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Black tar heroin is dangerous to inject

It's not practical to make black tar heroin sterile, for example, by heating a solution with a lighter for a minute. Black tar heroin injection is associated with Clostridium botulinuminfection. Prion: "For prion elimination, various recommendations state 121–132 °C (250–270 °F) for 60 minutes or 134 °C (273 °F) for at least 18 minutes." A pressure cooker reach 120 °C at full pressure. However, we don't recommend black tar heroin injection even if you own a pressure cooker with a PSI meter due to lack of safety data.

This form of heroin is diacetylmorphine acetate, a product of heroin production that does not require further acetylation. It differs in texture from powder heroin in that it is black, gooey, viscous, and a texture ranging from quite similar to wet asphalt and a hard rock of material. It is commonly produced in South America and is found on the western coast of the USA. 

The actual chemical contents of black tar heroin can vary from the white powder form. Black tar might contain a variable mixture of morphine derivatives, predominantly 6-MAM (6-monoacetylmorphine) which is another result of crude acetylation that occurs in the clandestine manufacturing process.

When injected into any type of tissue, this form of heroin results in an increased risk of wound botulism. Wound botulism can be fatal and leads to amputations and death at a higher rate of black tar heroin users. Because of the consistency of the substance (tar-like), it can pose a greater risk for collapsing, damaging, or infecting veins. This damage to veins leads to a higher chance of subcutaneous and intradermal injection which is not advocated from a harm reduction point of view. 

Like many other opioids, unadulterated heroin at appropriate dosages does not cause many long-term complications other than physical and psychological dependence and constipation. Outside of the extremely powerful addiction and physical dependence, the harmful or toxic aspects of opioid usage are exclusively associated with not taking the necessary precautions in regards to its administration, overdosing and using impure heroin products that contain harmful additives. 

Heavy dosages of heroin can result in severe respiratory depression which can result in dangerous or even fatal levels of anoxia (oxygen deprivation). This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors - this effect is proportional to the dosage of the substance consumed. 

Due to the nature of the unregulated drug market, illicit heroin is of widely varying and unpredictable purity. A user may prepare what they consider to be a moderate dose while actually taking far more than intended in the event of obtaining a purer product than they are used to, or may be cut unknowingly with more potent and dangerous substances such as fentanyl.[16] Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours and is a direct result of  respiratory depression leading onto anoxia (oxygen deprivation) resulting from the breathing reflex being suppressed by agonism of µ-opioid receptors. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 600mg.[17]

Heroin can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position). 

In case of a suspected or known overdose, it is advised to administer a dose of naloxone intravenously, intramuscularly, or nasally to reverse the effects of opioid agonism

As with other opioids, the chronic use of heroin can be considered extremely addictive with a high potential for abuse and is capable of causing psychological and physical dependence among certain users. When psychological or physical addiction has developed, mental and physical withdrawal symptoms and cravings may occur if a person suddenly stops their usage.

Tolerance to many of the effects of heroin develops with prolonged and repeated use. The rate at which this occurs develops at different rates for different effects, with tolerance to the constipation-inducing effects developing particularly slowly for instance. This results in users having to administer increasingly large doses to achieve the same psychoactive effects of a previously lower dose. After heroin tolerance has developed, it takes about 3 - 7 days for the tolerance to be reduced to half and 1 - 2 weeks to be back at baseline (in the absence of further consumption). Heroin presents cross-tolerance with all other opioids, meaning that after the consumption of heroin all opioids will have a reduced effect.

The risk of fatal heroin overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance.[19] When users dose their old doses, they no longer have the physical tolerance to handle the sedative effects of heroin and overdose occurs. To account for this lack of physical tolerance, it is safer to only dose a fraction of one's usual dosage if using after a prolonged period of sobriety. It has also been found that the environment one is in can play a role in tolerance: in one scientific study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.[20]

Studies have shown that the subjective cognitive euphoria and physical euphoria of heroin use, which is the reinforcing component of addiction, is proportional in its' intensity to the rate at which the blood level concentrations of the drug increases.[21] Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the fastest. It is followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing).