Transcript HEROIN and other OPIATES

T.O Phase I
History & Origin of Opioids
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In its purest form, heroin is a whitish powder
that is highly potent.
Typically, heroin is not pure and additives such
as sugar, starch, powdered milk, and rat
poison are common.
Heroin is usually snorted, injected, or smoked.
Though heroin is generally the opiate
associated with abuse, all opiates have a high
potential for addiction and abuse.
Categories of Opiates
Natural Opiates- direct products of the opium
poppy. These include opium, morphine, and
codeine.
 Semi-synthetic Opiates- made by modifying the
chemicals contained in opium. These include
heroin, Diladid, and Percodan.
 Synthetic Opiates- chemically produced and
made in the laboratory. These include Methodone
OxyContin, & Demerol.
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History and Origin of Opioids
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Opium- comes from the poppy plant. Only produced
from 7-10 days out of the plants year long life.
Heroin is derived from a product generated from the
opium poppy plant and was introduced as an
alternative to morphine.
Greek physicians (1000 B.C) believed opium to be a
cure-all.
In 1729, China’s first law against opium smoking
mandated opium shop owners be strangled. The
Chinese then began smuggling the drug from India.
The Opium Wars
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1839- Opium wars began. Started when a
Chinese citizen ordered by the Emperor to
suppress Opium smuggling. The British
attempted to bring in about $6 million of Opium
which was destroyed.
Ten months later, the British army arrived and
in 2 years, won a victory over China. The
British were given the island of Hong Kong,
trading rights, and $6 million to reimburse
merchants. The opium trade was ended in
1913.
Where Did Heroin Come From?
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Toward the end of the 19th century, a chemical
transformation was made to the morphine
molecule.
Two acetyl groups were attached to morphine,
yielding diacetylmorphine, or heroin.
Heroin was put on the market in 1898 by Bayer
Laboratories.
Heroin was originally marketed as a non-habit
forming alternative to codeine.
By the early 1900’s, heroin’s high dependence
potential was known.
Legal Controls
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In 1915, the U.S. Supreme court decided that
possession of smuggled opioids was a crime.
In 1922, physicians were no longer allowed to
prescribe opioids to patients in order to
maintain their dependence. This ruling was
reversed in 1925.
During the late 1920’s, clinics for the treatment
of opioid dependence were closed due to the
pressure from federal officials.
Around this time, IV heroin use became
popular as the drug was expensive and users
wanted more ‘bang for their buck.’
How Does Heroin Work?
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Heroin crosses the blood brain barrier quickly
and is converted into morphine and absorbed
into the opioid receptors in the brain.
These receptors are specifically sensitive to
morphine and are involved in the perception of
pain and reward.
Receptors are also found in the brain stem,
important for automatic processes.
When this occurs, users report feeling a ‘rush.’
The intensity of the ‘rush’ depends on how
much of the drug is used and how rapidly it
enters the brain.
Acute Effects of Use
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Histamines are released into the bloodstream,
and can produce itching all over the body, as
well as reddening of the eyes.
Dry mouth and flushing of the skin.
Heaviness of extremities and ‘the nod,’ or
alternating between wakefulness and sleep.
Diminished sex drive.
Constriction of the pupils.
Depression of breathing and blood pressure
Slows down the GI tract, causing long term
constipation.
Long-Term Effects of Use
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Physical dependence and tolerance.
Changes in the brain and its chemistry.
Withdrawal symptoms.
Increased risk of HIV, Hepatitis, and other diseases
(due to sharing of needles).
Collapsed veins, infections of the heart lining and
valves, abscesses, and liver or kidney diseases.
Pulmonary complications, such as pneumonia can
also occur.
Heroin can contain toxic additives that can clog
blood vessels and cause permanent damage to the
vital organs.
Heroin Withdrawal
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Chronic use of heroin leads to physical dependence.
Symptoms can occur within a few hours of the last
drug use and can include:
Restlessness and heavy sweating
 Muscle and bone pain
 Insomnia
 Diarrhea
 Vomiting
 Cold flashes and goose bumps
 Kicking movements
 Severe cravings for the drug
Major w/d symptoms peak between 48 and 72 hours after the last
dose and typically subside in about one week.
Though heroin w/d is usually not fatal, it can cause death in users
who are in poor health.
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Treatment Options
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Usually, tx begins with medically assisted
detox, where medications such as clonidine
help users minimize w/d effects.
Medications to help prevent relapse include:
Methadone-binds to the same receptors as heroin
and when taken properly, reduces the cravings for
other opioids while preventing w/d symptoms.
 Buprenorphine- similar to Methadone, but with
less risk for overdose and w/d effects.
 Naltrexone- short acting opioid receptor blocker,
used to treat cases of overdose.
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How Widespread is Heroin Abuse?
8th Grade
10th Grade
12th Grade
Lifetime
1.3%
1.5%
1.5%
Past Year
0.8
0.8
0.9
Past Month
0.4
0.4
0.4
According to the 2006 National Survey on Drug Use and
Health, the number of current heroin users in the U.S.
increased from 136,000 in 2005 to 338,000 in 2006. There
were 91,000 first time users of heroin aged 12 or older in
2006, down from 108,000 reported in 2005. Among
persons aged 12 to 49, the average first use of heroin was
20.7 years old.