Editing Heroin (section)

==Routes of administration==
{| class="wikitable floatright" style="width: 15em"
|-
|'''Recreational uses:'''
* [[Euphoria (emotion)|Euphoria]]
'''Medicinal uses:'''
* [[Analgesic|Pain medication]]
* [[Cough suppressant]]
* Anti-[[diarrhea]]l
|-
|'''[[Contraindication]]s:'''
* [[Ethanol]] ([[alcoholic beverage]]s), [[isopropanol]], [[2M2B]]
* [[Barbiturate]]s and [[benzodiazepines]]
* [[Stimulant]]s
* Other [[opioid]]s
|-
|'''''Central nervous system:'''''
* [[Drowsiness]]
* [[Disorientation]]
* [[Delirium]]

'''''Neurological:'''''
* [[Analgesia]]
* [[drug tolerance|Tolerance]]
* [[Drug addiction|Addiction]]
* [[Drug dependence|Dependence]]

'''''Psychological:'''''
* [[Anxiolysis]]
* [[Confusion]]
* [[Euphoria (emotion)|Euphoria]]
* [[Somnolence]]

'''''Cardiovascular & Respiratory:'''''
* [[Bradycardia]]
* [[Hypotension]]
* [[Hypoventilation]]
* [[Shallow breathing]]

'''''Gastrointestinal:'''''
* [[Nausea]]
* [[wikt:protracted|Protracted]] vomiting
* [[Constipation]]
* [[Dyspepsia]] (indigestion)

'''''Musculoskeletal:'''''
* [[Analgesia]]
* [[Ataxia]]
* [[Muscle spasticity]]

'''''Skin:'''''
* Itching
* Flushing/Rash

'''''Miscellaneous:'''''
* Dry mouth ([[xerostomia]])
* [[Miosis]] (pupil constriction)
* [[Urinary retention]]
|}
The onset of heroin's effects depends upon the [[route of administration]]. Smoking is the fastest route of drug administration, although [[intravenous injection]] results in a quicker rise in blood concentration.<ref>{{cite journal | vauthors = Budman SH, Grimes Serrano JM, Butler SF | title = Can abuse deterrent formulations make a difference? Expectation and speculation | journal = Harm Reduction Journal | volume = 6 | issue = 8 | pages = 8 | date = May 2009 | pmid = 19480676 | pmc = 2694768 | doi = 10.1186/1477-7517-6-8 | doi-access = free }}</ref> These are followed by [[suppository]] (anal or vaginal insertion), [[Insufflation (medicine)|insufflation]] (snorting), and [[ingestion]] (swallowing).

A 2002 study suggests that a fast onset of action increases the reinforcing effects of addictive drugs. Ingestion does not produce a [[Rush (psychology)|rush]] as a forerunner to the high experienced with the use of heroin, which is most pronounced with intravenous use. While the onset of the rush induced by injection can occur in as little as a few seconds, the oral route of administration requires approximately half an hour before the high sets in. Thus, with both higher the dosage of heroin used and faster the route of administration used, the higher the potential risk for [[psychological dependence]]/[[addiction]].<ref>{{cite journal | vauthors = Winger G, Hursh SR, Casey KL, Woods JH | title = Relative reinforcing strength of three N-methyl-D-aspartate antagonists with different onsets of action | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 301 | issue = 2 | pages = 690–7 | date = May 2002 | pmid = 11961074 | doi = 10.1124/jpet.301.2.690 | s2cid = 17860947 }}</ref>

Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer [[Harold Shipman]] used diamorphine on his victims, and the subsequent [[Shipman Inquiry]] led to a tightening of the regulations surrounding the storage, prescribing and destruction of controlled drugs in the UK.

Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin lethal overdose was accidental, suicide or homicide. Examples include the overdose deaths of [[Sid Vicious]], [[Janis Joplin]], [[Tim Buckley]], [[Hillel Slovak]], [[Layne Staley]], [[Bradley Nowell]], [[Ted Binion]], and [[River Phoenix]].<ref>{{cite news|url=http://www.timesonline.co.uk/article/0,,11069-2329203,00.html |title=First murder charge over heroin mix that killed 400|newspaper=Times Online |date=13 March 2012 |access-date=20 July 2012 | vauthors = Eason K, Naughton P |location=London}}{{dead link|date=September 2024|bot=medic}}{{cbignore|bot=medic}}</ref><!-- more information needed! -->

===By mouth===
Use of heroin by mouth is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent.<ref>{{cite web |author=sepulfreak |url=http://www.erowid.org/experiences/exp.php?ID=41495 |title=Erowid Experience Vaults: Heroin – Catching the Waves – 41495 |publisher=Erowid.org |date=8 July 2005 |access-date=20 July 2012 |url-status=live |archive-url=https://web.archive.org/web/20121011062609/http://www.erowid.org/experiences/exp.php?ID=41495 |archive-date=11 October 2012}}</ref> Heroin is entirely converted to [[morphine]] by means of [[first-pass metabolism]], resulting in [[deacetylation]] when ingested. Heroin's oral [[bioavailability]] is both dose-dependent (as is morphine's) and significantly higher than oral use of morphine itself, reaching up to 64.2% for high doses and 45.6% for low doses; opiate-naive users showed far less absorption of the drug at low doses, having bioavailabilities of only up to 22.9%. The maximum plasma concentration of morphine following oral administration of heroin was around twice as much as that of oral morphine.<ref>{{cite journal | vauthors = Halbsguth U, Rentsch KM, Eich-Höchli D, Diterich I, Fattinger K | title = Oral diacetylmorphine (heroin) yields greater morphine bioavailability than oral morphine: bioavailability related to dosage and prior opioid exposure | journal = British Journal of Clinical Pharmacology | volume = 66 | issue = 6 | pages = 781–91 | date = December 2008 | pmid = 18945270 | pmc = 2675771 | doi = 10.1111/j.1365-2125.2008.03286.x }}</ref>

===Injection===
[[File:Injecting Heroin.JPG|thumb|Heroin solution injected after being filtered through cotton from a tampon]]

[[Drug injection|Injection]], also known as "slamming", "banging", "shooting up", "digging" or "mainlining", is a popular method which carries relatively greater risks than other methods of administration. Heroin base (commonly found in Europe), when prepared for injection, will only dissolve in water when mixed with an acid (most commonly citric acid powder or lemon juice) and heated. Heroin in the [[Eastern United States|east-coast United States]] is most commonly found in the hydrochloride salt form, requiring just water (and no heat) to dissolve.{{Citation needed|date=March 2023}} Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, users resort to more dangerous areas of the body, such as the [[femoral vein]] in the groin. Some medical professionals have expressed concern over this route of administration, as they suspect that it can lead to [[deep vein thrombosis]].<ref>{{cite book | vauthors = Strang J, Gossop M |title=Heroin Addiction and the British System: Treatment and policy responses |date=2005 |publisher=Psychology Press |isbn=978-0-415-29817-9 |page=121 |url=https://books.google.com/books?id=gdwgn83NEJgC&pg=PA121 }}</ref>

Intravenous users can use a variable single dose range using a [[hypodermic needle]]. The dose of heroin used for recreational purposes is dependent on the frequency and level of use.

As with the injection of any drug, if a group of users [[needle sharing|share a common needle]] without sterilization procedures, blood-borne diseases, such as [[HIV/AIDS]] or [[hepatitis]], can be transmitted.
The use of a common dispenser for water for the use in the preparation of the injection, as well as the sharing of spoons and filters can also cause the spread of blood-borne diseases. Many countries now supply small sterile spoons and filters for single use in order to prevent the spread of disease.<ref name="Thakarar_2020">{{cite journal | vauthors = Thakarar K, Nenninger K, Agmas W | title = Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs | journal = Infectious Disease Clinics of North America | volume = 34 | issue = 3 | pages = 605–620 | date = September 2020 | pmid = 32782104 | pmc = 7596878 | doi = 10.1016/j.idc.2020.06.013 }}</ref>

===Smoking===
Smoking heroin refers to vaporizing it to inhale the resulting fumes, rather than burning and inhaling the smoke. It is commonly smoked in glass pipes made from [[glassblowing|glassblown]] [[Pyrex]] tubes and light bulbs. Heroin may be smoked from aluminium foil that is heated by a flame underneath it, with the resulting smoke inhaled through a tube of rolled up foil, a method also known as "[[chasing the dragon]]".<ref>{{cite journal | vauthors = Strang J, Griffiths P, Gossop M | title = Heroin smoking by 'chasing the dragon': origins and history | journal = Addiction | volume = 92 | issue = 6 | pages = 673–83; discussion 685–95 | date = June 1997 | pmid = 9246796 | doi = 10.1111/j.1360-0443.1997.tb02927.x }}</ref>

===Insufflation===
Another popular route to intake heroin is [[Insufflation (medicine)|insufflation]] (snorting), where a user crushes the heroin into a fine powder and then gently inhales it (sometimes with a straw or a rolled-up [[banknote]], as with cocaine) into the nose, where heroin is absorbed through the soft tissue in the [[mucous membrane]] of the [[sinus cavity]] and straight into the bloodstream. This method of administration redirects [[First pass effect|first-pass metabolism]], with a quicker onset and higher bioavailability than oral administration, though the duration of action is shortened. This method is sometimes preferred by users who do not want to prepare and administer heroin for injection or smoking but still want to experience a fast onset. Snorting heroin becomes an often unwanted route, once a user begins to inject the drug. The user may still get high on the drug from snorting, and experience a nod, but will not get a rush. A "rush" is caused by a large amount of heroin entering the body at once. When the drug is taken in through the nose, the user does not get the rush because the drug is absorbed slowly rather than instantly.

Heroin for pain has been mixed with sterile water on site by the attending physician, and administered using a syringe with a nebulizer tip.<ref name="Surrey">{{cite web |title=Clinical Policy for the Use of Intranasal Diamorphine for Analgesia in Children Attending the Paediatric Emergency Department, SASH |url=https://www.surreyandsussex.nhs.uk/wp-content/uploads/2013/04/1-SASH_Intra_Nasal_Diamorphine.pdf |access-date=9 January 2020 |archive-url=https://web.archive.org/web/20200111133557/https://www.surreyandsussex.nhs.uk/wp-content/uploads/2013/04/1-SASH_Intra_Nasal_Diamorphine.pdf |archive-date=11 January 2020 |url-status=live }}</ref> Heroin may be used for fractures, burns, finger-tip injuries, suturing, and wound re-dressing, but is inappropriate in head injuries.<ref name=Surrey/>

===Suppository===
[[File:Anal Heroin.jpg|thumb|Modified IM/IV syringe used for "plugging" heroin.]]

Little research has been focused on the [[suppository]] (anal insertion) or [[pessary]] (vaginal insertion) methods of administration, also known as "plugging". These methods of administration are commonly carried out using an [[oral syringe]]. Heroin can be dissolved and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed. The rectum or the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining their walls.