Death is pretty long term. Pardon me if I’m pessimistic on this topic, I just watched a Janis Joplin documentary.

That's not a side effect of heroin, that's a side effect of overdosing. Death is also a side effect of overdosing on acetaminophen, and alcohol. Imagine if when I went to my local wine shop they made a mistake and sold me something that was 80% abv rather than 12-14% and I drank the bottle. Or my pharmacy gave me 5g acetaminophen tablets instead of 500mg, and I took 2 of them every four hours for a few days. Or my finely ground table salt was cut with some form of rodent poison. I'd be pretty dead in those cases most likely. Most illegal substances you have absolutely no idea what you're buying or how much you're buying unless you test it yourself. Yes, word gets around but that's no use to you if you accidentally take 10x a dose, or something that is just not what you were told it was.

Legal substances also have lots of information readily available around them - if I go to my pharmacy and ask for ibuprofen, they will tell me the dosages in advance. If I go to my doctor and they put me on oxycodone, they will give me a dose that they think is safe, (and in theory, a plan to reduce my dependence on them) without judgement. If you develop an opiod addiction, your support options are much more limited.

Thing is, good heroin/morphine is almost free of side effects. Paracetamol, for example, is a lot more dangerous than heroin.

Also, Joplin took heroin AND massive quantities of alcohol on the day of her death. It will be close to saying that when someone dies in a car crash while DUI, driving is the real and unique problem here.

But the drug-war irrationality is better exposed by taking a look at weed and MDMA. Two quite safe substances (certainly more safe than alcohol), with clear medical applications, and forbidden just because some ignorant decided to put them in Schedule I. MDMA at the time of its prohibition was being used in psychotherapy with success in tens of thousands of patients [1]. Today, no medical use is recognized, and being in Schedule I (making it un-researchable), none will be. I wouldn't be too surprised that some country discover that it could be used as a treatment for depression or PTSD.

[1] https://www.amazon.com/dp/0791418189

Okay sounds like you've got it all figured out. Good luck!

Switzerland started a program in 1995 where they give medical grade heroin to people suffering from addiction. From the people taking part in this program, none have died from heroin overdoses or due to toxic contamination in the drug.

So heroin is actually pretty safe if used correctly.

Indeed. If one reads the adverse effects of heroin (e.g. in Wikipedia) and ignores the ones caused by dirty injection, lacing and overdose, you are left with no long term effects other than a blurry "brain impairment to make decissions". On the short term, respiratory depression. That's it.

Not many legal drugs has such short list of side effects.

Death comes from _mis_use, which usually stems from _mis_information ("drugs are bad, let's not talk about them").

People die when they over-dose (which more often than not happens because they don't know exactly what they're getting, or the purity of it) or mix with other substances that they shouldn't.

Another common cause of overdoses which stems from a lack of education:

A person quits for a while, decides to start using again and shoots up their usual dose for which they no longer have sufficient tolerance.

If that person knew that this is a common way people end up killing themselves, they probably wouldn't make this mistake.

One source I've found about the long-term effects: https://www.drugabuse.gov/publications/research-reports/hero...

"Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations."

I expected something more damning. Unfortunately, I feel that we don't have enough studies (incl. long-term ones) when it comes to recreational drugs.

Worse: heroin destroys hippocampus function over time. If the hippocampus is damaged by disease or injury, it can influence a person's memories as well as their ability to form new memories. Hippocampus damage can particularly affect spatial memory, or the ability to remember directions, locations, and orientations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6758897/

So, what's the problem then? Why is using heroin bad?

Black market incentivises dealers doing things like mixing fentanyl into heroin in order to make it vastly more profitable (fentanyl is cheap and incredibly potent), with the side effect of increasing its deadliness massively.

Users often mix heroin with benzos and/or alcohol which increases the level of risk enormously. The vast majority of overdoses are caused by mixing CNS depressants in with heroin, not by heroin use alone.

If you can't get a steady supply then withdrawals are vicious and can cause a host of other problems (crime in order to get money for more heroin being a commonly cited one).

One of the ways that heroin itself can cause overdose deaths is relapses - users may take a dose that they were previously tolerant to. I believe this is still far less of a danger than combining with other substances.

These are all symptoms of the drug war, not heroin addiction.

That's kinda the point. Most drugs are not bad/evil in themselves. They can be used irresponsibly.

Many classic drugs (as opposed to research chemicals which introduce small molecular changes to circumvent banns on another substance) are pretty safe or at least have a well known safety profile.

Are there benefits in using heroin?

What would you characterize as a benefit? Medical, certainly. Recreationally, certainly (it feels good). Socially, I imagine so for some people and some doses.

Here's a reddit famous account from someone claiming to be an opiate addict that some find enlightening/haunting: https://www.reddit.com/r/IAmA/comments/wnj2d/iama_heroin_add...

Heroin habits tend to be incredibly expensive. Most people simply can't afford it, that's when the problems arise.