
#4
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#4
Chemical nameDiacetylmorphine (diamorphine)
Street namesDope, smack, H, black tar, junk
Drug classSemi-synthetic opioid agonist
US legal statusSchedule I; no accepted medical use
Medical use elsewherePrescribed as diamorphine in the UK and for treatment in several European countries and Canada
How it is usedInjected, smoked, or snorted
OnsetSeconds (injected) to minutes
Duration3 to 5 hours
Half-lifeMinutes; converted to morphine
Reversal agentNaloxone
Heroin is made by chemically modifying morphine from the opium poppy. It crosses into the brain faster than morphine and is then converted back to morphine, which produces an intense rush followed by sedation.[1]
It is sold as a white or brown powder or as a sticky dark substance called black tar heroin. Today most drugs sold as heroin in the US contain fentanyl, and many contain no heroin at all.[2]
Heroin causes a surge of euphoria, flushed skin, dry mouth, and heavy limbs, followed by hours of drowsiness, clouded thinking, slowed heart rate, and slowed breathing ("nodding").[1]
Effects begin within seconds when injected and within minutes when smoked or snorted, and last about 3 to 5 hours.
Overdose: heroin slows and can stop breathing. The risk is highest with fentanyl contamination, after a period without use, and with alcohol or benzodiazepines.[1]
Addiction: heroin is highly addictive. Tolerance builds quickly, and physical dependence develops within weeks of regular use.
Injection risks: HIV and hepatitis C from shared needles, skin abscesses, heart valve infections (endocarditis), and collapsed veins. Syringe services programs provide sterile equipment and reduce infections without increasing drug use.
Xylazine: a veterinary sedative increasingly found in the heroin and fentanyl supply. It deepens sedation, is not reversed by naloxone, and causes severe wounds.[3]
Choose what it would be combined with:
Fentanyl (often present without the buyer knowing)AlcoholBenzodiazepines, pills sold as XanaxCocaine or methamphetamine ("speedball")Xylazine
| Combined with | What happens | Risk level |
|---|---|---|
| Fentanyl (often present without the buyer knowing) | Much higher overdose risk | Leading cause of overdose deaths |
| Alcohol | Additive breathing suppression | Very high risk |
| Benzodiazepines, pills sold as Xanax | Profound sedation, stopped breathing | Very high risk |
| Cocaine or methamphetamine ("speedball") | Overdose when the stimulant wears off; heart strain | Very high risk |
| Xylazine | Deep sedation not reversed by naloxone; wounds | Give naloxone anyway and call 911 |
This is not a full list. Unregulated drugs often contain other substances, which makes any combination less predictable.
Signs of heroin overdose include pinpoint pupils, unresponsiveness, slow, shallow, or stopped breathing, gurgling or snoring, and blue or gray lips and fingertips.[4]
Never use alone. If you do, tell someone or call a never-use-alone hotline that sends help if you stop responding. Keep naloxone nearby and test drugs with fentanyl test strips.
Heroin is one of the most addictive drugs. Opioid use disorder is a treatable medical condition, and medicines are the most effective treatment.[1]
Warning: Tolerance drops within days of stopping. Overdose deaths are especially common after detox, jail, or hospital stays.
Buprenorphine and methadone reduce the risk of death by about half. Extended-release naltrexone (Vivitrol) is another option after detox.
Heroin is a Schedule I controlled substance, meaning federal law considers it to have a high potential for abuse and no accepted medical use in the US. It cannot be prescribed.[5]
Clinical research: heroin-assisted treatment is used in the UK, Switzerland, Germany, the Netherlands, and Canada (as prescribed diacetylmorphine or hydromorphone) for people who have not responded to other treatment. It is not available in the US.
Medicines for opioid use disorder work. Buprenorphine can be started by telemedicine and filled at ordinary pharmacies, and methadone is available through opioid treatment programs.[8][9]
| Country | Status |
|---|---|
| United Kingdom | Class A; diamorphine prescribed medically |
| Canada | Schedule I; prescribed diacetylmorphine for some patients in treatment |
| Switzerland | Prohibited except in heroin-assisted treatment programs |
| International | Schedule I and IV of the 1961 Single Convention |
Laws change and differ in detail. Check current rules before carrying any controlled medicine across a border
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