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Black Tar Heroin

Written by Jonathan Strum

& Medically Reviewed by Dr. Jessica Pyhtila, PharmD

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Last Updated - 07/21/2023

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Updated 07/21/2023

The most common type of heroin in the western half of the United States is black tar heroin, a drug with unique risks that make its use inherently dangerous.

Black tar heroin is an impure form of heroin that is typically produced in Mexico. As a Schedule I controlled substance, it has a high risk of addiction and is just as illegal as its white, powdered counterpart. Black tar heroin undergoes less processing than white powder heroin, making it less expensive in some cases. However, the impurities can make black tar heroin especially toxic, putting people at risk of dangerous infections.

Dangers of Black Tar Heroin

Black tar heroin is particularly dangerous because it adds the risks of toxic impurities and potentially fatal bacterial infections to heroin’s already-high risks of addiction and overdose. Black tar heroin can cause severe vein and vascular system damage, and dangerous additives range from the opioid fentanyl to the poison strychnine.

Vein and Organ Damage

Black tar heroin is linked to scarring when injected into veins, likely due to the harsh acids needed to turn the drug into a liquid. For this reason, when veins become too scarred, people often inject the drug into their skin or muscles. These injection sites increase the risk of certain types of infections, including:

  • Wound botulism: This wound infection occurs when a bacterial toxin attacks the nerves in the body, making it hard to breathe and move.
  • Necrotizing fasciitis: This is a flesh-eating bacterial disease that rapidly spreads in the body, attacking soft tissues.
  • Tetanus: This vaccine-preventable bacterial disease causes tightened muscles throughout the body.
  • Skin and soft tissue infections: Bacteria can take hold in wounds and black tar heroin injection sites, causing infections.
  • Myonecrosis: This deadly muscle infection is caused by a bacterial toxin and has occurred in people who inject black tar heroin.

Impurities in black tar heroin can also seriously damage other organs of the body. Black tar heroin injections have been linked to infections in the heart, as well as eye infections that can result in blindness.

Often Cut With Dangerous Additives

Black tar heroin is often mixed with other substances, including the powerful opioid fentanyl. Unlike white powder heroin, black tar heroin is only around 27% pure, with the remainder being additives and impurities. These additives may include:

  • Sugar
  • Starch
  • Powdered milk
  • Quinine
  • Strychnine

Other common additives include over-the-counter cough and cold medications, such as Tylenol PM. When mixed with black tar heroin, the combination is called “cheese.” Because nighttime cough and cold medications often contain central nervous system (CNS) depressants that promote sleep, combining them with a strong CNS depressant like black tar heroin is especially dangerous. Similarly, antihistamines for allergies are CNS depressants; when an antihistamine is mixed with black tar heroin, the combination is called “Chiva.”

Related Topic: Tylenol PM and alcohol

Increased Potential for Overdose

People who struggle with black tar heroin may be at high risk for overdose, especially if they mistakenly believe that black tar heroin is not as dangerous as white powder heroin. This may cause them to take more black tar heroin than their bodies can tolerate, increasing the risk of an overdose.

Black Tar Heroin Usage Statistics

Black tar heroin is most popular in the western half of the United States. In fact, nearly all heroin in the western half of the United States is black tar heroin. Around 80% of people who struggle with heroin originally took prescription opioids and later changed to heroin. One study found that common characteristics among people who used black tar heroin in San Francisco were low education level, unemployment and insecure housing.

Identifying Black Tar Heroin Use

When someone begins to rely on a drug like black tar heroin, they may show a variety of signs and symptoms. These can include withdrawal from friends and family, sudden mood changes and interpersonal or financial problems. Further, you may find paraphernalia like needles or syringes if a person is injecting black tar heroin, or a spoon or foil if the person is smoking it. As some black tar heroin comes in a rock-like form, you may also find a knife that is used to cut or crush the drug.


If you are worried a loved one is using black tar heroin, it’s important to know what it looks like. As its name suggests, black tar heroin is brown or black in color. It may look like a chunk of rock or coal, or it may be thick, gooey and have a similar texture to roofing tar.

Although black tar heroin is usually sold as a solid, it needs to be in a liquid form to be injected. The drug needs to be mixed with an acidic liquid, commonly vinegar, to dissolve. For this reason, black tar heroin often smells like vinegar.

How It Is Abused

Black tar heroin is abused in several different ways. Each of these routes has its own nickname. Heroin can be:

Sometimes, people believe mixing heroin with cocaine will cause a better high and stop a post-cocaine crash. When the two drugs are alternated, it is called “crisscrossing.” When they are taken at the same time, it is known as “speedballing.” Combining heroin and cocaine can be especially dangerous and has killed many people, including celebrities John Belushi, Chris Farley, Mitch Hedberg, Chris Kelly, Philip Seymour Hoffman and River Phoenix.

See More: Identifying Heroin Paraphernalia

Getting Help for Heroin Abuse

If you are struggling with heroin use, you may feel as if you are completely on your own. However, professional treatment is available at The Recovery Village at Baptist Health. Our knowledgeable and caring experts can help you recover from heroin use and start a healthier, opioid-free life. Contact us today to learn more about treatment plans that can work well for you.

View Sources

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Rettner, Rachel. “Black Tar Heroin May Be Causing Deadly ‘Flesh-Eating’ Infections in San Diego.” Live Science, December 6, 2019. Accessed October 17, 2020.

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City of Plano Police Department. “Heroin: Just the Facts.” Accessed October 17, 2020.

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Siemaszko, Corky. “Black-tar heroin figured into Houston gun battle that left 5 officers wounded.” NBC News, January 29, 2019. Accessed October 17, 2020.