1. T.O Phase I

2. History & Origin of Opioids  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.

3. 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.

4. History and Origin of Opioids  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.

5. The Opium Wars  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.

6. Where Did Heroin Come From?  Toward the end of the 19 th 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.

7. Legal Controls  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.’

8. How Does Heroin Work?  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.

9. Acute Effects of Use  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.

10. Long-Term Effects of Use  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.

11. Heroin Withdrawal  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.

12. Treatment Options  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.

13. How Widespread is Heroin Abuse? 8 th Grade10 th Grade12 th Grade Lifetime1.3%1.5% Past Year0.8 0.9 Past Month0.4 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.