The relaxing and euphoric states are accompanied by a number of negative phenomena: mental impairments such as confusion, disorientation, memory lapses, slurred and slurred speech as well as coordination disorders, extreme constipation, a reduction in sexual desire and - due to the dampening of the coughing and breathing centre - a sometimes severe and life-threatening reduction in breathing frequency to 2-4 breaths per minute can be the result.

Due to its chemical structure and high fat solubility, heroin reaches the brain faster than morphine. The short flooding time causes an intense high or "kick". The faster a substance reaches the brain, the greater its addictive potential. In the body, heroin is converted to morphine and finally excreted via the kidneys.

Regular use of heroin over several weeks leads to a so-called "tolerance" to the analgesic, euphoric and sedative effects. More has to be taken in order to achieve the desired state again. With continued use, the organism finally reacts with psychological and physical dependence: although the negative effects become increasingly clear, the craving for the calming and euphoric effects of the substance is unbroken. By this point at the latest, you are dependent on and addicted to opioids. As soon as tolerance has developed and the body is not supplied with the necessary amount of the substance, withdrawal symptoms occur 8-12 hours after the last heroin intake.

If the respective substance is finally discontinued after a longer period of consumption, the organism - which has become accustomed to the intake of foreign substances - reacts with unpleasant and often almost unbearable withdrawal symptoms (sweating and cold shivers, runny eyes and nose, vomiting, diarrhoea, restlessness, irritability, weakness, anxiety, depressive states, painful cramps, insomnia and, more rarely, hallucinations, psychotic phases and seizures).

Regardless of the duration of use - i.e. even the first time - the use of previously used syringes and syringe equipment (such as spoons and filters) can lead to the transmission of chronic infectious diseases such as hepatitis or HIV.

• Diseases of the lungs (such as asthma)
• As the liver and kidneys are heavily burdened by the breakdown of heroin, people with pre-existing liver or kidney disease may experience a worsening of the clinical picture.

• Heroin and other downers (e.g. alcohol or benzodiazepines)
  The effects of these substances are mutually reinforcing - the risk of an overdose or respiratory paralysis and, as a result, coma or death, is greatly increased. Similarly, taking heroin and GHB at the same time greatly increases the risk of respiratory paralysis.
• Heroin and cocaine
  Combinations of cocaine and opioids place a strain on the body due to their opposing effects on the organism. The immediate consequences can be shortness of breath and cardiovascular failure.

• The combination (before, at the same time and after) of two or more "downers", such as opioids, sleeping pills and tranquillisers, GHB and alcohol, increases the risk of nausea, vomiting, unconsciousness and respiratory paralysis. There is a particularly high risk of overdose with substances with a long duration of action, such as benzodiazepines.
• The risk of overdosing is particularly high after long periods of non-consumption and with extremely "pure substances".
• In contrast to injecting, smoking or snorting heroin is associated with slightly lower health risks: the amount can be better regulated and the risk of infection - for example, HIV and hepatitis (jaundice) - is very low. However, there is also a risk of hepatitis infection when sharing tubes for consumption through the nose. Smoking heroin can lead to irritation of the respiratory tract, snorting to irritation of the nasal mucosa.

• Intravenous consumption is characterised by a rapid and strong onset of action. Physical tolerance and psychological and physical addiction therefore occur more quickly with this form of consumption than with all other forms.
• Chronic infectious diseases such as hepatitis and HIV can easily be passed on through used syringes and injecting equipment. Use fresh needles, syringes, filters, swabs, distilled water and ascorbic acid for intravenous use. At some counselling centres, such as Jedmayer, you can exchange your old syringes for new ones free of charge.
• The liquid in the syringe must be transparent and must not contain any crumbs or flakes - dirt can cause major health complications such as heart disease, abscesses and embolisms (sudden blockage of blood vessels).
• Do not inject into old injection sites and always clean the skin with an alcohol swab beforehand.
• Before injecting, you must press the air out of the syringe.

In this method, heroin is heated and the resulting vapours are inhaled using a tube. A piece of aluminium foil is folded in half and the heroin is sprinkled on top. It is then heated over a low flame until it liquefies and vaporises. With a high flame, however, the heroin burns and the aluminium foil becomes porous.

Smoking - whether heroin, tobacco or cannabis - damages the airways and lungs. It is still unclear whether other health consequences can arise from inhaling heroin (such as brain damage).

If you decide to smoke heroin despite the health and criminal risks, you should observe the following rules:

• Take advantage of drug checking offers. You can only really know what you are consuming, how high the active ingredient content is and whether there are any (dangerous) additives by analysing it.
• Take a small puff at first and wait for the effect before smoking more.
• Do not share your tube with others, as this can be a transmission route for diseases (herpes, hepatitis C, possibly HIV).
• Use uncoated foil, which produces less harmful vapours during vaporisation. You can also obtain these from addiction counselling centres such as jedmayer.
• The combination (before, at the same time and after) of two or more downers (such as opioids, sleeping pills and tranquillisers, GHB and alcohol) increases the risk of nausea, vomiting, unconsciousness and respiratory paralysis. There is a particularly high risk of overdose with substances with a long duration of action, such as benzodiazepines.

Heroin, whose chemical name is diacetylmorphine, belongs to the class of semi-synthetic opioids. The so-called morphine base is extracted from the sap of the poppy plant (Papaver somniferum) using a distillation process. After further chemical processes, including the addition of acetic anhydride, diacetylmorphine is finally produced.

Illegal, non-medical heroin - also known as "H", "brown" or "poison" - is usually diluted in the street scene with substances such as glucose, lime, icing sugar or paracetamol before being sold and therefore has a relatively low purity of between 15-45%.

Heroin was first synthesised in 1874 and launched on the market in 1898 by the pharmaceutical company Bayer as a drug to treat coughs. As heroin was administered orally to treat coughs, which meant that it only reached the brain slowly and only had a weak psychological effect, the great addictive potential of this substance was not recognised for a long time. At the beginning of the 20th century, there was a growing rejection of the relatively widespread non-medical use of heroin in the USA, which ultimately led to the signing of the "Opium Convention" in 1912. The Opium Convention, a forerunner of the opium ban, provided for the "gradual suppression of the abuse of opium, morphine, cocaine, and such preparations and derivatives of these substances as give or may give rise to similar abuses". In 1920, 43 countries joined the Opium Convention, and in 1961 poppy straw concentrate, opium, raw opium, heroin, methadone, morphine and codeine were included in the New York Convention on Narcotic Drugs.

Heroin is subject to the Narcotic Substances Act and its judicial penal provisions. In particular, the acquisition, production, import and export, transfer to and procurement for others (transfer, sale, etc.) is punishable by law and can result in fines and imprisonment.