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Heroin

Heroin

Overview
Heroin also known as diamorphine (BAN
British Approved Name
A British Approved Name is the official non-proprietary or generic name given to a pharmaceutical substance, as defined in the British Pharmacopoeia...

), or, especially in older literature, as morphine diacetate, is an opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...

 analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

 synthesized from morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

, a derivative of the opium poppy
Opium poppy
Opium poppy, Papaver somniferum, is the species of plant from which opium and poppy seeds are extracted. Opium is the source of many opiates, including morphine , thebaine, codeine, papaverine, and noscapine...

. When used in medicine it is typically used to treat severe pain, such as that resulting from a heart attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

. It is the 3,6-diacetyl
Acetate
An acetate is a derivative of acetic acid. This term includes salts and esters, as well as the anion found in solution. Most of the approximately 5 billion kilograms of acetic acid produced annually in industry are used in the production of acetates, which usually take the form of polymers. In...

 ester
Ester
Esters are chemical compounds derived by reacting an oxoacid with a hydroxyl compound such as an alcohol or phenol. Esters are usually derived from an inorganic acid or organic acid in which at least one -OH group is replaced by an -O-alkyl group, and most commonly from carboxylic acids and...

 of morphine, and functions as a morphine prodrug
Prodrug
A prodrug is a pharmacological substance administered in an inactive form. Once administered, the prodrug is metabolised in vivo into an active metabolite, a process termed bioactivation. The rationale behind the use of a prodrug is generally for absorption, distribution, metabolism, and...

 (meaning that it is metabolically converted to morphine inside the body). The white crystalline form considered "pure heroin" is usually the hydrochloride
Hydrochloride
In chemistry, hydrochlorides are salts resulting, or regarded as resulting, from the reaction of hydrochloric acid with an organic base . This is also known as muriate, derived from hydrochloric acid's other name: muriatic acid....

 salt, diacetylmorphine hydrochloride.
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Encyclopedia
Heroin also known as diamorphine (BAN
British Approved Name
A British Approved Name is the official non-proprietary or generic name given to a pharmaceutical substance, as defined in the British Pharmacopoeia...

), or, especially in older literature, as morphine diacetate, is an opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...

 analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

 synthesized from morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

, a derivative of the opium poppy
Opium poppy
Opium poppy, Papaver somniferum, is the species of plant from which opium and poppy seeds are extracted. Opium is the source of many opiates, including morphine , thebaine, codeine, papaverine, and noscapine...

. When used in medicine it is typically used to treat severe pain, such as that resulting from a heart attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

. It is the 3,6-diacetyl
Acetate
An acetate is a derivative of acetic acid. This term includes salts and esters, as well as the anion found in solution. Most of the approximately 5 billion kilograms of acetic acid produced annually in industry are used in the production of acetates, which usually take the form of polymers. In...

 ester
Ester
Esters are chemical compounds derived by reacting an oxoacid with a hydroxyl compound such as an alcohol or phenol. Esters are usually derived from an inorganic acid or organic acid in which at least one -OH group is replaced by an -O-alkyl group, and most commonly from carboxylic acids and...

 of morphine, and functions as a morphine prodrug
Prodrug
A prodrug is a pharmacological substance administered in an inactive form. Once administered, the prodrug is metabolised in vivo into an active metabolite, a process termed bioactivation. The rationale behind the use of a prodrug is generally for absorption, distribution, metabolism, and...

 (meaning that it is metabolically converted to morphine inside the body). The white crystalline form considered "pure heroin" is usually the hydrochloride
Hydrochloride
In chemistry, hydrochlorides are salts resulting, or regarded as resulting, from the reaction of hydrochloric acid with an organic base . This is also known as muriate, derived from hydrochloric acid's other name: muriatic acid....

 salt, diacetylmorphine hydrochloride. When heroin is supplied illegally, though, it is often adulterated to a freebase form, dulling the sheen and consistency to a matte white powder. As of 2004, roughly 87% of the world supply of opium
Opium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...

 and its derivatives, including heroin, was thought to be produced in Afghanistan. However, production in Mexico has risen six-fold from 2007 to 2011, changing that percentage and placing Mexico as the second largest opium producer in the world.

As with other opioids, diacetylmorphine is used as both an analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

 and a recreational drug. Frequent and regular administration is associated with tolerance and physical dependence
Physical dependence
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...

, which may develop into addiction
Substance dependence
The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...

. Internationally, diacetylmorphine is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs
Single Convention on Narcotic Drugs
The Single Convention on Narcotic Drugs of 1961 is an international treaty to prohibit production and supply of specific drugs and of drugs with similar effects except under licence for specific purposes, such as medical treatment and research...

. It is illegal
Drug prohibition law
Drug prohibition law is prohibition-based law by which governments prohibit, except under licence, the production, supply, and possession of many, but not all, substances which are recognised as drugs, and which corresponds to international treaty commitments in the Single Convention on Narcotic...

 to manufacture, possess, or sell diacetylmorphine without a license
License
The verb license or grant licence means to give permission. The noun license or licence refers to that permission as well as to the document recording that permission.A license may be granted by a party to another party as an element of an agreement...

 in almost every country.

Under the chemical names diamorphine and diacetylmorphine, heroin is a legally prescribed
Prescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...

 controlled drug
Controlled Drug
The United Kingdom Misuse of Drugs Act 1971 aimed to control the possession and supply of numerous listed drugs and drug-like substances as a controlled substance. The act allowed and regulated the use of some Controlled Drugs by various classes of persons The United Kingdom Misuse of Drugs Act...

 in the United Kingdom, and is supplied in tablet or injectable form for the same indications as morphine is, often being preferred over morphine due to its lower side effect profile. It is also available for prescription to long-term users in the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

, United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....

, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

 and Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...

 alongside psycho-social care, and a similar programme is being campaigned for by liberal political parties in Norway.

Usage



The BBC reported that "Worldwide, the UN estimates there are more than 50 million regular users of heroin, cocaine and synthetic drugs." Global users of diacetylmorphine are estimated at between 15.16 million and 21.13 million people aged 15–64.

Medical use


Under the chemical name diamorphine, diacetylmorphine is prescribed as a strong analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

 in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, where it is given via subcutaneous, intramuscular, intrathecal
Intrathecal
Intrathecal is an adjective that refers to something introduced into or occurring in the space under the arachnoid membrane of the brain or spinal cord...

 or intravenous route. Its use includes treatment for acute pain, such as in severe physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

, myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

, post-surgical pain, and chronic pain, including end-stage cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 and other terminal illness
Terminal illness
Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as...

es. In other countries it is more common to use morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 or other strong opioids in these situations. In 2004, the National Institute for Health and Clinical Excellence
National Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence is a special health authority of the English National Health Service , serving both English NHS and the Welsh NHS...

 produced guidance on the management of caesarian section which recommended the use of intrathecal or epidural diacetylmorphine for post-operative pain relief.

In 2005, there was a shortage of diacetylmorphine in the UK, because of a problem at the main UK manufacturers. Because of this, many hospitals changed to using morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 instead of diacetylmorphine. Although there is no longer a problem with the manufacturing of diacetylmorphine in the UK, some hospitals there have continued to use morphine (the majority, however, continue to use diacetylmorphine, and diacetylmorphine tablets are supplied for pain management
Pain management
Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists,...

).

Diacetylmorphine continues to be widely used in palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...

 in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, where it is commonly given by the subcutaneous route, often via a syringe driver
Syringe driver
A syringe driver or syringe pump is a small infusion pump , used to gradually administer small amounts of fluid to a patient or for use in chemical and biomedical research....

, if patients cannot easily swallow oral morphine solution
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

. The advantage of diacetylmorphine over morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 is that diacetylmorphine is more fat soluble and therefore more potent (by injection only), so smaller doses of it are needed for the same analgesic effect. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...

.

The medical use of diacetylmorphine (in common with other strong opioids such as morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

, fentanyl and oxycodone
Oxycodone
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...

) is controlled in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 by the Misuse of Drugs Act 1971
Misuse of Drugs Act 1971
The Misuse of Drugs Act 1971 is an Act of Parliament which represents UK action in line with treaty commitments under the Single Convention on Narcotic Drugs, the Convention on Psychotropic Substances, and the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic...

. In the UK, it is a class A controlled drug
Controlled Drug
The United Kingdom Misuse of Drugs Act 1971 aimed to control the possession and supply of numerous listed drugs and drug-like substances as a controlled substance. The act allowed and regulated the use of some Controlled Drugs by various classes of persons The United Kingdom Misuse of Drugs Act...

. Registers of its use are required to be kept in hospitals.

Diacetylmorphine is also used as a maintenance drug to treat addicts. Though this is somewhat controversial among proponents of a zero tolerance
Zero tolerance
Zero tolerance imposes automatic punishment for infractions of a stated rule, with the intention of eliminating undesirable conduct. Zero-tolerance policies forbid persons in positions of authority from exercising discretion or changing punishments to fit the circumstances subjectively; they are...

 drug policy, it has proven superior to methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...

 in improving the social and health situation of addicts. See: Heroin prescription for addicts

Recreational use


Diacetylmorphine, in non-medical settings called heroin, is used as a recreational drug for the transcendent relaxation and intense euphoria
Euphoria (emotion)
Euphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of well-being, elation, happiness, ecstasy, excitement and joy...

 it induces. Anthropologist Michael Agar once described heroin as "the perfect whatever drug." Tolerance
Physiological tolerance
Physiological tolerance or drug tolerance is commonly encountered in pharmacology, when a subject's reaction to a drug is reduced at a later time even though the dose or concentration at the effect site is the same. This means that larger doses are required to achieve the same effect...

 quickly develops, and users need more of the drug to achieve the same effects. Its popularity with recreational drug users, compared to morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

, reportedly stems from its perceived different effects. In particular, users report an intense rush
Rush (psychology)
In psychology, a rush is an acute transcendent state of euphoria. Psychoactive drugs which enhance dopaminergic neurotransmission in the central nervous system are commonly capable of such an event....

, an acute transcendent state of euphoria
Euphoria
Euphoria is an emotional and mental state defined as a sense of great elation and well being.Euphoria may also refer to:* Euphoria , a genus of scarab beetles* Euphoria, a genus name previously used for the longan and other trees...

, that occurs while diacetylmorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Heroin produces more euphoria than other opioids upon injection. One possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin. While other opioids of recreational use, such as codeine, produce only morphine, heroin also leaves 6-MAM, also a psycho-active metabolite
Active metabolite
- Prodrugs :Sometimes drugs are formulated deliberately so they will break down inside the body to form the active drug, these are called prodrugs. The reason for this may be because the drug is more stable during manufacture and storage as the prodrug form, or because the prodrug is better...

. However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other. Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.

Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine. When compared to the opioids hydromorphone
Hydromorphone
Hydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug...

, fentanyl, oxycodone
Oxycodone
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...

, and pethidine
Pethidine
Pethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...

/meperidine, former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to abuse and addiction. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids.

Some researchers have attempted to explain heroin use and the culture that surrounds it through the use of sociological theories. In Righteous Dopefiend, Philippe Bourgois and Jeff Schonberg use anomie theory to explain why people begin using heroin. By analyzing a community in San Francisco, they demonstrated that heroin use was caused in part due to internal and external factors such as violent homes and parental neglect. This lack of emotional, social, and financial support causes strain and influences individuals to engage in deviant acts, including heroin usage. They further found that heroin users practiced "retreatism", a behavior first described by Howard Abadinsky, in which those who suffer from such strain reject society's goals and institutionalized means of achieving them.

Prescription for addicts



The UK Department of Health's Rolleston Committee Report in 1926 established the British approach to diacetylmorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diacetylmorphine to users when withdrawing from it would cause harm or severe distress to the patient. This "policing and prescribing" policy effectively controlled the perceived diacetylmorphine problem in the UK until 1959 when the number of diacetylmorphine addicts doubled every 16th month during a period of ten years, 1959–1968. In 1964 the Brain Committee
Brain Committee
The Interdepartmental Committee on Drug Addiction, commonly called the Brain Committee after its chairman Sir Russell Brain, was created by the Home Office in 1958 to consider issues related to drugs and drug addiction in the United Kingdom...

 recommended that only selected approved doctors working at approved specialised centres be allowed to prescribe diacetylmorphine and benzoylmethylecgonine (cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

) to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...

, until now only a small number of users in the UK are prescribed diacetylmorphine.

In 1994 Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....

 began a trial diacetylmorphine maintenance program for users that had failed multiple withdrawal programs. The aim of this program is to maintain the health of the user to avoid medical problems stemming from the illicit use of diacetylmorphine. Reducing drug-related crime
Drug-Related Crime
In the United States, Illegal drugs are related to crime in multiple ways. Most directly, it is a crime to use, possess, manufacture, or distribute drugs classified as having a potential for abuse...

 and preventing overdoses were two other goals. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000 based on the apparent success of the program. Participants are allowed to inject diacetylmorphine in specially designed pharmacies for 15 Swiss franc
Swiss franc
The franc is the currency and legal tender of Switzerland and Liechtenstein; it is also legal tender in the Italian exclave Campione d'Italia. Although not formally legal tender in the German exclave Büsingen , it is in wide daily use there...

s per day. A national referendum in November 2008
Swiss referendum, November 2008
On 30 November 2008, a referendum was conducted in Switzerland on four popular initiatives and one proposed change of a federal statute.Swiss voters rejected initiatives aiming at a legalisation of cannabis, at a flexibilisation of the pension age and at restricting the right of appeal of...

 showed 68% of voters supported the plan, introducing diacetylmorphine prescription into federal law. The trials before were based on time-limited executive ordinances.

The success of the Swiss trials led German, Dutch, and Canadian cities to try out their own diacetylmorphine prescription programs. Some Australian cities (such as Sydney) have instituted legal diacetylmorphine supervised injecting centers
Safe injection site
Supervised injection sites are legally sanctioned and medically supervised facilities designed to reduce nuisance from public drug use and provide a hygienic and stress-free...

, in line with other wider harm minimization programs.

Since January 2009 Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...

 has prescribed diacetylmorphine to a few addicts that have tried methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...

 and subutex without success. Beginning in February 2010, addicts in Copenhagen
Copenhagen
Copenhagen is the capital and largest city of Denmark, with an urban population of 1,199,224 and a metropolitan population of 1,930,260 . With the completion of the transnational Øresund Bridge in 2000, Copenhagen has become the centre of the increasingly integrating Øresund Region...

 and Odense
Odense
The city of Odense is the third largest city in Denmark.Odense City has a population of 167,615 and is the main city of the island of Funen...

 will be eligible to receive free diacetylmorphine. Later in 2010 other cities including Århus and Esbjerg
Esbjerg
Esbjerg Municipality is a municipality in Region of Southern Denmark on the west coast of the Jutland peninsula in southwest Denmark. Its mayor is Johnny Søtrup, from the Venstre political party...

 will join the scheme. In total, around 230 addicts will be able to receive free diacetylmorphine.
However, Danish addicts will only be able to inject heroin according to the policy set by Danish National Board of Health. Of the estimated 1500 drug users who do not benefit from the current oral substitution treatment, approximately 900 will not be in the target group for treatment with injectable diacetylmorphine, either because of "massive multiple drug abuse of non-opioids" or "not wanting treatment with injectable diacetylmorphine".

In July 2009, the German Bundestag
Bundestag
The Bundestag is a federal legislative body in Germany. In practice Germany is governed by a bicameral legislature, of which the Bundestag serves as the lower house and the Bundesrat the upper house. The Bundestag is established by the German Basic Law of 1949, as the successor to the earlier...

 passed a law allowing diacetylmorphine prescription as a standard treatment for addicts; while diacetylmorphine prescription was started in 2002, it was only authorized as a large-scale trial.

Detection in biological fluids


The major metabolites of diacetylmorphine, 6-MAM, morphine, morphine-3-glucuronide and morphine-6-glucuronide, may be quantitated in blood, plasma or urine to monitor for abuse, confirm a diagnosis of poisoning or assist in a medicolegal death investigation. Most commercial opiate screening tests cross-react appreciably with these metabolites, as well as with other biotransformation products likely to be present following usage of street-grade diacetylmorphine such as 6-acetylcodeine and codeine. However, chromatographic techniques can easily distinguish and measure each of these substances. When interpreting the results of a test, it is important to consider the diacetylmorphine usage history of the individual, since a chronic user can develop tolerance to doses that would incapacitate an opiate-naive individual, and the chronic user often has high baseline values of these metabolites in his system. Furthermore, some testing procedures employ a hydrolysis step prior to quantitation that converts many of the metabolic products to morphine, yielding a result that may be many times larger than with a method that examines each product individually.

Adverse effects


Like most opioids, unadulterated heroin doesn't cause many long-term complications other than dependence and constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

. Adulterated "street" heroin however is considered to be one of the most harmful drugs especially if consumed intravenously.
  • Intravenous use of heroin (and any other substance) with non-sterile needles and syringes or other related equipment may lead to:
    • The risk of contracting blood-borne pathogens such as HIV
      HIV
      Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

       and hepatitis
      Hepatitis
      Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...

    • The risk of contracting bacterial or fungal endocarditis
      Endocarditis
      Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...

       and possibly venous sclerosis
    • Abscesses
  • Poisoning from contaminants added to "cut
    Cutting agent
    A cutting agent is a chemical used to "cut" illicit drugs with something less expensive than the drug itself.-Overview:The classical model of drug cutting A cutting agent is a chemical used to "cut" (dilute) illicit drugs with something less expensive than the drug itself.-Overview:The classical...

    " or dilute heroin
  • Chronic constipation
    Constipation
    Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

  • Addiction
    Substance dependence
    The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...

  • Tolerance
  • Physical dependence
    Physical dependence
    Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...

     can result from prolonged use of all opioids, resulting in withdrawal symptoms on cessation of use
  • Decreased kidney function (although it is not currently known if this is because of adulterants or infectious diseases)


Many countries and local governments have begun funding programs that supply sterile
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...

 needles to people who inject illegal drugs in an attempt to reduce these contingent risks and especially the contraction and 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 drug use by injection. The United States federal government does not operate needle exchanges, although some state and local governments do support needle exchange programs.

Anthropologists Philippe Bourgois
Philippe Bourgois
Philippe Bourgois is a Richard Perry University Professor of Anthropology & Family and Community Medicine at the University of Pennsylvania. He also served as founding Chair of the Department of Anthropology, History and Social Medicine at the University of California, San Francisco from 1998...

 and Jeff Schonberg, who did a decade of field work among homeless heroin and cocaine addicts in San Francisco, reported that the African-American addicts they observed were more inclined to "direct deposit" heroin into a vein, rather than "skin-popping" their injections. (Skin-popping was a far more widespread practice among the white addicts: "By the midpoint of our fieldwork, most of the whites had given up searching for operable veins and skin-popped. They sank their needles perfunctorily, often through their clothing, into their fatty tissue.") Bourgois and Schonberg describes how the cultural difference between the African-Americans and the whites leads to this contrasting behavior, and also points out that the two different ways to inject heroin comes with different health risks. Skin-popping more often results in abscesses, and direct injection more often leads to fatal overdose and also to hepatitis C and HIV infection.

Heroin overdose is usually treated with an opioid antagonist
Receptor antagonist
A receptor antagonist is a type of receptor ligand or drug that does not provoke a biological response itself upon binding to a receptor, but blocks or dampens agonist-mediated responses...

, such as naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...

 (Narcan), or naltrexone
Naltrexone
Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade...

, which has high affinity for opioid receptors but does not activate them. This reverses the effects of heroin and other opioid agonists and causes an immediate return of consciousness but may precipitate withdrawal
Withdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...

 symptoms. The half-life
Half-life
Half-life, abbreviated t½, is the period of time it takes for the amount of a substance undergoing decay to decrease by half. The name was originally used to describe a characteristic of unstable atoms , but it may apply to any quantity which follows a set-rate decay.The original term, dating to...

 of naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...

 is much shorter than that of most opioid agonists, so that antagonist typically has to be administered multiple times until the opioid has been metabolized by the body.

Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours because of anoxia resulting from the breathing reflex being suppressed by µ-opioids. An overdose is immediately reversible with an opioid antagonist
Opioid antagonist
An opioid antagonist is a receptor antagonist that acts on opioid receptors.Naloxone and naltrexone are commonly used opioid antagonist drugs which are competitive antagonists that bind to the opioid receptors with higher affinity than agonists but do not activate the receptors...

 injection. Diacetylmorphine overdoses can occur because of an unexpected increase in the dose or purity or because of diminished opioid tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other depressant
Depressant
A depressant, or central depressant, is a drug or endogenous compound that depresses the function or activity of a specific part of the brain...

 drugs like alcohol or benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...

s. It should also be noted that since heroin can cause nausea and vomiting, a significant number of deaths attributed to heroin overdose are caused by aspiration of vomit by an unconscious victim. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 375 mg. Illicit heroin is of widely varying and unpredictable purity. This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended. Also, tolerance typically decreases after a period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in a dangerous overdose.

It has been speculated that an unknown portion of heroin related deaths are the result of an overdose or allergic reaction to quinine
Quinine
Quinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...

, which may sometimes be used as a cutting agent.

A final factor contributing to overdoses is place conditioning
Operant conditioning
Operant conditioning is a form of psychological learning during which an individual modifies the occurrence and form of its own behavior due to the association of the behavior with a stimulus...

. Diacetylmorphine use is a highly ritualized behavior. While the mechanism has yet to be clearly elucidated, longtime heroin users display increased tolerance to the drug in locations where they have repeatedly administered. When the user injects in a different location, this environment-conditioned tolerance does not occur, resulting in a greater drug effect. The user's typical dose of the drug, in the face of decreased tolerance, becomes far too high and can be toxic, leading to overdose.

A small percentage of heroin smokers, and occasionally IV users, may develop symptoms of toxic leukoencephalopathy
Toxic leukoencephalopathy
Toxic leukoencephalopathy or toxic spongiform leukoencephalopathy is a condition that is characterized by progressive damage , of the white matter of the brain due to ingested toxins ....

. The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon adulterant
Adulterant
An adulterant is a chemical substance which should not be contained within other substances for legal or other reasons. Adulterants may be intentionally added to more expensive substances to increase visible quantities and reduce manufacturing costs or for some other deceptive or malicious purpose...

 that is only active when heated. Symptoms include slurred speech and difficulty walking.

Cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

 is sometimes used in combination with heroin, and is referred to as a speedball
Speedball (drug)
Speedball is a term commonly referring to the hazardous intravenous use of heroin or morphine and cocaine together in the same syringe. The speedball can also be taken by insufflation. The original speedball used cocaine hydrochloride mixed with morphine sulfate, as opposed to heroin...

 when injected or moonrocks when smoked together. Cocaine acts as a stimulant
Stimulant
Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...

, whereas heroin acts as a depressant
Depressant
A depressant, or central depressant, is a drug or endogenous compound that depresses the function or activity of a specific part of the brain...

. Coadministration provides an intense rush of euphoria
Euphoria
Euphoria is an emotional and mental state defined as a sense of great elation and well being.Euphoria may also refer to:* Euphoria , a genus of scarab beetles* Euphoria, a genus name previously used for the longan and other trees...

 with a high that combines both effects of the drugs, while excluding the negative effects, such as anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

 and sedation
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...

. The effects of cocaine wear off far more quickly than heroin, thus if an overdose of heroin was used to compensate for cocaine, the end result is fatal respiratory depression.

Withdrawal



The withdrawal syndrome from heroin (the so-called cold turkey
Cold turkey
"Cold turkey" describes the actions of a person who abruptly gives up a habit or addiction rather than gradually easing the process through gradual reduction or by using replacement medication....

) may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms may include: sweating
Sweating
Perspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...

, malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...

, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

, akathisia
Akathisia
Akathisia, or acathisia, is a syndrome characterized by unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless...

, priapism
Priapism
Priapism is a potentially harmful and painful medical condition in which the erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours. There are two types of priapism: low-flow and high-flow. Low-flow...

, extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, excessive yawning or sneezing, tears
Tears
Tears are secretions that clean and lubricate the eyes. Lacrimation or lachrymation is the production or shedding of tears....

, rhinorrhea
Rhinorrhea
Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucous fluid. The condition, commonly known as "runny nose", occurs relatively frequently and is not usually considered dangerous. Rhinorrhea is a common symptom of allergies or certain diseases,...

, sleep difficulties (insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

), cold sweats, chills, severe muscle and bone aches; nausea and vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

, diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

, cramps, and fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

.

Pharmacology



When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation
Acetylation
Acetylation describes a reaction that introduces an acetyl functional group into a chemical compound...

, making it a prodrug
Prodrug
A prodrug is a pharmacological substance administered in an inactive form. Once administered, the prodrug is metabolised in vivo into an active metabolite, a process termed bioactivation. The rationale behind the use of a prodrug is generally for absorption, distribution, metabolism, and...

 for the systemic delivery of morphine. When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood-brain barrier
Blood-brain barrier
The blood–brain barrier is a separation of circulating blood and the brain extracellular fluid in the central nervous system . It occurs along all capillaries and consists of tight junctions around the capillaries that do not exist in normal circulation. Endothelial cells restrict the diffusion...

 because of the presence of the acetyl groups, which render it much more fat soluble than morphine itself. Once in the brain, it then is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), and then to morphine which bind to μ-opioid receptor
Mu Opioid receptor
The μ-opioid receptors are a class of opioid receptors with high affinity for enkephalins and beta-endorphin but low affinity for dynorphins. They are also referred to as μ opioid peptide receptors. The prototypical μ receptor agonist is the opium alkaloid morphine; μ refers to morphine...

s, resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic
Anxiolytic
An anxiolytic is a drug used for the treatment of anxiety, and its related psychological and physical symptoms...

 (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor. Unlike hydromorphone and oxymorphone, however, administered intravenously, heroin creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective "body high" to some, but also instances of pruritus
Itch
Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response...

 (itching) when they first start using.

Both morphine and 6-MAM are μ-opioid
Mu Opioid receptor
The μ-opioid receptors are a class of opioid receptors with high affinity for enkephalins and beta-endorphin but low affinity for dynorphins. They are also referred to as μ opioid peptide receptors. The prototypical μ receptor agonist is the opium alkaloid morphine; μ refers to morphine...

 agonist
Agonist
An agonist is a chemical that binds to a receptor of a cell and triggers a response by that cell. Agonists often mimic the action of a naturally occurring substance...

s which bind to receptors present throughout the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...

, spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

 and gut
Gut (zoology)
In zoology, the gut, also known as the alimentary canal or alimentary tract, is a tube by which bilaterian animals transfer food to the digestion organs. In large bilaterians the gut generally also has an exit, the anus, by which the animal disposes of solid wastes...

 of all mammal
Mammal
Mammals are members of a class of air-breathing vertebrate animals characterised by the possession of endothermy, hair, three middle ear bones, and mammary glands functional in mothers with young...

s. The μ-opioid receptor also binds endogenous opioid peptide
Opioid peptide
Opioid peptides are short sequences of amino acids that bind to opioid receptors in the brain; opiates and opioids mimic the effect of these peptides. Opioid peptides may be produced by the body itself, for example endorphins. The effects of these peptides vary, but they all resemble opiates...

s such as β-endorphin
Beta-endorphin
β-endorphin is an endogenous opioid peptide neurotransmitter found in the neurons of both the central and peripheral nervous system.The amino acid sequence is:...

, Leu-enkephalin
Leu-enkephalin
Leu-enkephalin is an endogenous opioid peptide neurotransmitter with the amino acid sequence Tyr-Gly-Gly-Phe-Leu that is found naturally in the brains of many animals, including humans. It is one of the two forms of enkephalin; the other is met-enkephalin. The tyrosine residue at position 1 is...

, and Met-enkephalin
Met-enkephalin
[Met]enkephalin, sometimes referred to as opioid growth factor , is a naturally-occurring, endogenous opioid peptide that has opioid effects of a relatively short duration. It is one of the two forms of enkephalin, the other being [leu]enkephalin...

. Repeated use of heroin results in a number of physiological changes, including decreases in the number of μ-opioid receptors. These physiological alterations lead to tolerance and dependence, so that cessation of heroin use results in a set of remarkably uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called the opioid withdrawal
Withdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...

 syndrome. Depending on usage it has an onset four to 24 hours after the last dose of heroin. Morphine also binds to δ
Delta Opioid receptor
The δ-opioid receptors, also known as delta opioid receptor or simply delta receptor, abbreviated DOR, is an opioid receptor that has enkephalins as its endogenous ligands.-Function:...

- and κ
Kappa Opioid receptor
The κ-opioid receptor is a protein that in humans is encoded by the OPRK1 gene. The κ-opioid receptor is one of five related receptors that bind opium-like compounds in the brain and are responsible for mediating the effects of these compounds...

-opioid receptors.

There is also evidence that 6-MAM binds to a subtype of μ-opioid receptors which are also activated by the morphine metabolite morphine-6β-glucuronide but not morphine itself. The third substype of third opioid type (mu-3) receptor. Which may be a commonality to other six position monoesters of morphine. The contribution of these receptors to the overall pharmacology of heroin remains unknown.

A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses includes the clinically used strong analgesics nicomorphine
Nicomorphine
Nicomorphine is the 3,6-dinicotinate ester of morphine. It is a strong opioid agonist analgesic two to three times as potent as morphine with a side effect profile similar to that of dihydromorphine, morphine, and diamorphine. Nicomorphine was patented as Vilan by Lannacher Heilmittel Ges. m.b.H...

 (Vilan), and dipropanoylmorphine
Dipropanoylmorphine
Dipropanoylmorphine is an opiate derivative, the 3,6-dipropanoyl ester of morphine. It was developed in 1974 as an analgesic...

; there is also the latter's dihydromorphine
Dihydromorphine
Dihydromorphine is a semi-synthetic opioid invented in Germany in 1900. In structure, it is very similar to morphine, the only difference being the reduction of the double bond between positions 7 and 8 in morphine to a single bond...

 analogue, diacetyldihydromorphine
Diacetyldihydromorphine
Diacetyldihydromorphine is a potent opiate derivative developed in Germany in 1929 which is rarely used in some countries for the treatment of severe pain such as that caused by terminal cancer, as a more potent form of diamorphine...

 (Paralaudin). Two other 3,6 diesters of morphine invented in 1874-5 along with diacetylmorphine, dibenzoylmorphine
Dibenzoylmorphine
Dibenzoylmorphine is an opiate analogue that is a derivative of morphine. It was developed in the early 1900s after first having been synthesised in 1875 in the UK, along with various other esters of morphine, but was never used medically, instead being widely sold as one of the first "designer...

 and acetylpropionylmorphine
Acetylpropionylmorphine
Acetylpropionylmorphine is an opiate analogue that is a derivative of morphine. It was developed in the early 1900s after first being synthesised in Great Britain in 1875 but shelved along with heroin and various other esters of morphine, but was never used medically, instead being widely sold as...

, were made as substitutes after it was outlawed in 1925 and therefore sold as the first "designer drugs" until they were outlawed by the League of Nations in 1930.

Etymology


In 1895, the German
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

 drug company Bayer
Bayer
Bayer AG is a chemical and pharmaceutical company founded in Barmen , Germany in 1863. It is headquartered in Leverkusen, North Rhine-Westphalia, Germany and well known for its original brand of aspirin.-History:...

 marketed diacetylmorphine as an over the counter drug under the trademark name Heroin. The name was derived from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...

 word "Hero
Hero
A hero , in Greek mythology and folklore, was originally a demigod, their cult being one of the most distinctive features of ancient Greek religion...

s
" because of its perceived "heroic" effects upon a user. It was chiefly developed as a morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 substitute for cough suppressants
Cough medicine
A cough medicine is a medicinal drug used in an attempt to treat coughing and related conditions. For dry coughs, treatment with cough suppressants may be attempted to suppress the body's urge to cough...

 that did not have morphine's addictive side-effects. Morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 at the time was a popular recreational drug, and Bayer wished to find a similar but non-addictive substitute to market. However, contrary to Bayer's advertising as a "non-addictive morphine substitute," heroin would soon have one of the highest rates of dependence amongst its users.


History



The opium poppy
Opium poppy
Opium poppy, Papaver somniferum, is the species of plant from which opium and poppy seeds are extracted. Opium is the source of many opiates, including morphine , thebaine, codeine, papaverine, and noscapine...

 was cultivated in lower Mesopotamia
Mesopotamia
Mesopotamia is a toponym for the area of the Tigris–Euphrates river system, largely corresponding to modern-day Iraq, northeastern Syria, southeastern Turkey and southwestern Iran.Widely considered to be the cradle of civilization, Bronze Age Mesopotamia included Sumer and the...

 as long ago as 3400 BCE. The chemical analysis of opium
Opium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...

 in the 19th century revealed that most of its activity could be ascribed to two alkaloids, codeine
Codeine
Codeine or 3-methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties...

 and morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

.

Diacetylmorphine was first synthesized in 1874 by C. R. Alder Wright, an English chemist working at St. Mary's Hospital
St Mary's Hospital (London)
St Mary's Hospital is a hospital located in Paddington, London, England that was founded in 1845. Since the UK's first academic health science centre was created in 2008, it is operated by Imperial College Healthcare NHS Trust, which also operates Charing Cross Hospital, Hammersmith Hospital,...

 Medical School in London. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride
Acetic anhydride
Acetic anhydride, or ethanoic anhydride, is the chemical compound with the formula 2O. Commonly abbreviated Ac2O, it is the simplest isolatable acid anhydride and is a widely used reagent in organic synthesis...

 for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine or morphine diacetate. The compound was sent to F. M. Pierce of Owens College in Manchester for analysis. Pierce told Wright:
Wright's invention did not lead to any further developments, and diacetylmorphine only became popular after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann
Felix Hoffmann
Felix Hoffmann was a German chemist, credited for the first synthesized medically useful forms of heroin and aspirin, though some sources maintain that Arthur Eichengrün was the real creator of the latter. Hoffmann was born in Ludwigsburg and studied Chemistry in Munich...

. Hoffmann, working at the Aktiengesellschaft Farbenfabriken (today the Bayer
Bayer
Bayer AG is a chemical and pharmaceutical company founded in Barmen , Germany in 1863. It is headquartered in Leverkusen, North Rhine-Westphalia, Germany and well known for its original brand of aspirin.-History:...

 pharmaceutical company) in Elberfeld, Germany, was instructed by his supervisor Heinrich Dreser
Heinrich Dreser
Heinrich Dreser was a German chemist, responsible for the aspirin and heroin projects at Bayer AG. He was a key factor in the creation of the widely used modern drug, Codeine. On December 21, 1924, Dreser died of a stroke....

 to acetylate morphine with the objective of producing codeine
Codeine
Codeine or 3-methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties...

, a constituent of the opium poppy, pharmacologically similar to morphine but less potent and less addictive. Instead the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself.

From 1898 through to 1910 diacetylmorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant. Bayer marketed the drug as a cure for morphine addiction before it was discovered that it rapidly metabolizes into morphine. As such, diacetylmorphine is essentially a quicker acting form of morphine. The company was embarrassed by the new finding, which became a historic blunder for Bayer.

In the U.S.A. the Harrison Narcotics Tax Act
Harrison Narcotics Tax Act
The Harrison Narcotics Tax Act was a United States federal law that regulated and taxed the production, importation, and distribution of opiates...

 was passed in 1914 to control the sale and distribution of diacetylmorphine and other opioids, which allowed the drug to be prescribed and sold for medical purposes. In 1924 the United States Congress banned its sale, importation or manufacture. It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs
Single Convention on Narcotic Drugs
The Single Convention on Narcotic Drugs of 1961 is an international treaty to prohibit production and supply of specific drugs and of drugs with similar effects except under licence for specific purposes, such as medical treatment and research...

 treaty, including the United States.

The Health Committee of the League of Nations
League of Nations
The League of Nations was an intergovernmental organization founded as a result of the Paris Peace Conference that ended the First World War. It was the first permanent international organization whose principal mission was to maintain world peace...

 banned diacetylmorphine in 1925 although it took more than three years for this to be implemented. In the meantime, the first designer drugs, viz. 3,6 diesters and 6 monoesters of morphine and acetylated analogues of closely related drugs like hydromorphone
Hydromorphone
Hydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug...

 and dihydromorphine
Dihydromorphine
Dihydromorphine is a semi-synthetic opioid invented in Germany in 1900. In structure, it is very similar to morphine, the only difference being the reduction of the double bond between positions 7 and 8 in morphine to a single bond...

 were produced in massive quantities to fill the worldwide demand for diacetylmorphine—this continued until 1930 when the Committee banned diacetylmorphine analogues with no therapeutic advantage over drugs already in use, the first major legislation of this type.

Later, as with Aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...

, Bayer lost some of its trademark rights to Heroin under the 1919 Treaty of Versailles
Treaty of Versailles
The Treaty of Versailles was one of the peace treaties at the end of World War I. It ended the state of war between Germany and the Allied Powers. It was signed on 28 June 1919, exactly five years after the assassination of Archduke Franz Ferdinand. The other Central Powers on the German side of...

 following the German defeat in World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...

.

Routes of administration

Recreational uses:
  • Euphoria
    Euphoria (emotion)
    Euphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of well-being, elation, happiness, ecstasy, excitement and joy...

  • Transcendent relaxation


Medicinal uses:
  • Powerful analgesic (pain killer)
  • Cough suppressant
  • Anti-diarrhea
    Diarrhea
    Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

    l
Contraindication
Contraindication
In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.Some contraindications are absolute, meaning that there are no reasonable circumstances for undertaking a course of action...

s:
  • Alcohol
    Ethanol
    Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...

  • Barbiturate
    Barbiturate
    Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...

    s and benzodiazepines
  • Stimulant
    Stimulant
    Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...

    s
  • Other opioid
    Opioid
    An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...

    s
  • Central nervous system:
  • Drowsiness
  • Disorientation
  • Delirium
    Delirium
    Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...



  • Neurological:
    • Analgesia
    • Tolerance
    • Addiction (physical dependence)


    Psychological:
    • Addiction (psychological dependence)
    • Anxiolysis
    • Confusion
      ConFusion
      ConFusion is an annual science fiction convention organized by the Stilyagi Air Corps and its parent organization, the Ann Arbor Science Fiction Association. Commonly, it is held the third weekend of January. It is the oldest science fiction convention in Michigan, a regional, general SF con...

    • Euphoria
      Euphoria (emotion)
      Euphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of well-being, elation, happiness, ecstasy, excitement and joy...

    • Somnolence
      Somnolence
      Somnolence is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods . It has two distinct meanings, referring both to the usual state preceding falling asleep, and the chronic condition referring to being in that state independent of a circadian rhythm...



    Cardiovascular & Respiratory:
    • Bradycardia
      Bradycardia
      Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

    • Hypotension
      Hypotension
      In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...

    • Hypoventilation
      Hypoventilation
      In medicine, hypoventilation occurs when ventilation is inadequate to perform needed gas exchange...

    • Shallow breathing
      Shallow breathing
      Shallow breathing, thoracic breathing, or chest breathing is the drawing of minimal breath into the lungs, usually by drawing air into the chest area using the intercostal muscles rather than throughout the lungs via the diaphragm. Shallow breathing can result in or be symptomatic of rapid...

    • Respiratory depression


    Gastrointestinal:
    • Nausea
      Nausea
      Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

    • Protracted vomiting
      Vomiting
      Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

    • Constipation
      Constipation
      Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

    • Dyspepsia
      Dyspepsia
      Dyspepsia , also known as upset stomach or indigestion, refers to a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating...

       (heartburn)


    Musculoskeletal:
    • Analgesia
    • Ataxia
      Ataxia
      Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...

    • Muscle spasticity


    Skin:
    • Itching
    • Flushing/Rash


    Miscellaneous:
    • Dry mouth (xerostomia
      Xerostomia
      Xerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or...

      )
    • Miosis
      Miosis
      Miosis is the constriction of the pupil of the eye to two millimeters or less...

       (pupil
      Pupil
      The pupil is a hole located in the center of the iris of the eye that allows light to enter the retina. It appears black because most of the light entering the pupil is absorbed by the tissues inside the eye. In humans the pupil is round, but other species, such as some cats, have slit pupils. In...

       constriction)
    • Urinary retention
      Urinary retention
      Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...




    The onset of heroin's effects depends upon the route of administration
    Route of administration
    A route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is taken into the body.-Classification:Routes of administration are usually classified by application location...

    . Studies have shown that the subjective pleasure of drug use (the reinforcing component of addiction) is proportional to the rate at which the blood level of the drug increases. Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the most quickly, followed by smoking, suppository
    Suppository
    A suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications....

     (anal or vaginal insertion), insufflation
    Insufflation (medicine)
    Insufflation is the practice of inhaling a substance. Insufflation has limited medical use, but is a common route of administration with many respiratory drugs used to treat conditions in the lungs and paranasal sinus .The technique is common for many recreational drugs and is also used for some...

     (snorting), and ingestion
    Ingestion
    Ingestion is the consumption of a substance by an organism. In animals, it normally is accomplished by taking in the substance through the mouth into the gastrointestinal tract, such as through eating or drinking...

     (swallowing).

    Ingestion does not produce a rush
    Rush (psychology)
    In psychology, a rush is an acute transcendent state of euphoria. Psychoactive drugs which enhance dopaminergic neurotransmission in the central nervous system are commonly capable of such an event....

     as forerunner to the high experienced with the use of heroin, which is most pronounced with intravenous use. While the onset of the rush induced by injection can occur in as little as a few seconds, the oral route of administration requires approximately half an hour before the high sets in. Thus, with both higher the dosage of heroin used and faster the route of administration used, the higher potential risk for psychological addiction.

    can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer Dr Harold Shipman
    Harold Shipman
    Harold Fredrick Shipman was an English doctor and one of the most prolific serial killers in recorded history with 218 murders being positively ascribed to him....

     used it on his victims, as did Dr John Bodkin Adams
    John Bodkin Adams
    John Bodkin Adams was an Irish-born British general practitioner, convicted fraudster and suspected serial killer. Between the years 1946 and 1956, more than 160 of his patients died in suspicious circumstances. Of these, 132 left him money or items in their will. He was tried and acquitted for...

     (see his victim: Edith Alice Morrell
    Edith Alice Morrell
    Edith Alice Morrell , was a resident of Eastbourne and patient of the suspected serial killer John Bodkin Adams. He was tried for her murder in 1957 but acquitted...

    ).

    Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin lethal overdose was accidental, suicide or homicide. Examples include the overdose deaths of Sid Vicious
    Sid Vicious
    Sid Vicious was an English musician best known as the bassist of the influential punk rock group Sex Pistols...

    , Janis Joplin
    Janis Joplin
    Janis Lyn Joplin was an American singer, songwriter, painter, dancer and music arranger. She rose to prominence in the late 1960s as the lead singer of Big Brother and the Holding Company and later as a solo artist with her backing groups, The Kozmic Blues Band and The Full Tilt Boogie Band...

    , Tim Buckley
    Tim Buckley
    Timothy Charles Buckley III was an American vocalist, and musician. His music and style changed considerably through the years; his first album was mostly folk oriented, but over time his music incorporated jazz, psychedelia, funk, soul, avant-garde and an evolving "voice as instrument," sound...

    , Layne Staley
    Layne Staley
    Layne Thomas Staley was an American musician who served as the lead singer and co-lyricist of the rock group Alice in Chains, which was formed in Seattle, Washington in 1987 by Staley and guitarist Jerry Cantrell. Alice in Chains rose to international fame as part of the grunge movement of the...

    , Bradley Nowell
    Bradley Nowell
    Bradley James Nowell was an American musician who served as lead singer and guitarist of the Californian band Sublime. He died at the age of 28 from a heroin overdose shortly before the release of Sublime's self-titled major label debut.Raised in Long Beach, California, Nowell developed an...

    , Ted Binion
    Ted Binion
    Lonnie Theodore "Ted" Binion was a wealthy U.S. gambling executive and one of the sons of famed Las Vegas casino magnate Lester Ben "Benny" Binion, owner of Binion's Horseshoe...

    , and River Phoenix
    River Phoenix
    River Jude Phoenix was an American film actor, musician, and teen icon. He was the oldest brother of fellow actors Rain, Joaquin, Liberty, and Summer Phoenix.Phoenix began acting at age 10 in television commercials...

    .

    Chronic use of heroin and other opioids, has potentially been shown to be a cause of hyponatremia
    Hyponatremia
    Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...

    , resultant because of excess vasopressin
    Vasopressin
    Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a neurohypophysial hormone found in most mammals, including humans. Vasopressin is a peptide hormone that controls the reabsorption of molecules in the tubules of the kidneys by affecting the tissue's...

     secretion.

    Oral


    Oral use of heroin is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent. Heroin is entirely converted to morphine
    Morphine
    Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

     by means of first-pass metabolism, resulting in deacetylation when ingested. Heroin's oral bioavailability is both dose-dependent (as is morphine's) and significantly higher than oral use of morphine itself, reaching up to 64.2% for high doses and 45.6% for low doses; opiate-naive users showed far less absorption of the drug at low doses, having bioavailabilities of only up to 22.9%. The maximum plasma concentration of morphine following oral administration of heroin was around twice as much as that of oral morphine.

    Injection



    Injection
    Drug injection
    In substance dependence and recreational drug use, drug injection is a method of introducing a drug into the body with a hollow needle and a syringe which is pierced through the skin into the body...

    , also known as "slamming", "banging", "shooting up" or "mainlining", is a popular method used by addicts which carries relatively greater risks than other methods of administration. Heroin base (commonly found in Europe), when prepared for injection will only dissolve in water when mixed with an acid (most commonly citric acid powder or lemon juice) and heated. Heroin in the United States is most commonly found in the hydrochloride salt form, requiring just water to dissolve. Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, through damage caused by the acid, the user will often resort to injecting in other veins. Intravenous users can use a various single dose range using a hypodermic needle
    Hypodermic needle
    A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...

    . The dose of heroin used for recreational purposes is dependant on the frequency and level of use, thus a first-time user may use between 5 and 20 mg, while an addict may require several hundred mg per day. As with the injection of any drug, if a group of users share a common needle
    Needle sharing
    Needle sharing is the practice of intravenous drug-users by which a syringe is shared by multiple individuals to administer intravenous drugs, and is a primary vector for diseases which can be transmitted through blood ....

     without sterilization procedures, blood-borne diseases, such as HIV
    HIV
    Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

     or hepatitis
    Hepatitis
    Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...

    , can be transmitted.

    Smoking


    Smoking heroin refers to vaporizing it to inhale the resulting fumes, not burning it to inhale the resulting smoke. It is commonly smoked in glass pipes made from glassblown
    Glassblowing
    Glassblowing is a glassforming technique that involves inflating molten glass into a bubble, or parison, with the aid of a blowpipe, or blow tube...

     Pyrex tubes
    Pyrex
    Pyrex is a brand name for glassware, introduced by Corning Incorporated in 1915.Originally, Pyrex was made from borosilicate glass. In the 1940s the composition was changed for some products to tempered soda-lime glass, which is the most common form of glass used in glass bakeware in the US and has...

     and light bulbs. It can also be smoked off aluminium foil, which is heated underneath by a flame. This method is also known as "chasing the dragon
    Chasing the dragon
    "Chasing the dragon" refers to inhaling the vapor from heated morphine, heroin, oxycodone or opium that has been placed on a piece of foil...

    " (whereas smoking methamphetamine
    Methamphetamine
    Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...

     is known as "chasing the white dragon").

    Insufflation


    Another popular route to intake heroin is insufflation (snorting), where a user crushes the heroin into a fine powder and then sharply inhales it (sometimes with a straw or a rolled up banknote
    Banknote
    A banknote is a kind of negotiable instrument, a promissory note made by a bank payable to the bearer on demand, used as money, and in many jurisdictions is legal tender. In addition to coins, banknotes make up the cash or bearer forms of all modern fiat money...

    , as with cocaine
    Cocaine
    Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

    ) into the nose where heroin is absorbed through the soft tissue in the mucous membrane
    Mucous membrane
    The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...

     of the sinus cavity and straight into the bloodstream. This method of administration redirects first pass metabolism, with a quicker onset and higher bioavailability
    Bioavailability
    In pharmacology, bioavailability is a subcategory of absorption and is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. By definition, when a medication is administered...

     than oral administration, though the duration of action is shortened. This method is sometimes preferred by users who do not want to prepare and administer heroin for injection or smoking, but still experience a fast onset with a rush.

    Suppository


    Little research has been focused on the suppository
    Suppository
    A suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications....

     (anal or vaginal insertion) method of administration, also known as "plugging". This method of administration is commonly administered using an oral syringe. Heroin can be dissolved and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed. Rectal administration of heroin is very efficient, as the dose used is slightly larger than the dose used for IV. Users get a rush from the drugs effects starting 40 seconds after administration, which has been described as being as overwhelming as intravenous use. The rectum and the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining its walls.

    Regulation



    In the Netherlands
    Netherlands
    The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

    , diacetylmorphine is a List I drug of the Opium Law
    Opium Law
    The Opium Law is the section of the Dutch law which covers nearly all psychotropic drugs. All non-psychotropic, but prescription-only drugs are covered by the Medicine Act.- Origin and history :...

    . It is available for prescription under tight regulation exclusively to long-term addicts for whom methadone maintenance
    Methadone maintenance
    Methadone maintenance is the use of methadone over a prolonged time as treatment for someone who is addicted to opioids or has severe pain problems that are resistant to other drugs.-Modality:...

     treatment has failed. It cannot be used to treat severe pain
    Pain
    Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

     or other illnesses.

    In the United States, diacetylmorphine is a schedule I drug according to the Controlled Substances Act of 1970, making it illegal to possess without a DEA license. Possession of more than 100 grams of diacetylmorphine or a mixture containing diacetylmorphine is punishable with a minimum mandatory sentence of 5 years of imprisonment in a federal prison.

    In Canada, diacetylmorphine is a controlled substance under Schedule I of the Controlled Drugs and Substances Act
    Controlled Drugs and Substances Act
    The Controlled Drugs and Substances Act is Canada's federal drug control statute. Passed in 1996 by the Chrétien government, it repeals the Narcotic Control Act and Parts III and IV of the Food and Drug Act and establishes eight Schedules of controlled substances and two Classes of precursors...

     (CDSA). Any person who seeks or obtains diacetylmorphine without disclosing authorization 30 days prior to obtaining another prescription from a practitioner is guilty of an indictable offense and subject to imprisonment for a term not exceeding seven years. Possession of diacetylmorphine for the purpose of trafficking is guilty of an indictable offense and subject to imprisonment for life.

    In Hong Kong, diacetylmorphine is regulated under Schedule 1 of Hong Kong's
    Hong Kong
    Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...

     Chapter 134 Dangerous Drugs Ordinance. It is available by prescription. Anyone who supplies diacetylmorphine without a valid prescription can be fined $10,000 (HKD
    Hong Kong dollar
    The Hong Kong dollar is the currency of the jurisdiction. It is the eighth most traded currency in the world. In English, it is normally abbreviated with the dollar sign $, or alternatively HK$ to distinguish it from other dollar-denominated currencies...

    ). The penalty for trafficking or manufacturing diacetylmorphine is a $5,000,000 (HKD) fine and life imprisonment. Possession of diacetylmorphine without a license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.

    In the United Kingdom, diacetylmorphine is available by prescription, though it is a restricted Class A drug. According to the 50th edition of the British National Formulary
    British National Formulary
    The British National Formulary is a medical and pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about all medicines available on the National Health Service , including indication,...

     (BNF), diamorphine hydrochloride
    Hydrochloride
    In chemistry, hydrochlorides are salts resulting, or regarded as resulting, from the reaction of hydrochloric acid with an organic base . This is also known as muriate, derived from hydrochloric acid's other name: muriatic acid....

     may be used in the treatment of acute pain, myocardial infarction
    Myocardial infarction
    Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

    , acute pulmonary oedema, and chronic pain
    Chronic pain
    Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...

    . The treatment of chronic non-malignant
    Malignant
    Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...

     pain must be supervised by a specialist. The BNF notes that all opioid analgesics cause dependence and tolerance but that this is "no deterrent in the control of pain in terminal illness". When used in the palliative care
    Palliative care
    Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...

     of cancer patients, diacetylmorphine is often injected using a syringe driver
    Syringe driver
    A syringe driver or syringe pump is a small infusion pump , used to gradually administer small amounts of fluid to a patient or for use in chemical and biomedical research....

    .

    Production


    Diacetylmorphine is produced from acetylation of morphine derived from natural opium sources. Numerous mechanical and chemical means are used to purify the final product. The final products have a different appearance depending on purity and have different names.

    Trafficking


    Traffic is heavy worldwide, with the biggest producer being Afghanistan. According to a U.N. sponsored survey, , Afghanistan accounted for production of 87 percent of the world's diacetylmorphine. Afghan opium kills around 100,000 people annually.

    The cultivation of opium in Afghanistan reached its peak in 1999, when 350 square miles (906.5 km²) of poppies were sown. The following year the Taliban banned poppy cultivation, a move which cut production by 94 percent. By 2001 only 30 square miles (77.7 km²) of land were in use for growing opium poppies. A year later, after American and British troops had removed the Taliban and installed the interim government, the land under cultivation leapt back to 285 square miles (738.1 km²), with Afghanistan supplanting Burma to become the world's largest opium producer once more.
    Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War in Afghanistan
    War in Afghanistan (2001–present)
    The War in Afghanistan began on October 7, 2001, as the armed forces of the United States of America, the United Kingdom, Australia, and the Afghan United Front launched Operation Enduring Freedom...

     once again appeared as a facilitator of the trade. Some 3.3 million Afghans are involved in producing opium.

    At present, opium poppies are mostly grown in Afghanistan
    Afghanistan
    Afghanistan , officially the Islamic Republic of Afghanistan, is a landlocked country located in the centre of Asia, forming South Asia, Central Asia and the Middle East. With a population of about 29 million, it has an area of , making it the 42nd most populous and 41st largest nation in the world...

    , and in Southeast Asia
    Southeast Asia
    Southeast Asia, South-East Asia, South East Asia or Southeastern Asia is a subregion of Asia, consisting of the countries that are geographically south of China, east of India, west of New Guinea and north of Australia. The region lies on the intersection of geological plates, with heavy seismic...

    , especially in the region known as the Golden Triangle straddling Myanmar
    Myanmar
    Burma , officially the Republic of the Union of Myanmar , is a country in Southeast Asia. Burma is bordered by China on the northeast, Laos on the east, Thailand on the southeast, Bangladesh on the west, India on the northwest, the Bay of Bengal to the southwest, and the Andaman Sea on the south....

    , Thailand
    Thailand
    Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...

    , Vietnam
    Vietnam
    Vietnam – sometimes spelled Viet Nam , officially the Socialist Republic of Vietnam – is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea –...

    , Laos
    Laos
    Laos Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ Sathalanalat Paxathipatai Paxaxon Lao, officially the Lao People's Democratic Republic, is a landlocked country in Southeast Asia, bordered by Burma and China to the northwest, Vietnam to the east, Cambodia to the south and Thailand to the west...

     and Yunnan
    Yunnan
    Yunnan is a province of the People's Republic of China, located in the far southwest of the country spanning approximately and with a population of 45.7 million . The capital of the province is Kunming. The province borders Burma, Laos, and Vietnam.Yunnan is situated in a mountainous area, with...

     province in the People's Republic of China. There is also cultivation of opium poppies in the Sinaloa
    Sinaloa
    Sinaloa officially Estado Libre y Soberano de Sinaloa is one of the 31 states which, with the Federal District, comprise the 32 Federal Entities of Mexico. It is divided in 18 municipalities and its capital city is Culiacán Rosales....

     region of Mexico
    Mexico
    The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

     and in Colombia
    Colombia
    Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...

    . The majority of the heroin consumed in the United States comes from Mexico
    Mexico
    The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

     and Colombia
    Colombia
    Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...

    . Up until 2004, Pakistan
    Pakistan
    Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...

     was considered one of the biggest opium-growing countries.

    Conviction for trafficking heroin carries the death penalty in most Southeast Asian, some East Asian and Middle Eastern countries (see Use of death penalty worldwide for details), among which Malaysia, Singapore
    Singapore
    Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...

     and Thailand
    Thailand
    Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...

     are the most strict. The penalty applies even to citizens of countries where the penalty is not in place, sometimes causing controversy when foreign visitors are arrested for trafficking, for example the arrest of nine Australians in Bali
    Bali Nine
    The Bali Nine is the name given to a group of nine Australians arrested on 17 April 2005, in Denpasar, Bali, Indonesia, in a plan to smuggle of heroin valued at approximately A$4 million from Indonesia to Australia...

    , the death sentence
    Death Sentence
    Death Sentence is a short story by the American science-fiction writer Isaac Asimov. It was first published in the November 1943 issue of Astounding Science Fiction and reprinted in the 1972 collection The Early Asimov.-Plot summary:...

     given to Nola Blake
    Nola Blake
    Nola Blake is an Australian woman who in 1987 was arrested in Bangkok, Thailand for drug trafficking and subsequently sentenced to death. Her sentence was later commuted to life in prison...

     in Thailand in 1987, or the hanging of an Australian citizen Van Tuong Nguyen
    Van Tuong Nguyen
    Van Tuong Nguyen baptised Caleb, was an Australian from Melbourne, Victoria convicted of drug trafficking in Singapore...

     in Singapore.

    Trafficking history


    The origins of the present international illegal heroin trade can be traced back to laws passed in many countries in the early 1900s that closely regulated the production and sale of opium and its derivatives including heroin. At first, heroin flowed from countries where it was still legal into countries where it was no longer legal. By the mid-1920s, heroin production had been made illegal in many parts of the world. An illegal trade developed at that time between heroin labs in China (mostly in Shanghai and Tianjin) and other nations. The weakness of government in China and conditions of civil war enabled heroin production to take root there. Chinese triad gangs eventually came to play a major role in the illicit heroin trade. The French Connection
    French Connection
    The French Connection was a scheme through which heroin was smuggled from Turkey to France and then to the United States. The operation reached its peak in the late 1960s and early 1970s, when it provided the vast majority of the illicit heroin used in the United States...

     route started in the 1930s.

    Heroin trafficking was virtually eliminated in the U.S. during World War II
    World War II
    World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

     because of temporary trade disruptions caused by the war. Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium.

    After World War II, the Mafia
    Mafia
    The Mafia is a criminal syndicate that emerged in the mid-nineteenth century in Sicily, Italy. It is a loose association of criminal groups that share a common organizational structure and code of conduct, and whose common enterprise is protection racketeering...

     took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily. The Mafia took advantage of Sicily's location along the historic route opium took westward into Europe and the United States.

    Large scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s. The elimination of Chinese production happened at the same time that Sicily's role in the trade developed.

    Although it remained legal in some countries until after World War II, health risks, addiction, and widespread recreational use led most western countries to declare heroin a controlled substance by the latter half of the 20th century.

    In late 1960s and early 70s, the CIA supported anti-Communist Chinese Nationalists settled near Sino
    China
    Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

    -Burmese border and Hmong
    Hmong people
    The Hmong , are an Asian ethnic group from the mountainous regions of China, Vietnam, Laos, and Thailand. Hmong are also one of the sub-groups of the Miao ethnicity in southern China...

     tribesmen in Laos
    Laos
    Laos Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ Sathalanalat Paxathipatai Paxaxon Lao, officially the Lao People's Democratic Republic, is a landlocked country in Southeast Asia, bordered by Burma and China to the northwest, Vietnam to the east, Cambodia to the south and Thailand to the west...

    . This helped the development of the Golden Triangle
    Golden Triangle (Southeast Asia)
    The Golden Triangle is one of Asia's two main illicit opium-producing areas. It is an area of around that overlaps the mountains of four countries of Southeast Asia: Burma, Vietnam, Laos, and Thailand. Along with Afghanistan in the Golden Crescent and Pakistan, it has been one of the most...

     opium production region, which supplied about one-third of heroin consumed in US after 1973 American withdrawal from Vietnam. As of 1999, Myanmar
    Myanmar
    Burma , officially the Republic of the Union of Myanmar , is a country in Southeast Asia. Burma is bordered by China on the northeast, Laos on the east, Thailand on the southeast, Bangladesh on the west, India on the northwest, the Bay of Bengal to the southwest, and the Andaman Sea on the south....

     (formerly Burma), the heartland of the Golden Triangle remained the second largest producer of heroin, after Afghanistan
    Afghanistan
    Afghanistan , officially the Islamic Republic of Afghanistan, is a landlocked country located in the centre of Asia, forming South Asia, Central Asia and the Middle East. With a population of about 29 million, it has an area of , making it the 42nd most populous and 41st largest nation in the world...

    .

    Soviet-Afghan war led to increased production in the Pakistani-Afghan border regions, as U.S.-backed mujaheddin militants raised money for arms from selling opium, contributing heavily to the modern Golden Crescent
    Golden Crescent
    The Golden Crescent is the name given to one of Asia's two principal areas of illicit opium production, located at the crossroads of Central, South, and Western Asia...

     creation. By 1980, 60% of heroin sold in the U.S. originated in Afghanistan. It increased international production of heroin at lower prices in the 1980s. The trade shifted away from Sicily in the late 1970s as various criminal organizations violently fought with each other over the trade. The fighting also led to a stepped up government law enforcement presence in Sicily.

    Street price


    The European Monitoring Centre for Drugs and Drug Addiction
    European Monitoring Centre for Drugs and Drug Addiction
    The European Monitoring Centre for Drugs and Drug Addiction is an agency of the European Union. Established in 1993, the EMCDDA is located in Lisbon, Portugal.-Mission and role:...

     reports that the retail price of brown heroin varies from
    Euro
    The euro is the official currency of the eurozone: 17 of the 27 member states of the European Union. It is also the currency used by the Institutions of the European Union. The eurozone consists of Austria, Belgium, Cyprus, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg,...

    14.5 per gram in Turkey to €110 per gram in Sweden, with most European countries reporting typical prices of €35-40 per gram. The price of white heroin is reported only by a few European countries and ranged between €27 and €110 per gram.

    The United Nations Office on Drugs and Crime
    United Nations Office on Drugs and Crime
    The United Nations Office on Drugs and Crime is a United Nations agency that was established in 1997 as the Office for Drug Control and Crime Prevention by combining the United Nations International Drug Control Program and the Crime Prevention and Criminal Justice Division in the United Nations...

     claims in its 2008 World Drug Report that typical US retail prices are US$
    United States dollar
    The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies....

    172 per gram.

    Harm reduction




    Harm reduction
    Harm reduction
    Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...

     is a public health philosophy that seeks to reduce the harms associated with the use of diacetylmorphine. One aspect of harm reduction initiatives focuses on the behaviour of individual users. This includes promoting safer means of taking the drug, such as smoking, nasal use, oral or rectal insertion. This attempts to avoid the higher risks of overdose, infections and blood-borne viruses
    Blood-borne disease
    A blood-borne disease is one that can be spread through contamination by blood.The most common examples are HIV, hepatitis B, hepatitis C and viral hemorrhagic fevers....

     associated with injecting the drug. Other measures include using a small amount of the drug first to gauge the strength, and minimize the risks of overdose. For the same reason, poly drug use
    Poly drug use
    Polydrug use refers to the use of two or more psychoactive drugs in combination to achieve a particular effect. In many cases one drug is used as a base or primary drug, with additional drugs to leaven or compensate for the side effects of the primary drug and make the experience more enjoyable...

     (the use of two or more drugs at the same time) is discouraged. Injecting diacetylmorphine users are encouraged to use new needles, syringes, spoons/steri-cups and filters every time they inject and not share these with other users. Users are also encouraged to not use it on their own, as others can assist in the event of an overdose.

    Governments that support a harm reduction approach usually fund needle & syringe exchange programmes
    Needle-exchange programme
    A Needle & syringe programme or syringe-exchange programme is a social policy based on the philosophy of harm reduction where injecting drug users can obtain hypodermic needles and associated injection equipment at little or no cost. Many programmes are called "exchanges" because some require...

    , which supply new needles and syringes on a confidential basis, as well as education on proper filtering prior to injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing diacetylmorphine for injection may also be supplied including citric acid sachets/vitamin C sachets, steri-cups, filters, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop use of shoe laces or belts).

    Another harm reduction measure employed for example in Europe
    Europe
    Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...

    , Canada
    Canada
    Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

     and Australia
    Australia
    Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

     are safe injection sites where users can inject diacetylmorphine and cocaine
    Cocaine
    Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

     under the supervision of medically trained staff. Safe injection sites are low threshold and allow social services to approach problem users that would otherwise be hard to reach.

    Actors


    A number of actors are known for their use of heroin. Among them are:
    • John Belushi
      John Belushi
      John Adam Belushi was an American comedian, actor, and musician, best known as one of the original cast members of the NBC sketch comedy show Saturday Night Live, The Star of the Films National Lampoon's Animal House and the The Blues Brothers and for fronting the American blues and soul...

      , died of an overdose in 1982.
    • Robert Downey, Jr.
    • Chris Farley
      Chris Farley
      Christopher Crosby "Chris" Farley was an American comedian and actor. Farley was a member of Chicago's Second City Theatre and cast member of the NBC sketch comedy show Saturday Night Live from 1990 to 1995....

      , died of an overdose in 1997.
    • Artie Lange
      Artie Lange
      Arthur Steven "Artie" Lange, Jr. is an American actor, comedian and radio personality best known for his tenures with the The Howard Stern Show and the comedy sketch series MADtv....

    • MacKenzie Phillips
      Mackenzie Phillips
      Mackenzie Phillips is an American actress and singer best known for her roles in American Graffiti and as rebellious teenager Julie Cooper Horvath on the sitcom One Day at a Time...

    • Tom Sizemore
      Tom Sizemore
      Thomas Edward "Tom" Sizemore, Jr. is an American film and television actor and producer. He is known for his roles in films such as Saving Private Ryan, Strange Days, Pearl Harbor, Heat and Black Hawk Down....


    Film and television

    • The film, American Gangster, is loosely based on real life drug dealer Frank Lucas
      Frank Lucas (drug lord)
      Frank Lucas is a former U.S. heroin dealer and organized crime boss who operated in Harlem during the late 1960s and early 1970s. He was particularly known for cutting out middlemen in the drug trade and buying heroin directly from his source in the Golden Triangle...

      , who sold heroin.
    • The film Gia
      Gia
      Gia is a 1998 biographical television film about the life of model Gia Marie Carangi starring Angelina Jolie, Faye Dunaway, Mercedes Ruehl, and Elizabeth Mitchell. It was directed by Michael Cristofer and written by Cristofer and Jay McInerney...

      , based on a true story of model Gia Carangi
      Gia Carangi
      Gia Marie Carangi was an American fashion model during the late 1970s and early 1980s. Carangi is considered by some to be the first supermodel, although that title has been given to others, including Janice Dickinson, Dorian Leigh, and Jean Shrimpton...

      , is about her addiction and use of heroin and how it affected her.
    • The film Trainspotting
      Trainspotting (film)
      Trainspotting is a 1996 British satirical/drama film directed by Danny Boyle based on the novel of the same name by Irvine Welsh. The movie follows a group of heroin addicts in a late 1980s economically depressed area of Edinburgh and their passage through life...

      chronicles the exploits of a group of heroin addicts in Edinburgh, Scotland, during the late 1980s.

    Musicians


    Use of heroin by musicians has been recorded in the following cases.
    • Steven Adler
      Steven Adler
      Steven Adler is an American musician. He is best known as the former drummer of the hard rock band Guns N' Roses, with whom he achieved worldwide success in the late 1980s...

    • Phil Anselmo
      Phil Anselmo
      Philip Hansen "Phil" Anselmo is an American musician who is best known as the lead singer for the heavy metal band Pantera. He is currently the frontman for the Louisiana-based metal act Down. He is also the owner of Housecore Records....

      , former Pantera
      Pantera
      Pantera was an American heavy metal band from Arlington, Texas. Formed by the Abbott brothers, Vinnie Paul and Dimebag Darrell in 1981, bassist Rex Brown would join in late 1981 with vocalist Terry Glaze. Looking for a new and heavier sound, Pantera had Terry replaced in 1987 with Phil Anselmo as...

       vocalist, nearly died from an overdose in 1996, but was given a shot of adrenaline.

    • B.G.
      B.G. (rapper)
      Christopher Dorsey , better known by his stage name B.G. , is an American rapper and actor, from New Orleans, Louisiana. He began his music career signed to Cash Money Records in 1993 with Lil Wayne as half of the duo The B.G.'z...

      , a rap
      Rap
      Rap may refer to:*Rapping, performance in which rhyming lyrics are used, with or without musical accompaniment ; while an MC performs spoken verses in time to a beat/ melody**Hip hop subculture**Hip hop music...

       artist from New Orleans, raps about his previous addiction to heroin (via injection) in numerous songs.
    • Tommy Bolin
      Tommy Bolin
      Thomas Richard "Tommy" Bolin was an American-born guitarist who played with Zephyr , The James Gang , and Deep Purple , in addition to doing solo work...

    • Boy George
      Boy George
      Boy George is a British singer-songwriter who was part of the English New Romantic movement which emerged in the early 1980s. He helped give androgyny an international stage with the success of Culture Club during the 1980s. His music is often classified as blue-eyed soul, which is influenced by...

    • Ray Charles
      Ray Charles
      Ray Charles Robinson , known by his shortened stage name Ray Charles, was an American musician. He was a pioneer in the genre of soul music during the 1950s by fusing rhythm and blues, gospel, and blues styles into his early recordings with Atlantic Records...

       Charles began using heroin as a teenager. He went into rehab in 1965 and stayed clean for the rest of his life.
    • Kurt Cobain
      Kurt Cobain
      Kurt Donald Cobain was an American singer-songwriter, musician and artist, best known as the lead singer and guitarist of the grunge band Nirvana...

    • Darby Crash
      Darby Crash
      Darby Crash was an American punk musician who, along with long time friend Pat Smear , co-founded The Germs...

    • Robbin Crosby
      Robbin Crosby
      Robbin Crosby was an American guitarist who was a member of glam metal band Ratt, earning several platinum albums in the U.S. in the mid-to-late 1980s. Crosby was HIV positive, but died from a heroin overdose in 2002....

      : Guitarist for the 80's Glam Metal
      Glam metal
      Glam metal is a subgenre of hard rock and heavy metal that arose in the late 1970s and early 1980s in the United States, particularly on the Los Angeles Sunset Strip music scene...

       band RATT
      Ratt
      Ratt is an American heavy metal band that had significant commercial success in the 1980s. The band is best known for songs such as "Round and Round," "Wanted Man," "Lay It Down," "You're in Love", "Slip of the Lip", "Back For More", "Dance", "Body Talk", "I Want a Woman", and "Way Cool Jr." Ratt...

       died of a heroin overdose.
    • Miles Davis
      Miles Davis
      Miles Dewey Davis III was an American jazz musician, trumpeter, bandleader, and composer. Widely considered one of the most influential musicians of the 20th century, Miles Davis was, with his musical groups, at the forefront of several major developments in jazz music, including bebop, cool jazz,...

    • Bob Dylan
      Bob Dylan
      Bob Dylan is an American singer-songwriter, musician, poet, film director and painter. He has been a major and profoundly influential figure in popular music and culture for five decades. Much of his most celebrated work dates from the 1960s when he was an informal chronicler and a seemingly...

    • Marianne Faithfull
      Marianne Faithfull
      Marianne Evelyn Faithfull is an award-winning English singer, songwriter and actress whose career has spanned five decades....

    • John Frusciante
      John Frusciante
      John Anthony Frusciante is an American guitarist, singer, songwriter, record and film producer. He is best known as the former lead guitarist of the rock band Red Hot Chili Peppers, with whom he had been for a number of years and recorded five studio albums...

    • Jerry Garcia
      Jerry Garcia
      Jerome John "Jerry" Garcia was an American musician best known for his lead guitar work, singing and songwriting with the band the Grateful Dead...

      , guitarist for the Grateful Dead
      Grateful Dead
      The Grateful Dead was an American rock band formed in 1965 in the San Francisco Bay Area. The band was known for its unique and eclectic style, which fused elements of rock, folk, bluegrass, blues, reggae, country, improvisational jazz, psychedelia, and space rock, and for live performances of long...

      , was a heroin user for many years. He died of heart failure while at the Serenity Knolls drug treatment center in San Francisco, undergoing treatment for his heroin addiction after a recent relapse.
    • Brett Gurewitz
      Brett Gurewitz
      Brett W. Gurewitz , nicknamed Mr. Brett, is the guitarist and a songwriter of Bad Religion. He is also the owner of the music label Epitaph Records and sister-labels ANTI-, Burning Heart Records, Fat Possum Records, and Hellcat Records...

      , guitarist for Bad Religion
      Bad Religion
      Bad Religion is a punk rock band that formed in Los Angeles in 1979. Their current line-up consists of Greg Graffin , Brett Gurewitz , Jay Bentley , Greg Hetson , Brian Baker and Brooks Wackerman . Gurewitz is also the founder of the label Epitaph Records, which has released almost all of the...

    • Billie Holiday
      Billie Holiday
      Billie Holiday was an American jazz singer and songwriter. Nicknamed "Lady Day" by her friend and musical partner Lester Young, Holiday had a seminal influence on jazz and pop singing...

    • Steve Jones
      Steve Jones
      - Music :* Steve Jones , English rock and roll guitarist and singer, member of the Sex Pistols* Steve Jones, musician and television producer- Sports :* Steve Jones , Welsh athlete...

      , guitarist for the Sex Pistols
      Sex Pistols
      The Sex Pistols were an English punk rock band that formed in London in 1975. They were responsible for initiating the punk movement in the United Kingdom and inspiring many later punk and alternative rock musicians...

    • Janis Joplin
      Janis Joplin
      Janis Lyn Joplin was an American singer, songwriter, painter, dancer and music arranger. She rose to prominence in the late 1960s as the lead singer of Big Brother and the Holding Company and later as a solo artist with her backing groups, The Kozmic Blues Band and The Full Tilt Boogie Band...

    • Anthony Kiedis
      Anthony Kiedis
      Anthony Kiedis is an American vocalist/lyricist, and occasional actor best known as the lead vocalist of the Grammy-winning American rock band Red Hot Chili Peppers. Kiedis spent his youth in Grand Rapids, Michigan with his mother before moving, shortly before his 12th birthday, to Hollywood,...

    • Courtney Love
      Courtney Love
      Courtney Michelle Love is an American rock musician. Love is the lead vocalist, lyricist, and rhythm guitarist for alternative rock band Hole, which she formed in 1989, and is an actress who has moved from bit parts in Alex Cox films to significant and acclaimed roles in The People vs...

    • Jim Morrison
      Jim Morrison
      James Douglas "Jim" Morrison was an American musician, singer, and poet, best known as the lead singer and lyricist of the rock band The Doors...

    • Dave Mustaine
      Dave Mustaine
      David Scott "Dave" Mustaine is the founder, main songwriter, guitarist, and lead vocalist for the American heavy metal band Megadeth. Prior to Megadeth, Mustaine was the first lead guitarist and a co-songwriter of the heavy metal band Metallica until he was fired from the band in 1983. In 2009, he...

    • Mike Ness
      Mike Ness
      Mike Ness is an American guitarist, vocalist, and chief songwriter for the punk rock band Social Distortion, which was formed in 1978. As of Dennis Danell's death in 2000, he is now the only original member of the band...

      , singer/guitarist for Social Distortion
      Social Distortion
      Social Distortion is an American punk rock band formed in 1978 in Fullerton, California. The band currently consists of Mike Ness , Jonny Wickersham , Brent Harding and David Hidalgo, Jr...

    • Jerry Nolan
      Jerry Nolan
      Jerry Nolan was an American rock drummer, best known for his work with The New York Dolls and Johnny Thunders and The Heartbreakers.-Career:...

      , drummer for the New York Dolls
      New York Dolls
      The New York Dolls is an American rock band, formed in New York in 1971. The band's protopunk sound prefigured much of what was to come in the punk rock era; their visual style influenced the look of many new wave and 1980s-era glam metal groups, and they began the local New York scene that later...

       and The Heartbreakers
      The Heartbreakers
      Johnny Thunders and the Heartbreakers, also known as The Heartbreakers, were an American rock & roll band formed in New York in May 1975. The band was part of the first wave of punk rock.-History:...

    • Bradley Nowell
      Bradley Nowell
      Bradley James Nowell was an American musician who served as lead singer and guitarist of the Californian band Sublime. He died at the age of 28 from a heroin overdose shortly before the release of Sublime's self-titled major label debut.Raised in Long Beach, California, Nowell developed an...

      , died of an overdose in 1996.
    • Charlie Parker
      Charlie Parker
      Charles Parker, Jr. , famously called Bird or Yardbird, was an American jazz saxophonist and composer....

    • Kristen Pfaff
      Kristen Pfaff
      Kristen Marie Pfaff was an American bass guitarist, best known for her work with Hole.-Early life and career:Pfaff was born and raised in Buffalo, New York, attending Buffalo Academy of the Sacred Heart. She spent a short time in Europe and briefly attended Boston College before ultimately...

      , bassist for Hole
      Hole (band)
      Hole is an American alternative rock band that originally formed in Los Angeles in 1989. The band is fronted by vocalist/songwriter and rhythm guitarist Courtney Love, who co-founded Hole with former songwriter/lead guitarist Eric Erlandson...

       died of an overdose in 1994.
    • John Phillips
      John Phillips (musician)
      John Edmund Andrew Phillips , was an American singer, guitarist, songwriter and promoter . Known as Papa John, Phillips was a member and leader of the singing group The Mamas & the Papas...

    • Seth Putnam
      Seth Putnam
      Seth Edward Putnam was the founder of grindcore band Anal Cunt. He was known for his brutal screaming and lyrics that either shock, offend, or invoke morbid humor...

      , former Anal Cunt
      Anal Cunt
      Anal Cunt, also known as AxCx and A.C., was an American grindcore band that formed in Newton, Massachusetts in 1988. Since its inception, the band underwent a number of line-up changes. Known for its grindcore musical style and controversial lyrics, Anal Cunt released eight full-length studio...

       vocalist, suffered an overdose and went into a coma after a mixed effect of alcohol
      Alcohol
      In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

      , crack
      Crack cocaine
      Crack cocaine is the freebase form of cocaine that can be smoked. It may also be termed rock, hard, iron, cavvy, base, or just crack; it is the most addictive form of cocaine. Crack rocks offer a short but intense high to smokers...

      , sleeping pills, and heroin in 2004.
    • Joe Queer, singer/guitarist of The Queers
      The Queers
      The Queers are a punk band formed in 1981 by Portsmouth, New Hampshire native Joe King . The band originally broke up in 1984, but reformed with Joe Queer and a new line-up in 1986. In 1990, the band signed with Shakin' Street Records and released their first album Grow Up...

      .
    • Dee Dee Ramone
      Dee Dee Ramone
      Dee Dee Ramone was an American songwriter and musician, best known as founding member, bassist and main songwriter of the punk rock band the Ramones....

       of the Ramones
      Ramones
      The Ramones were an American rock band that formed in the New York City neighborhood of Forest Hills, Queens, in 1974. They are often cited as the first punk rock group...

       died of a heroin overdose in 2002 after a long history with the drug.
    • Trent Reznor
      Trent Reznor
      Michael Trent Reznor is an American multi-instrumentalist, composer, record producer, and leader of industrial rock band Nine Inch Nails. Reznor is also a member of How to Destroy Angels alongside his wife, Mariqueen Maandig, and Atticus Ross. He was previously associated with bands Option 30,...

    • Keith Richards
      Keith Richards
      Keith Richards is an English musician, songwriter, and founding member of the Rolling Stones. Rolling Stone magazine said Richards had created "rock's greatest single body of riffs", and placed him as the "10th greatest guitarist of all time." Fourteen songs written by Richards and songwriting...

    • Casey Royer
      Casey Royer
      Casey Royer is an American musician who began his career playing drums for punk band, Social Distortion at age 21 in 1979. He then moved on to play for The Adolescents from 1980–87. While The Adolescents were on hiatus from 1981–86, Casey went on to form D.I. in 1982, a Southern California punk...

    • Michael Rudetsky, keyboardist who collaborated with Culture Club
      Culture Club
      Culture Club are a British rock band who were part of the 1980s New Romantic movement. The original band consisted of Boy George , Mikey Craig , Roy Hay and Jon Moss...

      .
    • Slash
      Slash (musician)
      Saul Hudson , known by his stage name Slash, is a British-American musician and songwriter. He is best known as the former lead guitarist of the American hard rock band Guns N' Roses, with whom he achieved worldwide success in the late 1980s and early 1990s. During his later years with Guns N'...

    • Hillel Slovak
      Hillel Slovak
      Hillel Slovak ‏ was an Israeli-American musician best known as the original guitarist and founding member of the Los Angeles rock band Red Hot Chili Peppers...

      , guitarist for the Red Hot Chili Peppers
      Red Hot Chili Peppers
      Red Hot Chili Peppers is an American rock band, formed in Los Angeles in 1983. The group's musical style primarily consists of rock with an emphasis on funk, as well as elements from other genres such as punk, hip hop and psychedelic rock...

       died of a heroin overdose in 1988.
    • Nikki Sixx
      Nikki Sixx
      Nikki Sixx is an American musician, songwriter, author, fashion designer, radio host, and photographer, best known as the co-founder and bassist of the band Mötley Crüe. Prior to forming Mötley Crüe, Sixx was a member of Sister before going on to form London with his Sister band mate Lizzie Grey...

       of Mötley Crüe
      Mötley Crüe
      Mötley Crüe is an American heavy metal band formed in Los Angeles, California in 1981. The group was founded by bass guitarist Nikki Sixx and drummer Tommy Lee, who were later joined by lead guitarist Mick Mars and lead singer Vince Neil...

       released diaries from his time as a heroin addict titled: The Heroin Diaries: A Year in the Life of a Shattered Rock Star
      The Heroin Diaries: A Year in the Life of a Shattered Rock Star
      The Heroin Diaries: A Year in the Life of a Shattered Rock Star is a book co-written by Nikki Sixx, bassist of the rock band Mötley Crüe, and Ian Gittins. Additional reflections on the period from Sixx and others are interspersed throughout the book. The book also includes many black-and-white...

      . An album was also produced based on the book.
    • Layne Staley
      Layne Staley
      Layne Thomas Staley was an American musician who served as the lead singer and co-lyricist of the rock group Alice in Chains, which was formed in Seattle, Washington in 1987 by Staley and guitarist Jerry Cantrell. Alice in Chains rose to international fame as part of the grunge movement of the...

      , singer for Alice in Chains
      Alice in Chains
      Alice in Chains is an American rock band formed in Seattle, Washington, in 1987 by guitarist and songwriter Jerry Cantrell and original lead vocalist Layne Staley. The initial lineup was rounded out by drummer Sean Kinney, and bassist Mike Starr...

       died of an overdose in 2002.
    • Mike Starr
      Mike Starr
      Mike Starr may refer to:*Mike Starr , American actor*Mike Starr , American musician...

      , bassist for Alice in Chains
      Alice in Chains
      Alice in Chains is an American rock band formed in Seattle, Washington, in 1987 by guitarist and songwriter Jerry Cantrell and original lead vocalist Layne Staley. The initial lineup was rounded out by drummer Sean Kinney, and bassist Mike Starr...

       died of an overdose in 2011.
    • James Taylor
      James Taylor
      James Vernon Taylor is an American singer-songwriter and guitarist. A five-time Grammy Award winner, Taylor was inducted into the Rock & Roll Hall of Fame in 2000....

    • Johnny Thunders
      Johnny Thunders
      Johnny Thunders, born John Anthony Genzale, Jr. , was an American protopunk guitarist, singer and songwriter.He came to prominence in the early '70s as a member of the New York Dolls...

    • Sid Vicious
      Sid Vicious
      Sid Vicious was an English musician best known as the bassist of the influential punk rock group Sex Pistols...

       of the Sex Pistols
      Sex Pistols
      The Sex Pistols were an English punk rock band that formed in London in 1975. They were responsible for initiating the punk movement in the United Kingdom and inspiring many later punk and alternative rock musicians...

       died of a heroin overdose, and allegedly stabbed his girlfriend to death while both were strung out on heroin.
    • Scott Weiland
      Scott Weiland
      Scott Weiland is an American musician, lyricist, and vocalist, most notable for his work with Grammy Award-winning rock band Stone Temple Pilots. Weiland is also known for his five-year career with supergroup Velvet Revolver as well as his own solo career...

    • Rozz Williams
      Rozz Williams
      Rozz Williams was an American vocalist and musician of several varieties, most famous for fronting the band Christian Death, then later Shadow Project with musician Eva O, though his main project throughout his career was the industrial, Premature Ejaculation...

      's final album before his suicide, The Whorse's Mouth
      The Whorse's Mouth
      The Whorse's Mouth is an experimental spoken word studio album by Rozz Williams. It was released on June 3, 1997 by Hollows Hill, and was Williams' last studio album before his suicide in 1998. The Whorse's Mouth deals with Williams' heroin addiction, and features artwork consisting of collages...

      , dealt with his heroin addiction.
    • Andrew Wood, died of an overdose in 1990.
    • Josh Ramsay of Marianas Trench (band)
      Marianas Trench (band)
      Marianas Trench is a Juno-nominated Canadian pop punk band from Vancouver, British Columbia, formed in 2001. They have released three full length albums, the most recent titled Ever After, released on November 21, 2011...


    Songs


    Songs about heroin include:
    • "Heroin
      Heroin (song)
      "Heroin" is a song by The Velvet Underground, released on their 1967 debut album, The Velvet Underground & Nico. Written by Lou Reed in 1964, the song is one of the band's most celebrated compositions, overtly depicting heroin use and abuse...

      " by the Velvet Underground
    • "The Needle and the Damage Done
      The Needle and the Damage Done
      "The Needle and the Damage Done" is a song by Neil Young that describes the descent into heroin addiction of musicians he knew. It was written about the heroin use of his Crazy Horse guitarist Danny Whitten, and previews the theme of "Tonight's the Night", a song that addresses the heroin overdose...

      " by Neil Young
      Neil Young
      Neil Percival Young, OC, OM is a Canadian singer-songwriter who is widely regarded as one of the most influential musicians of his generation...

    • "Mr Brownstone" by Guns N Roses
    • "Space Oddity", David Bowie
      David Bowie
      David Bowie is an English musician, actor, record producer and arranger. A major figure for over four decades in the world of popular music, Bowie is widely regarded as an innovator, particularly for his work in the 1970s...

      's first single, was seemingly about his experience with heroin, as his 1980 single "Ashes to Ashes
      Ashes to Ashes (David Bowie song)
      "Ashes to Ashes" is a single by David Bowie, released in 1980. It made #1 in the UK and was the first cut from the Scary Monsters album, also a #1 hit. As well as its musical qualities, it is noted for its innovative video, directed by Bowie and David Mallet...

      " included lines that refer to Major Tom as "...a junkie/strung out on heaven's high/hitting an all-time low."

    Writers


    Writers known to have used heroin are;
    • Claude Brown
      Claude Brown
      Claude Brown is the author ofManchild in the Promised Land, published to critical acclaim in 1965, which tells the story of his coming of age during the 1940s and 1950s in Harlem...

      , in Manchild in the Promised Land
      Manchild in the Promised Land
      Manchild in the Promised Land is an autobiographical novel written by Claude Brown. It tells about the author's coming of age amidst poverty and violence in Harlem during the 1940s and 1950s...

    • William S. Burroughs
      William S. Burroughs
      William Seward Burroughs II was an American novelist, poet, essayist and spoken word performer. A primary figure of the Beat Generation and a major postmodernist author, he is considered to be "one of the most politically trenchant, culturally influential, and innovative artists of the 20th...

    • Jim Carroll
      Jim Carroll
      James Dennis "Jim" Carroll was an author, poet, autobiographer, and punk musician. Carroll was best known for his 1978 autobiographical work The Basketball Diaries, which was made into the 1995 film of the same name, starring Leonardo DiCaprio as Carroll.-Biography:Carroll was born to a...

      , in The Basketball Diaries
      The Basketball Diaries
      The Basketball Diaries is a 1978 memoir written by author and musician Jim Carroll. It is an edited collection of the diaries he kept between the ages of twelve and sixteen...


    Further reading

    • Diary Of A Drug Fiend by Aleister Crowley
      Aleister Crowley
      Aleister Crowley , born Edward Alexander Crowley, and also known as both Frater Perdurabo and The Great Beast, was an influential English occultist, astrologer, mystic and ceremonial magician, responsible for founding the religious philosophy of Thelema. He was also successful in various other...

       (1922)
    • Junkie (novel)
      Junkie (novel)
      Junkie is a 1953 semi-autobiographical novel by William S. Burroughs. It was his first published novel and has come to be considered a seminal text on the lifestyle of heroin addicts in the early 1950s. Burroughs' working title was Junk.-Inspiration:The novel was considered unpublishable more than...

       by William S. Burroughs
      William S. Burroughs
      William Seward Burroughs II was an American novelist, poet, essayist and spoken word performer. A primary figure of the Beat Generation and a major postmodernist author, he is considered to be "one of the most politically trenchant, culturally influential, and innovative artists of the 20th...

       (1953) ISBN 0-14-200316-6
    • Heroin (1998) ISBN 1-56838-153-0
    • Heroin Century (2002) ISBN 0-415-27899-6
    • This is Heroin (2002) ISBN 1-86074-424-9
    • The Heroin User's Handbook by Francis Moraes
      Francis Moraes
      Francis Moraes , whose online pseudonym is Dr. H, is an American writer, author of three opiate related non-fiction books and hundreds of articles....

       (paperback 2004) ISBN 1-55950-216-9
    • The Little Book of Heroin by Francis Moraes (paperback 2000) ISBN 0-914171-98-4
    • Heroin: A True Story of Addiction, Hope and Triumph by Julie O'Toole (paperback 2005) ISBN 1-905379-01-3
    • The Heroin Diaries: A Year in the Life of a Shattered Rockstar by Nikki Sixx (2007) ISBN 978-0-7434-8628-6
    • Heroin: The Myths and the Facts by Richard Ashley (1972), St. Martin's Press, Library of Congress No. 72-89417
    • "The Death Proclamation of Generation X: A Self-Fulfilling Prophesy of Goth, Grunge and Heroin" by Maxim W. Furek, M. (2008), i-Universe. ISBN 978-0-595-46319-0
    • Seeds of Terror: How Heroin is Bankrolling the Taliban and Al Qaeda, by Gretchen Peters, publ. Thomas Dunne Books (2009)

    External links





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