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Drug Profiles


HEROIN

The items listed below are the most frequently asked questions.

What are opiates?
Opiates, sometimes referred to as narcotics, are a group of drugs which are used medically to relieve pain, but also have a high potential for abuse. Some opiates come from a resin taken from the seed pod of the Asian poppy. This group of drugs includes opium, morphine, heroin, and codeine. Other opiates, such as meperidine (Demerol), are synthesized or manufactured. Opium appears as dark brown chunks or as a powder and is usually smoked or eaten.

Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as "black tar heroin." Although purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment. Heroin can be a white or brownish powder which is usually dissolved in water and then injected. Most street preparations of heroin are diluted, or "cut," with other substances such as sugar or quinine. Other opiates come in a variety of forms including capsules, tablets, syrups, solutions, and suppositories.

Which opiates are abused?
Heroin ("junk," "smack") accounts for 90 percent of the opiate abuse in the United States. Sometimes opiates with legal medicinal uses also are abused. They include morphine, meperidine, paregoric (which contains opium), and cough syrups that contain codeine [or a synthetic narcotic, such as dextromethorphan].

How do opiates affect you?
Opiates tend to relax the user. When opiates are injected, the user feels an immediate "rush." Other initial and unpleasant effects include restlessness, nausea, and vomiting. The user may go "on the nod," going back and forth from feeling alert to drowsy. With very large doses, the user cannot be awakened, pupils become smaller, and the skin becomes cold, moist, and bluish in color. Breathing slows down and death may occur.

Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching.

Does using opiates cause dependence or addiction?
Yes. Dependence is likely, especially if a person uses a lot of the drug or even uses it occasionally over a long period of time. When a person becomes dependent, finding and using the drug often becomes the main focus in life. As more and more of the drug is used over time, larger amounts are needed to get the same effects. This is called tolerance.

What are the physical dangers?
The physical dangers depend on the specific opiate used, its source, the dose, and the way it is used. Most of the dangers are caused by using too much of a drug, the use of unsterile needles, contamination of the drug itself, or combining the drug with other substances. Over time, opiate users may develop infections of the heart lining and valves, skin abscesses, and congested lungs. Infections from unsterile solutions, syringes, and needles can cause illnesses such stronger approximately 24-72 hours after they begin, and subside within 7-10 days. Sometimes symptoms such as sleeplessness and drug craving can last for months.

What treatment is available for opiate addiction?
The four basic approaches to drug abuse treatment are: detoxification (supervised withdrawal from drug dependence, either with or without medication) in a hospital or as an outpatient, therapeutic communities where patients live in a highly structured drug-free environment and are encouraged to help themselves, outpatient drug-free programs which emphasize various forms of counseling as the main treatment, and methadone maintenance which uses methadone, a substitute for heroin, on a daily basis to help people lead productive lives while still in treatment.

How does methadone treatment work?
Methadone, a synthetic or manufactured drug, does not produce the same "high" as illegal drugs such as heroin, but does prevent withdrawal and the craving to use other opiates. It often is a successful treatment for opiate dependence because it breaks the cycle of dependence on illegal drugs such as heroin. When patients are receiving methadone in treatment, they are not inclined to seek and buy illegal drugs on the street, activities which are often associated with crime. Patients in methadone maintenance programs also receive counselling, vocational training, and education to help them reach the ultimate goal of a drug-free normal life. Methadone's effects last for about 24 hours - four to six times as long as those of heroin - so people in treatment need to take it only once a day. Also, methadone is medically safe even when used continuously for 10 years or more. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives.

Detoxification from Heroin
The primary objective of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free state. Not in itself a treatment for addiction, detoxification is a useful step only when it leads into long-term treatment that is either drug-free (residential or outpatient) or uses medications as part of the treatment. The best documented drug-free treatments are the therapeutic community residential programs lasting at least 3 to 6 months.

What are narcotic antagonists?
Narcotic antagonists are drugs which block the "high" and other effects of opiates without creating physical dependence or producing a "high" of their own. They are extremely useful in treating opiate overdoses and may prove useful in the treatment of opiate dependence.

Naloxone and naltrexone are medications that also block the effects of morphine, heroin, and other opiates. As antagonists, they are especially useful as antidotes. Naltrexone has long-lasting effects, ranging from 1 to 3 days, depending on the dose. Naltrexone blocks the pleasurable effects of heroin and is useful in treating some highly motivated individuals. Naltrexone has also been found to be successful in preventing relapse by former opiate addicts released from prison on probation.

History of Opiates
The earliest reference to use of opium is amongst Sumerian people in the Middle East 6,000 years ago. It was used as a medicine and recreational drug amongst the Ancient Greeks and by the 7th or 8th century AD commonly used in Chinese medicine.

Use in China became widespread and caused great concern to the Emperor and authorities. Most Chinese opium was imported into China from India by the East India Company. In other words a British company was the main supplier to China using opium grown in conquered lands in India and the British government benefited greatly from the tax revenue. The Chinese introduced harsh laws to try and stop their people using opium. When this did not work in 1839 the Chinese authorities in Canton seized opium from British ships and flushed it into the sea. The British sent in troops and the Chinese authorities backed down.

In 1856 a similar incident led to a second 'Opium War' with the British navy shelling Canton and opening up other ports. The opium trade increased again so that up to 15 million Chinese became regular opium smokers. The Chinese authorities made opium use legal and began to grow their own poppies. Within a few decades Chinese opium production outstripped the Indian grown supplies and British sales and influence declined. In time China became a main supply for opium use in Europe.

Opium was used in the UK (and the rest of Europe) in medicines from the 1550s and by the 17th century drugs like laudanum - a mixture of opium and alcohol - were used for all sorts of ailments including to kill pain, aid sleep, for coughs, diarrhoea, period pains and for toothache and colic in babies. This trend continued well into the 19th century with the availability of many opium-based medicines bought from grocery stores and use of opium by many famous writers and poets. Concerns about the rising number of infant deaths through opium overdose resulted in the first controls on sales of opium in 1868.

Morphine was first synthesised from opium in 1805 by a German chemist and was advertised as a new wonder medicine that was non-addictive and could even be used for the treatment of opium dependence. About 1850, the hypodermic syringe came into use and at that time people believed that smoking opium, rather than injecting opiates led to dependence. Thousands of soldiers in the American Civil War came home addicted to morphine given to them to ease the pain of their injuries. In 1874, again in Germany, heroin was first made from morphine - again it was advertised as non-addictive, this time as a substitute for morphine. Although many people in the USA were addicted to medical opiates, all the press attention was focused on the Chinese community and their use of opium in opium dens. The Chinese were accused of fostering addiction and luring especially young women into white slavery through opium; the evil Fu Manchu image of the Chinese became a standard racist stereotype in both the USA and Britain..

Non-medical use of opiates was not an offence in the UK until after the First World War but doctors were still allowed to prescribe them (mainly morphine) to people who had become dependent. Not many people used morphine or heroin and most who did obtained it from doctors.

The mid 1970s saw the beginnings of a significant market in imported illegally manufactured heroin. In the mid 1980s the number of users of heroin and other opiates increased dramatically, particularly in inner city deprived areas. The government responded by developing new community based drug services and running anti- heroin media campaigns as well as needle exchange schemes to reduce needle sharing and the incidence of HIV.

Since the mid 1980s the number of users in the UK has continued to rise and there are now probably between 100,000 and 200,000 dependent users. Medical treatment for heroin dependence has now focused on prescribing of methadone.

The Law

Heroin and other opiates are controlled under the Misuse of Drugs Act making it illegal to possess them or to supply them to other people without a prescription. Heroin is treated as a Class A drug where the maximum penalties are 7 years imprisonment and a fine for possession and life imprisonment and a fine for supply.

Morphine, opium, methadone, pethidine and Diconal are also Class A drugs under the Act. Codeine and dihydrocodeine (DF 118) are Class B drugs and Temgesic and Distalgesic are Class C drugs.

Only a very few specially licensed doctors can prescribe heroin to maintain' a drug user. Methadone is much more commonly prescribed. Heroin can, however, be prescribed by doctors to relieve severe pain and has been found very effective with terminally ill cancer patients.

Methadone can be taken abroad in some circumstances, provided you have a prescription and sometimes an export permit for the drug and the destination country permits import. See the Home Office website for full details on what you can and can't take out the country.

Glossary

Addiction: A chronic, relapsing disease, characterized by compulsive drug seeking and use and by neurochemical and molecular changes in the brain.

Agonist: A chemical compound that mimics the action of a natural neurotransmitter.

Analog: A chemical compound that is similar to another drug in its effects but differs slightly in its chemical structure.

Antagonist: A drug that counteracts or blocks the effects of another drug.

Buprenorphine: A mixed agonist/antagonist medication being studied for the treatment of heroin addiction.

Craving: A powerful, often uncontrollable desire for drugs.

Designer drug: An analog of a restricted drug that has psychoactive properties.

Detoxification: A process of allowing the body to rid itself of a drug while managing the symptoms of with-drawal; often the first step in a drug treatment program. Detoxification

Fentanyl:
A medically useful opioid analog that is 50 times more potent than heroin.

Levo-alpha-acetyl-methadol (LAAM): An FDA-approved medication for heroin addiction that patients need to take only three to four times a week.

Meperidine: A medically approved opioid available under various brand names (e.g., Demerol).

Methadone: A long-acting synthetic medication shown to be effective in treating heroin addiction.

Physical dependence: An adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped; usually occurs with tolerance.

Rush: A surge of euphoric pleasure that rapidly follows administration of a drug.

Tolerance: A condition in which higher doses of a drug are required to produce the same effect as during initial use; often leads to physical dependence.

Withdrawal: A variety of symptoms that occur after use of an addictive drug is reduced or stopped.



With thanks to the National Institute for Drug Administration (NIDA) USA.