Heroin , also known as diamorphine among other names, is the most commonly used opioid as a recreational remedy for its euphoric effect. It is medically used in some countries to relieve pain or opioid replacement therapy. Heroin is usually injected, usually into a vein; However, it can also be smoked, snorted or inhaled. The onset of effects is usually rapid and lasts for several hours.
Common side effects include respiratory depression (decreased breathing), dry mouth, euphoria, and addiction. Other side effects may include abscesses, infected heart valves, blood-borne infections, constipation, and pneumonia. After a long-term use history, withdrawal symptoms can begin in the last few hours of use. When given an injection into the blood vessels, heroin has an effect of two to three times as the same dose of morphine. It usually appears as white or brown powder.
Treatment of heroin addiction often includes behavioral therapy and medication. Medications may include buprenorphine, methadone, or naltrexone. Overdose of heroin can be treated with naloxone. An estimated 17 million people in 2015 use opiates such as heroin, which together with opioids produce 122,000 deaths. The total number of opiate users increased from 1998 to 2007 after that remained more or less stable. In the United States about 1.6 percent of people have used heroin at some time. When people die of overdose of drugs, these drugs are usually opioids.
Heroin was first made by C.Ã, R. Alder Wright in 1874 from morphine, a natural product of opium poppy. Internationally, heroin is controlled on the basis of Schedule I and IV of the Single Convention on Narcotics Drugs. It is generally illegal to create, own or sell heroin without a license. By 2015 Afghanistan generates about 66% of the world's opium. Heroin, which is sold illegally, is sometimes mixed with other substances such as sugar, starch, quinine, or strychnine.
Video Heroin
Usage
Recreation
Genuine heroin trade names are commonly used in non-medical settings. It is used as a recreational drug for the euphoria it produces. Anthropologist Michael Agar once described heroin as "the perfect medicine." Tolerance develops rapidly, and increased doses are required to achieve the same effect. Its popularity with drug users, as compared to morphine, is reportedly derived from different perceived effects. Specifically, users report an intense rush, acute transition state of euphoria, which occurs when diamorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin - although the more likely explanation is the speed of onset. While other opioids from recreational use only produce morphine, heroin also leaves 6-MAM, as well as a psychoactive metabolite. However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of heroin and injectable morphine in individuals previously opioid addicted; these subjects showed no preference for one drug over another. The equivalent injecting dose has a comparable course of action, with no difference in feelings of euphoria, ambition, anxiety, relaxation, drowsiness, or drowsiness.
Short-term addiction studies by the same researchers show that tolerance develops at the same rate as heroin and morphine. When compared with opioid hydromorphone, fentanyl, oxycodone, and pethidine (meperidine), former addicts indicate a strong preference for heroin and morphine, suggesting that heroin and morphine are very susceptible to abuse and addiction. Morphine and heroin are also more likely to produce euphoria and other positive subjective effects when compared to these other opioids.
Some researchers have tried to explain the use of heroin and the culture that surrounds it through the use of sociological theory. In Rightly Dopefiend , Philippe Bourgois and Jeff Schonberg use anomie theory to explain why people start using heroin. By analyzing a community in San Francisco, they point out that heroin use is partly due to internal and external factors such as violent homes and parental neglect. This lack of emotional, social, and financial support causes tension and affects individuals to engage in deviant acts, including heroin use. They further found that heroin users practiced "rhetoric", a behavior that was first described by Howard Abadinsky, in which those who suffered the strain rejected the community's goals and instituted a way to achieve it.
Medical use
In the United States heroin is not accepted as medically beneficial.
Under the generic name diamorphine, heroin is prescribed as a powerful painkiller in England, where it is administered via subcutaneous, intramuscular, intrathecal or intravenous. Its use includes treatments for acute pain, such as severe physical trauma, myocardial infarction, postoperative pain, and chronic pain, including end-stage cancer and other terminal illnesses. In other countries, it is more common to use morphine or other powerful opioids in this situation. In 2004 the National Institute for Health and Clinical Excellence produced guidance on the management of the caesarean section, which recommended the use of intrathecal or epidural diamorphine to relieve post-operative pain.
Diamorphine continues to be widely used in palliative care in the UK, where it is commonly given by subcutaneous routes, often through syringe drivers, if the patient can not easily ingest the morphine solution. The advantage of diamorphine over morphine is that it is more soluble in fat and therefore stronger with injection, so smaller doses are required for the same effect on pain. Both of these factors are advantageous if giving high doses of opioids through subcutaneous routes, which are often required in palliative care.
Maintenance therapy
A number of European countries including Britain permit heroin recipes for heroin addiction.
Diamorphine is also used as a maintenance medication to aid the treatment of opiate addiction, usually in long-term intravenous chronic heroin (IV) users. It is only prescribed following a thorough effort on treatment through other means. It is sometimes considered that a heroin user can enter the clinic and come out with a prescription, but the process takes several weeks before the prescription for diamorphine is removed. While this is somewhat controversial among supporters of the zero tolerance drug policy, it has proved superior to methadone in improving the social and health situation of addicts.
The British Department of Health's Rolleston Committee report in 1926 establishes the UK's approach to prescribing diamorphine to users, which is maintained for the next 40 years: dealers are prosecuted, but doctors may prescribe diamorphine to users while withdrawing from it will cause severe harm or pressure. to the patient. This policing and prescribing policy effectively controlled the perceived diamor- gin problem in Britain until 1959 when the number of diamorphine addicts doubled every 16 months for ten years from 1959 to 1968. In 1964, the Brain Committee recommended that only selected elected physicians work in approved approved centers is permitted to prescribe diamorphine and benzoylmethylecgonine (cocaine) to the user. The law was stricter in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and use of methadone; currently only a small number of users in the UK are determined diamorphine.
In 1994, Switzerland initiated a trial diamorphine treatment program for users who had failed multiple withdrawal programs. The purpose of this program is to maintain the health of users by avoiding medical problems stemming from the use of illegal diamorphine. The first session in 1994 involved 340 users, although the enrollment was later expanded to 1000, based on the success of the program.
The trials prove the maintenance of diamorphine is superior to other forms of treatment in improving the social and health situation for this patient group. It has also been shown to save money, despite the high medical costs, as it significantly reduces the costs incurred by trials, detention, health interventions and delinquency. Patients appear twice daily at the treatment center, where they inject their diamorphine dose under the supervision of medical staff. They were asked to contribute around 450 Swiss francs per month for maintenance costs. A national referendum in November 2008 showed 68% of voters supported the plan, introducing diamorphine prescriptions into federal law. Previous trials are based on time-limited executive procedures. The success of Swiss trials encourages Germany, the Netherlands, and Canada to try their own diamorfin recipe program. Several cities in Australia (such as Sydney) have established injections that are monitored by diamorphine legal, in line with other widespread harm minimization programs.
Since January 2009, Denmark has given diamorphine to some addicts who have tried methadone and subutex without success. Beginning in February 2010, addicts in Copenhagen and Odense become eligible to receive free diamorfin. Then in 2010 other cities including ÃÆ'â € | rhus and Esbjerg joined the scheme. It is estimated that about 230 addicts will be able to receive free diamorphine. However, Danish addicts will only be able to inject heroin in accordance with the policies set by the Danish National Health Council. Of the approximately 1,500 drug users who did not benefit from current oral substitution treatment, about 900 would not be in the target group for treatment with injectable diamorphine, either because of "large non-opioid drug abuse" or "not wanting treatment with diamorphine injectable ".
In July 2009, the German Bundestag passed a law allowing the prescription of diamorphine as standard treatment for addicts; a large diamorphine recipe trial was validated in the country in 2002.
On August 26, 2016 Health Canada passed a law amending the previous rules that have been issued under the Controlled Drug and Materials Act; "New Class Practitioner Rules", "Narcotics Control Rules", and "Drug and Food Rules", to enable physicians to prescribe diamorphine to people who have severe opioid addiction who have not responded to other treatments. Heroin prescriptions are accessible to physicians through the Canada Health Special Access Program (SAP) for "emergency access to drugs for patients with serious or life-threatening conditions when conventional treatments have failed, are not, or are not available."
Maps Heroin
Administrative route
The onset of heroin effects depends on the route of administration. Studies have shown that the subjective enjoyment of drug use (an addiction booster component) is proportional to the rate at which the blood level of the drug increases. Intravenous injection is the fastest route of drug delivery, causing the blood concentration to rise most rapidly, followed by smoking, suppository (anal or vaginal insertion), insufflation, and ingestion (ingestion).
Ingestion does not produce a rush as a pioneer for experienced with high heroin use, the most prominent with intravenous use. While the onset of a rush caused by the injection can occur in just a few seconds, the oral route of administration takes about half an hour before the high set. Thus, with both higher doses of heroin used and the faster the administered route is used, the higher the risk potential for psychological addiction.
Large doses of heroin can cause fatal respiratory depression, and this drug has been used for suicide or as a murder weapon. The serial killer Harold Shipman uses diamorphine on his victim, and the Shipman Inquiry further leads to tightening of regulations surrounding the storage, prescription and destruction of controlled medicines in the UK. John Bodkin Adams is also known to use heroin as a murder weapon.
Since significant tolerance to respiratory depression develops rapidly with continuous use and disappears just as rapidly during withdrawal, it is often difficult to determine whether a lethal overdose of heroin is an accident, suicide or murder. Examples include the death of Sid Vicious overdose, Janis Joplin, Tim Buckley, Hillel Slovak, Layne Staley, Bradley Nowell, Ted Binion, and River Phoenix.
Chronic use of heroin and chronic opioids has been shown to be a potential cause of hyponatremia, resulting from excessive vasopressin secretion.
Oral
Oral use of heroin is less common than other administrative methods, mainly because there is little or no "rush", and the effect is less strong. Heroin is completely converted into morphine by first-pass metabolism, resulting in deacetylation when digested. Oral bioavailability Heroin is dose-dependent (such as morphine) and significantly higher than use of oral morphine alone, up to 64.2% for high doses and 45.6% for low doses; naive users showed much less drug absorption at low doses, having bioavailability of only up to 22.9%. The maximum concentration of plasma morphine after oral heroin administration is about twice that of oral morphine.
Injection
Injection, also known as "slamming", "banging", "shooting", "digging" or "mainline", is a popular method that carries a greater relative risk than other administrative methods. The heroin base (commonly found in Europe), when prepared for injection, will only dissolve in water when mixed with acid (most commonly citric acid powder or lemon juice) and heated. Heroin on the east coast of the United States is most often found in the form of hydrochloride salts, requiring only water (and no heat) to dissolve. Users tend to initially inject in easily accessible blood vessels, but because these veins collapse over time, users resort to more dangerous areas of the body, such as the femoral vein in the groin. Users who have used this route of administration often have deep vein thrombosis. Intravenous users may use a variety of single dose ranges using hypodermic needles. The dose of heroin used for recreational purposes depends on the frequency and level of use: so the user can first use between 5 and 20 mg, while the established addict may require several hundred mg per day. Like any drug injections, if a group of users share a common needle without a sterilization procedure, blood-borne diseases, such as HIV/AIDS or hepatitis, can be transmitted. The use of common water dispensers for use in injection preparation, as well as sharing of spoons and/or filters may also lead to the spread of diseases originating from the blood. Many countries now provide small sterile spoons and filters for single use to prevent the spread of the disease.
Smoking
Smoking heroin refers to evaporation to inhale the resulting smoke, not burning it to inhale the resulting smoke. It is generally smoked in glass pipes made of glass Pyrex tubes and light bulbs. It can also be inhaled from aluminum foil, which is heated under it by a flame and the resulting smoke is inhaled through a rolled foil tube. This method is also known as "chasing the dragon".
Insuflation
Another popular route for heroin intake is insufflation, where users crush heroin into fine powder and then inhale (sometimes with straws or rolled notes, such as with cocaine) into the nose, where heroin is absorbed through the soft tissues in the mucous membrane of the sinus cavity and directly into the bloodstream. This method of administration redirects first-pass metabolism, with faster onset and higher bioavailability than oral administration, although the duration of work is shortened. This method is sometimes preferred by users who do not want to prepare and manage heroin for injection or smoking, but are still experiencing rapid onset. Snorting heroin becomes a route that is often undesirable, once a user begins to inject the drug. Users may still get high medication for grunting, and experience a nod, but will not rush. A "rush" is caused by the large amount of heroin entering the body all at once. When the drug is taken through the nose, the user does not get busy because the drug is absorbed slowly rather than directly.
Suppositories
Small studies have focused on suppository (anal insertion) or method of injecting pessary (vaginal insertion), also known as "blockage". This method of administration is usually done by using an oral syringe. Heroin can be dissolved and drawn into an oral syringe which is then lubricated and inserted into the anus or vagina before the plunger is pushed. The vaginal rectum or vagina is where most drugs are likely to be taken, through a membrane lining the walls.
Adverse effects
Like most opioids, heroin that is not forged does not cause many long-term complications other than dependence and constipation. The purity of street heroin varies greatly. This variation has caused individuals to accidentally overdose when the purity of the drug is higher than they expected. Intensive use of heroin (and other substances) with needles and syringes or other related equipment may cause:
- Contract blood-borne pathogens such as HIV and hepatitis through needle sharing
- Contract bacterial or fungal endocarditis and possibly venous sclerosis
- Abscess
- Poisoning from contaminants is added to "cut" or dilute heroin
- Reduced renal function (nephropathy), although it is not currently known whether this is due to adultery or infectious disease
Many countries and local governments have begun funding programs that supply sterile needles to people who inject drugs in an attempt to mitigate these risks, and especially the spread of blood-borne diseases. The Drug Policy Alliance reports that up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of injecting drug use. The United States federal government does not operate needle exchange, although some states and local governments support the program.
Anthropologists Philippe Bourgois and Jeff Schonberg conducted a decade of field work among heroin addicts and cocaine addicts in San Francisco, published in 2009. They reported that the African-American addicts they observed were more likely to "steer the deposit" of heroin into blood vessels , while "skin-popping" is a much broader practice: "At the midpoint of our fieldwork, most white people have stopped searching for inoperable veins and injuring the skin, drowning their needles indifferently, often through their clothes, to in their fat tissue. "Bourgois and Schonberg explain how cultural differences between African-Americans and whites lead to this contrasting behavior, and also show that two different ways to inject heroin come with different health risks. Skin peels more often cause abscesses, and direct injections more often lead to fatal overdoses and also for hepatitis C and HIV infection.
A small percentage of heroin smokers, and sometimes IV users, may experience toxic leukoencephalopathy symptoms. The cause can not yet be identified, but one speculation is that the disorder is caused by unusual skin-eating that is only active when heated. Symptoms include slurred speech and walking difficulties.
Cocaine is sometimes used in combination with heroin, and is referred to as speedball when injected or moonrocks when smoking together. Cocaine acts as a stimulant, while heroin acts as a depressant. Co-administration provides an intense boost of high euphoria that combines both drug effects, while excluding negative effects, such as anxiety and sedation. The effects of cocaine fade much faster than heroin, so if a heroin overdose is used to compensate for cocaine, the end result is a fatal respiratory depression.
Withdrawal
The withdrawal syndrome of heroin (called "cold turkey") can be started within 6-24 hours of drug withdrawal; However, this time span may fluctuate with the level of tolerance as well as the number of doses consumed last. Symptoms may include: sweating, malaise, anxiety, depression, akathisia, priapism, extra sensitivity of the genitals in women, general weight, excessive yawning or sneezing, tears, rhinorrhea, insomnia, cold sweats, severe muscle and bone pain, nausea, vomiting, diarrhea, cramps, watery eyes, fever and pain such as unintentional cramps and seizures in the legs (ascribed to the term "kicking habits").
Overdose
Heroin overdose is usually treated with opioid antagonists, such as naloxone (Narcan). This reverses the effects of heroin and other opioids and causes immediate return of consciousness but can lead to withdrawal symptoms. The half-life of naloxone is shorter than most opioids, so it should be administered several times until the opioid is metabolized by the body.
Depending on drug interactions and many other factors, overdose deaths may last from a few minutes to several hours. Death usually occurs due to lack of oxygen due to lack of respiration caused by opioids. Heroin overdose can occur due to an unexpected increase in dose or purity or due to reduced opioid tolerance. However, many fatalities reported as an overdose may be caused by interactions with other depressant drugs such as alcohol or benzodiazepines. It should also be noted that because heroin can cause nausea and vomiting, a large number of deaths associated with heroin overdose are caused by aspiration of vomiting by an unconscious person. Some sources quote the median lethal dose (for an average of 75 kg of individual opiate-naively) as between 75 and 600 mg. Prohibited heroin has a very varied purity and can not be predicted. This means that users can prepare what they consider to be a moderate dose while actually taking more than intended. Also, tolerance usually decreases after a period of abstinence. If this happens and the user takes a dose comparable to the previous use, the user may experience a much larger drug effect than expected, potentially resulting in an overdose. It has been speculated that an unknown portion of heroin related death is the result of an overdose or allergy reaction to quinine, which can sometimes be used as a cutting agent.
Pharmacology
When taken orally, heroin undergoes first-pass metabolism through deacetylation, making it a prodrug for systemic morphine delivery. When the drug is injected, however, it avoids this first-pass effect, very quickly crossing the blood-brain barrier because of an acetyl group, which makes it much more soluble in fat than morphine itself. Once in the brain, then variously deacetylated into 3-monoacetylmorphine active and active 6-monoacetylmorphine (6-MAM), and then to morphine, which binds to -opioid receptors, resulting in drug euphoria, analgesics (pain). relief), and anxiolytic effects (anti-anxiety); heroin itself shows a relatively low affinity for? receptors. Unlike hydromorphone and oxymorphone, however, given intravenously, heroin creates a greater release of histamine, similar to morphine, resulting in a higher subjective "feeling" for some, but also a pruritus (itchy) example when they first start using.
Both morphine and 6-MAM are agonists -opioids that bind receptors present throughout the brain, spinal cord, and intestines of all mammals. The -opioid receptors also bind endogenous opioid peptides such as -endorphin, Leu-enkephalin, and Met-enkephalin. The use of heroin repeatedly results in a number of physiological changes, including increased production of the -opioid receptors (upregulation). These physiological changes lead to tolerance and dependence, thus stopping the use of heroin produces uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called opioid withdrawal syndrome. Depending on the use, it has an onset of 4-24 hours after the last dose of heroin. Morphine also binds to receptors-and -opioids?
There is also evidence that 6-MAM binds to a subtype of the -opioid receptor that is also activated by morphine-6 ​​morphine metabolites? -glucuronide but not morphine itself. The third subtype of the third type of opioid is the mu-3 receptor, which may be the same for the other six monoesters of morphine. The contribution of these receptors to the overall pharmacological heroin remains unknown.
The morphine derivative subclass, ie 3.6 morphine esters, with similar effects and uses, including analgesic nicomorphine (Vilan) clinically used analgesics, and dipropanoylmorphine; there is also the last dihydromorphine analog, diacetyldihydromorphine (Paralaudin). The other two 3.6 morphine diesters found in 1874-75 along with diamorphine, dibenzoylmorphine and acetylpropionylmorphine, were made as substitutes after being banned in 1925 and, therefore, were sold as the first "designer drug" until they were banned by the League of Nations on year 1930.
Chemistry
Heroin is derived from opium through a process involving various chemicals such as acetone and acetic anhydride.
Detection in body fluids
Major metabolites of diamorphine, 6-MAM, morphine, morphine-3-glucuronide and morphine-6-glucuronide, can be quantified in blood, plasma or urine to monitor abuse, confirm the diagnosis of poisoning or assist in the investigation of medicolegal death. Most commercial opiate screening tests react well with these metabolites, as well as with other biotransformation products that may be present after the use of street-class diamorphins such as 6-acetylcholine and codeine. However, chromatographic techniques can easily distinguish and measure each of these substances. When interpreting test results, it is important to consider the history of using individual diamorphine, because chronic users can develop dose tolerance that will paralyze naïve individuals, and chronic users often have a high baseline value from this. metabolites in the system. In addition, some test procedures use hydrolysis steps before quantization that converts many metabolic products into morphine, yielding results that may be 2 times greater than by methods that check each product individually.
History
Poppy opium cultivated in Mesopotamia is lower since 3400 BC. Analysis of opium chemistry in the 19th century reveals that much of its activity can be attributed to two alkaloids, codeine and morphine.
Diamorphine was first synthesized in 1874 by C. R. Alder Wright, a British chemist who works at St. Mary's Hospital Medical School in London. He has experimented with combining morphine with various acids. He boiled the anhydride anhydride anhydride with acetic anhydride for several hours and produced a stronger, acetylated form of morphine, now called diacetylmorphine or morphine diacetate. The compound was sent to F. M. Pierce from Owens College in Manchester for analysis. Pierce told Wright:
Dosage... injected subcutaneously into young dogs and rabbits... with the following general results... great sujud, fear, and drowsiness soon after giving, the eyes become sensitive, and the pupils narrow, much saliva produced in dogs. , and a slight tendency to vomit in some cases, but no actual emesis. Respiration was first accelerated, but later diminished, and cardiac action diminished, and became disordered. Marking wants to coordinate strength over muscle movement, and loss of strength in the pelvis and hind legs, along with a decrease in rectal temperature around 4 Â °.
Wright's discovery did not lead to further developments, and diamorphine became popular only after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann. Hoffmann, working at the Bayer pharmaceutical company in Elberfeld, Germany, was instructed by his superior Heinrich Dreser to acetylate morphine in order to produce codeine, a constituent of opium poppy, pharmacologically similar to morphine but less powerful and less addictive. In contrast, the experiment produces an acetylated form of morphine one and a half to two times stronger than morphine itself. The head of the Bayer research department is famous for the new name of this drug, "heroin," based on the German heroisch, meaning "heroic, powerful" (from the ancient Greek word "heros,"). The Bayer scientists were not the first to make heroin, but their scientists found a way to make it, and Bayer led the commercialization of heroin.
In 1895, the German drug company Bayer marketed diacetylmorphine as a over the counter under the Heroin brand name. It was developed primarily as a substitute for morphine for cough suppressants that had no side effects of morphine addiction. Morphine at the time was a popular recreational drug, and Bayer wanted to find a similar but not addictive substitute for the market. However, contrary to Bayer's advertisement as "an addictive substitute for morphine," heroin will soon have one of the highest addiction rates among its users.
From 1898 to 1910, diamorphine was marketed under the trademark Heroin as a substitute for non-addictive morphine and cough suppressants. In the 11th edition of the EncyclopÃÆ'Â|dia Britannica (1910), the article on morphine states: "In phthisis cough, minute doses [morphine] is a service, but in morphine this particular disease is common. preferably replaced with codeine or heroin, which examines an irritating cough without narcotics following morphine administration. "
In the US, the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of diacetylmorphine and other opioids, allowing the drug to be prescribed and sold for medical purposes. In 1924, the United States Congress banned the sale, import, or manufacture. Currently it is the substance of Schedule I, which makes it illegal for non-medical use in the signatory states of the Single Convention on Drug Narcotics agreements, including the United States.
The League Health Committee of the United Nations banned diacetylmorphine in 1925, although it took more than three years for this to take place. Meanwhile, the first designer drug, that is. 3.6 diesters and 6 analogous monoesters of morphine and acetate from closely related drugs such as hydromorphone and dihydromorphine, produced in large quantities to meet diacetylmorphine demand worldwide - this continued until 1930 when the Committee banned the diacetylmorphine analogue without therapeutic benefit over drugs which has been used, the first major legislation of this type.
Bayer lost some of his trademark rights to heroin under the 1919 Versailles Treaty following Germany's defeat in World War I.
The use of heroin by jazz musicians in particular is prevalent in the mid-twentieth century, including Billie Holiday, legend Charlie Parker and Art Pepper, guitarist Joe Pass and pianist/singer Ray Charles; "The number of jazz musicians who are surprising are addicts". It was also a problem with many rock musicians, especially from the late 1960s to the 1990s. Pete Doherty is also a self-confessed heroin user. The dependence of lead singer Nirvana, heroin addiction Kurt Cobain, is well documented. Pantera frontman, Phil Anselmo, switched to heroin during a tour during the 1990s to deal with his back pain. Many musicians have made songs that refer to their heroin use.
Society and culture
Name
"Diamorphine" is the International Nonproprietary Name and the Recommended British Approved Name. Other synonyms for heroin include: diacetylmorphine, and morphine diacetate. Heroin is also known by many street names including dope, H, smack, junk, horse, and brown, among others.
Legal status
Asia
In Hong Kong, diamorphine is set out under Schedule 1 of Chapter 132, Hong Kong Dangerous Drug Act, . It is available by prescription. Anyone who gives you a diamond without a valid prescription can be fined $ 10,000 (HKD). Penalties for trading or manufacturing diamorphine are a fine of $ 50,000 (HKD) and life imprisonment. The ownership of diamorphine without a license from the Ministry of Health is illegal with a fine of $ 10,000 (HKD) and/or 7 years in prison.
Europe
In the Netherlands, diamorphine is List I of the Opium Law medicine. It is available to be prescribed under strict regulations exclusively for long-term junkies for whom methadone treatment treatments have failed. It can not be used to treat severe pain or other illness.
In the UK, diamorphine is available by prescription, even though it is a limited Class A drug. According to the 50th edition of the British National Formulary (BNF), diamorphine hydrochloride can be used in the treatment of acute pain, myocardial infarction, acute pulmonary edema, and chronic pain. Treatment of chronic non-malignant pain should be supervised by a specialist. BNF notes that all opioid analgesics cause dependence and tolerance but this is "no deterrent in controlling the pain of terminal illness". When used in palliative care of cancer patients, diamorphine is often injected using a syringe driver.
It is controlled in the UK by the Abuse of Drug Act 1971. In the UK it is a class A controlled drug and therefore subject to guidelines around storage, administration and destruction. The ownership of untreated diamorphine is a retaliable offense. When diamorphine is prescribed in a hospital or similar environment, the administration must be supervised by two persons who must then complete and sign the list of controlled drugs (CD registers) detailing the patient's name, amount, time, date and route of administration. In the case of a doctor who gives diamorphine, he can administer the drug itself, but the rules requiring two registered practitioners, such as a nurse, midwife or other doctor to sign the CD register are still valid. The use of witnesses when giving diamorphine is to avoid the possibility of the drug being diverted to the black market.
For security reasons, many UK National Health Service hospitals only allow the administration of intravenous diamorphins in the designated areas. In practice this usually means critical care unit, accident and emergency room, operating room by anesthesiologist or anesthesia nurse or other area where close monitoring and support from senior staff is immediately available. However, administration by other routes is permitted in other areas of the hospital. These include subcutaneous, intramuscular, intravenously as part of patient-controlled analgesia, and as an existing epidural infusion pump. Subcutaneous infusions, along with subcutaneous and intramuscular injection (bolus), are often used in patients' own homes, to treat severe pain in terminal illnesses.
Australia
In Australia diamorphine is listed as a schedule of 9 substances under Standard Poison (October 2015). Drug Schedule 9 is outlined in the 1964 Poison Act as "Substances that may be misused or misused, manufacture, possess, sell or use should be prohibited by law except when necessary for medical or scientific research, or for analytical, teaching or training purposes with CEO approval. "
North America
In Canada, diamorphine is a controlled substance based on Schedule I of the Drug and Controlled Substances Act (CDSA). Anyone seeking or obtaining diamorphine without disclosing authorization 30 days before obtaining another prescription from a practitioner is guilty of an alleged and criminal offense for a period not exceeding seven years. The ownership of diamorphine for trade purposes is a violation that can be alleged and punishable for life.
In the United States, diamorphine is a drug Schedule I under the Controlled Substitution Act of 1970, making it illegal to own without a DEA license. Ownership of more than 100 grams of diamorphine or a mixture containing diamorphine can be punished with a mandatory minimum 5-year prison term in a federal prison.
Abuse of prescription drugs
Prescription drugs that are abused like opioids can cause heroin addiction. The number of deaths from illegal opioid overdoses follows an increase in the number of deaths caused by overdose of prescribed opioids. Prescription opioids are relatively easy to obtain. This may lead to heroin injections because heroin is less expensive than prescribed pills.
Economy
Production
Diamorphine is produced from acetylation of morphine derived from natural opium sources. Many mechanical and chemical ways are used to purify the final product. The end product has a different appearance depending on the purity and has a different name.
Heroin value
The purity of heroin has been classified into four classes. No.4 is the purest form - white powder (salt) to dissolve easily and injected. No.3 is "brown sugar" for smoking (base). No.1 and No.2 are unprocessed raw heroin (salt or base).
Trading and production process
Traffic is very heavy around the world, with Afghanistan's largest producer. According to a UN-sponsored survey, in 2004, Afghanistan was responsible for 87 percent of world diamorphine. Afghan opium kills about 100,000 people annually.
In 2003 The Independent reported:
... Ã, The cultivation of opium [in Afghanistan] peaked in 1999, when 350 square miles (910 km 2 ) of poppy flowers sown... The following year the Taliban banned the cultivation of opium, Ã,... a step that cut production by 94 percent... In 2001 only 30 square miles (78 km 2 ) land used to plant opium flowers. A year later, after US and British troops have removed the Taliban and installed a temporary administration, the land under cultivation jumps back to 285 square miles (740 km 2 ), with Afghanistan replacing Burma to become the world's largest producer of opium again.
The country's opium production has increased rapidly since then, reaching its highest level throughout 2006. The war in Afghanistan has once again emerged as a trade facilitator. About 3.3 million Afghans are involved in producing opium.
Currently, most opium poppies are grown in Afghanistan (224,000 hectares (550,000 hectares)), and in Southeast Asia, especially in the area known as the Golden Triangle located in Burma (57,600 hectares (142,000 acres)), Thailand, Vietnam, Laos ( 6,200 acres (15,000 hectares)) and Yunnan province in China. There is also opium flower planting in Pakistan (493 hectares (1,220 hectares)), Mexico (12,000 hectares (30,000 hectares)) and in Colombia (378 hectares (930 hectares)). According to the DEA, the majority of heroin consumed in the United States comes from Mexico (50%) and Colombia (43-45%) through Mexican crime cartels such as Sinaloa Cartel. However, these statistics may not be significantly reliant, the 50/50 DEA separation between Colombia and Mexico contradicts the number of hectares cultivated in each country and by 2014, the DEA claims most of the heroin in the US comes from Colombia. By 2015, Sinaloa Cartel is the most active drug cartel involved in smuggling drugs such as heroin to the United States and trading it across the United States. According to Royal Canadian Mounted Police, 90% of seized heroin in Canada (where it came from) are from Afghanistan. Pakistan is the destination and the transit point for 40 percent of the opium produced in Afghanistan, the other Afghan opium destinations are Russia, Europe and Iran.
Confidence for heroin trade brings death penalty in most Southeast Asian countries, some East Asian and Middle Eastern countries (see Use of death penalties worldwide for details), among which Malaysia, Singapore and Thailand are the most stringent. Penalties apply even to citizens in which punishment is not in place, sometimes causing controversy when foreign visitors are arrested for trade, for example the arrest of nine Australians in Bali, death sentence given to Nola Blake in Thailand in 1987, or hanging a citizen Australia, Van Tuong Nguyen in Singapore.
Trade history
The origins of international illegal heroin trade can now be traced back to legislation passed in many countries in the early 1900s that strictly regulated the production and sale of opium and its derivatives including heroin. Initially, heroin flows from countries where it is still legal to countries where it is no longer legal. By the mid-1920s, heroin production had been made illegal in many parts of the world. Illegal trade was developed at that time between heroin laboratories in China (mostly in Shanghai and Tianjin) and other countries. The weakness of the government in China and the conditions of civil war enabled heroin production to take root there. The Chinese triad gang has finally come to play a leading role in the forbidden heroin trade. The French Connection Route began in the 1930s.
Heroin trade was almost eliminated in the US during World War II due to temporary trade disruptions caused by war. The Japanese war with China has cut the normal distribution routes for heroin and the war in general has disrupted the movement of opium. After World War II, the Mafia took advantage of the weaknesses of the post-war Italian government and established a heroin laboratory in Sicily. The Mafia takes advantage of the Sicilian location along its historic opium route to the west to Europe and the United States. Large-scale international heroin production effectively ended in China with a communist victory in the civil war in the late 1940s. The abolition of Chinese production took place at the same time as the role of Sicilians in developing trade.
Although it remained legal in some countries until after World War II, health risks, addictions, and widespread recreational usage caused most western countries to declare heroin as a controlled substance in the second half of the 20th century. In the late 1960s and early 1970s, the CIA supported an anti-Communist Chinese nationalist settling near the Sino-Burmese border and the Hmong tribe in Laos. This helped the development of the Golden Triangle's opium production area, which supplies about one-third of the heroin consumed in the US after the American withdrawal in 1973 from Vietnam. In 1999, Burma, the heart of the Golden Triangle, is the second largest heroin producer, after Afghanistan.
The Soviet-Afghan war led to increased production in the Pakistan-Afghanistan border region, as US-backed mujahideen militants raised money for guns from the sale of opium, contributing greatly to the creation of the modern Golden Crescent. In 1980, 60 percent of heroin sold in the US came from Afghanistan. This increased international heroin production at a lower price in the 1980s. Trade shifted away from Sicily in the late 1970s as various criminal organizations fiercely battled each other over trade. The fighting also led to the presence of increasing government law enforcement in Sicily.
After the discovery at Jordan airport from a modified toner cartridge into an improvised explosive device, an increased rate of increased flight surveillance caused a great heroin (drought) shortage from October 2010 to April 2011. This was reported most deeply. from mainland Europe and the UK which led to a 30 percent price increase in street heroin costs and an increase in demand for redirected methadone. The number of addicts seeking treatment also increased significantly during this period. Other heroin droughts (shortages) have been linked to cartels restricting supply to force price increases and also for fungi that attack opium crops in 2009. Many people think that the American government has introduced pathogens to the Afghan atmosphere to destroy opium crops and thus starved the rebels' revenues.
On March 13, 2012, Haji Bagcho, who has ties to the Taliban, was convicted by the US District Conspiracy Court, the distribution of heroin to import into the United States and narcotics. Based on heroin production statistics compiled by the United Nations Office for Drugs and Crime, in 2006, Bagcho activities accounted for about 20 percent of the world's total production for that year.
The street price
The European Supervisory Center for Drugs and Drug Addiction reports that brown heroin retail prices vary from EUR14.5 per gram in Turkey to EUR110 per gram in Sweden, with most European countries reporting typical prices of EUR35-40 per gram. White heroin prices are only reported by some European countries and range between EUR27 and EUR110 per gram.
The UN Office for Drugs and Crime claims in the 2008 World Drug Report that the US retail price is $ 172 per gram.
Hazard reduction
Harm reduction is a public health philosophy that seeks to reduce the harm associated with the use of diamorphine. One aspect of the impact reduction initiative focuses on individual user behavior. This includes promoting safer ways to take medications, such as smoking, nasal use, oral or anal insertion. This effort is to avoid a higher risk of overdose, infection and blood-borne virus associated with injecting drugs. Other measures include using a small amount of the first drug to measure strength, and minimizing the risk of overdose. For the same reason, the use of poly (using two or more drugs at the same time) is not recommended. Users of injectable diamorphins are encouraged to use new needles, syringes, spoons/sticks and filters each time they inject and do not share it with other users. Users are also encouraged not to use it themselves, as others can help in case of overdose.
Governments that support the harm reduction approach typically fund needle exchange programs, which supply secret needles and syringes, as well as education about precise screening before injection, safer injection techniques, safe disposal of used injector equipment and other equipment used. when preparing diamorphine for injection can also be given including sachets of citric acid/sachet of vitamin C, sterate-glass, filter, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop the use of shoelaces or belts).
Other hazard reduction measures used eg in Europe, Canada and Australia are safe shots where users can inject diamorphine and cocaine under the supervision of medically trained staff. Safe injection sites are low thresholds and allow social services to approach users with hard to reach issues. In the UK, the Criminal Justice System has a protocol requiring every individual who is arrested and suspected of having substance abuse issues offered the opportunity to enter a treatment program. This has the effect of reducing the crime rate of an area drastically because people arrested for theft to supply funds for their drugs are no longer in a position to have to steal to buy heroin because they have been placed into a methadone program, quite often faster than it might have been if they not arrested. This aspect of hazard mitigation is seen as beneficial for both individuals and the wider community, which is then protected from the possibility of theft of their goods.
During the late 1980s and early 1990s, Swiss authorities ran the ZIPP-AIDS (Zurich Intervention Pilot Project), distributing free syringes in officially-tolerated drug scenes in the Platzspitz park. In 1994, Zurich started a pilot project using prescription heroin in the treatment with the help of heroin (HAT) that allowed users to get heroin and inject it under medical supervision. The HAT program proved beneficial to the community and improved overall patient health and social stability and has since been introduced in several European countries.
Research
Researchers are trying to reproduce the biosynthetic pathways that produce morphine in genetically modified yeast. In June 2015 S -retikulin can be produced from sugar and R -retikulin can be converted to morphine, but intermediate reactions can not be performed.
See also
- Allegations of CIA drug trafficking
- Heroin Politics in Southeast Asia
- Cheese (drugs)
References
External links
- Heroin in Curlie (based on DMOZ)
- NIDA InfoFacts in Heroin
- ONDCP Drug Facts
- US. National Drug Library: Drug Information Portal - Heroin
- The BBC article entitled 'When Heroin Was Legal'. References to the United Kingdom and the United States
- Deaths that poison drugs involve Heroin: United States, 2000-2013 US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
- Heroin Trade in the United States (2016) by Kristin Finklea, Congressional Research Service.
Source of the article : Wikipedia
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