Different Routes of Administration

• Heroin can be administered by several methods, including snorting, smoking, and subcutaneous and intravenous injection.

Onset of Action

• The onset of action of a drug depends on the speed with which the drug reaches the brain through the blood-brain barrier.
• Some routes of administration are associated with a quicker onset of action in comparison to others.
• For example, intravenous injection provides the greatest intensity and fastest onset of euphoria (7 to 8 seconds), followed by intramuscular injection (5 to 8 minutes) and inhalation (10 to 15 minutes). The effects of smoking heroin can be expected to come on as quickly as after injection, but are less intense.

Injection and Associated Risks

• Heroin is often injected, particularly by long-time users because of the intensity and quick onset of action associated with this route.
• Users who inject heroin are at additional risk for abscesses and other soft tissue infections as well as infectious diseases such as HIV/AIDS, and hepatitis B and C due to using dirty needles and/or sharing needles with other users.

Changing Trends in Heroin Administration: The Increase in Inhalation

• In the past, the association of heroin use with injection deterred many from trying the drug. However, researchers have discovered a recent shift from injecting the substance to snorting it, which is likely due to the increase in heroin's purity level in recent years.
• With the increase of inhalation as a route of administration comes an increase of new heroin users who are more ethnically, economically, and geographically diverse.

Progression of Addiction and Routes of Administration

• While many new users begin using heroin through inhalation, progression to injection may occur as they become addicted and their tolerance level increases. This means that they need to use larger amounts to obtain a high and/or use through a route of administration that delivers the drug in a more efficient way.

False Security

• Many new users, particularly adolescents, falsely believe that snorting heroin is a safer route of administration compared to injecting the substance. All forms of heroin administration are addictive. Overdose and death can result from heroin use, regardless of how it is used.