When you try to imagine who uses heroin, chances are good you don't think of cheerleaders or straight-A students or clean-cut suburban kids from upper middle-class families. You probably don't picture the young woman on the recent full page in The New York Times identified as Stacy, ex-entrepreneur, HIV-positive, who says, "After awhile, you're not doing heroin to get high. You're just sick, and you need it to get normal."

There is no typical heroin addict. Although older users (over 30) still represent the largest group of people seeking treatment for heroin, studies indicate an alarming increase in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. The incidence of first-time heroin use for young people ages 12 to 17 tripled from 1991 to 1997. In 1997, substance abuse treatment admissions for heroin and other opiates surpassed admissions for cocaine for the first time in years.

Many new heroin users are under the false impression that if they don't use needles, they are safe. While sharing needles can lead to hepatitis and HIV infections, all heroin is dangerous and potentially deadly. Medical consequences of chronic heroin use include scarred and collapsed veins, bacterial infections of the blood vessels and heart valves, other soft-tissue infections, and liver or kidney disease. Lung complications including various types of pneumonia and tuberculosis may also result.

Heroin is a highly addictive illicit drug. It increases pleasure and reduces pain by replacing natural endorphins with even stronger painkillers. After the initial rush, users usually experience flushing of the skin, a dry mouth and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting and severe itching. Then they grow drowsy for several hours. Heroin affects the central nervous system, and mental functions are clouded. Cardiac functions and breathing slow down severely, sometimes to the point of death. Although purer heroin is becoming more common, street heroin can be cut with strychnine or other poisons, and because abusers don't know the actual strength or contents of the heroin, they are at risk of fatal overdose.

Over the course of just three years, at least 17 young people have died from heroin overdoses in Plano, Texas, an affluent suburb just north of Dallas. Young people who never imagined doing drugs watched their friends take heroin at parties and decided to try it themselves. Scores of teenagers were seen visiting the little blue house in Plano that was eventually found to be the epicenter of the towns drug ring when 29 drug dealers were arrested.

Alan I. Leshner, Ph.D., former director of the National Institute on Drug Abuse (NIDA), says there is no such thing as use when it comes to heroin; there is only abuse. "People often think that if they sniff or smoke heroin instead of injecting it, it won't be addictive," he said, "but that's just not true. It's addictive no matter how you take it." Leshner said it is critical that physicians educate themselves about addiction so they can recognize it in their patients and refer them to appropriate treatment programs.

People do recover from heroin addiction. Leshner said that the best programs are comprehensive and multidimensional ones that treat the entire individual. A holistic approach could include medical treatment (including medications, such as methadone), behavioral counseling, family therapy, vocational rehabilitation, social and legal services. We have 20 years of scientific research laying out what works and what doesn't, said Leshner. We don't have to rely on intuition when it comes to addiction prevention and treatment.

Readers can learn more about heroin and other drugs by visiting NIDA's home page or they can call 1-888-NIH-NIDA to access its infofax system. A variety of materials on heroin addiction and recovery are also available from Hazelden Information and Educational Services at 800-328-9000.

--Published November 22, 1999