Opiates come from the opium poppy (papaver somniferum) in
the form of the coagulated juice from the unripe capsule. Opium and its natural and
synthetic derivatives are narcotics, from narcos, meaning sleep. It is
an ingredient in morphine, codeine, and thebaine. Although several illegal drugs are
produced from the opium poppy, the most common drugs produced are heroin, and morphine
and codeine for pain relief. In its natural state it is a milky white, gummy-like
substance that can be smoked, chewed or drunk in liquid form.
History
Non-clinical use of heroin was criminalized in the USA by the
Harrison narcotics Tax Act of 1914, and by other laws worldwide. The Controlled
Substances Act of 1970 markedly relaxed the harshness of the Harrison Act, although the
penalties still remained quite severe.
Opioid Analgesics: OxyContin, Codeine, Percodan, Darvocet, Hydrocodone
The term opioid is medical language for opium-based and
opioids are more commonly described as narcotics, the most commonly known forms being
morphine and heroin. In addition, it is commonly understood that one of many avenues to
heroin use is through prescription opioids like oxycontin, a class of medication called
opioid analgesics, and one that also includes percodan, darvocet, vicodin and
hydrocodone.
Recent information indicates that 31.3 million, more than 10% of the
US population 12 years of age and older, took the drug at least one time strictly for the
feeling of it rather than any medical use. This indicated a 4% increase over the
previous year and is an indicator that these drugs are being diverted and abused at an
alarming rate. Further study indicates that they are gaining in popularity with an
adolescent population, which frequently has initial access through parental supplies.
NIDA further indicates that in 2003, high school seniors "abused opioids more than any
other drug except marijuana."
In 2001, the FDA strengthened the warnings and precautions sections
in the labeling of OxyContin (oxycodone HCI controlled-release) tablets, a narcotic drug
approved for the treatment of moderate to severe pain, because of continuing reports of
abuse and diversion in several states. Some of these reported cases have been associated
with serious consequences including death. In an effort to educate health care providers
about these concerns, the manufacturing pharmaceutical company issued warning letters and
alerts to physicians, pharmacists, and other healing professionals explaining the changes
in the labeling including proper prescribing information and highlighting the problems
associated with the abuse and diversion of the drug.
OxyContin contains oxycodone, an opioid agonist with an addiction
potential similar to that of morphine. Opioid agonists are substances that act by
attaching to specific proteins called opioid receptors, which are found in the brain,
spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid
receptors in the brain and spinal cord they can effectively block the transmission of the
pain massage to the brain.
Heroin
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
substances known on the streets as "black tar heroin." Although a more "pure" 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 is usually injected, sniffed/snorted or smoked. Typically, a
heroin abuser may inject up to four times per day. Intravenous injection provides the
greatest intensity and most rapid onset of euphoria (7-8 seconds), while intramuscular
injection produces a relatively slow onset of euphoria (5 - 8 minutes). When heroin is
sniffed or smoked, peak effects are usually felt within 10 to 15 minutes.
Injection continues to be the predominant method of heroin use among
addicted users seeking treatment, and in many areas heroin is on the rise, while heroin
inhalation is on the decline. Certain groups, such as white suburbanites in the Denver
area, report smoking or inhaling heroin because they believe that these routes of
administration are less likely to lead to addiction. NIDA researchers have confirmed,
however, that all forms of heroin administration are addictive.
With the shift in heroin abuse patterns comes an even more diverse
group of users. In recent years, the availability of higher purity heroin (which is more
suitable for inhalation) and the decreases in prices reported in many areas have
increased the appeal of heroin for new users who are reluctant to inject with the result
that heroin use is appearing in the more affluent communities, and among
adolescents.
Scope
According to the 2003 National Survey on Drug use and Health, which
may actually underestimate illicit opiate (heroin) use, and estimated 3.7
million people had used heroin at sometime in their lives and over 119,000 of them
reported using it within the month preceding the survey. An estimated 314,000 American
have used heroin in the past year, and the group that represented the highest numbers of
those users were 26 or older. The Survey reported that from 1995 through 2002, the annual
number of new users ranged from 121,000 to 164,000. During this period, the age of most
new users dropped to age 18 and older, approximately 75%, and most were male. In 2003,
57.4% of past year users were classified with dependence on or abuse of heroin and an
estimated 281,000 persons received treatment for heroin abuse.
According to the Monitoring the Future Survey, NIDA's nationwide
annual survey of drug use among the Nation's 8th, 10th, and
12th -graders, heroin use remained stable from 2003 to 2004. Lifetime use
measured 1.6% among 8th graders and 1.5 percent among 10th -
12th graders. The 2002 Drug Abuse Warning Network (DAWN) which collects data
on drug-related hospital emergency department episodes from 21 metropolitan areas
reported almost 100,000 heroin-related emergency department episodes in 2002. In its 2003
December publication, heroin was mentioned as the primary drug of choice for large
portions of drug abuse treatment admissions in Baltimore, Boston, Detroit, Los Angeles,
Newark, New York and San Francisco.
Short-Term Effects of Heroin Use
Soon after injection or inhalation heroin crosses the blood-brain
barrier where it is converted to morphine and binds rapidly to opioid receptors. Users
typically report feeling a surge of pleasurable sensation or "rush." With heroin, the
"rush" is usually accompanied by a warm flushing of the skin, dry mouth and a heavy
feeling in the extremities.
Short-Term Effects
- "Rush"
- Depressed respiration; sometimes to the point of death
- Clouded mental function
- Nausea and vomiting
- Suppression of pain
- Spontaneous abortion
Long-Term Effects of Heroin Use
One of the most detrimental effects of long-term use is addiction
itself. Addiction is a chronic, relapsing disease, characterized by compulsive drug
seeking and use, and by neurochemical and molecular changes in the brain. Heroin also
produces profound degrees of tolerance and physical dependence, which are also powerful
motivating factors for compulsive use and abuse.
Physical dependence develops with higher doses of the drug and at
some point after continuous use, addiction will occur. With physical dependence, or
addiction, the body adapts to the presence of the drug and withdrawal symptoms occur if
use is reduced abruptly. Withdrawal may occur within a few hours after the last time the
drug was taken. Symptoms of withdrawal include restlessness, muscle and bone pain,
insomnia, diarrhea, vomiting, cold flashes with goose bumps and leg movements. Major
withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and
subside after about a week. Some people do show persistent withdrawal signs for several
months; however, withdrawal is never fatal to otherwise healthy adults. It can cause
death to the fetus of a pregnant addict.
Physical dependence and the emergence of withdrawal symptoms were
once believed to be the key features of heroin addiction. We now know this may not be the
case entirely, since craving and relapse can occur weeks and months after withdrawal
symptoms are long gone. We also know that patients with chronic pain who need opiates to
function, sometimes over long periods of time, have few if any problems leaving opiates
after their pain is resolved.
Short Term Effects of Heroin
- Addiction
- Exposure to infectious diseases: HIV / Hepatitis B &
C
- Collapsed veins
- Bacterial infections
- Abscesses
- Infection of heart lining and valves
- Arthritis and other rheumatologic problems
- Live and/or kidney disease
Treatment for Heroin Addiction
A variety of effective treatments are available for heroin addiction,
and all are more effective with early identification. As with any drug of abuse,
treatment protocols vary depending on the individual, but methadone, a synthetic opiate
that blocks the effects of heroin and eliminates withdrawal symptoms has a proven record
of success for people addicted to heroin.
Many behavioral therapies also are used for treating patients, in
addition to Buprenorphine, a recent addition to the array of medications now available
for treating opiate addiction. Buprenorphine is different from methadone in that it
offers less risk of addiction, can be prescribed in the privacy of a doctor's office and
offers a lower level of physical dependence, so patients who stop taking the medication
generally have fewer withdrawal symptoms than do those who stop taking methadone.
Buprenorphine / naloxone (Suboxone) is a combination drug product formulated to minimize
abuse.
Although behavioral and pharmacological treatments can both be
extremely useful when employed alone, research indicates that integration of the
treatment methods is the most effective approach and can include both residential and
outpatient treatment services. An element critical to a successful outcome, not matter
the approach, is careful development of the plan of care in order to meet the particular
needs of each patient.
Several new behavioral therapies, such as contingency management
therapy and cognitive-behavioral interventions, show particular promise especially when
applied in concert with pharmacotherapies. Contingency management therapy uses a
voucher-based system, where patients earn "points" based on negative drug tests. They can
exchange the vouchers for items that encourage healthy living. Cognitive-behavioral
interventions are designed to help modify the patient's expectations and behaviors
related to drug use, and to increase skills in coping with various life
stressors.
Both behavioral and pharmacological treatment approaches help to
restore a degree of normalcy to brain function and behavior, with increased employment
rates and lower risk of illegal behavior and an improved quality of life.
