Originally created as a less addictive substitute for morphine, heroin (also known as diamorphine) is one of the deadliest drugs in America.

Heroin addiction develops quickly, and many who become addicted will spend years chasing their first high. As the user continues, they become less able to take joy in simple pleasures such as eating. Even drugs begin to lose their edge, as the user’s tolerance quickly rises.

Many refer to constantly seeking the first high as “chasing the dragon.” This term actually originates from the practice of “chasing” the heroin by moving it around while heating it in foil, a process necessary to prevent overheating.

Today, however, many see the term as symbolic of addiction. Heroin addiction is like chasing a dragon because the dragon is not likely to be caught; moreover, catching it would not be safe in the first place. If a heroin user were to relive their first high, it would likely only worsen their addiction.

Heroin Effects and Abuse

When heroin interacts with the brain, it floods the user’s reward center with dopamine. In fact, it overloads the brain’s dopamine receptors so much that they become altered.

This leads to heroin addiction as the brain becomes both dependent on and tolerant to the effects of diamorphine. Since heroin is an opiate, the user may develop a cross-tolerance to drugs with similar effects.

There are a few different forms of heroin abuse, both in terms of substance and route of administration.

Aside from the notorious black tar heroin, the drug comes in both white and brown powdered forms. Users can follow one of several routes of administration. Some snort heroin, while others smoke it. Many choose to inject it, as this route of administration results in a strong, fast-acting high. It can also be the most dangerous way to use the drug, as the needles become a secondary source of danger in addition to the symptoms of the drug itself.

Heroin Abuse Statistics

Rates of heroin addiction and abuse have risen in recent years. According to the National Survey on Drug Use and Health, approximately 626,000 Americans suffered from heroin addiction in 2016. Of these, an approximate 475,000 were shown to be current users. This indicates that nearly three quarters of heroin abusers have either not received professional help or have continued using despite undergoing treatment. Since the Substance Abuse and Mental Health Services Administration gathers this information from survey data, it is also possible that there are far more current heroin users than reported.

Heroin-related deaths are also on the rise, increasing by more than 400% since 2010 and reaching an approximate 13,000 deaths by 2015 according to CDC data. These deaths are largely attributed to the impurity of modern heroin, which is often laced with potent synthetic opioids. Polydrug use also plays a role in these numbers, as more than 90% of heroin users engage in the misuse of other substances. In fact, nearly 75% of newly minted heroin users admit to having struggled with prescription opioid addiction before turning to diamorphine.

Common Heroin Drug Combinations

Heroin users often begin with other drugs. As of late, there appears to be an increase in those who begin using heroin because they are unable to access prescription opioids. Due to the current overdose epidemic, many doctors have adopted stricter prescribing practices. Those who can no longer purchase opioid painkillers—whether for recreational reasons or legitimate struggles with chronic pain—are forced to turn elsewhere. Since heroin is an opiate drug, originally synthesized from products of the opium poppy (typically morphine), it is the most logical choice.

Even before measures were taken to prevent overprescribing, many who misused painkillers would eventually turn to heroin when their addiction became too costly. Heroin does not cost as much as your typical prescription drug, although those who become severely addicted can still spend hundreds or even thousands of dollars per day funding their habit. Users who prefer painkillers may abuse them alongside heroin, although individuals struggling with heroin addiction have also been known to use benzodiazepines, cocaine and other substances as well.