Updated 03 February 2014


Here's more about heroin, its effects, and the signs of heroin overdose.


Pure heroin is a white powder with a bitter taste. Most illicit heroin is distributed in powder form. It may vary in color from white to dark brown because of impurities left from the manufacturing process or the presence of additives. Because it physically resembles many other pulverized products on the market, many things can be added to it without users becoming overly suspicious.

Opium, derived from the seeds of the poppy plant, has been in use for centuries. Heroin is a refined version of this and is produced chemically, mostly in developing countries. In the early part of the 20th century, morphine, also an opiate, was very widely abused.

In an effort to eliminate the addictiveness of morphine, German pharmacists tinkered with its molecular structure. They invented a derivative called diacetylmorphine. The Bayer Company named it heroin and marketed it as a less addictive and less toxic alternative to morphine.

Heroin turned out to be two to three times more potent than morphine. It was in fact an already metabolized version of morphine, so heroin had a more direct rout to the brain than morphine itself. By the late 1920s heroin was the world’s most widely abused opiate.

During the last decade, the purity of street heroin ranged from one to ten percent. More recently, the purity of heroin, especially that from South America, has skyrocketed to rates as high as 98 percent, with the national purity average in the US at 41 percent. Heroin is most often injected, but high-purity heroin may also be snorted or smoked.

Heroin in South Africa
On the street heroin has many different names – smack, junk, Thai White and jive amongst others.

This hard-line drug found a foothold in our society after the relaxing of border controls after the 1994 election. Initially dealers sold heroin at very low prices and then waited until there was a demand for the drug before they pushed up their prices dramatically. Depending on the quality, heroin now sells for as much as ten times the original price, but the price is still much lower than the going rate in the US, for example. Heroin is mostly sold in clubs and on the streets in South Africa. It is more expensive when bought in clubs and cafés than it is on street corners. All drugs delivered by dealers are more expensive than those bought in public places.

In South Africa, hard drugs such as crack and heroin are mostly used in cities rather than rural areas and Cape Town tops the list for drug abuse in South Africa, with Johannesburg running a close second.

The reasons for the high use of drugs such as heroin in Cape Town are hotly debated - it is a port city, it has the biggest rave circuit, it is a wine-producing region, there are large numbers of foreign tourists.

The average age of those using hard drugs such as heroin and crack seems to be dropping.

How is heroin used?
Heroin is most often injected; however, high-purity heroin may also be snorted or smoked. It is also sometimes used in conjunction with other drugs, but far less often than a substance like dagga. It is usually heated on tin foil, usually over an open flame, so that it liquefies. It is then injected.

The purity of heroin varies greatly. Heroin can be mixed with powdered milk, sugar, baking soda, procaine or even laundry detergent, talc, starch, curry powder, Ajax cleaner or strychnine. All of these additives are dangerous if they are injected into the bloodstream.

Heroin is smoked or inhaled as a powder or it can be mixed with water, heated, then injected. Heroin crosses through the blood brain barrier 100 times faster than morphine since it is highly soluble in lipids.

Injecting heroin into a vein (intravenous use) produces effects in four to eight seconds. Injecting heroin into a muscle (intramuscular use) or under the skin (subcutaneous use) can produce effects in five to eight minutes. Addicts sometimes inject themselves up to four times in one day.

It is a drug which in the past carried a tremendous stigma, but that seems to be reducing, Jardine says.

The needle marks in the groin, the elbows, the neck and so-called pocket shots (injected between the toes in order to avoid detection) are usually instant tell-tale marks that someone is using heroin.

The effects of heroin
Heroin depresses the central nervous system: “Heroin is an escapist drug, that temporarily places a user in his own world, makes people feel intensely relaxed and causes a sensation of warmth and contentment”, says Prof Knobel. Its effects are short-lived and users find that they have to take increasing amounts to effect the same sensations as they experienced the first time.

Like other opiates, heroin locks onto the body’s endorphin receptors and mimics the body’s feel-good hormones, called endorphins. It is easy to see how someone could become addicted to something that makes them feel so good.

Because heroin is used intravenously, its effects are usually felt within seconds.

Symptoms of excessive use
Counsellors say that because heroin is so highly addictive, there is no such thing as moderate use of heroin. Once is too much. The symptoms of heroin use include mood swings, personality changes, dilated pupils, changes in weight and general appearance – for the worse, slurred speech, decreased sex drive and retarded social and emotional development.

It is easy to overdose on heroin as the strength of the drug is at best uncertain. It can lead to unconsciousness and respiratory failure. Hospitals can usually diagnose heroin overdoses by the accompanying needle marks on the body of the patient.

Lesser doses can lead to severe agitation and psychotic attacks, a high fever, coupled with dehydration and bleeding disorders.

“People who use heroin usually either die quickly, or get to rehabilitation centres fairly early on. The reason for this is that heroin is extremely addictive and its use impacts immediately on someone’s ability to function in daily life. It is quickly apparent to friends and family, unlike alcohol addiction, which can sometimes be hidden for years” says Jardin.

Like an evil twin, the morphine molecule locks onto the endorphin-receptor sites on nerve endings in the brain and begins the succession of events that leads to euphoria or analgesia (pain relief).

Heroin detoxification
Heroin causes the most dramatic withdrawal symptoms – much more dramatic than even strong other drugs such as cocaine.

About ten hours after the last heroin use, an addict’s eyes begin to water and general flu-like symptoms are experienced. These include sneezing, a feeling of weakness, depressions, muscle cramps, nausea and vomiting and diarrhoea. These symptoms can increase in severity over a period of two to three days.

These symptoms can take up to ten days to disappear and during this time, muscle spasms, violent shivering and cold chills are experienced. The latter gives its name to the detoxification process called ‘cold turkey’ as the skin resembles that of a plucked fowl.

(Sources: Drug Counselling Centre, MRC)

(Susan Erasmus, updated February 2014)

Read more:
My life as a heroin addict
Heroin basics


Read Health24’s Comments Policy

Comment on this story
Comments have been closed for this article.

Live healthier

Exercise benefits for seniors »

Working out in the concrete jungle Even a little exercise may help prevent dementia Here’s an unexpected way to boost your memory: running

Seniors who exercise recover more quickly from injury or illness

When sedentary older adults got into an exercise routine, it curbed their risk of suffering a disabling injury or illness and helped them recover if anything did happen to them.