Heroin 193chic distance between the user and the world, making reality seem unimpor-
tant. Used in that way the drug is an escape—not into happiness but into
emptiness. Someone intoxicated by a dose of heroin does not care what hap-
pens any more. Lesser doses simply reduce tension, taking the edge off life’s
stresses. People using lesser doses of heroin in that way may function more
productively, or they may experience trouble because they feel confident
enough to get into situations they would otherwise avoid.
Drawbacks.Classic unwanted heroin actions are nausea, vomiting, and con-
stipation. Many other afflictions attributed to the drug actually come from
adulterants in illicit supplies or from dosage techniques—such as addicts shar-
ing the same hypodermic needle with one another, a custom promoting dis-
eases ranging from hepatitis to AIDS (acquired immunodeficiency syndrome).
Researchers find, however, that injectors of a heroin variety called “black tar”
have an increased risk for botulism infection at the injection site, no matter
how hygienic their equipment and technique. Injectors of any type heroin are
more prone to all sorts of infections, and some researchers suspect that heroin
impairs the immune system. Inhaling heated heroin vapor can rapidly pro-
duce enough brain damage to cripple a person, although case reports indicate
that partial recovery is possible. Inhaling either the vapor or powder can also
cause breathing trouble, and injection can cause swift fluid buildup in the
lungs. A study found reduced bone density in chronic male heroin users,
making broken bones more likely, and researchers suspected the problem re-
sulted from lowertestosteronelevels caused by heroin (a heroin action that
is also known to reduce male sex drive). Apparently the bone density and
testosterone problems can correct themselves if heroin use stops. Although
stroke is an uncommonly reported outcome of heroin use, autopsy examina-
tions of 100 heroin addict brains indicate that 5% to 10% of injectors suffer
small strokes that may not cause the person to seek medical treatment but
that may thereafter affect the person’s behavior. One experiment with heroin
addicts found still another unwanted effect: Most of them see colors somewhat
differently than nonusers do.
Abuse factors.All the above hazards are real, but experience also shows
that addicts can take maintenance doses (enough to hold off withdrawal
symptoms but not enough to get high) for years with no apparent ill effect.
The behavior of people on a maintenance dose can be indistinguishable from
someone using no drug at all; while on a maintenance dose of heroin ordinary
middle-class persons can function well in all aspects of life at work and at
home.^1 Such factors are highly influenced by the legal setting of heroin use.
When federal legislation outlawed the drug in the early twentieth century, the
kinds of persons who took the drug changed, as did the common reasons for
using the drug.
Achieving heroin addiction is normally a lengthy process; people do not
become addicts instantly with a single dose. Indeed, persons can use heroin
intermittently for years and not develop dependence, let alone develop a com-
pulsion to take the drug. Someone with a fulfilling life is unlikely to become
addicted even if heroin is used occasionally. In contrast, people with nothing
to live for may find heroin to be the best part of their lives, a discovery leading
to addiction.