Heroin, fentanyl, and nitazenes

What is heroin?

Heroin is an opiate drug made by chemically altering morphine, which comes from opium poppies. Street names for heroin include H, brown, gear and smack. It usually comes as a fine powder ranging from an off-white to brown colour.

How is heroin used?

Snorting

The drug dissolves slowly through the lining of the nostrils and enters the bloodstream.

Smoking

The powder is usually heated on foil and the fumes inhaled. It gets into your body via the lungs and affects you almost immediately.

Injecting

Heroin that's injected has been dissolved in citric or ascorbic acid. Injecting is a quick way to get a lot of it into your bloodstream and up to your brain, producing what you might call a ‘rush’. It’s also the most dangerous way to take it.

What are the effects of heroin?

Heroin is a downer and makes you feel calm, relaxed, safe, and warm. It can also constipate you and make you feel sick – particularly the first few times you use it.

What are the problems with heroin?

Physical dependence

You can become physically dependent after regular, repeated use. That means you’ll experience withdrawal symptoms when you stop using.

Overdose

Heroin slows down your breathing and heart rate. It can be fatal to use more heroin than you’re used to or from a more potent batch than usual.

If you haven't used heroin for a while and your tolerance levels have dropped, using the same amount as you were used to can be particularly risky.

Mixing heroin with other downer drugs, such as methadone, alcohol, and benzodiazepines, like diazepam (Valium) and temazepam, is dangerous and increases the risk of overdose.

Signs of an overdose including the following:

confusion
unconsciousness (unable to wake someone up when you shout or shake them)
severe nausea and vomiting
having a fit
difficulty breathing
snoring or raspy breathing
blue/pale tingeing of knees, hands, and lips
slow or erratic pulse (heartbeat)
pale, cold, and clammy skin

If you think somebody is overdosing, put them in the recovery position (on their side) and call an ambulance as soon as you can. A 999 operator can also talk you through giving naloxone.

New synthetic opioids

Heroin and other drugs like illicit oxycodone, Xanax, and synthetic cannabis (spice) are increasingly mixed with new synthetic opioids like fentanyl and nitazenes.

Synthetic opioids are made in labs and mimic the effects of natural opioids such as heroin. They're much stronger than heroin – even hundreds of times stronger – and at least as potent as fentanyl. A growing number of overdoses and deaths across the country have been caused by heroin and other drugs that have been mixed with nitazenes.

You won't know if your drug has been contaminated with nitazenes because it'll look no different. But the risk of overdosing has significantly increased.

Infection

Sharing equipment, including needles, filters, containers, spoons, and water, can spread infections and blood-borne viruses like hepatitis C and HIV.

Skin damage

Repeated injections, particularly in the same spot, can cause damage to your skin and veins, leading to ulcers, abscesses, and collapsed veins.

Reduce the risks

Carry naloxone

Always carry naloxone because you can use it to reverse an opioid overdose temporarily.

You can still use naloxone even if you're unsure whether opioids are involve because it won't cause harm.

Naloxone is only a temporary fix. The person overdosing still needs immediate medical help.

If synthetic opioids are involved in the overdose, you may need to give them more than one dose of naloxone. You only need to restore breathing; they don't need to regain consciousness.

Naloxone is available from all drug and alcohol services. Make sure you find out where you can get it locally.

Don't use alone

Avoid taking drugs alone. If you do, tell someone what you're taking, how much, and when, so they can check on you.

Take it easy

Start low, go slow! Start with a small test dose to feel the effects.

Test your drugs

Fentanyl test strips can confirm the presence of fentanyl. These are available online or you can contact your local drug and alcohol service. Nitazene test strips are available from CGL Wirral Ways.

Don't mix drugs

Avoid mixing drugs, including alcohol and medicines.

Safer injecting

Use new equipment each time, including filters and sterile water. Never reuse or share anything. Filter your solution properly to remove harmful particles.

Clean the site with an alcohol swab and rotate where you inject to protect your veins. Avoid infected areas. Injecting produces the quickest effect, but it's also the riskiest way to use. Get help if you notice any signs of infection like redness, swelling, or heat.

Sterile supplies are available from needle exchanges or you can buy them online. Use colour-coded equipment so you know which kit is yours and get tested regularly for blood-borne viruses.

Stay hydrated

Smoking heroin dries out your mouth. Use lip balm, drink small sips of water regularly, and brush your teeth twice daily.

Avoid getting drawn in by dealers

A dealer might offer you more drugs than you asked for. This can be a deliberate ploy to get you indebted to them, which gives them a hold over you. Only buy what you can afford.