Heroin Drug addiction has been the scourge of our times. Heroin and cocaine especially are the leading cause of imprisonment in the civilized world. (Johnson, 1973) The anti-drug lobbies aver with statistics that show that marijuana users often fall prey to more potent narcotics -- especially those that are seeking that perennial "high."

This essay will present a comprehensive picture of the factors -- physical, pharmacological, societal and epidemiological -- that surround heroin in Australia. (Hirst, 1979)

Heroin (Hulburd, 1952). Pharmacologically, heroin belongs to a class of drugs called depressants. This is because heroin use slows down the brain and central nervous system.

Heroin usually comes in powder form. In its pure form, heroin is white. But depending on how it is "cut" or diluted, it can have different colors. In some third world countries, users are familiar with "brown sugar" (severely cut heroin, occasionally even with rat poison). (Charles, Nair, Britto, & National Addiction Research Centre (Bombay India), 1999) Brown sugar is the color of sand. Heroin is usually injected, smoked or snorted -- however, mostly injected. It is absorbed into the blood and acts on the brain very quickly. How quickly heroin is metabolized also depends largely on several factors: dosage, purity of heroin, the physical characteristics of height and weight, health of the individual, if there has been any past experience, whether heroin is used in conjunction with any other drugs and the physical surroundings of the user. The effects of heroin are almost immediate, that is why it is so popular. Again, altering from user to user, the duration of the effects of heroin varies. The immediate effects are that they instantly eliminate any physical pain. Other manifestations include: nausea, decreasing in the size of pupils, shallow breathing, constipation, induce sleepiness and also euphoria -- the last is particularly notable.

In addition, there are several long-term effects. Over a period of time, increased dosage may result in "obstipation" (obstinate constipation), damage to the vein or collapsed vein (this causes the user to find veins not traditionally used for injecting), and users can get skin abscesses. In addition, the "high" is followed by a general feeling of malaise that sends the user out to look for more heroin for the next "high." Other long-term effects include loss of appetite or malnourishment -- the user does not prioritize good and healthy food. Pneumonia and heart diseases are prevalent, especially if the user is unusually susceptible to cardiovascular diseases. (Ashbrook & Solley, 1979) Plus, there is the additional danger from problems associated with the sharing of needles or other drug paraphernalia. In fact, the top five leading cause of the spread of AIDS has been the sharing of used and infected needles. Other risks include hepatitis B or C. And septicemia. Street heroin is usually cut. Therefore, it is hard to know how strong the heroin is and this can lead to accidental overdose or death.

Then there is the problem of overdose. Also called "dropping," overdosing is very common -- as is the death resulting from it. Even small amounts of heroin may cause some people to overdose - for example, new users or those who started using again. Overdose occurs especially when heroin is taken in combination with alcohol and benzodiazepines. The symptoms of overdosing are generally a decreasing in the breathing rates, sudden drops in body temperature, decrease in heat rates, muscle-twitching and spasms. The slowing down of the central nervous systems slows down the involuntary functions. The outward manifestations in addition to cold skin are gurgling sounds from the throat with vomiting and anoxia showing in the blue tips of fingernails/toenails because of low oxygen. The users lose consciousness. If not properly revived, coma and death are often not far behind. (Waring, Steventon, & Mitchell, 2002)

One of the most terrifying aspects of heroin use, which makes it very difficult to stop its use "cold turkey," is withdrawal. Withdrawal begins to occur only a few hours after last the last use. Some of the symptoms, which escalate from mild to excruciating, involve cravings, restlessness, yawning, runny noses, weeping (hysterically), diarrhea, stomach and leg cramps, goose bumps and low blood pressure. If the patient makes it through these few days of physical pain the mental and emotional withdrawal is chronic and perhaps more difficult to overcome. A user that has reached this level of addiction has usually managed to alienate his

There is often an overwhelming sense of loneliness. A very strong support structure is absolutely essential to help the afflicted get back on his or her feet.
Some other relevant factors about heroin factors with noting are that in Australia, it cost approximately, $320 per gram. These prices are liable to rise or fall depending on the (un)availability of heroin in the local market. The average purity of heroin sold on the streets of major cities was about 65%. In Australia, using, keeping, selling or giving heroin to someone else is illegal. If caught and convicted, penalties range from $2,000 to $500,000 with jail terms ranging from a few months to imprisonment for life. Many overseas countries like Malaysia, Singapore, Thailand and Indonesia impose harsher penalties including the death penalty for those that break these very stringent drug laws. In addition there are other problems, those convicted of drug charges has the entire lives irrevocably. They are refused financial help such as loans and credit cards. They are also not allowed to travel abroad. It is illegal to drive under the influence of drugs, including heroin. Penalties include losing your license, a fine and/or jail.

Australia has a population of around 17.5 million people. In Australia, since 1971, there have been at least ten Royal Commissions, Committees of Inquiry or Parliamentary Committees, which have dealt with drugs, drug use and ways of improving the effects of drug use. (Davies, 1986) In 1988, there were estimated to be 30,000-50,000 dependent heroin users in Australia. The economic costs of illicit drug use in Australia in 1988 were conservatively estimated at $l,441 million. A substantial proportion of drug users in Australia used heroin as the drug of choice (Davis, 1997) There are plans to increase dispensing through pharmacies and to introduce prescription through private general practitioners. Other treatment services include a therapeutic community, counseling, detoxification centers and a range of self-help groups. There are also halfway houses and referral and information services

The Australian Treatment Outcome Study (ATOS) (Holt, Ritter, Swan, & Pahoki, 2002) conducted the first large-scale prospective study of treatment outcome for heroin dependence to be conducted in Australia. This study carried out in Victoria for a period of more than one year beginning in 2001 purported to recruit heroin users to try three different heroin-weaning modalities. The first involved treatment with a cocktail of methadone and buprenorphine (35 participants), the second was withdrawal (40 participants) and the third was residential rehabilitation service (35 participants). The average age of the sample was around 30 years and the majority was male. It was found that the sample experienced much higher levels of Post Traumatic Stress Disorder, major depressive episodes, Borderline Personality Disorders and physical and mental disability than the general Australian population. The sample also experienced high rates of Anti-Social Personality Disorder and Impulsive Personality Disorder. Around half of the sample had attempted suicide at least once, while the majority of the group had overdosed from heroin at least once.

A comprehensive study of mortality related to heroin use in Australia showed that universally users were at substantially greater risk of premature mortality. Studies indicate yearly mortality rates of between 1% and 3% among heroin users (Bucknall & Robertson, 1986). Males (as in users) also made up the majority of fatalities (Frischer et al., 1993), ranging up to over 80% of recorded fatalities in some studies.

Eighty per cent of deaths were classified as dependent, regular users. (Garriot & Sturner, 1973). This indicates that in cases of users in trouble, there is time during which resuscitative procedures can be adopted.

Fatalities in are caused by true overdose as the result of a quantity or quality (purity) of heroin in excess of the person's current tolerance to the drug. This is the most widely believed cause of death from heroin use. The second form of heroin related deaths are due to contaminants. This theory avers that death is not because of any pharmacological activity of heroin per se, but due to the presence of toxic contaminants in the heroin. The amount of quinine "dilutant" was once identified as a contaminant in the case of mortalities. The poly-drug theory where alcohol and benzodiazepines in conjunction with heroin form a lethal combination has already been mentioned previously. (Darke, Finlay-Jones, Kaye, & Blatt, 1996)

Authors of several studies agree that the exact nature of the relationship between heroin and other CNS depressants in the etiology of deaths attributed to overdose would appear of primary importance. Specifically, more information on multiple drug use behaviors at the time of death would enhance our knowledge of the risk factors for overdose. The drug naltrexone…