HEROIN

It is used medicinally as an analgesic, but the majority of exposure is as a drug of abuse (HSDB, 1996). Heroin is an illicit drug and manufacture, importation, or sale are illegal in the USA. It is available as a strictly controlled substance in the UK, however (HSDB, 1996).
Heroin for legitimate medicinal use is available as the hydrochloride in 10 mg tablets or aqueous injection, as an elixir (with cocaine), and as linctuses (preparations which are taken by licking) (HSDB, 1996).
The most common routes of exposure to heroin are smoking and, in more developed countries, intravenous injection (ILO, 1983).
In much of the toxicological literature, human subjects for studies of heroin have actually been polydrug abusers. Heroin addicts are sometimes recruited for studies because they are enrolled in methadone maintenance clinics; in these cases methadone would be a confounder.

FORMS

Heroin is a member of the OPIOID family, also called OPIATES or NARCOTICS. It is a physically addictive substance.
Pure heroin occurs as white crystals or a crystalline powder, and is odorless with a bitter taste (Lewis, 1993). It is soluble in chloroform, slightly soluble in ether and alcohol, and sparingly soluble in water (Budavari, 1996). It slowly decomposes in air (HSDB, 1996).
Street heroin may vary tremendously in both purity and appearance. It is most commonly of 21 to 60 percent purity (Gomez & Rodriguez, 1989). Usually, the remaining ingredients in street heroin are not toxic (Shesser et al, 1991). However, typical diluents are mannitol, dextrose, lactose, talc, baking soda, quinine, strychnine, procaine, phenacetin, lidocaine, caffeine, lemon juice, boric acid, calomel, antipyrine, and dog manure (HSDB, 1996), some of which may cause toxicity of their own.
Many of the physiological and toxicological effects of opioids are similar, and to some extent this review describes the common effects for the narcotic family of drugs. Effects specifically attributed to heroin are identified where possible.

SOURCES

HEROIN, or DIACETYL MORPHINE, is a semisynthetic derivative of morphine which is derived from opium (Budavari, 1996). Most heroin originates in Afghanistan and Pakistan; heroin used in the USA comes from Mexico, and Southeast and Southwest Asia (HSDB, 1996).

-CLINICAL EFFECTS

GENERAL CLINICAL EFFECTS

Editor's Note: An ERG guide with information appropriate to this material does not exist.

ACUTE CLINICAL EFFECTS

Heroin is a highly toxic substance. Less than 1 grain (65 milligrams) can be fatal when ingested (HSDB, 1996). There have been many cases of sudden death from heroin overdose (HSDB , 1995).

Many cases of heroin overdose in the literature are undoubtedly acute effects superimposed on a pattern of chronic addiction. It may therefore be difficult to separate truly acute from chronic effects.

Heroin is effectively absorbed by all routes of exposure (nasal, inhalation, subcutaneous, intramuscular, intravenous, rectal). Injection is the usual mode of abuse.

General effects of opioids include analgesia, sweating or flushing, dizziness, mental slowness, visual disturbances, sleepiness, weakness, faintness, restlessness, agitation, euphoria or dysphoria, seizures, delirium, respiratory depression, and coma (HSDB, 1996).

The pupils can be either pinpoint or dilated. Blood pressure can be either high or low. Respiratory depression and/or arrest have occurred with heroin abuse (Hughes & Calverley, 1988). Pulmonary edema has been reported to occur in 48 percent of cases of heroin overdose (Duberstein & Kaufman, 1971; Sauder et al, 1983). Onset of pulmonary edema can be abrupt, immediately after use or within 2 hours (Duberstein & Kaufman, 1971). Intranasal use of heroin can lead to more delayed onset of pulmonary edema (4 hours) (Steinberg & Karlinger, 1968). Taking heroin by the inhalation route would be expected to produce pneumonitis.

Opioids can induce lethargy and coma; the latter may be recurring. Other CNS effects include tonic-clonic seizures and EEG changes. Heroin use has caused muscle weakness, jerking, and peripheral sensory neuropathy (De Gans et al, 1985).

Opioids increase the tone and amplitude of contraction of smooth muscle. Opioids impair peristalsis and can cause delayed gastric emptying, constipation, and fecal impaction. Urination may also be difficult because of increased tone of the vesical sphincter muscle (HSDB, 1996).

Rhabdomyolysis (breakdown of muscle cells) has been reported with heroin abuse (De Gans et al, 1985; Chan et al, 1990).

Heroin usage is also associated with an increased risk of diseases and conditions associated with intravenous administration. ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) and HEPATITIS B are secondary risks of drug abuse with contaminated needles. COTTON FEVER is a short-term reaction involving fever, malaise, chills, and abdominal and leg pain, contracted by filtering injected solutions through cotton (Harrison & Walls, 1990).

The amphetamine derivative 3,4-methylene dioxyethamphetamine (MDEA) and heroin appeared to antagonize the toxicity of each other in one patient (Jorens et al, 1996).

CHRONIC CLINICAL EFFECTS

Much of the toxicological literature on heroin and other opioids deals with chronic exposures in drug abusers. Heroin is addictive in both the physical and psychological sense, and can induce drug dependence and tolerance. Because heroin addicts may use increasingly larger doses over time, there is a danger of fatal overdose when using an unusually pure sample.

The profile of effects from heroin may change in the same individual over time; euphoria is more common before tolerance develops, while apathy, anhedonia, and social withdrawal are characteristic of tolerant individuals (HSDB, 1996).

Heroin is an immunologically active substance, and some deaths may be from hypersensitivity reactions. Wheals and pain may occur at the site of injection after repeated administration (HSDB , 1995). Bronchospasm, airway obstruction, wheezing, and severe asthma have occurred after inhalation or intravenous injection of heroin (Del Los Santos-Sastre et al, 1986; Anderson, 1986; Oliver, 1986; Hughes & Calverley, 1988). Respiratory insufficiency due to laryngeal edema has been reported in one case (Moreno Millan, 1984).

Signs consistent with a hypersensitivity response, including severe swelling and flaccid paralysis, were seen in a man who had injected heroin (Stamboulis et al, 1988). Increased levels of immunoglobulins have been found in narcotic addicts; IgM levels were elevated in 75 percent of adult subjects (HSDB, 1996). Isolated cases of thrombocytopenia have been attributed to a possible immunologic mechanism (Sala & Giralt, 1985).

Ironically, heroin addicts are often also immunosuppressed, as measured by reduced mitogenic response of the lymphocytes, interference with E-rosette formation, and increased incidence of opportunistic infections (Falek et al, 1991).

Heroin abusers have developed acute tubular necrosis, glomerulonephritis, glomerulosclerosis, amyloidosis, and kidney failure (Nicholls et al, 1982; Krige et al, 1983; Cunningham et al, 1983; Dubrow et al, 1985). Chronic hepatitis has also been seen in heroin abusers who died shortly after beginning methadone treatment (HSDB, 1996).

Another less common complication of heroin addiction is permanent sensorineural hearing loss, probably due to the direct action of morphine on the temporal lobe of the brain (Polpathapee et al, 1984). Spongiform leucoencephalopathy (destruction of white brain matter) has been seen in persons who smoke heroin regularly (Sempere et al, 1991; Schiffer et al, 1985).

-RANGE OF TOXICITY

MAXIMUM TOLERATED EXPOSURE

Carcinogenicity Ratings for CAS561-27-3 :

ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed
EPA (U.S. Environmental Protection Agency, 2011): Not Listed
IARC (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): Not Listed
NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
MAK (DFG, 2002): Not Listed
NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

TOXICITY AND RISK ASSESSMENT VALUES

EPA IRIS

EPA Risk Assessment Values for CAS561-27-3 (U.S. Environmental Protection Agency, 2011):

Not Listed

-STANDARDS AND LABELS

WORKPLACE STANDARDS

ACGIH TLV Values for CAS561-27-3 (American Conference of Governmental Industrial Hygienists, 2010):

Not Listed

AIHA WEEL Values for CAS561-27-3 (AIHA, 2006):

Not Listed

NIOSH REL and IDLH Values for CAS561-27-3 (National Institute for Occupational Safety and Health, 2007):

Not Listed

OSHA PEL Values for CAS561-27-3 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):

Not Listed

OSHA List of Highly Hazardous Chemicals, Toxics, and Reactives for CAS561-27-3 (U.S. Occupational Safety and Health Administration, 2010):

Not Listed

ENVIRONMENTAL STANDARDS

EPA CERCLA, Hazardous Substances and Reportable Quantities for CAS561-27-3 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA CERCLA, Hazardous Substances and Reportable Quantities, Radionuclides for CAS561-27-3 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA RCRA Hazardous Waste Number for CAS561-27-3 (U.S. Environmental Protection Agency, 2010b):

Not Listed
Editor's Note: The D, F, and K series waste numbers and Appendix VIII to Part 261 -- Hazardous Constituents were not included. Please refer to 40 CFR Part 261.

EPA SARA Title III, Extremely Hazardous Substance List for CAS561-27-3 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA SARA Title III, Community Right-to-Know for CAS561-27-3 (40 CFR 372.65, 2006; 40 CFR 372.28, 2006):

Not Listed

DOT List of Marine Pollutants for CAS561-27-3 (49 CFR 172.101 - App. B, 2005):

Not Listed

EPA TSCA Inventory for CAS561-27-3 (EPA, 2005):

Not Listed

LABELS

NFPA

NFPA Hazard Ratings for CAS561-27-3 (NFPA, 2002):

Not Listed

-PERSONAL PROTECTION

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

PROTECTIVE CLOTHING

CHEMICAL PROTECTIVE CLOTHING. Search results for CAS 561-27-3.

Specific recommendations and test data for this chemical were not found in the available manufacturers' product literature. A complete list of consulted manufacturers and references is presented below.

-PHYSICAL HAZARDS

FIRE HAZARD

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

FLAMMABILITY CLASSIFICATION

NFPA Flammability Rating for CAS561-27-3 (NFPA, 2002):

Not Listed

FIRE CONTROL/EXTINGUISHING AGENTS

Editor's Note: An ERG guide with information appropriate to this material does not exist.

NFPA Extinguishing Methods for CAS561-27-3 (NFPA, 2002):

Not Listed

EVACUATION PROCEDURES

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

AIHA ERPG Values for CAS561-27-3 (AIHA, 2006):

Not Listed

DOE TEEL Values for CAS561-27-3 (U.S. Department of Energy, Office of Emergency Management, 2010):

Not Listed

AEGL Values for CAS561-27-3 (National Research Council, 2010; National Research Council, 2009; National Research Council, 2008; National Research Council, 2007; NRC, 2001; NRC, 2002; NRC, 2003; NRC, 2004; NRC, 2004; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; United States Environmental Protection Agency Office of Pollution Prevention and Toxics, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; 62 FR 58840, 1997; 65 FR 14186, 2000; 65 FR 39264, 2000; 65 FR 77866, 2000; 66 FR 21940, 2001; 67 FR 7164, 2002; 68 FR 42710, 2003; 69 FR 54144, 2004):

Not Listed

NIOSH IDLH Values for CAS561-27-3 (National Institute for Occupational Safety and Health, 2007):

Not Listed

CONTAINMENT/WASTE TREATMENT OPTIONS

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

SMALL LEAK/SPILL

Editor's Note: An ERG guide with information appropriate to this material does not exist.

LARGE LEAK/SPILL

Editor's Note: An ERG guide with information appropriate to this material does not exist.

-PHYSICAL/CHEMICAL PROPERTIES

MOLECULAR WEIGHT

369.42

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Information to evaluate chemical incidents

Information to evaluate chemical incidents

Information to evaluate chemical incidents