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The varieties sources and uses of heroin

References Letter from the Director Heroin is a highly addictive drug, and its abuse has repercussions that extend far beyond the individual user. Although heroin abuse has trended downward during the past several years, its prevalence is still higher than in the early 1990s. These relatively high rates of abuse, the varieties sources and uses of heroin among school-age youth, and the glamorization of heroin in music and films make it imperative that the public has the latest scientific information on this topic.

Heroin also is increasing in purity and decreasing in price, which makes it an attractive option for young people. Like many other chronic diseases, addiction can be treated. Fortunately, the availability of treatments to manage opiate addiction and the promise from research of new and effective behavioral and pharmacological therapies provides hope for individuals who suffer from addiction and for those around them.

We hope this compilation of scientific information on heroin will help to inform readers about the harmful effects of heroin abuse and addiction as well as assist in prevention and treatment efforts. National Institute on Drug Abuse Chapter 1: 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 substance known on the streets as "black tar heroin. 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. What is the scope of heroin use in the United States?

According to the 2003 National Survey on Drug Use and Health, which may actually underestimate illicit opiate heroin use, an estimated 3.

An estimated 314,000 Americans used heroin in the past year, and the group that represented the highest number of those users were 26 or older. The survey reported that, from 1995 through 2002, the annual number of new heroin users ranged from 121,000 to 164,000. During this period, most new users were age 18 or older on average, 75 percent and most were male. Lifetime heroin use measured 1.

How is heroin used? Typically, a heroin abuser may inject up to four times a day.

Research Report Series: Heroin Abuse and Addiction

Intravenous injection provides the greatest intensity and most rapid onset of euphoria 7 to 8 secondswhile intramuscular injection produces a relatively slow onset of euphoria 5 to 8 minutes. When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. NIDA researchers have confirmed that all forms of heroin administration are addictive. Injection continues to be the predominant method of heroin use among addicted users seeking treatment; in many CEWG areas, heroin injection is reportedly on the rise, while heroin inhalation is declining.

However, 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. 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.

Heroin has also been appearing in more affluent communities.

  1. This is not a problem during surgical procedures because machines are used to help patients breathe.
  2. The user of LSD seems often to have an almost fanatic need to proselytize others to drug use.
  3. Most people are aware, however, even while under the influence of the drug, that their unusual perceptions have no basis in reality; so this is not a very accurate use of the term. Thought processes may also become disorganized, with fragmentation, disturbances of memory, and frequent shifts of attention acting to disrupt the orderly flow of ideas.
  4. Each of these approaches has had successes and has limitations.

What are the immediate short-term effects of heroin use? Soon after injection or inhalationheroin crosses the blood-brain barrier.

In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a "rush.

Social and ethical issues of drug abuse

With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching. After the initial effects, abusers usually will be drowsy for several hours. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot be accurately known.

What are the long-term effects of heroin use?

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One of the most detrimental long-term effects of heroin 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. As with abusers of any addictive drug, heroin abusers gradually spend more and more time and energy obtaining and using the drug.

The drugs literally change their brains and their behavior. Physical dependence develops with higher doses of the drug. With physical dependence, 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 is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps "cold turkey"and leg movements.

Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the fetus of a pregnant addict. At some point during continuous heroin use, a person can become addicted to the drug. Sometimes addicted individuals will endure many of the withdrawal symptoms to reduce their tolerance for the drug so that they can again experience the rush.

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 extended periods have few if any problems leaving opiates after their pain is the varieties sources and uses of heroin by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict. What are the medical complications of chronic heroin use?

  • Street heroin can also be cut with strychnine or other poisons;
  • Sedatives and hypnotics differ from general anesthetics only in degree;
  • The most long-lasting and conspicuous physiological responses are obtained from the central nervous system and the smooth muscle of the gastrointestinal tract;
  • Neurology, pharmacology, and policy;
  • Whatever the outcome, amphetamine induces a psychosis that comes closer to mimicking schizophrenia than any of the other drugs of abuse, including LSD;
  • The terms cannabis and marijuana also encompass the use of the flowering tops, fruit, seeds, leaves, stems, and bark of the plant even though the potency of these plant parts is considerably less than that of the pure resin itself.

Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain.

This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems. Of course, sharing of injection equipment or fluids can lead the varieties sources and uses of heroin some of the most severe consequences of heroin abuse-infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.

How does heroin abuse affect pregnant women? Heroin abuse during pregnancy and its many associated environmental factors e.

Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse, although infants exposed to methadone during pregnancy typically require treatment for withdrawal symptoms.

In the United States, several studies have found buprenorphine to be equally effective and as safe as methadone in the adult outpatient treatment of opioid dependence. Given this efficacy among adults, current studies are attempting to establish the safety and effectiveness of buprenorphine in opioid-dependent pregnant women. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.

Heroin users are at risk for contracting HIV, hepatitis C HCVand other infectious diseases, through sharing and reuse of syringes and injection paraphernalia that have been used by infected individuals, or through unprotected sexual contact with an infected person. NIDA-funded research has found that drug abusers can change the behaviors that put them at risk for contracting HIV through drug abuse treatment, prevention, and community-based outreach programs. Drug abuse prevention and treatment are highly effective in preventing the spread of HIV.

What are the treatments for heroin addiction? A variety of effective treatments are available for heroin addiction.

  • Cocaine has always been a potentially dangerous drug, and it has become especially popular among the middle and upper classes;
  • According to the 2003 National Survey on Drug Use and Health, which may actually underestimate illicit opiate heroin use, an estimated 3;
  • Prolonged use may lead to drug habituation and psychic dependence;
  • It is both the most abused and the most rapidly acting of the opiates;
  • Hallucinations are prominent with continued use of cocaine, particularly the tactile hallucinations that give the impression that bugs are under the skin;
  • J Subst Abuse Treat 24 4:

Treatment tends to be more effective when heroin abuse is identified early. The treatments that follow 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.

Other pharmaceutical approaches, such as buprenorphine, and many behavioral therapies also are used for treating heroin addiction. Buprenorphine is a recent addition to the array of medications now available for treating addiction to heroin and other opiates. Detoxification Detoxification programs aim to achieve safe and humane withdrawal from opiates by minimizing the severity of withdrawal symptoms and other medical complications.

The primary objective of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free state.

Not in itself a treatment for addiction, detoxification is a useful step only when it leads into long-term treatment that is either drug-free residential or outpatient or uses medications as part of the treatment. The best documented drug-free treatments are the therapeutic community residential programs lasting the varieties sources and uses of heroin to 6 months. Opiate withdrawal is rarely fatal. It is characterized by acute withdrawal symptoms which peak 48 to 72 hours after the last opiate dose and disappear within 7 to 10 days, to be followed by a longer term abstinence syndrome of general malaise and opioid craving.

Methadone programs Methadone treatment has been used for more than 30 years to effectively and safely treat opioid addiction. Properly prescribed methadone is not intoxicating or sedating, and its effects do not interfere with ordinary activities such as driving a car. The medication is taken orally and it suppresses narcotic withdrawal for 24 to 36 hours.

Patients are able to perceive pain and have emotional reactions. Most important, methadone relieves the craving associated with heroin addiction; craving is a major reason for relapse.

Among methadone patients, it has been found that normal street doses of heroin are ineffective at producing euphoria, thus making the use of heroin more easily extinguishable. Also, methadone is medically safe even when used continuously for 10 years or more.

Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin and other opiates and return to more stable and productive lives. Methadone dosages must be carefully monitored in patients who are receiving antiviral therapy for HIV infection, to avoid potential medication interactions.

Buprenorphine and other medications Buprenorphine is a particularly attractive treatment for heroin addiction because, compared with other medications, such as methadone, it causes weaker opiate effects and is less likely to cause overdose problems. Buprenorphine also produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than do those who stop taking methadone.

Because of these advantages, buprenorphine may be appropriate for use in a wider variety of treatment settings than the currently available medications. Several other medications with potential for treating heroin overdose or addiction are currently under investigation by NIDA. In addition to methadone and buprenorphine, other drugs aimed the varieties sources and uses of heroin reducing the severity of the withdrawal symptoms can be prescribed.

Clonidine is of some benefit but its use is limited due to side effects of sedation and hypotension.