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Heroin is an opioid drug that is illegal and highly addictive. It is made from morphine, which is a natural substance taken from the seed pod of opium poppy plants. These plants are mostly grown in Southeast and Southwest Asia, Mexico, and Columbia. Heroin can be a white or brown powder, or a black, sticky substance which is black tar heroin.

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Pure heroin can be snorted or smoked. Black tar heroin is usually dissolved, diluted, and injected into veins, muscles, or under skin. Most people who use heroin first misused prescription opioids, but still about one-third of users started with heroin. Prescription opioid pain medicines like OxyContin and Vicodin have similar effects to heroin. The misuse of these drugs may open the door to heroin use.

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Short term effects of heroin: after using it, users feel a "rush" (serge of pleasure or euphoria), dry mouth, heavy feeling in the arms and legs, severe itching, clouded mental function, and going "on the nod" (back-and-forth state of being conscious and unconscious.
Long term effects of heroin: insomnia, collapsed veins (people who inject it), damaged nose tissue (sniff or snort it), infection in heart lining or valves, liver and kidney disease, lung complications, mental disorders, sexual dysfunction for men, and irregular menstrual cycles for women. Another long-term effect is loss of the brains white matter which affects decision making, behavior control, and responses to stressful situation.

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In 2016, about 948,000 Americans reported using heroin in the past year. This number has been on the rise since 2007. Young adults (age 18-25) have the greatest increase in heroin usage, and while usage has declined in teens 12-17 years old. The global average of people who use heroin is 0.37%. The global average is much higher in and near the Middle East/Southwest Asia, Central Asia, and Eastern and Southeastern Europe.

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Heroin is highly addictive. People who use it regularly, often develop a tolerance for it, which means they need higher and more frequent dose. Once a person is addicted to heroin, seeking and using it becomes the main goal guiding their daily behavior. There are many treatments for heroin use/addiction. There are medicines developed to help with the withdrawal process. These medicines bind to the same opioid receptors in the brain as heroin, but is weaker. Another treatment called naltrexone blocks opioid receptors and prevents opioid drugs from having an effect. There also is behavioral therapies called cognitive-behavioral therapy and contingency management. These help modify the patients drug use expectations and behaviors, and provide motivational incentives. These behavioral methods are especially effective when used with medicines.

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This article talks about the island of Seychelles has the worlds worst heroin problem and what they are doing to help people. The total population of the country is 94,000 people, and between 5,000-6,000 people are addicted to heroin. Per capita, they suffer from the highest rate of heroin abuse in the world. Instead of attempting a "war on drugs", they are considering drug addiction as a chronic disease. They can either do a period of in-patient treatment, or join a low-threshold program that focuses on harm reduction. They currently have over 2,000 people in one of the programs and 68% of those people are employed now.

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The island paradise of Seychelles is suffering from a drug epidemic of huge proportions.

Known for its coral reefs, mangroves and white sandy beaches, 360,000 tourists travel to the Indian Ocean archipelago each year for a holiday of a lifetime.

But look beyond the private islands, the boutique resorts and high-end restaurants, and the small nation is battling a heroin epidemic of huge proportions.

Between 5,000 and 6,000 people out of a total population of 94,000 - the equivalent of nearly 10% of the working population - are addicted to heroin, according to the Agency for the Prevention of Drug Abuse and Rehabilitation (APDAR) in the Seychelles.

Per capita, the Seychelles suffers from the highest rate of heroin abuse in the world.

I was smoking heroin two to three times a day, even stealing from my grandmother to pay for my habit"

Jed Lesperance
Recovering drug addict

Jed Lesperance was 20 years old when he first started taking drugs. He is 34 now.

"I started smoking cannabis with my friends every now and again. At first it was fun," he said.

"But over time I graduated to heroin and it started taking over my life. I was smoking heroin two to three times a day, even stealing from my grandmother to pay for my habit. Within a few weeks, I had become addicted," he said.

Heroin makes the long journey from Central Asia, especially Afghanistan, before being smuggled to the islands via East Africa.

Made up of 115 islands, the Seychelles has many porous borders, which makes them hard to monitor and easy for drugs to come into the country.

Morning methadone clinics

But rather than attempting a "war on drugs", which would criminalise the large proportion of heroin users in the Seychelles, the head of the anti-drug agency has introduced a Portuguese-style drug policy - considering drug addiction as a chronic disease to be treated.

"The Agency for the Prevention of Drug Abuse and Rehabilitation was established in August 2017 and we introduced the Methadone Maintenance Programme (MMP) in May 2018," Patrick Herminie told the BBC.

Heroin users have two options:

To join a high-threshold MMP, which includes a period of in-patient treatment where they must commit to detoxification

Or the low-threshold programme, which focuses on harm reduction

Individuals have access to medical and psychosocial support under both programmes.

"Currently, we have over 2,000 people registered in one of our programmes and 68% of those are now gainfully employed," Mr Herminie said.

Mr Lesperance is one of those people who has benefitted from joining a rehabilitation programme set up by the agency.

Each morning, he visits one of the country's roaming methadone clinics - white vans that are manned by drug counsellors and qualified nurses to give the correct dose of methadone to recovering addicts.

Dozens of people line up outside the open windows of the white van ready to show their ID. Their name, the date and time are logged into a spreadsheet and on receipt of the information, the correct dose of methadone is distributed to them.

Mr Lesperance, who has been clean for three months, now works as a pastry chef in a five-star hotel on Mahe, the largest island in the Seychelles.

"Since I found work, I have a lot more stability and it has encouraged me to stay on the programme.

"I have also been able to give some of the money I earn back to my grandmother, which has made our relationship a lot better," he said.

More on drugs in Africa:

How addict Jesus survived South Africa's drug epidemic

Prescription drugs sold illegally in Uganda

How a codeine investigation changed Nigeria

Michelle Sabury, who helps recruit drug addicts on to rehabilitation programmes, agrees that "he is a completely different person".

"When he first came to us, he was underweight and had very little hope. Now he looks a lot healthier and is able to go to work each day. We are proud of what he has achieved," she told the BBC.

After receiving methadone, many of those enrolled in the programme stay to talk with their peers or a counsellor before heading off to work or back home.

Some arrive with family members in tow, illustrating how the stigma attached to treatment in the Seychelles is slowly disintegrating.

'My boyfriend was a dealer'

One of the counsellors, Levina Mosses, is a reformed heroin addict who now comes to offer support to others hoping to get clean.

The heroin epidemic has touched so many people in my country, it's only right to be open and honest about the problems we are facing"

"I started talking heroin when I was 17 years old. My boyfriend was a dealer at the time, so I never had to pay for drugs.

"But after years of heroin abuse, I had had enough. My only option was to get clean."

Ms Mosses left her boyfriend, also the father of her children, 11 years ago - and has been clean ever since.

"I think it's important to get support from people who have been in similar situations so they can see what it is like to come out of it on the other [side].

"The heroin epidemic has touched so many people in my country, it's only right to be open and honest about the problems we are facing," she said.

Following the rollout of the rehabilitation programmes, the price of heroin in the Seychelles has plummeted.

Five things about Seychelles:

Popular with tourists after overcoming history of coups and mutinies following independence

The Duke and Duchess of Cambridge spent their honeymoon there in 2011

The archipelago has a high per capita income, good health care and education

Much of the land on its 115 islands is protected as part of nature reserves

Home to the endangered Aldabra giant tortoises

"A line of heroin - around 0.1g - used to cost around 1,000 rupee [$73; £57] but now it can be bought for around 30 rupee," said the anti-drug agency head.

"The main aim [is] to undermine all of the work that we have done in rehabilitating the population and get people using again, but we are determined to keep up the fight," he said.

However, there is another threat mounting in the Seychelles as the popularity of synthetic drugs is now on the rise.

"We don't have any official numbers as yet but anecdotally, we have heard that dealers are starting [to] get their hands on new drugs, drugs that we cannot treat with methadone," Mr Herminie said.

"But we hope that the agency will be able to adapt quickly and target new threats that come our way."

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The island paradise with world's worst heroin problem

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The island paradise of Seychelles is suffering from a drug epidemic of huge proportions. Known for its coral reefs, mangroves and white sandy beaches, 360,000 tourists travel to the Indian Ocean archipelago each year for a holiday of a lifetime.

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This article is about a woman from Kalamazoo, MI, whose fiancee overdosed on heroin. She has no idea he was using the highly addictive drug, so she had no way to help him. She explained that people need to understand that addiction effects the addicts and their loved ones. She also talked about the stigma around addiction, and why it makes people keep theirs a secret. She wants people to be able to reach out and ask for help if they need it and not suffer in silence like her fiancee did.

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Addicted Michigan: One woman's story of heartbreak reveals a message of hope for addicts

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Alison Bailey met the love of her life and started planning her future, certain they'd spend many years together. In July, everything changed. Bailey found her fiancee dead in the basement of their home. He had overdosed on heroin, a drug she had no idea he was using.

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“Heroin.” NIDA for Teens, 1 Mar. 2019, teens.drugabuse.gov/drug-facts/heroin.
National Institute on Drug Abuse. “Heroin.” NIDA, Nov. 2019, www.drugabuse.gov/publications/drugfacts/heroin.
National Institute on Drug Abuse. “What Is Heroin and How Is It Used?” NIDA, June 2018, www.drugabuse.gov/publications/research-reports/heroin/what-heroin.
“What Is the Global Prevalence of Heroin Use?” Latest Medical News, Clinical Trials, Guidelines - Today on Medscape, 10 Nov. 2019, www.medscape.com/answers/166464-159460/what-is-the-global-prevalence-of-heroin-use.
National Institute on Drug Abuse. “What Is the Scope of Heroin Use in the United States?” NIDA, June 2018, www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states.