How Did Heroin Use Get Started?
First sold on a commercial scale in 1898 by the Bayer Company, heroin was largely hailed as a “wonder drug” initially. It is a more potent painkiller than morphine or codeine, two of the main drugs used to combat pain during that period.
It showed promising clinical results in a variety of areas, including helping with pain that resulted from respiratory diseases. It would only be later when experts began to fully understand the addictive nature of heroin.
The Progression to Addiction
Opioid addiction was a major issue at this time, although the trends in this addiction were different than they are today. For example, by 1895, the United States was considered to be in an addiction epidemic that affected roughly 1 in 200 Americans, but the typical opioid addict in America was an upper-class or middle-class white woman until around 1900. Heroin was one of several reasons this began to change.
In the early 1910s, people previously addicted to drugs like morphine began to understand the euphoric properties of heroin and the intense high it could produce when injected. As heroin use rose, narcotic regulations intensified, and the way opioid use was perceived began to change in the eyes of both the public and experts. While addiction had still been stigmatized, the sale and use of opioids began to carry serious criminal penalties, similar to those in place today.
It’s important to note that opioids have a legitimate place in medicine for controlling moderate to severe pain. It’s just important that the risks of these drugs are understood and that doctors use the least risky pain relief option available to them that can provide their patients needed relief.
While heroin had a legitimate place in medicine in the past, the real issue was its overprescription and a widespread misunderstanding of its risks.
Crime & Increasing Use
By the 1930s, there was a shortage of access to legitimate heroin prescriptions, with experts beginning to more fully understand its risks and the public largely viewing it as a drug of addiction and abuse. Unfortunately, this signaled an opportunity for the criminal underworld to take advantage and begin selling black market heroin.
The amount of confiscated heroin would spike, seeing a massive increase over the coming decades and indicating the beginning of an issue that would snowball. Heroin, combined with prescription painkiller overprescription, had become a major component of the modern opioid epidemic at this point, discussed more later. It is a major reason opioid abuse shifted from a problem associated mostly with wealthier women (many whose lives were still ruined by opioid use and are worth discussing and remembering) to an issue more associated with the wider public.
Quick Timeline of the History of Heroin
The following is a timeline of the above:
- 1895: About 1 in 200 Americans is addicted to some form of opioid.
- 1898: There is widespread commercial availability of heroin through the Bayer Company.
- 1900: Partially due to the widespread availability of heroin and soldiers regularly developing an addiction to opioids due to their overuse in war, the people most commonly affected by addiction began to shift from wealthier women to something more similar to what is seen today.
- 1930s: A more widespread understanding of the risks associated with opioids, combined with various political factions using opioid fears as a political tool, leads to tighter regulations and harsher penalties associated with opioid use and sales.
- 1930s to present: Heroin begins to take its modern place in history, with criminal organizations capitalizing on the dwindling availability of legally available heroin. It is a core component of the second wave of the modern opioid epidemic. Heroin use eventually levels off, but fentanyl use rises, making any positive change in heroin use debatable in a fuller context.
Basic Facts About Heroin
Heroin is a short-acting opioid, associated with a particularly short half-life and an intense euphoric high. It is considered to have significant addiction and abuse potential, with no accepted use in modern medicine in the U.S.
Most heroin in the United States originates from Mexico. In other parts of the world, their primary source of heroin is often Afghanistan. It largely depends on which area is geographically closer, as that significantly impacts how difficult it is to smuggle large amounts of drugs from one area to another.
Despite common statements made by political figures to the contrary, most opioids (including heroin) are smuggled through official ports of entry, with people hiding drugs on their persons or in areas like secret compartments in their vehicles and driving the drugs right through checkpoints without attracting suspicion. While drugs are sometimes passed through the border in other ways, such as sneaking them over the border by finding areas of the border that aren’t guarded and hopping or tunneling under any barriers, this isn’t very common.
While a person should avoid heroin use and seek help to stop using the drug if they can’t stop on their own, it’s also important not to stigmatize any type of opioid addiction, including heroin addiction.
Opioids like heroin fundamentally change the brain’s reward systems, slowly making it much more difficult to stop taking opioids once one begins. Addiction is a disease, a fact backed by medical evidence. It is not some moral failing.
Very few people intend to get addicted to a drug. Instead, they are driven to drug abuse by other issues in their life and then struggle to stop their drug use as they grow physically and psychologically addicted to drugs.
Statistics on the Opioid Epidemic
The United States is generally considered to be in a massive opioid abuse epidemic that has been going on for decades, with the epidemic coming in three distinct waves. The first was caused by a rise in prescription opioid abuse, largely attributed to OxyContin being deceptively marketed intentionally and sold as safer than it is.
The second was caused by a rise in heroin availability and use. The third and latest wave is a spike in the use of synthetic opioids, typically fentanyl, which can be extremely potent. Fentanyl use has significantly increased the rate of overdose deaths each year.
Heroin overdose deaths specifically had roughly leveled by 2016 and seem to be decreasing, although overall overdose deaths due to opioids have significantly increased due to the rise of synthetic opioid use. According to the CDC, 91,799 drug overdose deaths were reported in 2020, of which 56,516 were attributable to synthetic opioid use, usually fentanyl. These deaths are also spiking upward in number each year on average, whereas heroin-related deaths are only slowly and mildly trending downward.
For more context, 2010 saw about 21,000 deaths attributable in part to opioid use. In 2017, there were about 47,600 deaths, a significant spike, which then appeared to somewhat stabilize. Then, 2020 saw over 68,000 deaths attributable in part to opioid use of some kind.
This does mean the spike in opioid deaths is likely going to level off at some point. It is still a massive issue that needs to be dealt with, with thousands dying each year of preventable opioid-related deaths.
Getting Help for Heroin Addiction & Abuse
Fortunately, opioid addiction, including heroin addiction, is well researched, with a number of evidence-based treatments available. While there is no cure for addiction, it can be effectively managed for life.
The primary treatment for addiction is cognitive behavioral therapy, where you work with mental health experts to better understand what drives you to use drugs. You’ll learn to identify unhealthy thought patterns around drugs and drug use, avoiding those thoughts and feelings when possible and channeling them in healthier ways when they do occur so you can avoid drug use even if you feel a craving to use drugs.
Medication-assisted treatment (MAT) can help make quitting drugs like heroin easier, and it is often considered the gold standard in treatment for opioid use disorder. Drugs like methadone and Suboxone, which combines buprenorphine and naloxone, can be taken on a schedule to suppress drug cravings and withdrawal symptoms. Combined with therapy and counseling, these MATs have been shown to often make it much easier for a person to avoid opioid abuse long term and see better results from their addiction recovery treatment.
Aftercare and ongoing support are critical to sustained recovery, and most addiction treatment programs will prioritize these as part of the overall treatment plan. While heroin is an incredibly potent drug, people recover from heroin addiction every day, going on to live full lives in recovery.
- De-Stigmatizing Addiction (August 2001). Acta Pharmaceutica Hungarica.
- Inside the Story of America’s 19th-Century Opiate Addiction. (January 2018). Smithsonian Magazine.
- Heroin DrugFacts. (December 2022). National Institute on Drug Abuse.
- Overdose Death Rates. (January 2022). National Institute on Drug Abuse.
- What Are the Treatments for Heroin Use Disorder? (June 2018). National Institute on Drug Abuse.