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Heroin Additives and How it’s Cut

Heroin is a highly addictive, illicit opioid drug.1 As an illegally manufactured substance, heroin may be “cut” with a number of additives or contaminants prior to being sold.1 This article will explore the different types of heroin, what heroin is cut with, heroin’s background and history, the dangers of using heroin with or without cutting agents, and how to find help for heroin misuse and addiction.

What Is Heroin?

Heroin is a Schedule I controlled substance in the United States, with no recognized medical use.2 In various parts of the country, it may be encountered as a white or brownish powder or as a sticky black substance known as “black tar” heroin.1

Heroin can be sniffed, snorted, smoked, or injected, depending on its form.1 Regardless of the form or method of use, heroin exerts its effects by binding to and activating opioid receptors in the brain.1 Opioid receptor activation triggers an increase of dopamine release in certain reward centers of our brain.1 The heroin-induced increase in dopamine—a chemical known as a neurotransmitter—signals a “reward” to the brain that reinforces the behavior of using heroin.1

In addition to an initial euphoric rush, a few potential adverse short-term effects of using heroin include:1

  • Drowsiness.
  • Nausea and vomiting.
  • Warm, itchy skin.
  • Slowed heartbeat and breathing.
  • Decreased mental status.
  • Loss of consciousness.

What Is Heroin Made of?

Heroin is produced from morphine, a natural opiate alkaloid extracted from certain varieties of poppy plants.1 In different markets across the globe, drug manufacturers may process poppy-extracted morphine with varying precision and attention to purity.1 Relatively more refined processing methods produce a powder that can be smoked or snorted.1 Crude processing methods produce an impure product that is more commonly dissolved and diluted in liquid solution before a person can inject it into the body to feel its effects.1

Different Types of Heroin

While there are many unknown varieties of heroin based on undisclosed additives, there are a few widely recognized categories of the drug depending on how, and potentially where, it is made.2

White Heroin

White powder heroin is primarily manufactured in Mexico and South America, with some also originating from Southeast Asia.1,2 Historically, this form has been considered a “purer” form of heroin.1 More pure forms of white heroin are sometimes snorted or smoked.1

Black Tar Heroin

Black tar heroin is a sticky or hard, blackish substance commonly produced in Mexico and distributed in the United States.1 It is processed with crude purification methods, which leave behind many impurities.1 To use it, people commonly dissolve, dilute, and inject the sample.1

Brown Heroin

Brown heroin is a powdered form of the drug that also primarily originates in Mexico.2 Like other powdered forms of the drug, brown heroin can be smoked, snorted, or dissolved and injected.3

What Is Heroin Cut With?

Many adulterant agents, and sometimes other drugs, may be cut into a sample of heroin, leaving buyers often unable to guarantee the type or amount of cutting agent.1 Heroin mixed with other substances may be referred to as “laced heroin” or “cut heroin.”2,4

Examples of Heroin Cutting Agents

The effects of heroin use depend on the substance the drug was cut with, which could influence additional toxicity. Over the years, potential cutting agents have included:1,5,6

  • Fentanyl.
  • Over-the-counter cold medicine tablets.
  • Diphenhydramine.
  • Quinine.
  • Sugars.
  • Powdered milk.
  • Starches.

The following sections explore a few historically notable cutting agents and their effects in greater detail.

Quinine Heroin

Quinine is an antimalarial medication that has been reported in heroin samples as early as the 1940s.5 Quinine has a bitter taste which may mimic that of heroin itself.6

Some effects of quinine include:6

  • Lowering of blood pressure, which some postulate may contribute to a subjective heroin “rush.”
  • Anti-fever properties.
  • Pain control.
  • Anti-inflammatory effects.
  • Potentially pro-arrhythmic effects on the heart.

Diphenhydramine

Medications containing the antihistamine diphenhydramine (found in Benadryl or Dormin) have also been reported in some heroin samples.5 Diphenhydramine may enhance heroin’s effects or address heroin’s side effect of itching.5 However, other effects of diphenhydramine at unknown doses may include:6

  • Increased heart rate.
  • Agitation.
  • Blurry vision.
  • Delirium.
  • Seizures.

Over-the-Counter Cold Medicine Tablets (Cheese Heroin)

Cheese heroin got its name from its parmesan cheese-like consistency, which is a mixture of black tar heroin and crushed, over-the-counter cold medicine tablets.7 Cutting black tar heroin with crushed tablets or other powders allows the sticky substance to become a tan powder that can be inhaled.1 The tablets used are often a mixture of acetaminophen (the active ingredient in Tylenol) and diphenhydramine.7

What Makes Heroin Additives So Dangerous?

The lack of consistency in product presents a danger to individuals who use heroin through the possibility of toxicities and overdose from a lack of knowledge regarding the sample’s contents.1

The presence of the dangerous additive, fentanyl, has increased in heroin samples and contributed to the rise in overdose deaths.5 Some individuals report that certain suppliers selling “heroin” are selling fentanyl with or without other added drugs, without any traces of actual heroin.5

Heroin Addiction Treatment

Treatment is available for heroin use disorder. Substance use disorder treatment is provided on a continuum of care, depending on the needs of the person.8 A patient’s recovery journey may include any of the following:8

  • Detoxification. Often the first step of treatment, during detox, the body cleanses itself of heroin. Medically supervised detox may help a person manage withdrawal symptoms and stabilize them for ongoing recovery efforts.
  • Inpatient treatment. Residential/inpatient treatment consists of 24/7 care in a structured addiction recovery program in a hospital or residential setting.
  • Outpatient care. These programs may vary in intensity and duration, depending on the needs of the patient and the type of program. Partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) require more intense outpatient treatment. Traditional outpatient programs may occur a few times per week and be more flexible around a person’s school or work schedule.
  • Aftercare. This may refer to several types of continuing care after the initial completion of a formal treatment. Examples of aftercare include mutual support groups such as Alcoholics Anonymous (AA) and sober living homes, among others. Ongoing involvement helps reduce the risk of relapse.

Treatment may consist of a combination of behavioral therapies and medication at different stages of recovery.8 Each person may benefit from different combinations of medication and therapy.8 That’s why it is best to consult an addiction professional to determine which individualized treatment plan is right. Examples of behavioral therapies and FDA-approved medications for heroin use disorder include:1

  • Cognitive behavioral therapy (CBT). Cognitive behavioral therapy helps a person change their thought patterns and expectations to change unwanted behaviors.
  • Contingency management (CM). CM uses a positive reinforcement system to encourage desirable behaviors, such as abstinence. Rewards may use a voucher-based system in which vouchers can be exchanged for items or gift cards that encourage healthy living.
  • Methadone. This is a long-acting full opioid agonist medication. Administered orally, methadone works on the same brain receptors as heroin to prevent the onset of heroin withdrawal and reduce heroin cravings.
  • Buprenorphine. This partial opioid agonist reduces heroin cravings without producing a high. It also has a lower risk for overdose, making the medication a safer option for some people.
  • Naltrexone. This opioid antagonist blocks heroin’s rewarding effects if a person tries to relapse. A long-acting injectable form of this medication prevents the need for daily doses and self-administration.

Finding Heroin Addiction Treatment

If you or a loved one are looking for heroin addiction treatment, you don’t have to begin the journey alone. Speaking with your primary care doctor or another physician about your heroin use is a good way to start. Your doctor will have resources that can get you started with treatment. They can also recommend programs based on several factors, including:

  • Approach to treatment.
  • Availability of specialized programs.
  • Accreditation.
  • Type and length of a program.
  • Location.
  • Staffing.

Admissions navigators are available 24/7 by phone or online chat to answer any questions you may have about recovery. They are trained to determine which type of treatment may be best for those seeking help for substance misuse issues. Contact an admissions navigator today to discuss the benefits of rehab and recovery for heroin use disorder at .

Check if Your Insurance Covers Heroin Rehab

When considering treatment for opioid use disorder, there are many options for payment. Most health insurance providers are required by law to pay for at least a portion of substance use disorder treatment. Laws such as the Affordable Care Act (ACA) have made mental health and substance use disorder coverage a legal requirement and essential health benefit.9 Insurance providers must give comparable coverage for mental health as they do for medical benefits.9

For those without insurance, many addiction treatment facilities accept public or federal funding, sliding scale plans, and other payment methods. Ask about the options at multiple treatment centers before deciding where to get treatment.

Insurance plan coverage and complexities like varying copays, deductibles, and out-of-pocket maximums may feel overwhelming. You can get help checking your insurance coverage ahead of time with free online insurance verification programs. Look online or call today to check your coverage and get started on your road to recovery.

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