Heroin is an opiate medication made from morphine, which is itself obtained from the opium poppy plant (Papaver somniferum). The techniques vary, but most growers use either the seed pods or the flowering plant's straw chaff to extract a light brown powder that contains concentrated morphine.
Opium poppies and their derivatives – including the pain reliever codeine and laudanum, cough – suppressant noscapine and morphine – are known throughout human history.
Neolithic burial sites in Spain show evidence of poppy consumption. The first recorded reference to opium dates from 3400 BC. When the opium poppy was grown in Mesopotamia, according to the Drug Enforcement Agency (DEA). The ancient Sumerians referred to the poppy as hul gil (the "joy plant"), and ancient Egyptian, Greek, Minoan and Sanskrit texts document the use of medicines derived from poppy seeds.
The opium wars occurred in the early 1800s when British merchants attempted to correct a trade imbalance with China by flooding the Asian nation with cheap opium, leading to widespread addiction. Chinese officials tried to stop the opium trade, but the invasion of British troops forced China to accept an open trade policy – including opium imports – with European powers. According to Humberto Fernandez and Therissa A. Libby, authors of "Heroin: History, Pharmacology, and Treatment" (Hazelden, 2011), China in 1900 had 13.5 million addicts who consumed 39,000 tons of opium a year.
The poppy plant grows in mild climates around the world: Afghanistan produces the most opium poppies, but the plant is also grown in Mexico, Colombia, Turkey, Pakistan, India, Burma, Thailand, Australia and China.
An accidental discovery
Morphine was first extracted from opium resin in 1803; It quickly gained popularity among doctors as a pain reliever and was used extensively in the U.S. Civil War and other conflicts.
1898 while morphine was used to synthesize codeine – an opiate that was less effective and less addictive than morphine chemist Felix Hoffman combined morphine with acetic anhydride and accidentally produced heroin (diacetylmorphine) that was many times more effective is as morphine.
Hoffman's company, which eventually became the pharmaceutical giant Bayer, marketed diacetylmorphine as "heroin" for its supposed heroic qualities. The company advertised its new product as a safer pain reliever than morphine until it was found that heroin is quickly converted to morphine in the body.
The United States and most other countries eventually banned heroin. It is now listed as a List I narcotic under the U.S. Controlled Substances Act, which means that it has no medical benefits and high abuse potential, according to the DEA.
The addictive substance can be a white or brown powder or a black sticky substance known as "black tarheroin", said Dr. Scott Krakower, deputy director of psychiatry at Sugar Hillside Hospital in Long Island, New York York.
Taking the drug can lead to euphoria and, according to NIDA (US National Institute on Drug Abuse), is often accompanied by dry mouth, reddened skin, a feeling of heaviness in the extremities, and cloudy thinking. Because heroin stimulates the brain's reward pathway, people often return to the drug to feel comfortable, NIDA reported.
"It gives people an immediate rush or high and can ultimately be fatal," Krakower told Live Science.
How Heroin Works
Heroin is known by street names like "horse" and "blow". According to the DEA, it is often cut with substances such as milk powder, sugar, starch, quinine or other contaminants. (A drug can be mixed with other compounds so that the trader can make more money with a small amount of heroin or give the user better value, Krakower said.)
Heroin can be inhaled in powder form, "snorted" in the nose or smoked, said Krakower. However, many prefer to inject a liquid form of the drug, as this method can lead to a faster, more intense high, he said.
Like other opioid-based pain relievers, heroin binds to opioid receptors in the brain and spinal cord, particularly to receptors that are along the reward pathway, such as the nucleus accumbens, according to NIDA.
The bond leads to an intense "rush" of euphoria and freedom from pain, followed by a warming feeling and the sleepy feeling of well-being that is typical of opioid pain relievers, Krakower said. This high can last for several hours depending on the strength of the dose.
(Photo credit: berna namoglu / Shutterstock.com)
Side effects of heroin
In addition to impairment of mental functions due to the high proportion, heroin use can lead to tolerance in which Users need more of the drug to achieve the same level of euphoria. Repeated use can also lead to addiction, according to NIDA, where people continue to take the drug to eliminate withdrawal symptoms.
Heroin use is associated with a deterioration in white matter in the brain, which can affect people's ability to make decisions, regulate their behavior, and respond to stressful situations, NIDA reported.
The drug also causes pupil constriction, nausea, constipation, muscle spasms and a slowed pulse and respiratory rate, according to the DEA.
High doses of heroin can cause cramps, a dangerously low pulse, blue lips and fingernails, and wet skin, a coma, or even death, according to the United States Agency for Substance Abuse and Mental Health (SAMHSA). The depressive effect of the drug on breathing can lead to slow, shallow breathing, which can come to a complete standstill in the event of an overdose – breathing interruption is one of the most common causes of death among heroin users.
"Physiologically speaking, over the long term, respiratory and kidney dysfunction may occur," said Krakower. "If you use it intravenously, it can cause blood vessels to collapse."
Injection of heroin – especially with shared needles – has also been linked to the spread of blood borne pathogens, including hepatitis and HIV / AIDS, according to the National Institutes of Health (NIH).
In addition, heroin can be cut with any number of toxic contaminants, including fentanyl, another opioid pain reliever that can significantly increase the effectiveness of heroin NIDA.
Treatment of Heroin Use
Heroin has gained popularity in recent years. In 2011, an estimated 4.2 million Americans (or 1.6 percent) 12 years and older said they had tried heroin at least once in their lives, according to NIDA.
Heroin overdose deaths almost quadrupled from 2000 to 2013, from 0.7 to 2.7 deaths per 100,000 people in the United States, according to the Centers for Disease Control and Prevention.
However, according to NIDA, not everyone becomes addicted to it, since the environment and personality also play a role. About 23 percent of people who have tried heroin become addicted to it, NIDA reported.
Treatment for heroin addiction often includes behavioral counseling and medical therapies, including the regulated use of methadone, a synthetic opioid, with varying degrees of success in treating opioid addiction.
"Methadone is a fairly effective treatment," said Krakower. "It's also a narcotic, but it works on the receptors so that someone doesn't feel like they have high levels of heroin."
People usually need to go to a clinic to get methadone, but treatment regimens and lengths vary. "Patients can be there for years," Krakower said. "They take methadone and sometimes stay with it for a lifetime."
Side effects of methadone include sedation, constipation, pupil constriction, difficulty breathing, and constipation, as with other opioid agents, Krakower said. Other medications like laxatives can help, he said.
Buprenorphine (brand name: Subutex) and buprenorphine and naloxone (Suboxone) can also treat the addition of opioids by preventing withdrawal symptoms when a person stops taking heroin, according to the NIH. Another drug, naltrexone, can help reduce cravings by blocking the effects of heroin, the NIH said.
Naloxone (Narcan), which blocks opioid receptors, can also be used to save someone during an overdose, Krakower said. It can be injected intravenously or intramuscularly and is now available as a nasal spray, according to the NIH. If anyone has an overdose of heroin, call 911, Krakower said.
Without the help of most medications, withdrawal from heroin use can be a difficult and lengthy process – symptoms can be extreme pain, insomnia, nausea and vomiting, and diarrhea, according to the NIH.
People can find heroin therapy by visiting the SAMHSA Behavioral Health Treatment Services Locator, Krakower said.
Additional reporting from Marc Lallanilla, Staff Writer.
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