What Is Heroin Cut With?
On the street, heroin goes by a variety of names, including “junk,” “skag,” “smack,” and “H.” Regardless of the name used, anytime you purchase heroin there’s no way of knowing what’s actually in it, short of doing a chemical analysis.
Pure uncut heroin consists of pure white powder that carries a bitter taste, though it’s highly unlikely that a street dealer will sell pure heroin. The materials used to cut heroin can also increase the dangerous effects on the body, especially in cases where toxic additives are used.
Before heroin gets into a dealer’s hands, the drug must be synthesized from its botanical source: the opium poppy. Depending on how thorough the manufacturing process is, the final product may contain as many as 40 different impurities.
Substances commonly cut into heroin that are not inherently toxic. But they can do damage to the body. Most often, heroin is cut with one of the following:
- Talcum powder
- Powdered milk
Part of the reason why heroin is so addictive is because of its ability to reach the brain quickly. When this happens, the brain releases dopamine and produces feelings of euphoria. The most often a person uses heroin, the more the brain becomes reliant on heroin to produce feelings of pleasure. Addiction also increases the chance of overdose, since the brain and the body build up a tolerance to the drug. Impurities are often introduced to heroin to increase potency or cut production costs. These cutting agents have disastrous effects on the body. Some of the cutting agents include:
Additives are unknown and can vary by batch, making it virtually impossible for a user to know what else is in the heroin. Because of this, there’s no way of knowing whether or not it’s “safe” to consume. Even more alarming is the fact that there are literally countless toxic additives that dealers might introduce to the heroin. The result is an impossible-to-guess strength and purity of heroin, making it even more dangerous to use.
Materials used to cut heroin, which range from toxic additives to simple fillers, can also have harmful effects on the body—particularly if the heroin is injected. One of the most common adulterants is quinine. This medication is used to treat malaria. When injected, it can cause serious reactions.1
- Kidney damage
- Severe allergic reactions
- Serious bleeding problems
The amount of actual heroin contained in a batch ranges wildly. There’s no real way for a user to tell. Some research suggests the potency can range from 3-99%.2
Regional variations of heroin can partly explain differences in appearance and purity levels. There are four main types of heroin available on most commercial market: white, black tar, brown, and cheese.
White heroin most commonly originates in Southeast Asia. It’s white in appearance and is relatively pure. White heroin easily dissolves in water. In the U.S., this is the most common type of heroin available on the east coast. Some of the adverse effects of white heroin include the following.3
- Slurred speech
- Attention and memory problems
- Increased risk of suicide
- Collapsed veins
- Peripheral edema
- Increased risk of contraction of tuberculosis, HIV, and hepatitis
- Sexual dysfunction
Black tar heroin is generally created in Mexico. It has a dark color and is sticky and hard. Black tar is less pure than white because of how it’s processed. It’s generally less expensive than white heroin.3
The majority of black tar heroin contains dangerous additives and adulterants. These additives have been known to cause serious physical complications including some of the following:4-9
- Abscesses: complications associated with untreated abscesses include infection of the heart lining, bone, or blood
- Wound botulism: caused by the presence of bacteria in injection sites, can cause paralysis and death
- Tetanus: difficulty swallowing, stiffness of back and neck, muscle spasms, excessive sweating, and difficulty breathing
- Necrotizing fasciitis: caused by bacteria and characterized by a rapidly propagating, widespread death of tissues
- Gas gangrene: bacterial infection can be life-threatening and also causes tissue death
Brown heroin is a brown powder form of heroin that’s manufactured in southwest Asia. This form of heroin easily dissolves in water. Despite the differences in appearance, the health consequences associated with brown heroin are similar to those of white heroin.10
Cheese heroin is relatively new to the market. It first emerged in Texas in 2004. This is a cheap form of heroin that is cut with acetaminophen, hydrochloride, and diphenhydramine. This combination of drugs severely lowers the heart rate and breathing under the user dies. Among heroin users under the age of 20, cheese overdose deaths continue to rise.11
Shooting up means that heroin is directly injected into the veins. Some users prefer to snort heroin. Black tar heroin and Mexican brown powder are the brands most commonly used for injection and snorting. Solutions are made by dissolving either brown powder or tar heroin in water.
Shooting up produces the most intense effects the fastest, but additives and adulterants leave a person open to a number of health risks. These include the following:
- Artery blockages
- Heart tissue infections
- Blocked blood vessels in the brain
- Lung disease
- Liver damage
It’s very unlikely that a dealer will sell pure heroin on the street market, so every time a person uses the drug, there are unknown and dangerous risks involved. There are many different types of heroin addiction treatment that can be tailored to your specific needs. Inpatient rehab is the ideal choice if a patient is suffering from severe heroin addiction. In this kind of setting, a patient is in a safe environment so he/she can concentrate on recovery efforts.
Living at the treatment center helps separate a user from the heroin-using environment. Outpatient treatment allows someone to live at home and attend daily sessions at the treatment center. This is helpful if there are work or school obligations to meet. A luxury rehab center is by far the most costly but will also offer an array of amenities not found in other treatment centers. Every center is different, but most resemble a resort with added services like yoga, massage therapy, and private rooms.
- Phillips, K.A., Hirsch, G.A., Epstein, D.H., Preston, K.L. (2012). Cardiac Complications of Unwitting Co-injection of Quinine/Quinidine with Heroin in an Intravenous Drug User. J Gen Intern Med, 27(12), 1722-1725.
- Johns Hopkins Bloomberg School of Public Health. (2019). Safe Consumption Spaces Would Be Welcomed By High-Risk Opioid Users.
- National Institute on Drug Abuse. (n.d.). Heroin.
- Bamberger, J., Terplan, M. (1998). Wound Botulism Associated with Black Tar Heroin. JAMA, 280(17), 1479-1480.
- Pollini, R.A., Gallardo, M., Hasa, S., Minuto, J., Lozada, R., Vera, A., Zuniga, M.L., Strathdee, S.A. (2010). High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico. International Journal of Infectious Diseases, 14(3), e117-e122.
- Beeching, N.J., Crowcroft, N.S. (2005). Tetanus in injecting drug users. BMJ, 330(7485), 208-209.
- Centers for Disease Control and Prevention. (2015). Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy.
- .S. National Library of Medicine. (2019). MedlinePlus: Gas gangrene.
- Ciccarone, D. (2009). Heroin in Brown, Black and White: Structural Factors and Medical Consequences in the US Heroin Market. Int J Drug Policy, 20(3), 277-282.
- Darke, S., Hall, W. (2003). Heroin overdose: research and evidence-based intervention. J Urban Health, 80(2), 189-200.
- Maxwell, J.C., Coleman, J.J., Feng, S.Y., Goto, C.S., Tirado, C.F. (2012). Cheese: an old drug in a new wrapper. Drug Alcohol Depend, 126(1-2), 161-167.