Black tar heroin looks different than powder heroin. It is a dark-colored form of heroin that can be rock-like or sticky like roofing tar. During production, black tar heroin often is mixed, or “cut,” with low quality substances such as burned cornstarch or lactose. The substance generally is less refined and cheaper than conventional powder heroin.
People who use black tar heroin usually smoke it or inject it after dissolving and diluting the drug. In most cases, black tar heroin is injected into veins, muscles or under the skin. But it can be heated on foil over an open flame and inhaled through a straw or similar device. The tar can also be mixed with water over heat and sprayed into the nose.
Black tar heroin is primarily produced in Mexico using crude processing methods, according to the New York Office of Alcoholism and Substance Abuse Services. But parts of South America, Southeast Asia and Southwest Asia have also manufactured the substance. The drug is sometimes called heroin acetate because black tar heroin is often produced after a stage of the refinement process called acetylation.
It is often the most prevalent form of heroin available in the western United States, but it has also been found in parts of the northeastern United States, western Canada and Europe. The drug is generally sold in chunks weighing about an ounce.
Like other types of heroin, black tar heroin is associated with a host of physical complications, including soft tissue infections and vascular sclerosis, a condition that hardens arteries. People who frequently use the drug can experience mental health problems, withdrawals and addiction.
Many heroin treatment programs across the United States use evidence-based strategies to help wean people off black tar heroin and address psychological problems associated with its use.
Multiple studies show that people who inject the drug are more likely to be older men who have extensive histories of drug use and test positive for viruses such as HIV or hepatitis. Those who inject or shoot black tar heroin generally started using heroin earlier than those who inhale or smoke the drug, and they also have higher levels of dependency.
A 2006 study published in the Journal of Maintenance in the Addictions examined the characteristics of 199 black tar heroin users receiving methadone treatment in Texas.
According to the report, at the time of admission:
About 25 percent of patients in the study had health insurance, and many could not readily access care. Among the study’s participants, 43 percent were diagnosed with a mental health problem by a medical professional. Depression was the most common psychiatric disorder among black tar heroin users.
People who intravenously inject black tar heroin could develop venous sclerosis, a condition characterized by the narrowing and hardening of the veins. Black tar users also face increased risk of bacterial infections such as necrotizing fasciitis, a flesh eating disease.
In fact, a 2016 study published in the Journal of Psychoactive Drugs found that black tar heroin users were twice as likely as Colombian-produced powder heroin users to develop soft tissue infection such as necrotizing fasciitis.
Some physical symptoms of black tar heroin use include:
Black tar heroin can be combined with cold medication to form “Cheese,” a highly addictive tan-colored powder. Cheese can result in lethargy, disorientation, excessive thirst, drowsiness and hunger. Between 2005 and 2007, the concoction was associated with a rise in teen deaths in Texas.
Black tar heroin can lead to overdose. Signs of a heroin overdose include clammy skin, slow or shallow breathing, blue lips and fingernails, convulsions and coma. If not treated immediately, overdose can lead to death.
Heroin can be tainted with more powerful opioids. In recent years, mixing powder heroin with fentanyl — a synthetic opioid 25 to 50 times more toxic than heroin — has resulted in a bevy of overdose deaths in the United States. However, fentanyl is not commonly added to black tar heroin in the United States.
“I have not yet heard stories of people lacing black tar heroin with fentanyl,” Dr. Kevin Wandler, chief medical officer at Advanced Recovery Systems, told DrugRehab.com.
Multiple reports warn that black tar heroin use may lead to botulism, a rare neurological illness that can arise when an injection wound is contaminated with a certain type of bacteria.
Botulism can cause a number of health problems, including difficulty swallowing, blurred vision, trouble breathing or paralysis.
In the 1990s, black tar heroin use increased in the United States, and botulism became more widespread among injection drug users. From 2000 to 2004, more than 30 heroin or cocaine users in Europe developed botulism. Researchers found no confirmed cases of botulism related to drug use in the U.K. prior to 2000.
A 2017 report published in the journal Neurocritical Care examined 15 patients in El Paso, Texas, who were hospitalized for botulism and had a history of black tar heroin use. Researchers concluded that injecting the substance under the skin was associated with developing botulism.
The prevalence of HIV among injection drug users is higher in cities where powder heroin use is more common than black tar heroin use, according to a 2009 study published in the International Journal on Drug Policy.
The report stated that black tar heroin may cause scarring in the veins, so many people choose to inject the drug below the skin or into the muscle. These routes of administration are less likely to transmit HIV than injecting the drug into the veins.
Many people who use black tar heroin flush their syringes with water or apply heat to remove the sticky residue that gathers on needles after use. Researchers at the University of California, San Francisco, found that thoroughly cleaning black tar heroin syringes may reduce the risk for developing HIV.
The treatment approach for black tar heroin addiction is similar to treatment for powder heroin addiction, according to Wandler. Evidence-based rehab centers in the United States use a combination of behavioral and pharmacological approaches to help people overcome addiction to black tar heroin. Treatment for black tar heroin addiction begins with heroin detox or the initiation of maintenance medications.
Some medications used in heroin addiction treatment include:
Methadone is a slow-acting opioid agonist that lessens euphoria and prevents heroin withdrawal symptoms associated with use. The medication is available only through outpatient treatment care.
Naltrexone is a nonaddictive medication that blocks the effects of opioids. Some studies have found that clients are less likely to comply with naltrexone treatment than treatments involving other medications. However, naltrexone is effective when used as prescribed.
In addiction to the medication used in rehab for black tar heroin, behavioral treatments such as contingency management and cognitive behavioral therapy have proved effective in treating heroin addiction. Contingency management uses positive reinforcements and stimulus control to alter problematic behaviors related to addiction, while cognitive behavioral therapy helps people identify, understand and change these behaviors.