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In the U.S.A., the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of diacetylmorphine and other opioids, which allowed the drug to be prescribed and sold for medical purposes. In 1924, the United States Congress banned its sale, importation or manufacture. It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States.

Abstract

Heroin is a drug made from morphine, a natural substance in the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Heroin can be injected, smoked or snorted. Heroin abuse is a serious problem in the United States. Major health problems from heroin include miscarriages, heart infections and death from overdose. People who inject the drug also risk infectious diseases, including HIV/AIDS and hepatitis.

Street names

Dragon
Dope
Heron
Herone
Hero
Hera
Big H
White
China White
White Nurse
White Lady
White Horse
White Girl
White Boy
White Stuff
Boy
He
Black
Black Tar
Black Pearl
Black Stuff
Black Eagle
Brown
Brown Crystal
Brown Sugar
Brown Tape
Brown Rhine
Chiba
Chiva
Chieva
Mexican Brown
Mexican Mud
Mexican Horse
Junk
Tar
Snow
Snowball
Smack
Scag
Scat
Sack
Skunk
Number 3
Number 4
Number 8
[3]

History

The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BCE. The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two alkaloids, codeine, and morphine.

From 1898 through to 1910, diacetylmorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant. Bayer marketed the drug as a cure for morphine addiction before it was discovered that it rapidly metabolizes into morphine. As such, diacetylmorphine is in essence a quicker-acting form of morphine. The company was embarrassed by the new finding, which became a historic blunder for Bayer.

In the U.S.A., the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of diacetylmorphine and other opioids, which allowed the drug to be prescribed and sold for medical purposes. In 1924, the United States Congress banned its sale, importation or manufacture. It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States.
[4]

Pharmacology

The chemical formula for heroin is: C21H23NO5

When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine. When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood–brain barrier because of the presence of the acetyl groups, which render it much more fat soluble than morphine itself. Once in the brain, it then is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), and then to morphine, which bind to μ-opioid receptors, resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor.[48] Unlike hydromorphone and oxymorphone, however, administered intravenously, heroin creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective "body high" to some, but also instances of pruritus (itching) when they first start using.
[3]

Uses

Heroin is used in the following ways:

Medical use:

Under the chemical name diamorphine, diacetylmorphine is prescribed as a strong analgesic in the United Kingdom, where it is given via subcutaneous, intramuscular, intrathecal or intravenous route. Its use includes treatment for acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain, and chronic pain, including end-stage cancer and other terminal illnesses. In other countries it is more common to use morphine or other strong opioids in these situations. In 2004, the National Institute for Health and Clinical Excellence produced guidance on the management of caesarian section, which recommended the use of intrathecal or epidural diacetylmorphine for post-operative pain relief. It can also be used for detection in biological fluids in brain.

Recreational use:

Recreational users of heroin have generally reported an intense rush, an acute transcendent state of euphoria, that occurs while diacetylmorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Some believe that heroin produces more euphoria than other opioids upon injection; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin - although a more likely explanation is the rapidity of onset. While other opioids of recreational use, such as codeine, produce only morphine, heroin also leaves 6-MAM, also a psycho-active metabolite. However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other. Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.
[3]

Scheduling

Heroin is a Schedule I substance under the Controlled Substances Act. Schedule I drugs have a high potential for abuse and serve no legitimate medical purpose in the United States.
[1]

Psychological and physical addiction liability

Heroin addiction is psychological dependency on the regular use of cocaine. Heroin dependency may result in physiological damage, lethargy, psychosis, depression, akathisia, and fatal overdose.
[5]

Long term effects

The long term effects of taking heroin, is wanting more of the drug in order to get the equal pleasurable effect as taken on the first time of usage , or scientific terms the effects of euphoria. People who inject heroin can have damaged veins, and higher the chances of contaminating the parts of the heart, by a large amount. People who smoke, or take in the drug, will have their important body organs quickly get destroyed, also it is impossible for the liver, and kidneys to not get damaged no matter how it is eaten, or smoked. Victims can also expect to get massive damage to the lungs, and brain when it comes to long term effects. heroin on the body in a long term effect could bring the body into needing the drug, and relying on the drug. The body would want more of the enjoyable effects of heroin that come in short term effects (euphoric, also known as happiness) therefore finding drugs to get the same euphoric effects. The body would want more of the drug, otherwise known as addiction.
[6]

Physical effects

Infection of the heart lining and valves, normally due to lack of sterile technique.
Liver disease - Approximately 70-80% of new hepatitis C infections in the U.S. each year are the result of injection drug use, and even sharing snorting straws has been linked to hepatitis transmission.
Kidney disease-Pulmonary complications, which are often infection related
Skin infections and abscesses, especially among chronic injectors who suffer scarred or collapsed veins

Withdrawal Effects

Early symptoms of withdrawal include:

Agitation
Anxiety
Muscle aches
Increased tearing
Insomnia
Runny nose
Sweating
Yawning

Late symptoms of withdrawal include:

Abdominal cramping
Diarrhea
Dilated pupils
Goose bumps
Nausea
Vomiting

Heroin withdrawal reactions are very uncomfortable but are not life threatening. Symptoms usually start within 12 hours of last heroin usage and within 30 hours of last methadone exposure.
[6]

Medical Treatment options

Medical treatment involves supportive care and medications. The most commonly used medication, clonidine, primarily reduces anxiety, agitation, muscle aches, sweating, runny nose, and cramping.

Buprenorphine (Suptex) has been shown to work better than other medications for treating withdrawal from opiates, and it can shorten the length of detox. It may also be used for long-term maintenance like methadone.

People withdrawing from methadone may be placed on long-term maintenance. This involves slowly decreasing the dosage of methadone over time. This helps reduce the intensity of withdrawal symptoms.

Some drug treatment programs have widely advertised treatments for opiate withdrawal called detox under anesthesia or rapid opiate detox. Such programs involve placing you under anesthesia and injecting large doses of opiate-blocking drugs, with hopes that this will speed up the return the body to normal opioid system function.

There is no evidence that these programs actually reduce the time spent in withdrawal. In some cases, they may reduce the intensity of symptoms. However, there have been several deaths associated with the procedures, particularly when it is done outside a hospital.

Psychological treatment options

Among the treatment options, the following are the ones, commonly suggested:

Natural Detoxification:

During natural detoxification, medications dispensed to heroin or opiate addicted patients remain conservative. Anti-anxiety drugs, antidepressants and anti-psychotics may be prescribed to alleviate any withdrawal-induced or preexisting mental health issues that may impede recovery. Over-the-counter medications may be given to help the patient remain comfortable during his or her stay and mitigate withdrawal symptoms. Medical supervision is provided during natural detoxification as well, to guard against complications and to ensure monitoring of vital signs and overall health.

Clinical Therapy as heroin Addiction Treatment:

Sessions with a qualified mental health counselor have been shown to make rehabilitation more effective than simply detoxification or group meetings alone. Clinical therapy methods used in heroin or opiate addiction treatment can range widely, from Cognitive Behavioral Therapy (CBT) approaches that focus on behavior and belief modification to reward-based contingency management therapy (CMT). Depending on the heroin treatment facility, patients may also undergo other therapies alongside traditional cognitive therapy, such as EMDR or art therapy.

12-Step heroin Treatment Modalities:

One of the most time-tested methods of heroin and opiate addiction treatment help is the 12 step model. Through participation in group meetings and working of the 12 tenets of addiction recovery, patients can gain understanding, insight and support for practical, daily recovery. Best of all, 12-step group meetings can be located in virtually any locale throughout the nation, allowing recovering heroin addicted patients to continue their recovery upon graduation from a residential drug treatment facility.

Psychological Treatment

Psychosocial treatments for opioid dependence are a critical component of the overall treatment package. Psychosocial interventions require evaluation as separate interventions but also as part of a combination with pharmacotherapy treatments. This current review focuses on the role of psychosocial interventions alone for opioid dependence and abuse. In parallel with this review, there are two other partner reviews looking at the effect of combining psychosocial therapy with pharmacotherapy attracted conflicting views.

Overall the psychosocial component of therapy is thought to be a critical component of the holistic treatment and is delivered in very differing ways in different countries and also in different types of treatment settings. What is most striking is the heterogeneous
range of psychosocial interventions that are provided in the field of drug and alcohol dependence. This heterogeneity makes comparison of psychosocial interventions a significant challenge across the field of drug and alcohol.

Related drugs

The other drugs related to heroin are: Morphine, codeine, opium, methadone, hydroquinone, fentanyl, and oxycodone

Related synthetics

The following are the synthetic derivatives of heroin that are currently available:

Acetyldihydrocodeine
Benzylmorphine
Buprenorphine
Desomorphine
Dihydrocodeine
Dihydromorphine
Ethylmorphine
Diamorphine
Hydrocodone
Hydromorphinol
Hydromorphone
Nicocodeine
Nicodicodeine
Nicomorphine
Oxycodone
Oxymorphone
[6]

References

[1] http://www.drugabuse.gov/publications/drugfacts/heroin
[2] http://www.licadd.com/drug-alcohol-info/heroin/
[3] http://www.thecyn.com/heroin-rehab/heroin-street-names.html
[4] http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html
[5] http://alcoholism.about.com/od/heroin/a/heroin.htm
[6] http://www.justice.gov/ndic/pubs3/3843/index.htm