leaving it to swim around in the blood stream until it is eliminated from the system. HOWEVER, this does not mean that is impossible to overdose on heroin or other opiates while on Suboxone. If you use enough of any full agonist opiate, you can break through the Suboxone/Subutex. Doing so is a very dangerous practice though, as the dosages required would be so high that they could certainly cause an overdose.
The purpose of this thread is to post any information from experienced users, or questions from inexperienced users. There is a lot of misinformation that goes around on the street, hopefully we can collectively sift through the bullshit.. Most threads pertaining to first time/beginner heroin use will be merged here (with some exceptions). Please post away!
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