In 1996, it was reported that heroin was the primary drug of abuse related to drug abuse treatment admissions in Newark, San Francisco, Los Angeles, and Boston, and it ranked a close second to cocaine in New York and Seattle. In 2000, as part of DAWN's Year-End Emergency Data report, heroin related emergency room visits increased by 15 percent from the year before.
In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. In New Mexico, Rio Arriba County has the greatest problem with heroin on a per capita basis. With a population of approximately 34,000 people, the county recorded an average of 18.3 heroin-induced deaths per 100,000 inhabitants between 1993-1995.
In some areas, "shabanging" - picking up cooked heroin with a syringe and squirting it up the nose - has increased in popularity. In the mid-Nineties, it seemed heroin was suddenly staging a comeback. The reality, however, was that heroin had never left. While overall drug use in the U.S. dropped sharply through the Eighties, heroin use remained relatively steady. During the Nineties, it started to rise, as the addict population grew and changed. Heroin on the street became purer; the price stayed the same; and more young and middle-class Americans began using the drug.
Individuals who abuse heroin over time develop a tolerance for the drug, meaning that they must use increasingly larger doses to achieve the same intensity or effect they experienced when they first began using the drug. Infections (mainly of the heart lining and valves) and abscesses are also common. Infectious disease – IV drug users show greatly increased rates of HIV and Hepatitis C infection. In some areas of the US, more than 75 percent of IV drug users test positive for Hepatitis C.
Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). It suppresses the central nervous system. It's possible to develop collapsed veins from injections of heroin.
Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.
Medical grade heroin is a white powder. Illicit heroin in America may be white, off-white or brown powder, or a black tar-like substance. Substances used to dilute pure heroin change the color away from pure white. The purity and potency of heroin sold in America can vary greatly, adding significantly to the challenges of correct dosing and to the risks heroin overdose.