Editing Heroin (section)

==Adverse effects==
[[File:HarmCausedByDrugsTable.svg|class=skin-invert-image|thumb|left|upright=1.4|A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Heroin was found to be the second overall most dangerous drug.<ref>{{cite journal | vauthors = Nutt DJ, King LA, Phillips LD | title = Drug harms in the UK: a multicriteria decision analysis | journal = Lancet | volume = 376 | issue = 9752 | pages = 1558–65 | date = November 2010 | pmid = 21036393 | doi = 10.1016/S0140-6736(10)61462-6 | s2cid = 5667719 | citeseerx = 10.1.1.690.1283 }}</ref>]]

Heroin is classified as a hard drug in terms of [[drug harmfulness]]. Like most [[opioids]], unadulterated heroin may lead to [[adverse effects]]. The purity of street heroin varies greatly, leading to overdoses when the purity is higher than expected.<ref>{{cite news | vauthors = Seelye KQ |title=Heroin Epidemic Is Yielding to a Deadlier Cousin: Fentanyl |url=https://www.nytimes.com/2016/03/26/us/heroin-fentanyl.html |archive-url=https://ghostarchive.org/archive/20220103/https://www.nytimes.com/2016/03/26/us/heroin-fentanyl.html |archive-date=3 January 2022 |url-access=subscription |url-status=live |work=[[The New York Times]] |date=25 March 2016 }}{{cbignore}}</ref>

===Short-term effects===
[[File:Short-term effects of heroin.png|thumb|Short-term effects of usage<ref name="ONDCP">{{cite web |url=http://www.whitehousedrugpolicy.gov/drugfact/heroin/heroin_ff.html#healtheffects |title=Office of National Drug Control Policy (ONDCP): Heroin Facts & Figures |publisher=Whitehousedrugpolicy.gov |access-date=20 July 2012 |url-status=live |archive-url=https://web.archive.org/web/20110806022931/http://www.whitehousedrugpolicy.gov/drugfact/heroin/heroin_ff.html#healtheffects |archive-date=6 August 2011}}</ref>]]
Users report an intense [[Rush (psychology)|rush]], an acute transcendent state of [[euphoria]], which occurs while diamorphine is being metabolized into [[6-monoacetylmorphine]] (6-MAM) and morphine in the brain. Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin – although a more likely explanation is the rapidity of onset. While other opioids of recreational use produce only morphine, heroin also leaves 6-MAM, also a psycho-[[active metabolite]].

However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other. Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.<ref name="martin and fraser" />

The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities. [[Nausea]], [[vomiting]], and severe [[itch]]ing may also occur. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows, and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent [[brain damage]].<ref name="National Institute on Drug Abuse">{{Cite web|url=https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use|title=What are the immediate (short-term) effects of heroin use? | author = National Institute on Drug Abuse |access-date=7 September 2018|archive-url=https://web.archive.org/web/20180908054251/https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use|archive-date=8 September 2018|url-status=dead}}</ref> Heroin use has also been associated with [[myocardial infarction]].<ref>{{cite journal | vauthors = Karoli R, Fatima J, Singh P, Kazmi KI | title = Acute myocardial involvement after heroin inhalation | journal = Journal of Pharmacology & Pharmacotherapeutics | volume = 3 | issue = 3 | pages = 282–4 | date = July 2012 | pmid = 23129970 | pmc = 3487283 | doi = 10.4103/0976-500X.99448 | doi-access = free }}</ref>

===Long-term effects===
[[File:Long-term effects of heroin.png|thumb|Long-term effects of intravenous usage, including – and indeed primarily because of – the effects of the contaminants common in illegal heroin and contaminated needles<ref name="ONDCP" />]]
Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of the brain's white matter due to heroin use,<ref name=Hamp2019>{{cite journal | vauthors = Hampton WH, Hanik I, Olson IR | title = [Substance Abuse and White Matter: Findings, Limitations, and Future of Diffusion Tensor Imaging Research] | language = en | journal = Drug and Alcohol Dependence | volume = 197 | issue = 4 | pages = 288–298 | year = 2019 | pmid = 30875650 | pmc = 6440853 | doi = 10.1016/j.drugalcdep.2019.02.005}}</ref> which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations. Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects. With [[Substance dependence|physical dependence]], the body adapts to the presence of the [[drug]], and withdrawal symptoms occur if use is reduced abruptly.<ref name="National Institute on Drug Abuse" />

===Injection ===
[[Intravenous]] use of heroin (and any other substance) with needles and syringes or other related equipment may lead to:

* Contracting blood-borne [[pathogens]] such as HIV and [[hepatitis]] via the sharing of needles
* Contracting bacterial or fungal [[endocarditis]] and possibly venous sclerosis
* [[Abscesses]]
* Poisoning from [[contaminants]] added to "[[cutting agent|cut]]" or dilute heroin
* [[Kidney disease|Decreased kidney function (nephropathy)]], although it is not currently known if this is because of adulterants or infectious diseases<ref>{{cite journal | vauthors = Dettmeyer RB, Preuss J, Wollersen H, Madea B | title = Heroin-associated nephropathy | journal = Expert Opinion on Drug Safety | volume = 4 | issue = 1 | pages = 19–28 | date = January 2005 | pmid = 15709895 | doi = 10.1517/14740338.4.1.19 | s2cid = 11646280 }}</ref>

===Smoking===
{{Also|Chasing the dragon}}

Inhaling heroin appears to rarely lead to [[toxic leukoencephalopathy]].<ref name="Offiah_2008">{{cite journal | vauthors = Offiah C, Hall E | title = Heroin-induced leukoencephalopathy: characterization using MRI, diffusion-weighted imaging, and MR spectroscopy | journal = Clinical Radiology | volume = 63 | issue = 2 | pages = 146–152 | date = February 2008 | pmid = 18194689 | doi = 10.1016/j.crad.2007.07.021 }}</ref><ref name="Buxton_2011">{{cite journal | vauthors = Buxton JA, Sebastian R, Clearsky L, Angus N, Shah L, Lem M, Spacey SD | title = Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia | journal = Harm Reduction Journal | volume = 8 | issue = 1 | pages = 3 | date = 2011 | pmid = 21255414 | pmc = 3035193 | doi = 10.1186/1477-7517-8-3 | doi-access = free }}</ref> There are also documented cases of both severe acute [[asthma]] and exacerbation of underlying asthma caused by heroin inhalation, potentially resulting in death.<ref name="Hughes_1988">{{cite journal | vauthors = Hughes S, Calverley PM | title = Heroin inhalation and asthma. | journal = BMJ | location = Clinical Research Ed. | volume = 297 | issue = 6662 | pages = 1511–1512 | date = 10 December 1988 | pmid = 3147049 | pmc = 1835195 | doi = 10.1136/bmj.297.6662.1511 }}</ref><ref name="Krantz_2003">{{cite journal | vauthors = Krantz AJ, Hershow RC, Prachand N, Hayden DM, Franklin C, Hryhorczuk DO | title = Heroin Insufflation as a Trigger for Patients With Life-Threatening Asthma | journal = Chest | volume = 123 | issue = 2 | pages = 510–517 | date = February 2003 | pmid = 12576374 | doi = 10.1378/chest.123.2.510 | s2cid = 14206292 | s2cid-access = free }}</ref><ref name="Levine_2005">{{cite journal | vauthors = Levine M, Iliescu ME, Margellos-Anast H, Estarziau M, Ansell DA | title = The Effects of Cocaine and Heroin Use on Intubation Rates and Hospital Utilization in Patients With Acute Asthma Exacerbations | journal = Chest | volume = 128 | issue = 4 | pages = 1951–1957 | date = October 2005 | pmid = 16236840 | doi = 10.1016/S0012-3692(15)52588-9 }}</ref>

===Withdrawal===
{{Main|Opioid withdrawal}}
[[File:OpioidWithdrawalCourse.jpg|thumb|Course of opioid withdrawal]]

The [[drug withdrawal|withdrawal]] syndrome from heroin may begin within as little as two hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose, and more typically begins within 6–24 hours after cessation. Symptoms may include [[sweating]], [[malaise]], anxiety, depression, [[akathisia]], [[priapism]], extra sensitivity of the genitals in females, general feeling of heaviness, excessive yawning or sneezing, [[rhinorrhea]], [[insomnia]], cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps, watery eyes,<ref>{{cite web|author=Myaddiction|title=Heroin Withdrawal Symptoms|publisher=MyAddiction|date=16 May 2012|url=http://www.myaddiction.com/heroin.html|access-date=16 May 2012|url-status=live|archive-url=https://web.archive.org/web/20120511193410/http://www.myaddiction.com/heroin.html|archive-date=11 May 2012}}</ref> fever, cramp-like pains, and involuntary spasms in the limbs (thought to be an origin of the term "kicking the habit"<ref>{{cite book | title=The Street Addict Role: A Theory of Heroin Addiction | publisher=SUNY Press | vauthors = Stephens R | year=1991 | page=7 | isbn=978-0-7914-0619-9}}</ref>).<ref>{{cite web | url=http://www.discoveryplace.info/narcotic-drug-withdrawal | title=Narcotic Drug Withdrawal | publisher=Discovery Place | access-date=18 April 2014 | url-status=dead | archive-url=https://web.archive.org/web/20140419025851/http://www.discoveryplace.info/narcotic-drug-withdrawal | archive-date=19 April 2014}}</ref><ref>{{Cite web|url=https://medlineplus.gov/ency/article/000949.htm|title=Opiate and opioid withdrawal: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=20 November 2019|archive-url=https://web.archive.org/web/20191208070501/https://medlineplus.gov/ency/article/000949.htm|archive-date=8 December 2019|url-status=live}}</ref>