Heroin (Encyclopedia of Drugs and Addictive Substances)
- Heroin and Terrorism
- Heroin Chronology
- How Is It Taken?
- Usage Trends
- Effects on the Body
- Reactions with Other Drugs or Substances
- For More Information
What Kind of Drug Is It?
Heroin is a powerful narcotic drug that is very habit-forming. It is derived from the opium poppy plant. Its sale and use are illegal in most parts of the world. However, this has not stopped the cultivation or farming of poppies and the creation of heroin in many countries in Southeast Asia, Southwest Asia, Central America, South America, and Mexico.
Highly addictive and quick-acting, heroin is a Schedule I controlled substance in the United States. The federal government does not believe that heroin has any medical value in treating illness, but it does consider heroin a very dangerous drug for or experimentation.
In December 2004, the Knight Ridder/Tribune News Service reported that prices for heroin being sold on the street had reached twenty-year lows, while the purity of illegal heroin had increased. The major reason this occurred was because opium poppy farmers in Afghanistan had started growing huge amounts of the plants again. The supply of opium out of Afghanistan greatly increased after the fall of the country's Taliban government in late 2001.
The Taliban government had tightly controlled opium production before being overthrown by U.S. troops and their allies during Operation Enduring Freedom. The United States and its allies invaded Afghanistan after terrorists flew airplanes into the World Trade Center in New York and the Pentagon in Washington, D.C., on September 11, 2001. The Taliban was suspected of allowing terrorists to train in Afghanistan. After the fall of the Taliban, poppy production soared, giving American drug dealers plentiful supplies of more affordable heroin to peddle to consumers.
The increased purity meant that users could experience the heroin high without having to inject the drug into a vein. Typically, heroin users snort, smoke, or inject the drug just under the skin or into a muscle. Some people mistakenly believe that they will not become addicted to the substance if they do not inject it. Like all other natural and syntheticMade in a laboratory. , powdered heroin carries a high risk of producing dependence over a period of time. Dependence is the physical need for a drug in order to ward off withdrawal symptoms.
No one gets out of bed one day and decides on a whim to seek out a dark alley in a rundown neighborhood to buy a bag of heroin, convert it to a liquid, and then shoot it into a vein with a hypodermic needle. However, this is often the end result of continued recreational use of the drug. As the testimony of countless former addicts showss well as the number of emergency room visitshe drug can take hold of a user and destroy his or her life.
According to the Drug Abuse Warning Network (DAWN), between 1990 and 2000, emergency room visits related to heroin nearly tripled, from 33,884 in 1990 to 97,287 in 2000. DAWN statistics from the last half of 2003 showed that heroin was involved in 47,604 drug-related emergency department visits during that time. In addition, the California Department of Alcohol and Drug Programs reported that the average age of American heroin users dropped from 27.4 years to 17.6 years between 1988 and 1997. Heroin fatalities strike rich and famous users as well as poor and anonymous users. Itisan illegal substance that lures new addicts all over the world every year.
Heroin is made from the fluid that drips out of opium poppy bulbs. The use of opium poppies for medication dates back more than 6,000 years. The first archaeological record of poppy use can be found in the ancient cultures of the Fertile Crescent (now the nations or Iraq and Iran). A document discovered in the ancient Egyptian city of Thebes, dated to 1552 BCE, lists more than 700 illnesses for which opium was used. By the time of the great civilizations of ancient Greece and Rome, opium was well known for its painkilling propertiesnd for its effects on the brain. The Greek god Morpheus, god of dreams, is depicted in artwork carrying a bouquet of opium poppies.
During the Middle Ages (c. 500. 1500), physicians experimented with opium for use in treating diarrhea and . Swiss scientist Paracelsus (1493541) mixed opium with alcohol and called the resulting tinctureCombinations of an active drug and a liquid alcohol. laudanum, the Latin word for "to be praised." In the centuries that followed, opium would appear in a variety of widely dispensed medicines, even for teething babies. American inventor Benjamin Franklin (1706790) used opium to relieve the pain of gout and was believed to have been addicted to opium when he died.
In the nineteenth century, opium use was legal. In most cases it was socially acceptable and not considered any worse than smoking tobacco. Poets such as Samuel Taylor Coleridge (1772834) wrote under its influence, and wealthy women used it habitually for a variety of complaints. In 1803, a German pharmacist isolated the active ingredients in opium and was able to create morphine, which was named after the Greek god Morpheus. Stronger and faster-acting than opium, morphine quickly gained a following as a painkiller. Its habit-forming nature soon became evident, too. In 1848, the modern hypodermic needle was invented. This allowed surgeons to inject patients with liquid morphine to ease pain. This proved a boon during surgery and recovery, but it also created addicts. So many soldiers came home from the American Civil War (1861865) with morphine addiction that the condition was called "the soldiers' disease."
It was the search for a less habit-forming painkiller that led to the creation of heroin. In 1874, British chemist Alder Wright boiled morphine with an acid called acetic anhydride. The compound he produced, diacetylmorphine, at first seemed to be a miracle drug. It was a better painkiller than morphine, and it was quickly put to use for chronic coughs, especially in those suffering from . The German pharmaceutical company Bayer began marketing diacetylmorphine under the trade name "heroin" in 1898, principally as a cough suppressant.
At the beginning of the twentieth century, the medical community began to admit that opiate addiction had become a public health crisis. In his book Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse, Paul M. Gahlinger wrote that an estimated 250,000 Americans in a population of 75 million (or 1 in 300) were morphine, heroin, or opium addicts. The most noticeable of these were the opium smokers, who frequented "opium densDarkly lit establishments, often in the Chinatown section of big cities, where people went to smoke opium; many dens had beds, boards, or sofas upon which people could recline while experiencing the effects of the drug." where they smoked the drug to get high.
But just as serious was the use of medicines that contained opium derivatives, most of which did not even list the ingredients. Cranky infants were given "soothing syrups" that contained morphine, codeine, or heroin. Sometimes they died of overdoses. Men and women from all economic levels depended on their "tinctures" and "elixirs." Even the fictional detective Sherlock Holmes, created by Scottish author Sir Arthur Conan Doyle (1859930), solved one of his cases by visiting an opium den.
Crackdowns on Use
In 1906 the Pure Food and Drug Act made it illegal to dispense medicine without listing the ingredients on the bottle. Less than ten years later, the Harrison Narcotic Act prohibited opium and its derivatives (including heroin) in all but prescription medications. The particular dangers of heroin singled it out
even further from its less powerful cousins, morphine and codeine. (Entries on morphine and codeine are available in this encyclopedia.) Heroin production in the United States was outlawed in 1924. For some time after that, doctors were able to obtain imported heroin for use as a painkiller. However, in 1956 the drug was completely outlawed, even for medical use. As such, heroin was one of the first drugs to go from being used in medicines to being classified as an illegal substance.
Outlawing heroin promoted its use as a recreational drug. A post-World War II generation of young people, resistant to authority and eager to try new things, began experimenting with heroin and other opiates. One of them, William S. Burroughs (1914997), would go on to describe his experiences as an addict in novels such as Junkie (1953) and The Naked Lunch (1959). Illegal heroin gained popularity as a recreational drug in the 1960s and 1970s, drawing many artists, musicians, and actors into its grip. Some of them, like comedian John Belushi (1949982) and singer/songwriter Kurt Cobain (1967994), died during heroin highs. Others, like musician Eric Clapton (1945), successfully battled addiction.
In the early 1980s a new danger crept into heroin abuse. Addicts who injected heroin and shared needles already knew that they ran a greater risk of contracting . But a new virus called AIDS (acquired immunodeficiency syndrome) was found to spread quickly through shared needles, too. AIDS is an infectious disease that destroys the body's immune system, leading to illness and death. By the mid-1980s, public health officials were warning that AIDS was spreading at higher rates among drug addicts than in other at-risk groups. The addition of AIDS to the heroin addict's list of dangers accounts for part of the rise in emergency room visits related to heroin in the 1980s and 1990s.
For a time, the risk of AIDS lowered the use of heroin in the United States. But the introduction of purer doses that could be snorted or smoked has brought the drug new users. These users do not run the risk of contracting AIDS by using dirty needles. However, heroin use can lead to risky behaviors, like having unprotected sex, which can lead to AIDS. In addition, users still face all the other dangers associated with heroin, including its tendency to promote dependence. As abusers build a toleranceA condition in which higher and higher doses of a drug are needed to produce the original effect or high experienced. to heroin over time, they become more likely to inject the drug, since this is the quickest way to achieve a high.
What Is It Made Of?
Heroin is simply an organic, or plant-derived, compound that combines morphine with acetic acid (vinegar) or acetic anhydride (an acid). It is processed from the same raw gum opium that can produce morphine, codeine, or thebaine. Farmers drain the sap from ripening opium poppies and boil it down into a sticky gum. The gum is treated in a water base with chemicals such as lime, ammonium chloride, activated charcoal, and hydrochloric acid. This causes the morphine to leach out of the gum.
When this product is dry, it is shaped into bricks. The bricks are then sent to other secret laboratories that mix the morphine with acetic anhydride, more activated charcoal, and sodium bicarbonate (baking soda). Once again the particles are allowed to settle in water. When the particles have dried, they are treated with hydrochloric acid, producing the heroin hydrochloride that is sold on the streets as a white powder.
Most of the white powder heroin sold in the United States comes from Vietnam, Afghanistan, and Pakistan. The product sold to users is never pure heroin. Instead the heroin is "cut" with a number of other water-soluble substances, including sugar, over-the-counter painkillers like acetaminophen (Tylenol), , baking soda, powdered milk, starch, and talcum powder. Some batches of heroin reportedly have been cut with rat poison or laundry detergent. cuttingAdding other ingredients to a powdered drug to stretch the drug for more sales. reduces the purity of the product and allows the dealer to stretch the supply. It also provides the user with an uncertain dosage that can range from 70 percent heroin to 20 percent heroin.
In Mexico, Central America, and South America, underground growers and chemists produce "tar heroin" that comes to the American as a sticky black or brown substance with an odor of vinegar.
How Is It Taken?
Heroin is popular because its effects can be felt almost immediately. This is because heroin is the most fat soluble of the natural opiates. This means that a highly fat-soluble drug enters the bloodstream faster and moves to the brain faster, no matter how it is taken.
The traditional picture of a heroin user is well known from photographs and films. A user buys powdered heroin from a dealer (usually a few doses at a time), dissolves the heroin in water, and then "cooks" the dose over heat. The user then draws up a dose into a hypodermic needle and injects it into a vein. Users must be careful to inject a vein and not an artery, because heroin injected into an artery can cause severe damage to a limb or an internal organ. Over time, veins subjected to repeated injections grow hard or collapse, and the user must find new veins in other parts of the body. Hard-core heroin use leaves tell-tale needle tracks in the arms.
Injected heroin causes a brief, intense rush of pleasure, followed by a four- to six-hour period of weariness and well-being. Breathing slows, and the user experiences no pain. However, he or she may experience skin irritation that is relieved by scratching. Heroin activates the part of the brain that governs vomiting, so users often throw up right after injecting. They sometimes use the force of their nausea to judge the strength of the dose.
Some users inject heroin right under the skin process called "chipping." Users also inject it into muscle tissue as well. Both of these processes delay the onset of the high by several minutes.
The increased purity of street heroin has led to two new delivery systems: smoking and snorting. Many first-time users snort the drug, confident that they are avoiding AIDS and other infections caused by
needle sharing. Some users may be under the impression that snorting or smoking heroin reduces the chances of dependence. This is not the case. Any method of heroin intake can expose the user to a cycle of increased usage, leading eventually to addiction and (in many cases) the use of needles to get the best high for the price.
Are There Any Medical Reasons for Taking This Substance?
Heroin was once used as a painkiller, but today that work is done by other medications, from morphine to the synthetic such as fentanyl. (An entry for fentanyl is available in this encyclopedia.) Some doctors have lobbied for use of heroin in terminally ill cancer patients, for whom addiction is not an issue. But as of mid-2005, the drug had not been approved for this use.
In 2005 the Canadian government joined several European nations (most notably the Netherlands) in a pilot program to give free heroin to heroin addicts. Public health officials in Canada expressed the hope that those receiving free heroin would be able to live crime-free lives; would no longer be forced to share dirty needles; and would be more open to beginning the process of detoxificationOften abbreviated as detox; a difficult process by which substance abusers stop taking those substances and rid their bodies of the toxins that accumulated during the time they consumed such substances.. The Canadian program works with the most dedicated addictseople who have tried and failed at least twice to quit using the drug.
Those who support the plan say that, at the very least, giving addicts free heroin will reduce crime. They believe that such addicts will no longer need to steal or become prostitutes to earn enough for a . Those who oppose the planncluding officials in the U.S. governmentay that the program encourages drug abuse. A reporter in The Economist wrote: "The hope is that if hard-core addicts no longer have to commit crimes to fund their habits they are more likely to become productive citizens and leave drugs behind."
The "free heroin" plans in Canada and parts of Europe are not necessarily just for the addicts, but also for the non-abusing public at large. Canadian officials hope to reduce crime and the costs of fighting it, as well as the spread of infectious diseases like AIDS and hepatitis.
According to the National Survey on Drug Use and Health (NSDUH), in 2003 an estimated 19.5 million Americans age twelve and up used illicit (illegal) drugs. Of these, an estimated 119,000 teenagers between twelve and eighteen had tried heroin at least once.
The Drug That Does Not Discriminate
The image of a heroin user is typically a poor, unemployed, uneducated person who lives in an inner city. It is true that some poor, uneducated people do abuse heroin. However, there is no such thing as a "typical" heroin user. In 2004 for example, Colin Farrell, one of the year's top Hollywood actors, admitted to the press that he had tried the drug. The list of actors, artists, musicians, students, business executives, and politicians, among others, who have had a heroin habit is long. As such, heroin is abused by people from all segments of the populationoung and old; rich and poor; uneducated and educated; employed and unemployed; and people living in the city, suburbs, and rural areas.
From 1995 until 1999, Dr. Lance L. Gooberman ran an "ultra rapid detox" facility for heroin abusers in a New Jersey-area suburb. According to Carol Ann Campbell in the Newark, New Jersey Star-Ledger, an investigation of Dr. Gooberman's practice "has shone a light into the hidden world of suburban heroin use." The reporter added: "Gooberman's clients included business executives, college students and parents who opened their checkbooks to get themselves or their children off drugs." In another Star-Ledger piece, Gooberman himself said he received 2,000 calls each week for his services. "We get all kindsail to Yale," he said. "We've had rock stars, an oil company heir, a Kuwaiti prince."
Heroin is not just a drug for the poor. It has found its way into the wealthiest neighborhoods in America. It is safe to say that heroin does not play a major role in the "club drug" scene. Under the influence of heroin, users become quiet and withdrawn. They tend to sit or lie in one place, nodding. Their speech becomes slurred. This sort of behavior does not fit the "" or dance party environment.
Can scientists identify a particular personality trait that may lead someone to experiment with heroin or abuse it? According to Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), neurobiology, the workings of the brain, do play a part in determining who may develop a heroin habit. Volkow told Psychology Today that addiction "may be a malfunction of the normal human craving for stimulation. If you connect to the world in a meaningful way, and have more chances to get excited about natural stimuli, you're less likely to need an artificial boost." However, people who tend to look at the world in a dark way may be at a greater risk for drug addiction. This includes people who are easily bored or who feel bad about themselves, people who are stressed by work or school, or people who feel unpopular and disliked.
Heroin abuse and addiction is not just an American problem, either. Sohail Abdul Nasir in the Bulletin of the Atomic Scientists estimates that 4.5 million Pakistanis are addicted to the drug. Arrests for possession or sale of heroin have occurred on every continent except Antarctica, and some countries have extremely harsh penalties for those caught with the drug. The problem is so serious in the United Kingdom, Germany, and the Netherlands that those nations have established a few, carefully controlled "free heroin" clinics for addicts in hopes of reducing crime and the spread of illness.
The populations that show the least use of heroin are those where the poppies are actually grown. To many opium poppy farmers, growing the plants is just business way to provide for their families.
Effects on the Body
Whether injected, sniffed, or snorted, heroin speeds to the brain and spinal cord. Users feel an almost immediate rush, or "smack" of , especially when the drug is injected. This is because heroin turns to morphine in the brain and floods the brain's receptors that search for endorphinsA group of naturally occurring substances in the body that relieve pain and promote a sense of well-being. and . The user's pleasure centers literally all fire at once, and the feeling is one of complete release from pain, anxiety, and unhappiness, replaced by a warm sensation of pleasure. After the immediate rush, the user settles into a "high" in which the pleasurable sensations continue, along with drowsiness and a general unwillingness to move or disrupt the dreamlike state. Users' heads may bob up and down. They may develop itchy skin from a mild allergic reaction to the heroin. They may become nauseated and vomit.
Within four to six hours, the heroin-turned-to-morphine slowly clears the brain. During the high, the body reacts to the opiate surge by causing slowed breathing, cessation (stopping) of coughing, and pinpoint pupils. Since all opiates work on the part of the brain that controls breathing, an overdose of any of them can cause a user to stop breathing. If the user is alone at the time of an overdose, he or she will die of suffocation. Cessation of breathing is one of the leading causes of death in heroin overdose cases.
Addiction, Cravings, and Withdrawal
Can a person become dependent on heroin after a single dose? In truth, heroin is less addictive than nicotine or cocaine. (Entries on nicotine and cocaine are available in this encyclopedia.) Some people can use it occasionally without developing a habit. But the fact remains that the intense rush of pleasure associated with a heroin high is quite seductive. The same is true of the longer-lasting sense of well-being and freedom from anxiety that follows the rush. If a user makes a point of seeking the drug a second time, that could indicate the onset of habitual behavior.
Repeated use of heroin requires higher doses to achieve the high. This is known as "tolerance." Eventually, when dependence sets in, the user rarely achieves the same high that drew him or her to the drug the first time. Instead, the user seeks the drug to avoid symptoms. Life becomes a constant struggle to find the money to pay for another fix, to find the dealer and buy the fix, and to find a way to achieve the high.
Some experts estimate that as many as 80 percent of heroin addicts never free themselves from opiates. Once the habitual use is established, it is extremely difficult to stop.
Heroin withdrawal begins with a three- to five-day period of intense anxiety, insomniaDifficulty falling asleep or an inability to sleep., and a host of flu-like symptoms from uncontrolled coughing and yawning to stuffy nose, cramps, chills, sweating, diarrhea, and "goose bumps." Having goose bumps led to the origin of the phrase "quitting cold turkey." Additionally, muscles that have been relaxed by the drug tighten and twitch, causing severe pain and uncontrolled, reflexive motion ("kicking the habit"). A recovering addict named Joey Peets told Scholastic Choices: "It's the worst feeling. Most people say they'd rather be shot than be sick on drugs. Being addicted and having to get off drugs is the worst experience. I wouldn't wish it on my worst enemy."
Yet, these desperate physical symptoms of withdrawal are not the worst aspect of opiate addiction. The addict experiences psychological that are so intense that they become nearly impossible to fight. To quote Alfred Lubrano of the Knight Ridder/Tribune News Service: "The smell of burned matches, the sight of a $10 bill (the price for a 'dime bag' of drugs), even those 'Just Say No' anti-drug posters with a crossed-out needle, all act as potent cues that could bring even long-clean addicts to their knees, screaming for dope." Scientists have actually shown recovering addicts films of drug abuse while monitoring the drug users' brain activity. The results: Watching someone else use drugs, even on a film, spurs activity in the parts of the brain that govern motivation and craving.
Reactions with Other Drugs or Substances
"Speedballs" are a deadly combination of cocaine and heroin. "Hot rocks" combination of heroin and crack cocainere often fatal to users as well. Many other drugs enhance the dangers of heroin, including tranquilizers and alcohol. Taking with heroin can cause an irregular heartbeat. (An entry on amphetamines is also available in this encyclopedia.)
One of the worst aspects of heroin use is that dosages vary. Dealers cut the pure heroin with fillers ranging from powdered milk to the ingredients found in rat poison. The purity of the heroin arriving from abroad can vary, too, depending on the health of the poppy crop and how the raw opium was processed. Those who use heroin never really know the strength of the product they are about to ingest. This can lead to overdose in even the most opiate-tolerant individuals.
Research has also shown that heroin addicts can have different reactions to the same dose of heroin if they take it in unfamiliar surroundings. A dose they can manage in a comfortable setting may become an overdose in a different setting. Scientists can offer no explanation for this particular reaction.
A person who has stopped taking heroin for some time, perhaps during detoxification or other therapy, can die of an overdose if he or she returns to the drug. Once the brain's chemical levels come closer to normal, doses that a user tolerated as an addict can become fatal. It was a return to heroin use after a period of detox that led to the death of the up-and-coming young American artist Jean-Michel Basquiat in 1988. Basquiat was just twenty-seven years old.
Treatment for Habitual Users
When heroin was first introduced to the medical community at the beginning of the twentieth century, it was used to help people overcome opium and morphine addiction. Heroin was considered a "step-down" drug. However, the cure was worse than the original addiction. It is no coincidence that heroin was the first opiate product declared illegal in the United States. Once a dependence is established, it is very difficult to end.
The "rapid detox" method used in New Jersey in the 1990s was declared illegal after nearly a dozen patients ended up in emergency rooms with life-threatening complications. Many of those who successfully completed the "rapid detox"eing put to sleep while an opiate , Narcan, was shot into the braineturned to heroin use due to inadequate psychiatric follow-up. The dream of easy, pain-free detoxification from heroin has remained just that dream.
Typically, heroin addicts undergo several steps before seeking treatment. First, they come to recognize that the drug has altered their lives. This may happen when a marriage breaks up, when an addict resorts to crime to pay for drugs, when a friend dies of an overdose, or when an addict begins to have serious health problems related to drug use. At that point addicts might decide to continue to use heroin simply to avoid any withdrawal symptoms. In the next step, addicts may ask about the types of help they can expect and talk to health care workers about what might happen in an inpatient setting or a methadone clinic. (Methadone is a drug that is used to
help addicts overcome heroin addiction. An entry on methadone is available in this encyclopedia.) In the third step, addicts decide to accept help.
Drug Treatment for Heroin Addiction
Heroin addiction is treated with several other drugs. One of them is the opiate methadone, which is most often taken in liquid or pill form. It is released slowly into the body and keeps withdrawal symptoms away but does not provide the high of heroin. Ideally, recovering heroin addicts begin with high doses of methadone and gradually taper down until they are drug-free. They combine the medication with talk therapy and lifestyle changes. The course of methadone treatment is rarely smooth, however. Sometimes addicts return to heroin. Sometimes they abuse the methadone instead.
Nevertheless, at the beginning of the twenty-first century, methadone was still the medication of choice for treating opiate addiction.
Another drug, naloxone (Narcan), works differently. This substance quickly frees the pleasure centers of the brain from the opiate. Emergency room doctors use Narcan to revive victims of heroin overdose who have stopped breathing. However, naloxone causes violent withdrawal symptoms if administered by injection. Scientists are experimenting with a continuous release form of naloxone that would be implanted under the skin and would block the effects of heroin even if the user took a dose. Doctors are also prescribing buprenorphine (byoo-preh-NORR-feen), another drug found to block the absorption of heroin in the brain. Buprenorphine (Temgesic, Subutex) lasts longer than methodoneeventy-two hours rather than twenty-four. This allows recovering addicts to make fewer visits to clinics. It is still in the experimental stages.
People can overcome heroin addiction. Self-help groups such as Narcotics Anonymous (NA) provide group therapy and the experiences of other recovering users to bolster the addict's courage. The group provides emotional support during the difficult times. Recovering heroin users must also be willing to undergo counseling to understand what underlying feelings led them to experiment with the drugnd how to cope with the cravings when they occur. It is sometimes necessary to begin a "whole new life," separating from the friends, settings, and personal habits that the user employed during addiction. It is also necessary to realize that cravings for the high will continue, sometimes for years, especially in times of stress or on occasions when something reminds the user of the drug experience.
Heroin addicts are at far greater risk than the general public for contracting HIV/AIDS, a deadly illness. Heroin users also run a greater risk of contracting any one of several hepatitis viruses, all of which attack the liver. These infectious illnesses are spread through the use of shared needles. If a heroin addict manages to avoid AIDS and hepatitis, long-term use of the drug can lead to: 1) damaged veins ("tracks"); 2) bacterial infections that damage blood vessels and the heart; 3) kidney and liver disease; 4) pneumonia; or 5) tuberculosis. Because heroin causes slower breathing, lung and brain damage can occur from repeated use. Sometimes those who inject heroin suffer strokes when some undissolved particle lodges in a blood vessel.
There are many health risks associated with injecting the substances that are used to cut the purity of heroin. Along with stroke, users might have breathing problems if the drug has been cut with tranquilizers, or irregular heartbeat if the drug contains amphetamines. Long-term use of heroin leads to tooth decay and gum disease, since the drug reduces the production of saliva.
One of the most destructive consequences of heroin use is loss of lifestyle. The American and international press is filled with accounts of parents who have lost custody of children because they neglected their kids while searching for more drugs. Some heroin habits climb to as much as $100 a day. People go through their life savings, sell their belongings, and eventually turn to crime to support their habits. Theft, drug dealing, and prostitution go hand-in-hand with heroin addiction. Such crimes can lead to jail time, where authorities are unlikely to help the addict manage his or her withdrawal symptoms.
Detoxification and rehabilitation in a clinical setting can be costly too. Few heroin addicts beat their dependence on the drug and still have a steady job or an intact marriage waiting for them. Recovering addicts often must deal with guilt over broken relationships, criminal records, and loss of peer respect.
Heroin is a Schedule I controlled substance in the United States. It is illegal to possess or sell even a small amount of it. Heroin is also illegal in every country in Europe, as well as in Mexico, Canada, and the countries of Central and South America. Even where it is grown, the drug is illegal and must be produced and refined without government knowledge.
A person convicted on U.S. federal charges of possessing a Schedule I substance faces prison terms and hefty fines. Those who manage to avoid prison on a first offense are subject to probation and random urine tests for drugs. Any detection of drugs during a test sends the user to jail. Other fines and sentences vary from state to state. For instance, in many places people can be arrested for possessing the pipes and needles used to ingest heroino-called "drug paraphernalia."
The penalties for second and third offenses are much greater and almost always involve as much as two years in prison. States with "three strikes" programs give life sentences to those convicted of a third instance of selling a controlled substance.
Heroin dependence carries with it many opportunities to run afoul of the law. Theft and prostitution both result in criminal records, possible jail time, and publicity. Many hard-core drug users turn to drug dealing to support their habits, thus increasing their chances of stiff sentences if they are arrested. People caught selling drugs within 1,000 feet of a school face the most serious sentences of all. Even first-time convictions carry minimum prison terms and double fines.
Some people and organizations have pressed to make some Schedule I drugs legal. However, no doctors, religious sects, or research scientists have asked that heroin be made available to anyone, for any reason. Opinion of the drug is universally low among those who understand its workings on the brain.
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See also: Cocaine; Codeine; Fentanyl; Hydromorphone; Methadone; Morphine; Opium; Oxycodone
Heroin (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
MORPHINE was first identified as the pain-relieving active ingredient in OPIUM in 1806. But morphine was not free of the habit-forming and toxic effects of opium. By the late nineteenth century, the idea of modifying molecules to change their pharmacological actions was well established. It seemed quite reasonable to use this approach to develop new chemical entities that might be free of the problems seen with morphine. In Germany, in 1898, H. Dresser introduced such a new drug, 6-diacetylmorphinento medical use; it was named there by the Bayer Company, which produced and marketed it, named it heroin (presumably from heroisch, meaning "heroical"), because it was more potent than morphine.
Although heroin is structurally very similar to morphine, it was hoped that it would relieve PAIN without the tendency to produce ADDICTION. Turn-of-the-century medical writings and advertisements, both in Europe and the United States, claimed that heroin was effective for treating pain and cough. Many suggested that it was less toxic than morphine and was nonaddictive. A few even suggested that heroin could be a nonaddicting cure for the morphine habit. Clearly, this was not the case, and within a year or two of its introduction, most of the medical community knew so. By the 1920s, heroin had become the most widely abused of the OPIATES.
PHARMACOLOGYHeroin is a white powder that is readily soluble in water. The introduction of just two esters onto the morphine molecule changes the physical properties
Following injection, heroin is very potent, with the ability to cross the blood-brain barrier and enter the brain. This barrier results from a unique arrangement of cells around blood vessels within the brain, which limits the free movement of compounds. Many factors contribute to the barriern general, the less polar a drug, the more rapidly it enters the brain. Heroin, however, has a very short half-life in the blood (amount of time that half the drug remains). It is rapidly degraded by esterases, the enzymes that break ester bonds. The acetyl group at the 3-position of the molecule is far more sensitive to these enzymes than the acetyl group at the 6-position. Indeed, the 3-acetyl group is attacked almost immediately after injection and, within several minutes, virtually all the heroin is converted to a metabolite, 6-acetylmorphine. The remaining acetyl group at the 6-position is also lost, but at a slower rate. Loss of both acetyl groups generates morphine. It is believed that a combination of 6-acetylmorphine and morphine is responsible for the actions of heroin.
The pharmacology of heroin is virtually identical to that of morphine. This probably reflects its rapid conversion to 6-acetylmorphine and morphine. Detailed
One widespread use of heroin in the United Kingdom was in the early formulations of Brompton's Cocktail, a mixture of drugs designed to relieve severe pain in terminal cancer patients. The heroin employed in the original formula is now typically replaced with morphine without any loss in effectiveness. For many years, some groups have maintained that heroin is more effective in the relief of cancer pain than morphine is. Careful clinical studies show that this is not true, but the most important issue is using an appropriate dose. Thus, heroin offers no major advantage over morphine from the medical perspective.
Since heroin has no approved medical indications in the United States, it is only available and used illicitly. The marked variability of its purity and the use of a wide variety of other substances and drugs to "cut" street heroin poses a major problem. This inability to know what is included in each drug sale makes the street drug more than doubly dangerous. Typically, heroin is administered intravenously, which provides a rapid "rush," a euphoria, which is thought to be the important component of heroin's addictive properties. It can be injected under the skin (subcutaneously, SC) or deep into the muscle (intramuscularly, IM). Multiple intravenous injections leave marks, called tracks, in a much-used injection site, which often indicate that a person is abusing drugs; but heroin can also be heated and the vapors inhaled through a straw (called "chasing the dragon"). It can also be smoked in a cigarette. While the heat tends to destroy some of the drug, if the preparation is pure enough, a sufficient amount can be inhaled to produce the typical opiate effect.
Heroin use is associated with TOLERANCE AND DEPENDENCE. Chronic use of the drug leads to a decreased sensitivity toward its euphoric and analgesic actions, as well as to dependence. Like morphine, the duration of action of heroin is approximately 4 to 6 hours. Thus, addicts must take the drug several times a day to prevent the appearance of WITHDRAWAL signs. Many believe that the need to continue taking the drug to avoid withdrawal enhances its addictive potential.
Patients taking opiates medicinally can be taken off them gradually, without problems. Lowering the opiate dose by 20 to 25 percent daily for two or three days will prevent severe withdrawal discomfort and still permit rapid taper off the drug. Abrupt withdrawal of all of the drug is very differentnd leads to a well-defined abstinence syndrome that is very similar for both heroin and morphine. It includes eye tearing, yawning, and sweating after about eight to twelve hours past the last dose. As time goes on, people develop restlessness, dilated pupils, irritability, diarrhea, abdominal cramps, and periodic waves of gooseflesh. The term cold turkey is now used to describe abrupt withdrawal with the associated gooseflesh. The heroin withdrawal syndrome peaks between two and three days after stopping the drug, and symptoms usually disappear within seven to ten days, although some low-level symptoms may persist for many weeks. Babies of mothers dependent on opiates are born dependent, and special care must be taken to help them withdraw during their first weeks. Medically, although miserable, heroin withdrawal is seldom life threateningnlike withdrawal from alcohol, which can sometimes be fatal.
Overdosing is a common problem among heroin addicts. The reason is not always clear, but wide variation in the purity of the street drug can make it difficult for the addict to judge a dose. Some impurities used to cut the drug may be toxic themselves. With OVERDOSE, a person becomes stuporous and difficult to arouse. Pupils are typically small and the skin may be cold and clammy. Seizures may occur, particularly in children or babies. Breathing becomes slow, and cyanosiseen as a darkening of the lips to a bluish coloray develop, indicating inadequate levels of oxygen in the blood. With respiratory depression, blood pressure may then fall. These last two signs are serious, since most people who die from overdose, die from respiratory failure. Complicating the problem is the fact that many addicts may have taken other drugs, used alcohol, and so on. Some of them may have been taken on purpose, and some may have been a part of the street drug.
NALOXONE can readily reverse some opiate problems, since it is a potent opiate ANTAGONIST. This drug binds to opiate RECEPTORS and can reverse morphine and heroin actions. The appropriate dose may be a problem, however, since naloxone can also precipitate a severe abstinence syndrome in a dependent person.
(SEE ALSO: Addiction: Concepts and Definitions; International Drug Supply Systems; Methadone Maintenance Programs; Opioids: Complications and Withdrawal; Treatment: History of)
JAFFE, J. H. (1990). Drug addiction and drug abuse. In A. G. Gilman et al. (Eds.), Goodman and Gilman's the pharmacological basis of therapeutics, 8th ed. New York: Pergamon.
JAFFE, J. H., & MARTIN, W. R. (1990). Opioid analgesics and antagonists. In A. G. Gilman et al. (Eds.), Goodman and Gilman's the pharmacological basis of therapeutics, 8th ed. New York: Pergamon.
GAVRIL W. PASTERNAK