Heroin is a semi-synthetic opioid derived from morphine, a substance extracted from the opium poppy plant. As an illicit drug, it is known for its powerful effects on the brain’s reward systems. It is sold as a powder or a sticky substance. The drug interacts with opioid receptors in the brain, which are involved in the perception of pain and pleasure.
What Is Liquid Heroin?
The term “liquid heroin” does not refer to a chemically distinct form of the drug but rather to heroin that has been prepared for injection. This is done by taking heroin powder, which can be white or brownish, and dissolving it in water. The process involves heating the powder and water mixture in a vessel like a spoon or bottle cap with a lighter to help it dissolve into an injectable solution. The resulting liquid’s appearance can range from nearly clear to a dark, muddy brown, depending on the purity and type of heroin used, such as black tar heroin.
Black tar heroin is a less refined, sticky, and dark form of the drug that is also dissolved for injection. Due to its impurities, it may not dissolve as easily as purer powder forms. Liquid heroin should be distinguished from substances like “lean” or “purple drank.” These beverages are a mixture of prescription-strength cough syrup containing codeine and promethazine, soda, and candy. While codeine is also an opioid, it is pharmacologically different from heroin, and this mixture is consumed orally rather than injected.
Administration and Immediate Effects
The most common method for administering liquid heroin is intravenous injection, which delivers the drug directly into the bloodstream and to the brain within seconds, producing an intense, euphoric sensation called a “rush.” The intensity of this experience is directly related to how quickly the substance crosses the blood-brain barrier and binds to opioid receptors. Once in the brain, heroin is converted into morphine, which drives its primary effects.
Following the initial rush, which can last for a few minutes, the user enters a state of drowsiness that can persist for several hours. This is accompanied by a warm flushing of the skin, a dry mouth, and a heavy feeling in the arms and legs. The user’s mental functioning becomes clouded, and vital functions like breathing and heart rate slow down. Users may also experience nausea, vomiting, or severe itching.
Overdose Risks and Health Complications
The risk of overdose is high with liquid heroin. Since it is prepared in non-clinical settings, it is impossible for a user to know the precise concentration or potency of the heroin in the solution. A dose that was manageable on one occasion could be fatal on another due to variations in purity. This danger is amplified by the widespread contamination of the illicit drug supply with potent synthetic opioids like fentanyl, which is 50 times more powerful than heroin, meaning a user may unknowingly inject a lethal amount.
Chronic intravenous use leads to a range of health complications. The repeated puncture of veins can cause them to collapse, a condition known as venous sclerosis. Non-sterile injection practices can introduce bacteria into the body, leading to serious skin and soft-tissue infections like abscesses and cellulitis at the injection site. Insoluble additives used to “cut” the heroin can clog small blood vessels, causing damage to organs like the lungs, liver, and kidneys. Sharing needles creates a high risk for transmitting blood-borne viruses, including HIV and Hepatitis B and C.
Identifying Use and Accessing Treatment
Certain items, known as paraphernalia, are associated with the preparation and use of liquid heroin. These include:
- Syringes
- Spoons or bottle caps with burn marks
- Lighters
- Cotton balls used to filter the solution
- A shoelace or rubber hose used as a tourniquet
Recognizing the signs of an overdose is also important. Symptoms include unresponsiveness, extremely slow or stopped breathing, gurgling sounds, cold and clammy skin, and constricted “pinpoint” pupils.
In the event of a suspected opioid overdose, call 911 immediately. Naloxone (sold as Narcan) is a medication that can rapidly reverse an opioid overdose by blocking the drug’s effects on the brain and restoring normal breathing. It can be administered as a nasal spray or an injection and is a temporary measure until medical help arrives. For help with substance use disorders, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a National Helpline at 1-800-662-HELP (4357) for confidential, free, 24/7 information and treatment referrals.