Heroin & Other Opiates
2- Heroin & Other Opiates
Substances that come from the opium poppy, as well as any substance that dulls the senses, relieves pain, and causes deep sleep are called opiates. Opiates are present in a variety of drugs and are used for pharmaceutical or illegal purposes.
3- Morphine & Codeine
What is heroin
- Heroin (Diamorphine) is one of a group of drugs called ’opiates’ which are derived from the opium poppy. Opium is the dried milk of the opium poppy. It contains morphine and codeine, both effective painkillers. Heroin is made from morphine and in its pure form is a white powder. The main source of street heroin is the Golden Crescent countries of South West Asia, mainly Afghanistan, Iran and Pakistan. Street heroin usually comes as an off white or brown powder.
- For medical use heroin usually comes as a tablets or an injectable liquid. A number of synthetic opiates (called Opioids) are also manufactured for medical use and have similar effects to heroin. These include Dihydrocodeine (DF 118s), Pethidine (often used in childbirth), Diconal, Palfium, Temgesic and Methadone, a drug, which is often prescribed as a substitute drug in the treatment of heroin addiction.
- Heroin can be smoked, snorted or prepared for injection. Opioids made for medical use usually come in tablet or injectable form and may be used for non-medical reasons, especially by heroin users who cannot get hold of heroin. Methadone is usually prescribed as syrup, which is drunk. Methadone is a drug that in some countries gets used for maintenance or detoxification purposes. Though this may alleviate some of the physical symptoms of withdrawing from heroin addiction, it does not help with its psychological symptoms nor address the root of the problem. Methadone has a reputation among heroin addicts as being more difficult to detox from compared to heroin. Morphine, opium, methadone, Pethidine and Diconal are Class A drugs and Codeine and dihydrocodeine (DF118) are Class B drugs and Temgesic and Distalgesic are Class C drugs.
Effects & Risks of Heroin
- Heroin and other opiates are sedative drugs that depress the nervous system. They slow down body functioning and are able to combat both physical and emotional pain. The effect is usually to give a feeling of warmth, relaxation and detachment with a lessening of anxiety. Effects start quickly and can last several hours but this varies with how much is taken and how the drug is taken.
- Initial use can result in nausea and vomiting but these unpleasant reactions fade with regular use. With high doses sedation takes over and people become drowsy. Excessive doses can produce coma and even death from respiratory failure.
- With regular use tolerance develops so that more is needed to get the same effect. The disease of addiction can also develop from regular use. Physical withdrawal from heroin addiction can produce unpleasant flu like symptoms and may include aches, tremor, sweating and chills and muscular spasms. These usually fade after 7- 10 days depending on the person, but feelings of weakness and feeling ill may last longer. Whilst many people do successfully get clean from heroin addiction, staying off them can be very difficult. Use of 12 Step programs and the support of Narcotics Anonymous Fellowship has proved the most effective approach for heroin addicts to maintain sobriety.
- For further information on how get clean and recover using 12 Step programs and the support of anonymous fellowships, please refer to: Recovery 12 Steps
- Fatal overdoses can happen, especially when addicts take their initial dose after a break during which tolerance has faded, or when opiate use is combined with use of other depressant drugs such as an alcohol, Tranquilizers or other opiates. Many regular heroin users will use other opiates or depressant drugs when they cannot get hold of heroin.
- It is often difficult to know exactly what is being taken because the purity of street heroin varies and it is often mixed with adulterants. Injecting increases these risks and also puts users at risk of a range of infections including hepatitis and HIV if injecting equipment is shared. The physical effects of long-term heroin use are rarely serious in themselves but may include chronic constipation, irregular periods for women and possibly pneumonia and decreased resistance to infection. This can be made worse by poor nutrition and self neglect. Regular injectors may suffer more health problems including damaged veins, heart and lung disorders.
What is Opium
- Opium is a resinous narcotic formed from the latex released by lacerating (or “scoring”) the immature seedpods of opium poppies. It contains up to 16% morphine, and opiate alkaloid, which is most frequently processed chemically to produce heroin for the black market. Cultivation of opium poppies for food, anesthetic, and ritual purposes dates back to at least the Neolithic. The Sumerian, Assyrian, Egyptian, Minoan, Greek, Roman and Persian Empires each made widespread use of opium, which was the most potent form of pain relief then available, allowing ancient surgeons to perform prolonged surgical procedures.
- Morphine is the primary biologically active chemical constituent of opium and contains two main groups of alkaloids. Those that use opium are commonly referred to as “opiates” include morphine, codeine and thebaine, and are the main narcotic constituents.
- Morphine is by far the most prevalent and important alkaloid in opium, consisting of 10%-16% of the total, and is responsible for most of its harmful effects such as lung edema, respiratory difficulties, coma, or cardiac or respiratory collapse, with a normal lethal dose of 120 to 250ml—the amount found in approximately two grams of opium.
Effects & Risks of Opium
- Morphine binds to and supresses the opioid receptors in the brain, spinal cord, stomach and intestine. Regular use leads to physical tolerance and addiction. Chronic opium addicts in 1906 China or modern-day Iran consume an average of eight grams daily.
- Both analgesia and drug addiction are functions of the opiod receptor, the class of opiod receptor first identified as responsive to morphine.
- In the industrialized world, the USA is the world’s biggest consumer of prescription opioids, with Italy one of the lowest. Most opium imported into the United States is broken down into its alkaloid constituents, and whether legal or illegal, most current drug use occurs with processed derivatives such as heroin rather than with pure and untouched opium.
- Intravenous injection of opiates is most used: by comparison with injection, “dragon chasing” (heating of heroin with barbital on a piece of foil) and smoking of cigarettes containing heroin powderare only 40% and 20% efficient, respectively. Most heroin deaths result not from overdose, but combination with other depressant drugs such as alcohol or Benzodiazepine.
What are Morphine & Codeine
- Morphine is a highly potent opiate analgesic drug and is the principal active agent in opium. Like other opiates, e.g. heroin, morphine acts directly on the central nervous system to relieve pain. Studies done on the efficacy of various opioids have indicated that, in the management of severe pain, no other narcotic analgesic is more effective or superior to morphine. Morphine is highly addictive when compared to other substances, and tolerance, physical and psychological dependences develop very rapidly. Morphine has long been known to act on receptors expressed on cells of the central nervous system resulting in pain relief and analgesia. Most of the licit morphine produced is used to make codeine.
- Morphine is used legally:
- as an analgesic in hospital settings to relieve
- in the relief of severe chronic pain
- as an adjunct to general anesthetic
- as an antitussive for severe cough
- as an antidiarrheal in chronic cases
Effects & Risks of Morphine & Codeine
- Morphine is a highly addictive substance, both psychologically and physically, with an addiction potential comparable to heroin. In a study comparing the physiological and subjective effects of heroin and morphine administered intravenously in post-addicts, the post-addicts showed no preference for one or the other of these drugs when administered on a single injection basis.
- The withdrawal symptoms associated with morphine addiction are usually experienced shortly before the time of the next scheduled dose, sometimes within as early as a few hours (usually between 6-12 hours) after the last administration.
- Early symptoms include strong drug craving, watery eyes, insomnia, diarrhea, runny nose, yawning, dysphoria, and sweating. Restlessness, irritability, loss of appetite, body aches, severe abdominal pain, nausea and vomiting, tremors, and even stronger and more intense drug craving appear as the syndrome progresses. Severe depression and vomiting are very common. The heart rate and blood pressure are elevated. Chills or cold flashes with goose bumps (“cold turkey”) alternating with flushing (hot flashes), kicking movements of the legs (“kicking the habit”) and excessive sweating are also characteristic symptoms. Severe pains in the bones and muscles of the back and extremities occur, as do muscle spasms.
- Major withdrawal symptoms peak between 48 and 96 hours after the last dose and subside after about 8 to 12 days. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although morphine withdrawal is considered less dangerous than alcohol or barbiturate withdrawal.
- The psychological dependence associated with morphine addiction is complex and protracted. Long after the physical need for morphine has passed, the addict will usually continue to think and talk about the use of morphine (or other drugs) and feel strange or overwhelmed coping with daily activities without being under the influence of morphine. Psychological withdrawal from morphine is a very long and painful process. Addicts often suffer severe depression, anxiety, insomnia, mood swings, amnesia (forgetfulness), low self-esteem, confusion, paranoia, and other psychological disorders. The psychological dependence on morphine can, and usually does, last a lifetime.
- There is a high probability that relapse will occur after morphine withdrawal when neither the physical environment nor the behavioral motivators that contributed to the abuse have been altered. Testimony to morphine’s addictive and reinforcing nature is its relapse rate. Abusers of morphine (and heroin), have the highest relapse rates among all drug users, including abusers of other opiods, cocaine and methamphetamine. Other complication that may arise from long term morphine abuse, that is not seen with other narcotic analgesics, is neurotoxicity and brain damage.
- For information on the stages of relapse and how to prevent one, please refer to Addiction Relapse
What is Methadone
- Methadone is one of a number of synthetic opiates (also called opioids) that are manufactured for medical use and have similar effects to heroin. Methadone and Subutex (Buprenorphine) are used in some countries as opiate substitutes for heroin in the treatment of heroin addiction. Opiates are sedative drugs that depress the nervous system. They slow down body functioning and reduce physical and psychological pain. The effect is usually to give a feeling of warmth, relaxation and detachment. Methadone can help to relieve feelings of anxiety and has similar of heroin.
- Methadone that’s prescribed to people trying to come off ‘street’ heroin is usually a liquid which is swallowed, but it can come in tablet or injectable form. Subutex (Buprenorphine) is dissolved in the mouth. Effects can start quickly and can last several hours.
- Methadone that’s prescribed by a doctor is subject to stringent controls, as with any other medicine, so you can be sure of its strength and that it has not been tampered with. You can’t be as sure with methadone that’s bought on the street which may be an unusually concentrated variant and more powerful than expected.
Effects & Risks of Methadone
- Some people are sick the first time they take it and they can become constipated.
- With high doses, the sedation dominates and users feel sleepy. Too much and you can fall into a coma or stop breathing completely.
- Many women don’t have periods when they use opiates regularly. If they cut down, or stop, the periods may return. There’s a good chance of getting pregnant during this time if they don’t use contraception.
- Opiates may possibly increase the risk of miscarriage and still births and opiate users may give birth to smaller babies. It’s not a good idea to stop using opiates suddenly if you’re pregnant as this can cause premature labor and miscarriage. Methadone may be continued throughout pregnancy to minimize such risk.