Heroin: Difference between revisions
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Script assisted update of identifiers for the Chem/Drugbox validation project (updated: 'ChEBI'). |
PuppyMonkey (talk | contribs) Changing short description from "Opioid used as an analgesic and a recreational drug for its euphoric effects" to "Opioid analgesic and recreational drug" |
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{{Short description|Opioid analgesic and recreational drug}} |
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{{Distinguish|heroine}} |
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{{ |
{{Other uses}} |
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{{Distinguish|Heroine}} |
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{{semiprotected|small=yes}} |
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{{Pp-semi-indef}} |
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{{drugbox |
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{{cs1 config|name-list-style=vanc|display-authors=6}} |
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| verifiedrevid = 408050291 |
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{{Use dmy dates|date=July 2022}} |
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| IUPAC_name = (5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol diacetate |
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{{infobox drug |
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| image = Heroin - Heroine.svg |
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| Watchedfields = changed |
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| image2 = Heroin-from-xtal-horizontal-3D-balls.png |
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| verifiedrevid = 443854562 |
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| drug_name = Heroin |
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| BAN = Diamorphine<ref name="Martindale36">{{Cite book| veditors = Sweetman SC |title=[[Martindale: the complete drug reference]] |edition=36th |publisher=Pharmaceutical Press |location=London |year=2009 |isbn=978-0-85369-840-1 |page=42}}</ref> |
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| IUPAC_name = (5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol diacetate |
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| image = Heroin - Heroine.svg |
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| image2 = Heroin-from-xtal-horizontal-3D-balls.png |
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<!--Clinical data--> |
<!--Clinical data-->| pronounce = Heroin: {{IPAc-en|ˈ|h|ɛr|oʊ|ᵻ|n}} |
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| Drugs.com = {{drugs.com|parent|heroin}} |
| Drugs.com = {{drugs.com|parent|heroin}} |
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| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X --> |
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| pregnancy_category = Category X{{Citation needed|date=April 2011}} |
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| pregnancy_AU_comment = |
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| legal_AU = S9 |
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| pregnancy_US = <!-- A / B / C / D / X / N --> |
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| legal_CA = Schedule I |
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| pregnancy_US_comment = |
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| legal_UK = Class A |
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| pregnancy_category = |
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| legal_US = Schedule I |
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| legal_AU = S9 |
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| dependency_liability = High |
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| legal_BR = F1 |
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| routes_of_administration = Inhalation, Transmucosal, Intravenous, Oral, Intranasal, Rectal, Intramuscular |
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| legal_CA = Schedule I |
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| legal_DE = [[Anlage I]], [[Anlage II|II]] and [[Anlage III|III]] |
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| legal_NZ = Class A |
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| legal_UK = Class A |
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| legal_US = Schedule I |
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| legal_UN = Narcotic Schedules I and IV |
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| dependency_liability = Very high<ref>{{cite book | vauthors = Bonewit-West K, Hunt SA, Applegate E |title=Today's Medical Assistant: Clinical and Administrative Procedures |date=2012 |publisher=Elsevier Health Sciences |isbn=978-1-4557-0150-6 |page=571 |url=https://books.google.com/books?id=YalYPI1KqTQC&pg=PA571 |language=en}}</ref> |
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| addiction_liability = Very high<ref name=Drugs2014/> |
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| routes_of_administration = Intravenous, inhalation, transmucosal, by mouth, intranasal, rectal, intramuscular, subcutaneous, intrathecal |
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| class = [[Opioid]] |
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<!--Pharmacokinetic data-->| bioavailability = <35% (by mouth), 44–61% (inhaled)<ref name="pmid16433897">{{cite journal | vauthors = Rook EJ, van Ree JM, van den Brink W, Hillebrand MJ, Huitema AD, Hendriks VM, Beijnen JH | title = Pharmacokinetics and pharmacodynamics of high doses of pharmaceutically prepared heroin, by intravenous or by inhalation route in opioid-dependent patients | journal = Basic & Clinical Pharmacology & Toxicology | volume = 98 | issue = 1 | pages = 86–96 | date = January 2006 | pmid = 16433897 | doi = 10.1111/j.1742-7843.2006.pto_233.x | doi-access = free | issn = 1742-7835 }}</ref> |
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<!--Pharmacokinetic data--> |
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| protein_bound = 0% ([[morphine]] metabolite 35%) |
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| bioavailability = <35% (oral), 44–61% (inhaled)<ref>{{cite journal|last1=Rook|first1=Elisabeth J.|last2=Van Ree|first2=Jan M.|last3=Van Den Brink|first3=Wim|last4=Hillebrand|first4=Michel J. X.|last5=Huitema|first5=Alwin D. R.|last6=Hendriks|first6=Vincent M.|last7=Beijnen|first7=Jos H.|title=Pharmacokinetics and Pharmacodynamics of High Doses of Pharmaceutically Prepared Heroin, by Intravenous or by Inhalation Route in Opioid-Dependent Patients|journal=Basic <html_ent glyph="@amp;" ascii="&"/> Clinical Pharmacology <html_ent glyph="@amp;" ascii="&"/> Toxicology|volume=98|pages=86–96|year=2006|doi=10.1111/j.1742-7843.2006.pto_233.x}}</ref> |
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| metabolism = [[Liver]] |
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| protein_bound = 0% ([[morphine]] metabolite 35%) |
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| onset = Within minutes<ref>{{cite book| vauthors = Riviello RJ |title=Manual of forensic emergency medicine: a guide for clinicians|date=2010|publisher=Jones and Bartlett Publishers|location=Sudbury, Mass.|isbn=978-0-7637-4462-5|page=41|url=https://books.google.com/books?id=keng9ELAE2IC&pg=PA41|url-status=live|access-date=29 August 2017|archive-url=https://web.archive.org/web/20170318224346/https://books.google.com/books?id=keng9ELAE2IC&pg=PA41|archive-date=18 March 2017}}</ref> |
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| metabolism = [[hepatic]] |
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| elimination_half-life = 2–3 minutes<ref name=EMC>{{cite web|title=Diamorphine Hydrochloride Injection 30 mg – Summary of Product Characteristics|website=electronic Medicines Compendium|publisher=ViroPharma Limited|date=24 September 2013|access-date=30 March 2014|url=http://www.medicines.org.uk/emc/medicine/28258/SPC/Diamorphine+Hydrochloride+Injection+30+mg/|url-status=dead|archive-url=https://web.archive.org/web/20140330154716/http://www.medicines.org.uk/emc/medicine/28258/SPC/Diamorphine+Hydrochloride+Injection+30+mg/|archive-date=30 March 2014}}</ref> |
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| elimination_half-life = <10 minutes <ref>{{cite web|url=http://www.osha.gov/dts/chemicalsampling/data/CH_244675.html|title=Chemical Sampling Information: Heroin|publisher=Osha.gov|date=|accessdate=2010-10-20}}</ref> |
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| duration_of_action = 4 to 5 hours<ref>{{cite book| vauthors = Field J |title=The Textbook of Emergency Cardiovascular Care and CPR|date=2012|publisher=Lippincott Williams & Wilkins|isbn=978-1-4698-0162-9|page=447|url=https://books.google.com/books?id=o3m4oNRB4D4C&pg=PA447|url-status=live|archive-url=https://web.archive.org/web/20170910234542/https://books.google.com/books?id=o3m4oNRB4D4C&pg=PA447|archive-date=10 September 2017}}</ref> |
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| excretion = 90% [[renal]] as [[glucuronide]]s, rest [[biliary]] |
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| excretion = 90% [[kidney]] as [[glucuronide]]s, rest [[biliary]] |
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<!--Identifiers--> |
<!--Identifiers-->| CAS_number_Ref = {{cascite|correct|??}} |
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| CAS_number = 561-27-3 |
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| CASNo_Ref = {{cascite|correct|CAS}} |
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| ATC_prefix = N07 |
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| CAS_number = 561-27-3 |
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| ATC_suffix = BC06 |
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| ATC_prefix = N02 |
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| ChEBI_Ref = {{ebicite|correct|EBI}} |
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| ATC_suffix = AA09 |
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| ChEBI = 27808 |
| ChEBI = 27808 |
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| PubChem = 5462328 |
| PubChem = 5462328 |
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| DrugBank_Ref = {{drugbankcite|correct|drugbank}} |
| DrugBank_Ref = {{drugbankcite|correct|drugbank}} |
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| DrugBank = DB01452 |
| DrugBank = DB01452 |
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| |
| KEGG_Ref = {{keggcite|correct|kegg}} |
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| KEGG = D07286 |
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| ChemSpiderID = 4575379 |
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| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} |
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| ChemSpiderID = 4575379 |
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| UNII = 8H672SHT8E |
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| UNII_Ref = {{fdacite|correct|FDA}} |
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| UNII = 70D95007SX |
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| ChEMBL = 459324 |
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| index2_label = HCl |
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| CAS_number2_Ref = {{cascite|correct|CAS}} |
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<!--Chemical data--> |
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| |
| CAS_number2 = 1502-95-0 |
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| UNII2_Ref = {{fdacite|correct|FDA}} |
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| molecular_weight = 369.41 g/mol |
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| UNII2 = 8H672SHT8E |
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| smiles = CC(=O)Oc1ccc2c3c1O[C@@H]4[C@]35CCN([C@H](C2)[C@@H]5C=C[C@@H]4OC(=O)C)C |
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| ChEMBL_Ref = {{ebicite|correct|EBI}} |
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| InChI = 1/C21H23NO5/c1-11(23)25-16-6-4-13-10-15-14-5-7-17(26-12(2)24)20-21(14,8-9-22(15)3)18(13)19(16)27-20/h4-7,14-15,17,20H,8-10H2,1-3H3/t14-,15+,17-,20-,21-/m0/s1 |
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| ChEMBL = 459324 |
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| StdInChI_Ref = {{stdinchicite|correct|chemspider}} |
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| C = 21 |
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| StdInChI = 1S/C21H23NO5/c1-11(23)25-16-6-4-13-10-15-14-5-7-17(26-12(2)24)20-21(14,8-9-22(15)3)18(13)19(16)27-20/h4-7,14-15,17,20H,8-10H2,1-3H3/t14-,15+,17-,20-,21-/m0/s1 |
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| H = 23 |
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| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} |
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| N = 1 |
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| StdInChIKey = GVGLGOZIDCSQPN-PVHGPHFFSA-N |
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| O = 5 |
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| synonyms = Diamorphine, Diacetylmorphine, Acetomorphine, (Dual) Acetylated morphine, Morphine diacetate |
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| smiles = CC(OC1=C(O[C@@H]2[C@]34CCN(C)[C@@H]([C@@H]4C=C[C@@H]2OC(C)=O)C5)C3=C5C=C1)=O |
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| StdInChI_Ref = {{stdinchicite|correct|chemspider}} |
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| StdInChI = 1S/C21H23NO5/c1-11(23)25-16-6-4-13-10-15-14-5-7-17(26-12(2)24)20-21(14,8-9-22(15)3)18(13)19(16)27-20/h4-7,14-15,17,20H,8-10H2,1-3H3/t14-,15+,17-,20-,21-/m0/s1 |
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| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} |
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| StdInChIKey = GVGLGOZIDCSQPN-PVHGPHFFSA-N |
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| synonyms = Diacetylmorphine, acetomorphine, (dual) acetylated morphine, morphine diacetate |
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| alt = |
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| caption = |
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| type = |
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| MedlinePlus = |
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| legal_status = |
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| licence_EU = |
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| licence_US = |
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}} |
}} |
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<!--Definition and medical uses--> |
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'''Heroin''', also known as '''diacetylmorphine''' and '''diamorphine''' among other names,<ref name="Martindale36"/> is a [[morphinan]] [[opioid]] substance synthesized from the [[Opium|dried latex]] of the [[Papaver somniferum|opium poppy]]; it is mainly used as a [[recreational drug]] for its [[euphoric]] effects. Heroin is used medically in several countries to [[Pain reliever|relieve pain]], such as during childbirth or a heart attack, as well as in [[opioid replacement therapy]].<ref>{{cite journal |vauthors=Friedrichsdorf SJ, Postier A |date=2014 |title=Management of breakthrough pain in children with cancer |journal=Journal of Pain Research |volume=7 |pages=117–23 |doi=10.2147/JPR.S58862 |pmc=3953108 |pmid=24639603 |doi-access=free}}</ref><ref>{{cite book |author1=National Collaborating Centre for Cancer (UK) |title=Opioids in Palliative Care: Safe and Effective Prescribing of Strong Opioids for Pain in Palliative Care of Adults |date=May 2012 |publisher=National Collaborating Centre for Cancer (UK) |location=Cardiff (UK) |pmid=23285502}}</ref><ref>{{cite journal |vauthors=Uchtenhagen AA |date=March 2011 |title=Heroin maintenance treatment: from idea to research to practice |url=http://www.zora.uzh.ch/47764/1/Heroinmaintenance_Uchtenhagen-V.pdf |url-status=dead |journal=Drug and Alcohol Review |volume=30 |issue=2 |pages=130–7 |doi=10.1111/j.1465-3362.2010.00266.x |pmid=21375613 |archive-url=https://web.archive.org/web/20210828105215/http://www.zora.uzh.ch/id/eprint/47764/1/Heroinmaintenance_Uchtenhagen-V.pdf |archive-date=28 August 2021 |access-date=20 April 2018}}</ref> [[Medical-grade]] diamorphine is used as a pure [[Hydrochloride|hydrochloride salt]]. Various white and brown powders sold illegally around the world as ''heroin'' are routinely diluted with [[cutting agent]]s. [[Black tar heroin]] is a variable admixture of [[morphine]] derivatives—predominantly [[6-MAM]] (6-monoacetylmorphine), which is the result of crude [[acetylation]] during clandestine production of street heroin.<ref name="Drugs2014">{{cite web|title=Heroin|url=https://www.drugs.com/illicit/heroin.html|website=Drugs.com|access-date=19 October 2016|date=18 May 2014|url-status=live|archive-url=https://web.archive.org/web/20161019154754/https://www.drugs.com/illicit/heroin.html|archive-date=19 October 2016}}</ref> |
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'''Heroin''' ('''diacetylmorphine''' ([[International Nonproprietary Name|INN]])), also known as '''diamorphine''' ([[British Approved Name|BAN]]), or, especially in older literature, as '''morphine diacetate''', is a semi-[[Wiktionary:synthetic|synthetic]] [[opioid]] [[drug]] synthesized from [[morphine]], a derivative of the [[opium poppy]]. It is the 3,6-[[acetate|diacetyl]] [[ester]] of morphine (''di-acetyl-morphine'') and a morphine [[prodrug]].<ref name="Sawynok 1986">{{cite journal |author=Sawynok J |title=The therapeutic use of heroin: a review of the pharmacological literature |journal=Can. J. Physiol. Pharmacol. |volume=64 |issue=1 |pages=1–6 |year=1986 |month=January |pmid=2420426 |doi= |url=}}</ref> The white [[crystalline form]] is commonly the [[hydrochloride salt]] '''diacetylmorphine hydrochloride''', though, when supplied illegally, it is often adulterated, thus dulling the sheen and consistency from that to a matte white powder, which diacetylmorphine [[Free base (chemistry)|freebase]] typically is.<ref>{{cite web|url=http://alcoholism.about.com/od/heroin/a/heroin.htm |title=Basic Facts About Heroin |publisher=Alcoholism.about.com |date= |accessdate=2010-10-20}}</ref> 90% of illicit diamorphine (heroin) is thought to be produced in Afghanistan.<ref>{{cite news| url=http://news.bbc.co.uk/2/hi/8540726.stm | work=BBC News | title=Russia blames Nato for drug surge | date=2010-02-27 | accessdate=2010-05-04 | first=Rupert | last=Wingfield-Hayes}}</ref> |
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Heroin is typically [[Drug injection|injected]], usually into a [[vein]], but it can also be snorted, smoked, or inhaled. In a clinical context, the route of administration is most commonly [[intravenous injection]]; it may also be given by intramuscular or subcutaneous injection, as well as orally in the form of tablets.<ref>{{cite web |title=Diamorphine |url=https://www.sps.nhs.uk/medicines/diamorphine/ |website=SPS – Specialist Pharmacy Service |date=15 February 2013 |access-date=2 August 2020 |archive-date=4 May 2020 |archive-url=https://web.archive.org/web/20200504165006/https://www.sps.nhs.uk/medicines/diamorphine/ |url-status=dead }}</ref><ref name=Drugs2014/><ref name=NIH2014/><ref>{{Cite book|url=https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/heroinrrs_11_14.pdf|title=Research Report Series: Heroin|last=National Institutes on Drug Abuse|publisher=National Institutes on Drug Abuse|year=2014|pages=1|quote=Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use…. Impure heroin is usually dissolved, diluted, and injected into veins, muscles, or under the skin.|url-status=live|archive-url=https://web.archive.org/web/20161230054652/https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/heroinrrs_11_14.pdf|archive-date=30 December 2016}}</ref> The onset of effects is usually rapid and lasts for a few hours.<ref name=Drugs2014/> |
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As with other [[opioids]], diacetylmorphine is used as both an [[analgesic]] and a [[recreational drug]]. Frequent and regular administration is associated with [[Drug tolerance|tolerance]] and [[physical dependence]], which may develop into [[Substance dependence|addiction]]. Internationally, diacetylmorphine is controlled under Schedules I and IV of the [[Single Convention on Narcotic Drugs]].<ref>{{cite web |
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| month = December | year = 2004| url = http://www.incb.org/pdf/e/list/46thedition.pdf |
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| title = Yellow List: List of Narcotic Drugs Under International Control| format = PDF |
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| publisher = [[International Narcotics Control Board]] |
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| accessdate = May 5, 2006 |
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}} ''Referring URL = http://www.incb.org/incb/yellow_list.html''</ref> It is [[Drug prohibition law|illegal]] to manufacture, possess, or sell diacetylmorphine without a [[license]] in almost every country. |
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<!--Side effects and mechanism--> |
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Under the chemical name diamorphine, diacetylmorphine is a legally [[Prescription drug|prescribed]] [[controlled drug]] in the United Kingdom, and is supplied in tablet or injectable form for the same indications as morphine is. It is available for [[heroin maintenance|prescription to long-term users]] in the [[Netherlands]], [[United Kingdom]], [[Switzerland]], [[Germany]] and [[Denmark]] alongside psycho-social care,<ref>{{cite web|url=http://stopthedrugwar.org/chronicle/588/germany_approves_heroin_maintenance |title=Europe: German Parliament Approves Heroin Maintenance |publisher=StoptheDrugWar.org |date= |accessdate=2010-10-20}}</ref><ref>{{cite web|url=http://stopthedrugwar.org/chronicle/525/denmark_heroin_maintenance_pilot_program |title=Europe: Denmark Parliament Approves Heroin Maintenance Pilot Project |publisher=StoptheDrugWar.org |date= |accessdate=2010-10-20}}</ref> and a similar programme is being campaigned for by liberal political parties in Norway. Some countries allow the government to sell or donate high-quality seizures of drugs and precursors which are otherwise legal for medicinal use to pharmaceutical manufacturers for use in preparing legal supplies of medical drugs and research chemicals; this was the case in [[Croatia]] before 2007.<ref>{{cite web|url=http://eldd.emcdda.europa.eu/html.cfm/index5174EN.html# |title=ELDD | Country profiles |publisher=Eldd.emcdda.europa.eu |date= |accessdate=2010-10-20}}</ref> |
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Common side effects include [[respiratory depression]] (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and [[addiction]].<ref name=NIH2014/> Use by injection can also result in [[abscesses]], [[endocarditis|infected heart valves]], [[blood-borne infections]], and [[pneumonia]].<ref name=NIH2014/> After a history of long-term use, [[opioid withdrawal]] symptoms can begin within hours of the last use.<ref name=NIH2014/> When given by injection into a vein, heroin has two to three times the effect of a similar dose of [[morphine]].<ref name="Drugs2014"/> It typically appears in the form of a white or brown powder.<ref name="NIH2014">{{cite web|title=DrugFacts—Heroin|url=https://www.drugabuse.gov/publications/drugfacts/heroin|website=National Institute on Drug Abuse|access-date=19 October 2016|date=October 2014|url-status=dead|archive-url=https://web.archive.org/web/20161019150657/https://www.drugabuse.gov/publications/drugfacts/heroin|archive-date=19 October 2016}}</ref> |
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<!--Treatment and epidemiology --> |
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==Usage== |
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Treatment of [[heroin addiction]] often includes [[behavioral therapy]] and medications.<ref name=NIH2014/> Medications can include [[buprenorphine]], [[methadone]], or [[naltrexone]].<ref name=NIH2014/> A heroin overdose may be treated with [[naloxone]].<ref name=NIH2014/> An estimated 17 million people {{as of|2015|lc=y}} use opiates, of which heroin is the most common,<ref name=WDR2016/><ref>{{cite web |title=Information sheet on opioid overdose |url=https://www.who.int/substance_abuse/information-sheet/en/ |website=WHO |access-date=10 December 2018 |date=August 2018 |archive-url=https://web.archive.org/web/20190421140401/https://www.who.int/substance_abuse/information-sheet/en/ |archive-date=21 April 2019 |url-status=live }}</ref> and opioid use resulted in 122,000 deaths.<ref>{{cite journal | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal| collaboration = GBD 2015 Mortality and Causes of Death Collaborators | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 }}</ref> The total number of heroin users worldwide as of 2015 is believed to have increased in Africa, the Americas, and Asia since 2000.<ref name=WDR2017Part3/> In the United States, approximately 1.6 percent of people have used heroin at some point.<ref name=NIH2014/><ref>{{cite web |title=What is the scope of heroin use in the United States? |url=https://www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states |website=National Institute on Drug Abuse |access-date=10 December 2018 |language=en |archive-url=https://web.archive.org/web/20181210110910/https://www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states |archive-date=10 December 2018 |url-status=live }}</ref> When people die from overdosing on a drug, the drug is usually an opioid and often heroin.<ref name="WDR2016">{{cite book|title=World Drug Report 2016|chapter-url=http://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf|access-date=1 August 2016|chapter=Statistical tables|isbn=978-92-1-057862-2|location=Vienna, Austria|date=May 2016|page=xii, 18, 32|url-status=live|archive-url=https://web.archive.org/web/20160809143704/http://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf|archive-date=9 August 2016| author = United Nations Office on Drugs and Crime }}</ref><ref>{{cite web | vauthors = Valencia M |title=Record 29 million people drug-dependent worldwide; heroin use up sharply – UN report |url=https://www.un.org/sustainabledevelopment/blog/2016/06/record-29-million-people-drug-dependent-worldwide-heroin-use-up-sharply-un-report/ |website=United Nations Sustainable Development |access-date=10 December 2018 |date=23 June 2016 |archive-url=https://web.archive.org/web/20190414091050/https://www.un.org/sustainabledevelopment/blog/2016/06/record-29-million-people-drug-dependent-worldwide-heroin-use-up-sharply-un-report/ |archive-date=14 April 2019 |url-status=live }}</ref> |
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<!--IMAGE-->[[File:Long-term effects of heroin.png|thumb|Long-term effects of intravenous usage, including the effects of the contaminants common in illegal heroin and contaminated needles.<ref name=ONDCP/>]] |
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<!--IMAGE-->[[File:Short-term effects of heroin.png|thumb|Short-term effects of usage<ref name=ONDCP>[http://www.whitehousedrugpolicy.gov/drugfact/heroin/heroin_ff.html#healtheffects Office of National Drug Control Policy (ONDCP): Heroin Facts & Figures]. Retrieved 11 February 2009.</ref>]] |
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The BBC reported that "Worldwide, the [[UN]] estimates there are more than 50 million regular users of heroin, cocaine and synthetic drugs."<ref>"[http://news.bbc.co.uk/hi/english/static/in_depth/world/2000/drugs_trade/default.stm Drug Trade]". BBC News.</ref> Global users of diacetylmorphine are estimated at between 15.16 million and 21.13 million people aged 15–64.<ref>"[http://www.cbc.ca/health/story/2009/06/24/f-unitednations-drug-report-canada-ecstasy.html Illegal drugs: Canada's growing international market]". CBC News. June 24, 2009.</ref> |
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Heroin was first made by [[Charles Romley Alder Wright|C. R. Alder Wright]] in 1874 from morphine, a natural product of the [[Papaver somniferum|opium poppy]].<ref>{{cite book|title=A Century of International Drug Control|date=2010|publisher=United Nations Publications|isbn=978-92-1-148245-4|page=49|url=https://books.google.com/books?id=uRQiAVTTiYwC&pg=PT50|language=en|url-status=live|archive-url=https://web.archive.org/web/20170910234542/https://books.google.com/books?id=uRQiAVTTiYwC&pg=PT50|archive-date=10 September 2017}}</ref> Internationally, heroin is controlled under Schedules I and IV of the [[Single Convention on Narcotic Drugs]],<ref>{{cite web|date=December 2004 |url=http://www.incb.org/pdf/e/list/46thedition.pdf |title=Yellow List: List of Narcotic Drugs Under International Control |publisher=International Narcotics Control Board |access-date=5 May 2006 |archive-url=https://web.archive.org/web/20120510002957/http://www.incb.org/pdf/e/list/46thedition.pdf |archive-date=10 May 2012 }} Referring URL = {{cite web|url=http://www.incb.org/incb/yellow_list.html |title=Yellow List |access-date=21 June 2006 |url-status=dead |archive-url=https://web.archive.org/web/20060621035248/http://www.incb.org/incb/yellow_list.html |archive-date=21 June 2006}}</ref> and it is generally illegal to make, possess, or sell without a license.<ref>{{cite book| vauthors = Lyman MD |title=Drugs in Society: Causes, Concepts, and Control|date=2013|publisher=Routledge|isbn=978-0-12-407167-4|page=45|url=https://books.google.com/books?id=bRU4AAAAQBAJ&pg=PA45|language=en|url-status=live|archive-url=https://web.archive.org/web/20170910234542/https://books.google.com/books?id=bRU4AAAAQBAJ&pg=PA45|archive-date=10 September 2017}}</ref> About 448 tons of heroin were made in 2016.<ref name="WDR2017Part3">{{cite book |title=World Drug Report 2017 Part 3 |date=May 2017 |publisher=United Nations |isbn=978-92-1-148294-2 |pages=14, 24 |url=http://www.unodc.org/wdr2017/field/Booklet_3_Plantbased_drugs.pdf |access-date=10 December 2018 |archive-url=https://web.archive.org/web/20180727180346/https://www.unodc.org/wdr2017/field/Booklet_3_Plantbased_drugs.pdf |archive-date=27 July 2018 |url-status=live }}</ref> In 2015, Afghanistan produced about 66% of the world's opium.<ref name="WDR2016"/> Illegal heroin is often mixed with other substances such as sugar, [[starch]], [[caffeine]], [[quinine]], or other opioids like [[fentanyl]].<ref name=Drugs2014/><ref>{{Cite book|title=CUT: a guide to adulterants, bulking agents and other contaminants found in illicit drugs|date=2010 | vauthors = Cole C | location = Liverpool | publisher = Centre for Public Health. Faculty of Health and Applied Social Sciences, John Moores University. |isbn=978-1-907441-47-9 |oclc=650080999}}</ref> |
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==Uses== |
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===Recreational=== |
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Under the chemical name diamorphine, diacetylmorphine is [[Prescription medicine|prescribed]] as a strong [[analgesic]] in the [[United Kingdom]], where it is given via [[subcutaneous]], [[intramuscular]], [[intrathecal]] or [[intravenous]] route. Its use includes treatment for acute pain, such as in severe [[physical trauma]], [[myocardial infarction]], post-surgical pain, and chronic pain, including end-stage [[cancer]] and other [[terminal illness]]es. In other countries it is more common to use [[morphine]] or other strong [[opioids]] in these situations. In 2004, the [[National Institute for Health and Clinical Excellence]] produced guidance on the management of [[caesarian section]] which recommended the use of intrathecal or epidural diacetylmorphine for post-operative pain relief.<ref>"[http://www.nice.org.uk/nicemedia/live/10940/29331/29331.pdf]" NICE Clinical Guideline 13: Caesarian section, p20.</ref> |
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[[Bayer]]'s original trade name of heroin is typically used in non-medical settings. It is used as a recreational drug for the [[Euphoria (emotion)|euphoria]] it induces. [[Anthropology|Anthropologist]] Michael Agar once described heroin as "the perfect whatever drug."<ref name="agar">{{cite web | vauthors = Agar M | title = Dope Double Agent: The Naked Emperor on Drugs | url = http://www.americanethnography.com/article_sql.php?id=95 | access-date = 22 October 2009 | quote = What a great New York drug heroin was, I thought. As any city, but more than most, New York is an information overload, a constant perceptual tornado that surrounds you most places you walk on the streets. Heroin is the audio-visual technology that helps manage that overload by dampening it in general and allowing a focus on some part of it that the human perceptual equipment was, in fact, designed to handle. | url-status = live | archive-url = https://web.archive.org/web/20091117152041/http://www.americanethnography.com/article_sql.php?id=95 | archive-date = 17 November 2009}}</ref> [[Physiological tolerance|Tolerance]] develops quickly, and increased doses are needed in order to achieve the same effects. Its popularity with recreational drug users, compared to [[morphine]], reportedly stems from its perceived different effects.<ref>{{cite journal|author1-link=Wolfgang Tschacher | vauthors = Tschacher W, Haemmig R, Jacobshagen N | title = Time series modeling of heroin and morphine drug action | journal = Psychopharmacology | volume = 165 | issue = 2 | pages = 188–93 | date = January 2003 | pmid = 12404073 | doi = 10.1007/s00213-002-1271-3 | s2cid = 33612363 | url = https://boris.unibe.ch/21515/ }}</ref> |
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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]], [[fentanyl]], [[oxycodone]], and [[pethidine]] (meperidine), former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to misuse and causing dependence. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids.<ref name="martin and fraser">{{cite journal | vauthors = Martin WR, Fraser HF | title = A comparative study of physiological and subjective effects of heroin and morphine administered intravenously in postaddicts | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 133 | pages = 388–99 | date = September 1961 | pmid = 13767429 | url = http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=13767429 }}</ref> |
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In 2005, there was a shortage of diacetylmorphine in the UK, because of a problem at the main UK manufacturers.<ref>{{cite web|url=http://www.ukhra.org/statements/diamorphine_shortage_uk.html |title=Diamorphine shortage: UKHRA statement on the UK diamorphine shortage |publisher=Ukhra.org |date=2005-09-14 |accessdate=2010-10-20}}</ref> Because of this, many hospitals changed to using [[morphine]] 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]]). |
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===Medical uses=== |
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Diacetylmorphine continues to be widely used in [[palliative care]] in the [[United Kingdom]], where it is commonly given by the [[subcutaneous]] route, often via a [[syringe driver]], if patients cannot easily swallow [[morphine|oral morphine solution]]. The advantage of diacetylmorphine over [[morphine]] is that diacetylmorphine is more [[lipophilicity|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]]. |
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In the [[United States]], heroin is not accepted as medically useful.<ref name=Drugs2014/> |
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[[File:Drug store sign for products Heroin and Aspirin before US Heroin ban 1924.jpg|thumb|upright|Advertising sign from Bayer for use in US drug stores, dating from before the [[Federal Law|federal prohibition]] of heroin in 1924]] |
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Under the generic name diamorphine, heroin is [[prescription medicine|prescribed]] as a strong [[analgesic|pain medication]] in the [[United Kingdom]], where it is administered via [[Tablet (pharmacy)|oral]], [[Subcutaneous injection|subcutaneous]], [[intramuscular]], [[intrathecal]], [[intranasal]] or intravenous routes. It may be prescribed for the treatment of acute pain, such as in severe [[physical trauma]], [[myocardial infarction]], post-[[surgery|surgical]] pain and [[chronic pain]], including end-stage [[terminal illness]]es. In other countries it is more common to use morphine or other strong opioids in these situations. In 2004, the [[National Institute for Health and Clinical Excellence]] produced guidance on the management of [[caesarean section]], which recommended the use of intrathecal or [[epidural]] diamorphine for post-operative [[pain relief]]. For women who have had intrathecal opioids, there should be a minimum hourly observation of respiratory rate, sedation and pain scores for at least 12 hours for diamorphine and 24 hours for morphine. Women should be offered diamorphine (0.3–0.4 mg intrathecally) for intra- and postoperative analgesia because it reduces the need for supplemental analgesia after a caesarean section. Epidural diamorphine (2.5–5 mg) is a suitable alternative.<ref>{{cite web |url=http://www.nice.org.uk/guidance/cg132/chapter/1-recommendations#procedural-aspects-of-cs |title=National Institute for Health and Clinical Excellence (2011) Caesarean section.NICE Guideline (CG132) |date=23 November 2011 |access-date=28 October 2015 |url-status=live |archive-url=https://web.archive.org/web/20151025180200/http://www.nice.org.uk/guidance/cg132/chapter/1-recommendations#procedural-aspects-of-cs |archive-date=25 October 2015}}</ref> |
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Diamorphine continues to be widely used in [[palliative care]] in the UK, where it is commonly given by the [[Subcutaneous injection|subcutaneous]] route, often via a [[syringe driver]] if patients cannot easily swallow [[morphine|morphine solution]]. The advantage of diamorphine over morphine is that diamorphine is more [[lipophilicity|fat soluble]] and therefore more potent by injection, so smaller doses of it are needed for the same effect on pain. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary for palliative care. |
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The medical use of diacetylmorphine (in common with other strong [[opioids]] such as [[morphine]], [[fentanyl]] and [[oxycodone]]) is controlled in the [[United Kingdom]] by the [[Misuse of Drugs Act 1971]]. In the UK, it is a class A [[controlled drug]]. Registers of its use are required to be kept in hospitals. |
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It is also used in the palliative management of [[bone fractures]] and other trauma, especially in children. In the trauma context, it is primarily given by nose in hospital; although a prepared nasal spray is available.<ref>{{cite web |title=Ayendi 720microgram/actuation Nasal Spray – Summary of Product Characteristics (SmPC) – (emc) |url=https://www.medicines.org.uk/emc/product/5139/smpc |website=www.medicines.org.uk |access-date=29 December 2019 |archive-url=https://web.archive.org/web/20191229031102/https://www.medicines.org.uk/emc/product/5139/smpc |archive-date=29 December 2019 |url-status=live }}</ref> It has traditionally been made by the attending physician, generally from the same "dry" ampoules as used for injection. In children, Ayendi nasal spray is available at 720 micrograms and 1600 micrograms per 50 microlitres actuation of the spray, which may be preferable as a non-invasive alternative in pediatric care, avoiding the fear of injection in children.<ref name="DIAMORPHINE HYDROCHLORIDE (medicinal forms)">{{cite web |title=BNFc is only available in the UK |url=https://bnfc.nice.org.uk/medicinal-forms/diamorphine-hydrochloride.html |website=NICE |publisher=NICE – national institute for health and care excellence |access-date=3 July 2020}}</ref> |
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Diacetylmorphine is also used as a [[heroin maintenance|maintenance drug]] to treat addicts. Though this is somewhat controversial among proponents of a [[zero tolerance]] drug policy, it has proven superior to [[methadone]] in improving the social and health situation of addicts.<ref>{{cite journal |last1=Haasen |first1=C. |last2=Verthein |first2=U. |last3=Degkwitz |first3=P. |last4=Berger |first4=J. |last5=Krausz |first5=M. |last6=Naber |first6=D. |title=Heroin-assisted treatment for opioid dependence: Randomised controlled trial |journal=The British Journal of Psychiatry |volume=191 |pages=55–62 |year=2007 |pmid=17602126 |doi=10.1192/bjp.bp.106.026112}}</ref> See: [[#Heroin prescription for addicts|Heroin prescription for addicts]] |
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====Maintenance therapy==== |
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{{Main|Heroin-assisted treatment}} |
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Diacetylmorphine, in non-medical settings called heroin, is used as a recreational drug for the [[Wiktionary:transcendent|transcendent]] [[Wiktionary:relaxation|relaxation]] and intense [[Euphoria (emotion)|euphoria]] it induces. Anthropologist [[Michael Agar]] once described heroin as "the perfect whatever drug."<ref name="agar">{{cite book |
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A number of European countries prescribe heroin for treatment of [[heroin addiction]].<ref>{{cite journal | vauthors = Lintzeris N | title = Prescription of heroin for the management of heroin dependence: current status | journal = CNS Drugs | volume = 23 | issue = 6 | pages = 463–76 | date = 2009 | pmid = 19480466 | doi = 10.2165/00023210-200923060-00002 | s2cid = 11018732 }}</ref> The initial Swiss HAT ([[heroin-assisted treatment]]) trial ("PROVE" study) was conducted as a prospective cohort study with some 1,000 participants in 18 treatment centers between 1994 and 1996, at the end of 2004, 1,200 patients were enrolled in HAT in 23 treatment centers across Switzerland.<ref>{{cite book |doi=10.1159/000062984 |chapter=Preliminary Pages |title=Prescriptions of Narcotics for Heroin Addicts |series=Medical Prescription of Narcotics |year=1999 |volume=1 |publisher=KARGER |isbn=3-8055-6791-X }}</ref><ref>{{cite journal | vauthors = Fischer B, Oviedo-Joekes E, Blanken P, Haasen C, Rehm J, Schechter MT, Strang J, van den Brink W | title = Heroin-assisted treatment (HAT) a decade later: a brief update on science and politics | journal = Journal of Urban Health | volume = 84 | issue = 4 | pages = 552–62 | date = July 2007 | pmid = 17562183 | pmc = 2219559 | doi = 10.1007/s11524-007-9198-y }}</ref> Diamorphine may be used as a [[heroin maintenance|maintenance drug]] to assist the treatment of opiate addiction, normally in long-term chronic intravenous (IV) heroin users. It is only prescribed following exhaustive efforts at treatment via other means. It is sometimes thought that heroin users can walk into a clinic and walk out with a prescription, but the process takes many weeks before a prescription for diamorphine is issued. Though this is somewhat controversial among proponents of a [[zero-tolerance]] [[drug policy]], it has proven superior to [[methadone]] in improving the social and health situations of addicts.<ref name="haasen">{{cite journal | vauthors = Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D | title = Heroin-assisted treatment for opioid dependence: randomised controlled trial | journal = The British Journal of Psychiatry | volume = 191 | pages = 55–62 | date = July 2007 | pmid = 17602126 | doi = 10.1192/bjp.bp.106.026112 | doi-access = free }}</ref> |
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| last = Agar |
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| first = Michael |
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| title = Dope Double Agent: The Naked Emperor on Drugs |
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| publisher = Lulu.com |
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| year = 2007 |
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| isbn = 1411681037 |
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| url = http://www.americanethnography.com/article_sql.php?id=95 |
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| accessdate = 2009-10-22 |
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| quote = What a great New York drug heroin was, I thought. Like any city, but more than most, New York is an information overload, a constant perceptual tornado that surrounds you most places you walk on the streets. Heroin is the audio-visual technology that helps manage that overload by dampening it in general and allowing a focus on some part of it that the human perceptual equipment was, in fact, designed to handle. }}</ref> [[Physiological tolerance|Tolerance]] quickly develops, and users need more of the drug to achieve the same effects. Its popularity with recreational drug users, compared to [[morphine]], reportedly stems from its perceived different effects.<ref>{{cite journal |pages=188–93 |doi=10.1007/s00213-002-1271-3}}</ref> In particular, users report an intense [[Rush (psychology)|rush]], an [[Wiktionary:acute|acute]] [[Wiktionary:transcendent|transcendent]] state of [[euphoria]], 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]]. 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.<ref name="martin and fraser">{{cite journal |author=Martin WR, Fraser HF |title=A comparative study of physiological and subjective effects of heroin and morphine administered intravenously in postaddicts |journal=Journal of Pharmacology and Experimental Therapeutics |volume=133 |issue= |pages=388–99 |year=1961 |month=September |pmid=13767429 |doi= |url=http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=13767429}}</ref> |
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The UK Department of Health's [[Rolleston Committee]] Report<ref>{{cite web|title=Rolleston Report|url=http://www.drugtext.org/Table/Rolleston-Report/|publisher=Departmental Commission on Morphine and Heroin Addiction, United Kingdom|access-date=28 January 2011|year=1926|url-status=live|archive-url=https://web.archive.org/web/20110417125310/http://www.drugtext.org/Table/Rolleston-Report/|archive-date=17 April 2011}}</ref> in 1926 established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing. In 1964, the [[Brain Committee]] recommended that only selected approved doctors working at approved specialized centres be allowed to prescribe diamorphine and [[cocaine]] to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently, only a small number of users in the UK are prescribed diamorphine.<ref>{{cite web| vauthors = Goldacre B | year =1998| url =http://www.badscience.net/?p=327| title =Methadone and Heroin: An Exercise in Medical Scepticism| access-date =18 December 2006| url-status=live| archive-url =https://web.archive.org/web/20070304065723/http://www.badscience.net/?p=327| archive-date =4 March 2007}}</ref> |
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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]], [[fentanyl]], [[oxycodone]], and [[pethidine]]/[[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.<ref name="martin and fraser" /> |
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In 1994, Switzerland began a trial [[heroin-assisted treatment|diamorphine maintenance]] program for users that had failed multiple withdrawal programs. The aim of this program was to maintain the health of the user by avoiding medical problems stemming from the illicit use of diamorphine. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000, based on the apparent success of the program. The trials proved diamorphine maintenance to be superior to other forms of treatment in improving the social and health situation for this group of patients.<ref name="haasen"/> It has also been shown to save money, despite high treatment expenses, as it significantly reduces costs incurred by trials, incarceration, health interventions and [[:wikt:delinquency|delinquency]].<ref>{{cite web|url=https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |title=Heroin Assisted Treatment for Opiate Addicts – The Swiss Experience |publisher=Parl.gc.ca |date=31 March 1995 |access-date=12 October 2013 |archive-url=https://web.archive.org/web/20100120061027/https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |archive-date=20 January 2010}}</ref> Patients appear twice daily at a treatment center, where they inject their dose of diamorphine under the supervision of medical staff. They are required to contribute about 450 Swiss francs per month to the treatment costs.<ref>{{cite web| vauthors = Nadelmann E | date =10 July 1995| url =http://www.drugpolicy.org/library/tlcnr.cfm| title =Switzerland's Heroin Experiment| publisher =Drug Policy Alliance| access-date =22 October 2006| archive-url=https://web.archive.org/web/20041129115253/http://www.drugpolicy.org/library/tlcnr.cfm| archive-date=29 November 2004}}</ref> A [[Swiss referendum, November 2008|national referendum in November 2008]] showed 68% of voters supported the plan,<ref>{{cite news |title=Swiss approve prescription heroin |url=http://news.bbc.co.uk/2/hi/europe/7757050.stm |work=BBC News Online |date=30 November 2008 |access-date=30 November 2008 |url-status=live |archive-url=https://web.archive.org/web/20081130052931/http://news.bbc.co.uk/2/hi/europe/7757050.stm |archive-date=30 November 2008}}</ref> introducing diamorphine prescription into federal law. The previous trials were based on time-limited executive ordinances. The success of the Swiss trials led German, Dutch,<ref>{{cite news| url =http://news.bbc.co.uk/2/hi/health/4607233.stm| title =Heroin prescription 'cuts costs'| work =BBC News| access-date =22 October 2006| date =5 June 2005| url-status=live| archive-url =https://web.archive.org/web/20060628053230/http://news.bbc.co.uk/2/hi/health/4607233.stm| archive-date =28 June 2006}}</ref> and Canadian<ref>{{cite web| url =http://www.naomistudy.ca/| title =About the study| publisher =North American Opiate Medication Initiative| access-date =22 October 2006| url-status=dead| archive-url =https://web.archive.org/web/20061104035153/http://www.naomistudy.ca/| archive-date =4 November 2006}}</ref> cities to try out their own diamorphine prescription programs.<ref>{{cite journal | vauthors = Nordt C, Stohler R | title = Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis | journal = Lancet | volume = 367 | issue = 9525 | pages = 1830–4 | date = June 2006 | pmid = 16753485 | doi = 10.1016/S0140-6736(06)68804-1 | url = http://www.cesda.net/downloads/lancet1.pdf | url-status = dead | s2cid = 46366844 | citeseerx = 10.1.1.190.1876 | archive-url = https://web.archive.org/web/20100203001705/http://www.cesda.net/downloads/lancet1.pdf | archive-date = 3 February 2010 }}</ref> Some Australian cities (such as Sydney) have instituted legal diamorphine [[Safe injection site|supervised injecting centers]], in line with other wider [[harm minimization]] programs. |
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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.<ref name=righteous/> 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.<ref name=orgcrime>{{cite book|last=Abadinsky|first=Howard|title=Organized Crime|year=2007|publisher=Wadsworth}}</ref> |
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Since January 2009, Denmark has prescribed diamorphine to a few addicts who have tried methadone and [[buprenorphine]] without success.<ref> |
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===Prescription for addicts=== |
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{{cite web |date=November 2008 | url=http://www.dn.se/DNet/jsp/polopoly.jsp?d=3561&a=857991 | title=Danmark redo för skattebetalt heroin | trans-title = Denmark ready for tax-paid heroin | language=sv | access-date=30 November 2008 |archive-url=https://web.archive.org/web/20081203104630/http://www.dn.se/DNet/jsp/polopoly.jsp?d=3561&a=857991 |archive-date=3 December 2008}}</ref> Beginning in February 2010, addicts in [[Copenhagen]] and [[Odense]] became eligible to receive free diamorphine. Later in 2010, other cities including [[Århus]] and [[Esbjerg]] joined the scheme. It was estimated that around 230 addicts would be able to receive free diamorphine.<ref>{{cite web | date=January 2010 | url=http://www.information.dk/221689 | title=Gratis heroin klar til danske narkomaner | trans-title = Free heroin ready for Danish drug addicts | publisher=Information | language=da | access-date=14 February 2010 | url-status=live | archive-url=https://web.archive.org/web/20110430110231/http://www.information.dk/221689 | archive-date=30 April 2011}}</ref> |
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{{Main|Heroin assisted treatment}} |
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The UK Department of Health's Rolleston Committee Report<ref>{{cite web|title=Rolleston Report|url=http://www.drugtext.org/Table/Rolleston-Report/|publisher=Departmental Commission on Morphine and Heroin Addiction, United Kingdom|accessdate=28 January 2011|year=1926}}</ref> 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.<ref>[http://www.rns.se/swedish-addiction.asp Nils Bejerot: The Swedish Addiction Epidemic in global perspective]{{dead link|date=October 2010}}</ref> In 1964 the [[Brain Committee]] recommended that only selected approved doctors working at approved specialised centres be allowed to prescribe diacetylmorphine and benzoylmethylecgonine ([[cocaine]]) to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of [[methadone]], until now only a small number of users in the UK are prescribed diacetylmorphine.<ref>{{cite web |
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| last =Goldacre |
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| first =Ben |
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| year =1998 |
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| url =http://www.badscience.net/?p=327 |
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| title =Methadone and Heroin: An Exercise in Medical Scepticism |
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| accessdate =2006-12-18 |
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}}</ref> |
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However, Danish addicts would only be able to inject heroin according to the policy set by [[Danish National Board of Health]].<ref>{{cite web | vauthors = Dahlin U | date=February 2009 | url=http://www.information.dk/182783 | title=Heroin-behandling bliver kun i kanyler | trans-title = Heroin treatment stays only in needles | publisher=Information | language=da | access-date=14 February 2010 | url-status=live | archive-url=https://web.archive.org/web/20090220152740/http://www.information.dk/182783 | archive-date=20 February 2009}}</ref> Of the estimated 1500 drug users who did not benefit from the then-current oral substitution treatment, approximately 900 would not be in the target group for treatment with injectable diamorphine, either because of "massive multiple drug abuse of non-opioids" or "not wanting treatment with injectable diamorphine".<ref>{{cite report | date=October 2007 | url=http://sundhedsstyrelsen.dk/Udgivelser/2008/Prescription%20of%20injectable%20heroin%20for%20drug%20users.aspx | title=Prescription of injectable heroin for drug users | publisher=Danish National Board of Health | access-date=14 February 2010 | archive-url=https://web.archive.org/web/20110429192839/http://sundhedsstyrelsen.dk/Udgivelser/2008/Prescription%20of%20injectable%20heroin%20for%20drug%20users.aspx | archive-date=29 April 2011 | url-status=live }}</ref>{{Update inline|date=January 2015}} |
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In 1994 [[Switzerland]] 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]] 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]]s per day.<ref>{{cite web |
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| last =Nadelmann |
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| first =Ethan |
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| year =1995 |
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| month =July 10 |
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| url =http://www.drugpolicy.org/library%5Ctlcnr.cfm |
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| title =Switzerland's Heroin Experiment |
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| publisher =Drug Policy Alliance |
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| accessdate =2006-10-22 |
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}}</ref> A [[Swiss referendum, November 2008|national referendum in November 2008]] showed 68% of voters supported the plan,<ref>{{cite news |title=Swiss approve prescription heroin |curly=y |url=http://news.bbc.co.uk/2/hi/europe/7757050.stm |work= |publisher=BBC News Online |date=30 November 2008 |accessdate=30 November 2008 }}</ref> introducing diacetylmorphine prescription into federal law. The trials before were based on time-limited executive ordinances. |
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In July 2009, the German [[Bundestag]] passed a law allowing diamorphine prescription as a standard treatment for addicts; a large-scale trial of diamorphine prescription had been authorized in the country in 2002.<ref>{{cite web| date = 28 May 2009| url = http://www.bmg.bund.de/ministerium/presse/pressemitteilungen/2009-02/durchbruch-fuer-die-behandlung-von-schwerstopiatabhaengigen.html| title = Durchbruch für die Behandlung von Schwerstopiatabhängigen|trans-title=Breakthrough for the treatment of heavily addicted opiate users| language = de| publisher = Bundesministerium für Gesundheit (German ministry of health)| access-date = 28 April 2014| url-status=live| archive-url = https://web.archive.org/web/20140429045558/http://www.bmg.bund.de/ministerium/presse/pressemitteilungen/2009-02/durchbruch-fuer-die-behandlung-von-schwerstopiatabhaengigen.html| archive-date = 29 April 2014}}</ref> |
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The success of the Swiss trials led German, Dutch,<ref>{{cite news |
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| month =June 5 |
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| url =http://news.bbc.co.uk/2/hi/health/4607233.stm |
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| title =Heroin prescription 'cuts costs' |
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| publisher =BBC News |
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| accessdate =2006-10-22 |
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| date=2005-06-05}}</ref> and Canadian<ref>{{cite web |
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| url =http://www.naomistudy.ca/ |
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| title =About the study |
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| publisher =North American Opiate Medication Initiative |
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| accessdate =2006-10-22 |
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}}</ref> cities to try out their own diacetylmorphine prescription programs.<ref>{{cite journal |last1=Nordt |first1=C |last2=Stohler |first2=R |title=Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis |journal=The Lancet |volume=367 |pages=1830–4 |year=2006 |doi=10.1016/S0140-6736(06)68804-1 |pmid=16753485 |issue=9525}}</ref> Some Australian cities (such as Sydney) have instituted legal diacetylmorphine [[Safe injection site|supervised injecting centers]], in line with other wider [[harm minimization]] programs. |
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On 26 August 2016, [[Health Canada]] issued regulations amending prior regulations it had issued under the [[Controlled Drugs and Substances Act]]; the "New Classes of Practitioners Regulations", the "Narcotic Control Regulations", and the "Food and Drug Regulations", to allow doctors to prescribe diamorphine to people who have a severe opioid addiction who have not responded to other treatments.<ref name="gazette2016">{{cite web| date=7 September 2016| url=http://www.gazette.gc.ca/rp-pr/p2/2016/2016-09-07/html/sor-dors239-eng.php| title=Regulations Amending Certain Regulations Made Under the Controlled Drugs and Substances Act (Access to Diacetylmorphine for Emergency Treatment)| publisher=Canada Gazette Directorate| access-date=19 September 2016| url-status=live| archive-url=https://web.archive.org/web/20160918215019/http://www.gazette.gc.ca/rp-pr/p2/2016/2016-09-07/html/sor-dors239-eng.php| archive-date=18 September 2016}}</ref><ref>{{cite web| date =14 September 2016| url =http://www.cnn.com/2016/09/14/health/prescription-heroin-canada/index.html| title =Prescription heroin gets green light in Canada| publisher =CNN| access-date =19 September 2016| url-status=live| archive-url =https://web.archive.org/web/20160918230920/http://www.cnn.com/2016/09/14/health/prescription-heroin-canada/index.html| archive-date =18 September 2016}}</ref> The prescription heroin can be accessed by doctors through [[Health Canada]]'s Special Access Programme (SAP) for "emergency access to drugs for patients with serious or life-threatening conditions when conventional treatments have failed, are unsuitable, or are unavailable."<ref name="gazette2016" /> |
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Since January 2009 [[Denmark]] has prescribed diacetylmorphine to a few addicts that have tried [[methadone]] and [[subutex]] without success.<ref> |
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{{cite web | year=2008 | month=11 | url=http://www.dn.se/DNet/jsp/polopoly.jsp?d=3561&a=857991 | title=Danmark redo för skattebetalt heroin | language=swedish | accessdate=2008-11-30}} |
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</ref> Beginning in February 2010, addicts in [[Copenhagen]] and [[Odense]] will be eligible to receive free diacetylmorphine. Later in 2010 other cities including [[Århus]] and [[Esbjerg]] will join the scheme. In total, around 230 addicts will be able to receive free diacetylmorphine.<ref>{{cite web | year=2010 | month=01 | url=http://www.information.dk/221689 | title=Gratis heroin klar til danske narkomaner | publisher=Information | language=danish | accessdate=2010-02-14 }}</ref> |
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However, Danish addicts will only be able to inject heroin according to the policy set by Danish National Board of Health.<ref>{{cite web | year=2009 | month=02 | url=http://www.information.dk/182783 | title=Heroin-behandling bliver kun i kanyler | publisher=Information | language=danish | accessdate=2010-02-14 }}</ref> 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".<ref>{{cite journal | year=2007 | month=10 | url=http://sundhedsstyrelsen.dk/Udgivelser/2008/Prescription%20of%20injectable%20heroin%20for%20drug%20users.aspx | title=Prescription of injectable heroin for drug users | publisher=Danish National Boad of Health | accessdate=2010-02-14 }}</ref> |
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==Routes of administration== |
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In July 2009, the German [[Bundestag]] 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.<ref>{{cite web |
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{| class="wikitable floatright" style="width: 15em" |
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| year = 2009 |
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|- |
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| month = May 28 |
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|'''Recreational uses:''' |
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| url =http://www.bmg.bund.de/cln_091/nn_1195910/SharedDocs/Pressemitteilungen/DE/Drogenbeauftragte/2009/09-05-28_20Diamorphin_20Durchbruch.html |
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* [[Euphoria (emotion)|Euphoria]] |
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| title =Durchbruch für die Behandlung von Schwerstopiatabhängigen ("Breakthrough for the treatment of heavily addicted opiate users", German) |
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'''Medicinal uses:''' |
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| publisher = Bundesministerium für Gesundheit (German ministry of health) |
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* [[Analgesic|Pain medication]] |
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| accessdate =2009-08-23 |
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* [[Cough suppressant]] |
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}}</ref> |
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* Anti-[[diarrhea]]l |
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|- |
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|'''[[Contraindication]]s:''' |
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* [[Ethanol]] ([[alcoholic beverage]]s), [[isopropanol]], [[2M2B]] |
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* [[Barbiturate]]s and [[benzodiazepines]] |
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* [[Stimulant]]s |
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* Other [[opioid]]s |
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|- |
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|'''''Central nervous system:''''' |
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* [[Drowsiness]] |
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* [[Disorientation]] |
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* [[Delirium]] |
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'''''Neurological:''''' |
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===Detection in biological fluids=== |
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* [[Analgesia]] |
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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.<ref>{{cite book |first=R. |last=Baselt |title=Disposition of Toxic Drugs and Chemicals in Man |edition=9th |publisher=Biomedical Publications |location=Seal Beach, CA |year=2011 |pages=793–7 |isbn=978-0-9626523-8-7}}</ref> |
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* [[drug tolerance|Tolerance]] |
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* [[Drug addiction|Addiction]] |
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* [[Drug dependence|Dependence]] |
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'''''Psychological:''''' |
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==Adverse effects== |
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* [[Anxiolysis]] |
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*[[Intravenous]] use of heroin (and any other substance) with non-sterile needles and syringes or other related equipment leads to several serious risks: |
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* [[Confusion]] |
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**The risk of contracting blood-borne [[pathogens]] such as [[HIV]] and [[hepatitis]] |
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* [[Euphoria (emotion)|Euphoria]] |
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**The risk of contracting bacterial or fungal [[endocarditis]] and possibly venous sclerosis |
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* |
* [[Somnolence]] |
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*Poisoning from [[contaminants]] added to "[[Cutting agent|cut]]" or dilute heroin |
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*Chronic [[constipation]] |
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*[[Substance dependence|Addiction]] |
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*[[drug tolerance|Tolerance]] |
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*[[Physical dependence]] can result from prolonged use of all opioids, resulting in withdrawal symptoms on cessation of use |
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*Decreased kidney function (although it is not currently known if this is because of adulterants or infectious diseases)<ref>{{cite journal |last1=Dettmeyer |pages=19–28 |first1=Reinhard B |last2=Preuß |first2=Johanna |last3=Wollersen |issue=1 |first3=Heike |last4=Madea |first4=Burkhard |volume=4 |year=2005 |title=Heroin-associated nephropathy |pmid=15709895 |journal=Expert Opinion on Drug Safety |doi=10.1517/14740338.4.1.19 |url=}}</ref> |
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'''''Cardiovascular & Respiratory:''''' |
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Many countries and local governments have begun funding programs that supply [[sterilization (microbiology)|sterile]] 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. |
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* [[Bradycardia]] |
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* [[Hypotension]] |
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* [[Hypoventilation]] |
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* [[Shallow breathing]] |
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* [[Hypoventilation|Respiratory depression]] |
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'''''Gastrointestinal:''''' |
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Anthropologists [[Philippe Bourgois]] 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.<ref name=righteous>{{cite book | last = Bourgois | first = Philippe | coauthors = Jeff Schonberg | title = Righteous Dopefiend | url = http://www.americanethnography.com/article.php?id=92 | accessdate = 2009-10-13 | year = 2009 | publisher = University of California Press | location = Berkeley and Los Angeles | isbn = 0520254988}}</ref> |
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* [[Nausea]] |
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* [[wikt:protracted|Protracted]] vomiting |
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* [[Constipation]] |
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* [[Dyspepsia]] (heartburn) |
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'''''Musculoskeletal:''''' |
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Heroin [[overdose]] is usually treated with an opioid [[Receptor antagonist|antagonist]],{{Citation needed|date=June 2011}} such as [[naloxone]] ([[Narcan]]), or [[naltrexone]], 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]] symptoms. The [[half-life]] of [[naloxone]] 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. |
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* [[Analgesia]] |
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* [[Ataxia]] |
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* [[Muscle spasticity]] |
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'''''Skin:''''' |
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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]] 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]] drugs like alcohol or [[benzodiazepine]]s.<ref>{{cite journal |last1=Darke |first1=Shane |last2=Zador |first2=Deborah |title=Fatal heroin 'overdose': a review |journal=Addiction |volume=91 |issue=12 |pages=1765–1772 |year=1996 |pmid=8997759 |doi=10.1046/j.1360-0443.1996.911217652.x}}</ref> 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.<ref>{{cite web|url=http://lincoln.pps.k12.or.us/lscheffler/ToxicSubstances%20in%20water.htm |title=Toxic Substances in water |publisher=Lincoln.pps.k12.or.us |date= |accessdate=2010-10-20}}</ref> 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. |
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* Itching |
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* Flushing/Rash |
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'''''Miscellaneous:''''' |
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It has been speculated that an unknown portion of heroin related deaths are the result of an overdose or allergic reaction to [[quinine]], which may sometimes be used as a cutting agent.<ref>[http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm The "heroin overdose" mystery and other occupational hazards of addiction], Schaffer Library of Drug Policy</ref> |
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* Dry mouth ([[xerostomia]]) |
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* [[Miosis]] (pupil constriction) |
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* [[Urinary retention]] |
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|} |
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The onset of heroin's effects depends upon the [[route of administration]]. Smoking is the fastest route of drug administration, although [[intravenous injection]] results in a quicker rise in blood concentration.<ref>{{cite journal | vauthors = Budman SH, Grimes Serrano JM, Butler SF | title = Can abuse deterrent formulations make a difference? Expectation and speculation | journal = Harm Reduction Journal | volume = 6 | issue = 8 | pages = 8 | date = May 2009 | pmid = 19480676 | pmc = 2694768 | doi = 10.1186/1477-7517-6-8 | doi-access = free }}</ref> These are followed by [[suppository]] (anal or vaginal insertion), [[Insufflation (medicine)|insufflation]] (snorting), and [[ingestion]] (swallowing). |
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A 2002 study suggests that a fast onset of action increases the reinforcing effects of addictive drugs. Ingestion does not produce a [[Rush (psychology)|rush]] as a 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 the potential risk for [[psychological dependence]]/[[addiction]].<ref>{{cite journal | vauthors = Winger G, Hursh SR, Casey KL, Woods JH | title = Relative reinforcing strength of three N-methyl-D-aspartate antagonists with different onsets of action | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 301 | issue = 2 | pages = 690–7 | date = May 2002 | pmid = 11961074 | doi = 10.1124/jpet.301.2.690 | s2cid = 17860947 }}</ref> |
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A final factor contributing to overdoses is [[Operant conditioning|place conditioning]]. 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.<ref>{{cite journal |last1=Gerevich |first1=JóZsef |last2=Bácskai |first2=Erika |last3=Farkas |first3=Lajos |last4=Danics |first4=Zoltán |title=A case report: Pavlovian conditioning as a risk factor of heroin 'overdose' death |journal=Harm Reduction Journal |volume=2 |pages=11 |year=2005 |pmid=16042795 |pmc=1196296 |doi=10.1186/1477-7517-2-11}}</ref> |
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Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer [[Harold Shipman]] used diamorphine on his victims, and the subsequent [[Shipman Inquiry]] led to a tightening of the regulations surrounding the storage, prescribing and destruction of controlled drugs in the UK. |
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A small percentage of heroin smokers, and occasionally IV users, may develop symptoms of [[toxic leukoencephalopathy]]. The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon [[adulterant]] that is only active when heated.<ref>{{cite journal |author=Hill MD, Cooper PW, Perry JR |title=Chasing the dragon--neurological toxicity associated with inhalation of heroin vapour: case report |journal=CMAJ |volume=162 |issue=2 |pages=236–8 |year=2000 |month=January |pmid=10674060 |pmc=1232277 |doi= |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=10674060}}</ref><ref>{{cite journal |last1=Halloran |first1=O. |last2=Ifthikharuddin |first2=S |last3=Samkoff |first3=L |title=Leukoencephalopathy from "chasing the dragon" |journal=Neurology |volume=64 |issue=10 |pages=1755 |year=2005 |pmid=15911804 |doi=10.1212/01.WNL.0000149907.63410.DA}}</ref><ref>{{cite journal |last1=Offiah |first1=C |last2=Hall |first2=E |title=Heroin-induced leukoencephalopathy: characterization using MRI, diffusion-weighted imaging, and MR spectroscopy |journal=Clinical Radiology |volume=63 |issue=2 |pages=146–52 |year=2008 |pmid=18194689 |doi=10.1016/j.crad.2007.07.021}}</ref> Symptoms include slurred speech and difficulty walking. |
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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]], [[Janis Joplin]], [[Tim Buckley]], [[Hillel Slovak]], [[Layne Staley]], [[Bradley Nowell]], [[Ted Binion]], and [[River Phoenix]].<ref>{{cite news|url=http://www.timesonline.co.uk/article/0,,11069-2329203,00.html |title=First murder charge over heroin mix that killed 400|newspaper=Times Online |date=13 March 2012 |access-date=20 July 2012 | vauthors = Eason K, Naughton P |location=London}}</ref><!-- more information needed! --> |
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[[Cocaine]] is sometimes used in combination with heroin, and is referred to as a [[speedball (drug)|speedball]] when injected or ''moonrocks'' when smoked together. Cocaine acts as a [[stimulant]], whereas heroin acts as a [[depressant]]. Coadministration provides an intense rush of [[euphoria]] with a high that combines both effects of the drugs, while excluding the negative effects, such as [[anxiety]] and [[sedation]]. 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]].{{Citation needed|date=April 2010}} |
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===By mouth=== |
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<gallery> |
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Use of heroin by mouth is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent.<ref>{{cite web |author=sepulfreak |url=http://www.erowid.org/experiences/exp.php?ID=41495 |title=Erowid Experience Vaults: Heroin – Catching the Waves – 41495 |publisher=Erowid.org |date=8 July 2005 |access-date=20 July 2012 |url-status=live |archive-url=https://web.archive.org/web/20121011062609/http://www.erowid.org/experiences/exp.php?ID=41495 |archive-date=11 October 2012}}</ref> Heroin is entirely converted to [[morphine]] 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.<ref>{{cite journal | vauthors = Halbsguth U, Rentsch KM, Eich-Höchli D, Diterich I, Fattinger K | title = Oral diacetylmorphine (heroin) yields greater morphine bioavailability than oral morphine: bioavailability related to dosage and prior opioid exposure | journal = British Journal of Clinical Pharmacology | volume = 66 | issue = 6 | pages = 781–91 | date = December 2008 | pmid = 18945270 | pmc = 2675771 | doi = 10.1111/j.1365-2125.2008.03286.x }}</ref> |
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File:Heroin.JPG|Prepping heroin for injection |
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File:Anal Heroin.jpg|Modified syringe for suppository administration |
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File:Heroin Stamp.jpg|One stamp of heroin |
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File:chunkyno3.jpg|Chunky "No.3" heroin |
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</gallery> |
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=== |
===Injection=== |
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{{Main|Opioid withdrawal}} |
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The withdrawal syndrome from heroin (the so-called [[cold turkey]]) 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]], [[malaise]], [[anxiety]], [[clinical depression|depression]], [[akathisia]], [[priapism]], extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, excessive [[yawning]] or [[sneezing]], [[tears]], [[rhinorrhea]], sleep difficulties ([[insomnia]]), cold sweats, chills, severe muscle and bone aches; nausea and [[vomiting]], [[diarrhea]], [[cramps]], and [[fever]].<ref>[http://www.med.umich.edu/1libr/aha/aha_subabu_bha.htm Adult Health Advisor 2005.4: Narcotic Drug Withdrawal]{{dead link|date=October 2010}}</ref> |
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[[Drug injection|Injection]], also known as "slamming", "banging", "shooting up", "digging" or "mainlining", is a popular method 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 [[Eastern United States|east-coast United States]] is most commonly found in the hydrochloride salt form, requiring just water (and no heat) to dissolve.{{Citation needed|date=March 2023}} Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, users resort to more dangerous areas of the body, such as the [[femoral vein]] in the groin. Some medical professionals have expressed concern over this route of administration, as they suspect that it can lead to [[deep vein thrombosis]].<ref>{{cite book | vauthors = Strang J, Gossop M |title=Heroin Addiction and the British System: Treatment and policy responses |date=2005 |publisher=Psychology Press |isbn=978-0-415-29817-9 |page=121 |url=https://books.google.com/books?id=gdwgn83NEJgC&pg=PA121 |language=en}}</ref> |
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==Pharmacology== |
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[[File:Heroin black tar.jpg|thumb|[[Black tar heroin]]]] |
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When taken orally, heroin undergoes extensive [[first-pass metabolism]] via [[acetylation|deacetylation]], making it a [[prodrug]] for the systemic delivery of morphine.<ref name="Sawynok 1986"/> When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the [[blood-brain barrier]] because of the presence of the acetyl groups, which render it much more [[lipophilicity|fat soluble]] than morphine itself.<ref name="Klous 2005">{{cite journal |last1=Klous |first1=M |last2=Brink |first2=W |last3=Ree |first3=J |last4=Beijnen |first4=J |title=Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients |journal=Drug and Alcohol Dependence |volume=80 |issue=3 |pages=283–95 |year=2005 |pmid=15916865 |doi=10.1016/j.drugalcdep.2005.04.008}}</ref> 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 [[Mu opioid receptor|μ-opioid receptor]]s, resulting in the drug's euphoric, [[analgesia|analgesic]] (pain relief), and [[anxiolytic]] (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor.<ref>{{cite journal |last1=Inturrisi |first1=C |last2=Schultz |first2=M |last3=Shin |first3=S |last4=Umans |first4=JG |last5=Angel |first5=L |last6=Simon |first6=EJ |title=Evidence from opiate binding studies that heroin acts through its metabolites |journal=Life Sciences |volume=33 |pages=773–6 |year=1983 |pmid=6319928 |doi=10.1016/0024-3205(83)90616-1}}</ref> 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 [[Itch|pruritus]] (itching) when they first start using.<ref>[http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=35525 Histamine release by morphine and diamorphine in man.] & [http://bcbsma.medscape.com/viewarticle/468419_4 Cutaneous Complications of Intravenous Drug Abuse]</ref> |
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Intravenous users can use a variable single dose range using a [[hypodermic needle]]. The dose of heroin used for recreational purposes is dependent on the frequency and level of use. |
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Both morphine and 6-MAM are [[Mu opioid receptor|μ-opioid]] [[agonist]]s which bind to receptors present throughout the [[brain]], [[spinal cord]] and [[Gut (zoology)|gut]] of all [[mammal]]s. The μ-opioid receptor also binds endogenous [[opioid peptide]]s such as [[Beta-endorphin|β-endorphin]], [[Leu-enkephalin]], and [[Met-enkephalin]]. Repeated use of heroin results in a number of physiological changes, including decreases in the number of μ-opioid receptors. {{Citation needed|date=January 2009}} 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]] syndrome. Depending on usage it has an onset four to 24 hours after the last dose of heroin. Morphine also binds to [[delta opioid receptor|δ]]- and [[kappa opioid receptor|κ]]-opioid receptors. |
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As with the injection of any drug, if a group of users [[needle sharing|share a common needle]] without sterilization procedures, blood-borne diseases, such as [[HIV/AIDS]] or [[hepatitis]], can be transmitted. |
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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.<ref>{{cite journal |last1=Brown |first1=G |last2=Yang |first2=K |last3=King |first3=MA |last4=Rossi |first4=GC |last5=Leventhal |first5=L |last6=Chang |first6=A |last7=Pasternak |first7=GW |title=3-Methoxynaltrexone, a selective heroin/morphine-6β-glucuronide antagonist |journal=FEBS Letters |volume=412 |issue=1 |pages=35–8 |year=1997 |pmid=9257684 |doi=10.1016/S0014-5793(97)00710-2}}</ref> 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. |
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The use of a common dispenser for water for the use in the preparation of the injection, as well as the sharing of spoons and filters can also cause the spread of blood-borne diseases. Many countries now supply small sterile spoons and filters for single use in order to prevent the spread of disease.<ref name="Thakarar_2020">{{cite journal | vauthors = Thakarar K, Nenninger K, Agmas W | title = Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs | journal = Infectious Disease Clinics of North America | volume = 34 | issue = 3 | pages = 605–620 | date = September 2020 | pmid = 32782104 | pmc = 7596878 | doi = 10.1016/j.idc.2020.06.013 }}</ref> |
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===Smoking=== |
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A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses includes the clinically-used strong analgesics [[nicomorphine]] (Vilan), and [[dipropanoylmorphine]]; there is also the latter's [[dihydromorphine]] analogue, [[diacetyldihydromorphine]] (Paralaudin). Two other 3,6 diesters of morphine invented in 1874-5 along with diacetylmorphine, [[dibenzoylmorphine]] and [[acetylpropionylmorphine]], 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. |
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Smoking heroin refers to vaporizing it to inhale the resulting fumes, rather than burning and inhaling the smoke. It is commonly smoked in glass pipes made from [[glassblowing|glassblown]] [[Pyrex]] tubes and light bulbs. Heroin may be smoked from aluminium foil that is heated by a flame underneath it, with the resulting smoke inhaled through a tube of rolled up foil, a method also known as "[[chasing the dragon]]".<ref>{{cite journal | vauthors = Strang J, Griffiths P, Gossop M | title = Heroin smoking by 'chasing the dragon': origins and history | journal = Addiction | volume = 92 | issue = 6 | pages = 673–83; discussion 685–95 | date = June 1997 | pmid = 9246796 | doi = 10.1111/j.1360-0443.1997.tb02927.x }}</ref> |
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===Insufflation=== |
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Another popular route to intake heroin is [[Insufflation (medicine)|insufflation]] (snorting), where a user crushes the heroin into a fine powder and then gently inhales it (sometimes with a straw or a rolled-up [[banknote]], as with cocaine) into the nose, where heroin is absorbed through the soft tissue in the [[mucous membrane]] of the [[sinus cavity]] and straight into the bloodstream. This method of administration redirects [[First pass effect|first-pass metabolism]], with a quicker onset and higher bioavailability 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 want to experience a fast onset. Snorting heroin becomes an often unwanted route, once a user begins to inject the drug. The user may still get high on the drug from snorting, and experience a nod, but will not get a rush. A "rush" is caused by a large amount of heroin entering the body at once. When the drug is taken in through the nose, the user does not get the rush because the drug is absorbed slowly rather than instantly. |
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In 1895, the [[Germany|German]] drug company [[Bayer]] marketed diacetylmorphine as an [[over the counter drug]] under the trademark name Heroin.<ref name="etymonline.com">{{cite web|url=http://www.etymonline.com/index.php?term=heroin |title=Online Etymology Dictionary |publisher=Etymonline.com |date= |accessdate=2010-10-20}}</ref> The name was derived from the [[Greek language|Greek]] word "''[[Hero]]s''" because of its perceived "heroic" effects upon a user.<ref name="etymonline.com"/> It was chiefly developed as a [[morphine]] substitute for [[Cough medicine|cough suppressants]] that did not have morphine's addictive side-effects. [[Morphine]] at the time was a popular recreational drug, and Bayer wished to find a similar but non-addictive substitute to market.<ref>{{cite web|url=http://www.heroinaddiction.com/heroin_timeline.html |title=Heroin History Timeline, Heroin & Methadone Addiction Treatment By Narconon Arrowhead - Heroin Addiction Drug Rehab |publisher=Heroinaddiction.com |date= |accessdate=2010-10-20}}</ref> However, contrary to Bayer's advertising as a "non-addictive morphine substitute," Heroin would soon have one of the highest rates of [[drug addiction|dependence]] amongst its users.<ref>[http://www.drugrehabtreatment.com/most-addictive-drugs.html]{{dead link|date=October 2010}}</ref> |
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Heroin for pain has been mixed with sterile water on site by the attending physician, and administered using a syringe with a nebulizer tip.<ref name="Surrey">{{cite web |title=Clinical Policy for the Use of Intranasal Diamorphine for Analgesia in Children Attending the Paediatric Emergency Department, SASH |url=https://www.surreyandsussex.nhs.uk/wp-content/uploads/2013/04/1-SASH_Intra_Nasal_Diamorphine.pdf |access-date=9 January 2020 |archive-url=https://web.archive.org/web/20200111133557/https://www.surreyandsussex.nhs.uk/wp-content/uploads/2013/04/1-SASH_Intra_Nasal_Diamorphine.pdf |archive-date=11 January 2020 |url-status=live }}</ref> Heroin may be used for fractures, burns, finger-tip injuries, suturing, and wound re-dressing, but is inappropriate in head injuries.<ref name=Surrey/> |
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==History== |
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[[File:Bayer Heroin bottle.jpg|thumb|left|Bayer Heroin bottle]] |
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The [[opium poppy]] was cultivated in lower [[Mesopotamia]] as long ago as 3400 BCE.<ref>{{cite web |
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|url=http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html |
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|title=Opium Throughout History |
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|publisher=PBS Frontline |
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|accessdate=2006-10-22 |
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}}</ref> The chemical analysis of [[opium]] in the 19th century revealed that most of its activity could be ascribed to two [[alkaloids]], [[codeine]] and [[morphine]]. |
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===Suppository=== |
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Diacetylmorphine was first synthesized in 1874 by [[C. R. Alder Wright]], an English chemist working at [[St Mary's Hospital (London)|St. Mary's Hospital]] Medical School in London. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with [[acetic anhydride]] 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: |
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Little research has been focused on the [[suppository]] (anal insertion) or [[pessary]] (vaginal insertion) methods of administration, also known as "plugging". These methods of administration are commonly carried out 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. The rectum or the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining their walls. |
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==Adverse effects== |
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{{Cquote|Doses ... were [[Route of administration|subcutaneously injected]] into young dogs and rabbits ... with the following general results ... great [[prostration]], fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable [[salivation]] being produced in dogs, and slight tendency to [[vomit]]ing in some cases, but no actual emesis. [[Respiration (physiology)|Respiration]] was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4°.<ref>{{cite web |
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[[File:HarmCausedByDrugsTable.svg|thumb|left|upright=1.4|A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Heroin was found to be the second overall most dangerous drug.<ref>{{cite journal | vauthors = Nutt DJ, King LA, Phillips LD | title = Drug harms in the UK: a multicriteria decision analysis | journal = Lancet | volume = 376 | issue = 9752 | pages = 1558–65 | date = November 2010 | pmid = 21036393 | doi = 10.1016/S0140-6736(10)61462-6 | s2cid = 5667719 | citeseerx = 10.1.1.690.1283 }}</ref>]] |
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|url=http://adhpage.dilaudid.net/heroin.html |
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|title=On the Action of Organic Acids and their Anhydrides on the Natural Alkaloids |
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|last = Wright |
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|first = C.R.A. |
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|date=2003-08-12 |
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|archiveurl=http://web.archive.org/web/20040606103721/http://adhpage.dilaudid.net/heroin.html |
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|archivedate=2004-06-06 |
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}} Note: this is an annotated excerpt of {{cite journal |
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| last = Wright |
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| first = C.R.A. |
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| year = 1874 |
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| title = On the Action of Organic Acids and their Anhydrides on the Natural Alkaloids |
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| journal = [[Journal of the Chemical Society]] |
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| volume = 27 |
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| pages = 1031–1043 |
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| doi = 10.1039/js8742701031 |
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}}</ref> |
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}} |
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[[File:BayerHeroin.png|thumb|Advertisement for [[Bayer]] Heroin]] |
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Heroin is classified as a hard drug in terms of [[drug harmfulness]]. Like most [[opioids]], unadulterated heroin may lead to [[adverse effects]]. The purity of street heroin varies greatly, leading to overdoses when the purity is higher than expected.<ref>{{cite news | vauthors = Seelye KQ |title=Heroin Epidemic Is Yielding to a Deadlier Cousin: Fentanyl |url=https://www.nytimes.com/2016/03/26/us/heroin-fentanyl.html |archive-url=https://ghostarchive.org/archive/20220103/https://www.nytimes.com/2016/03/26/us/heroin-fentanyl.html |archive-date=3 January 2022 |url-access=subscription |url-status=live |work=[[The New York Times]] |date=25 March 2016 }}{{cbignore}}</ref> |
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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]]. Hoffmann, working at the Aktiengesellschaft Farbenfabriken (today the [[Bayer]] pharmaceutical company) in [[Elberfeld, Germany]], was instructed by his supervisor [[Heinrich Dreser]] to acetylate morphine with the objective of producing [[codeine]], 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. |
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===Short-term effects=== |
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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.<ref>{{cite web|url=http://opioids.com/heroin/heroinhistory.html |title=''How aspirin turned hero'', Sunday Times article, reproduced on a BLTC website, accessed 18 March 2009 |publisher=Opioids.com |date=1998-09-13 |accessdate=2010-10-20}}</ref> |
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[[File:Short-term effects of heroin.png|thumb|Short-term effects of usage<ref name="ONDCP">{{cite web |url=http://www.whitehousedrugpolicy.gov/drugfact/heroin/heroin_ff.html#healtheffects |title=Office of National Drug Control Policy (ONDCP): Heroin Facts & Figures |publisher=Whitehousedrugpolicy.gov |access-date=20 July 2012 |url-status=live |archive-url=https://web.archive.org/web/20110806022931/http://www.whitehousedrugpolicy.gov/drugfact/heroin/heroin_ff.html#healtheffects |archive-date=6 August 2011}}</ref>]] |
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Users report an intense [[Rush (psychology)|rush]], an acute transcendent state of [[euphoria]], which occurs while diamorphine is being metabolized into [[6-monoacetylmorphine]] (6-MAM) and morphine in the brain. Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin – although a more likely explanation is the rapidity of onset. While other opioids of recreational use produce only morphine, heroin also leaves 6-MAM, also a psycho-[[active metabolite]]. |
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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.<ref name="martin and fraser" /> |
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In the U.S.A. the [[Harrison Narcotics Tax Act]] 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 [[Controlled Substances Act#Schedule I controlled substances|Schedule I substance]], which makes it illegal for non-medical use in signatory nations of the [[Single Convention on Narcotic Drugs]] treaty, including the United States. |
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The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities. [[Nausea]], [[vomiting]], and severe [[itch]]ing may also occur. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows, and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent [[brain damage]].<ref name="National Institute on Drug Abuse">{{Cite web|url=https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use|title=What are the immediate (short-term) effects of heroin use? | author = National Institute on Drug Abuse |language=en|access-date=7 September 2018|archive-url=https://web.archive.org/web/20180908054251/https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use|archive-date=8 September 2018|url-status=dead}}</ref> Heroin use has also been associated with [[myocardial infarction]].<ref>{{cite journal | vauthors = Karoli R, Fatima J, Singh P, Kazmi KI | title = Acute myocardial involvement after heroin inhalation | journal = Journal of Pharmacology & Pharmacotherapeutics | volume = 3 | issue = 3 | pages = 282–4 | date = July 2012 | pmid = 23129970 | pmc = 3487283 | doi = 10.4103/0976-500X.99448 | doi-access = free }}</ref> |
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The Health Committee of the [[League of Nations]] 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]] and [[dihydromorphine]] 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.<ref>[[dibenzoylmorphine]]</ref> |
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===Long-term effects=== |
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Later, as with [[Aspirin]], Bayer lost some of its trademark rights to Heroin under the 1919 [[Treaty of Versailles]] following the German defeat in [[World War I]].<ref> |
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[[File:Long-term effects of heroin.png|thumb|Long-term effects of intravenous usage, including – and indeed primarily because of – the effects of the contaminants common in illegal heroin and contaminated needles<ref name="ONDCP" />]] |
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{{cite web |
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Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of the brain's white matter due to heroin use,<ref name=Hamp2019>{{cite journal | vauthors = Hampton WH, Hanik I, Olson IR | title = [Substance Abuse and White Matter: Findings, Limitations, and Future of Diffusion Tensor Imaging Research] | language = en | journal = Drug and Alcohol Dependence | volume = 197 | issue = 4 | pages = 288–298 | year = 2019 | pmid = 30875650 | pmc = 6440853 | doi = 10.1016/j.drugalcdep.2019.02.005}}</ref> which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations. Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects. With [[Substance dependence|physical dependence]], the body adapts to the presence of the [[drug]], and withdrawal symptoms occur if use is reduced abruptly.<ref name="National Institute on Drug Abuse" /> |
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|url=http://en.wikisource.org/wiki/Treaty_of_Versailles/Part_X#Article_298 |
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|date=1919-06-28 |
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|title=Treaty of Versailles, Part X, Section IV, Article 298 |
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|accessdate=2008-10-25 |
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|pages= Annex, Paragraph 5 |
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}}</ref> |
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===Injection === |
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==Routes of administration== |
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[[Intravenous]] use of heroin (and any other substance) with needles and syringes or other related equipment may lead to: |
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{| border="1" cellpadding="5" cellspacing="1" style="background:#fff; float:right; width:270px; border-collapse:collapse; clear:right; margin:0 0 0 0.5em;" |
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|- |
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|'''Recreational uses:''' |
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*[[Euphoria (emotion)|Euphoria]] |
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*[[Wiktionary:transcendent|Transcendent]] [[Wiktionary:relaxation|relaxation]] |
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* Contracting blood-borne [[pathogens]] such as HIV and [[hepatitis]] via the sharing of needles |
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'''Medicinal uses:''' |
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* Contracting bacterial or fungal [[endocarditis]] and possibly venous sclerosis |
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*[[Painkiller|Powerful analgesic]] (pain killer) |
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*[[ |
* [[Abscesses]] |
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* Poisoning from [[contaminants]] added to "[[cutting agent|cut]]" or dilute heroin |
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*Anti-[[diarrhea]]l |
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* [[Kidney disease|Decreased kidney function (nephropathy)]], although it is not currently known if this is because of adulterants or infectious diseases<ref>{{cite journal | vauthors = Dettmeyer RB, Preuss J, Wollersen H, Madea B | title = Heroin-associated nephropathy | journal = Expert Opinion on Drug Safety | volume = 4 | issue = 1 | pages = 19–28 | date = January 2005 | pmid = 15709895 | doi = 10.1517/14740338.4.1.19 | s2cid = 11646280 }}</ref> |
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|- |
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|'''[[Contraindication]]s:''' |
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*[[Ethanol|Alcohol]] |
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*[[Barbiturate]]s and [[benzodiazepines]] |
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*[[Stimulant]]s |
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*Other [[opioid]]s |
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|- |
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|'''''Central nervous system:''''' |
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*[[Drowsiness]] |
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*[[Disorientation]] |
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*[[Delirium]] |
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===Withdrawal=== |
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'''''Neurological:''''' |
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{{Main|Opioid withdrawal}} |
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*[[Analgesia]] |
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The [[drug withdrawal|withdrawal]] syndrome from heroin may begin within as little as two 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, and more typically begins within 6–24 hours after cessation. Symptoms may include [[sweating]], [[malaise]], anxiety, depression, [[akathisia]], [[priapism]], extra sensitivity of the genitals in females, general feeling of heaviness, excessive yawning or sneezing, [[rhinorrhea]], [[insomnia]], cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps, watery eyes,<ref>{{cite web|author=Myaddiction|title=Heroin Withdrawal Symptoms|publisher=MyAddiction|date=16 May 2012|url=http://www.myaddiction.com/heroin.html|access-date=16 May 2012|url-status=live|archive-url=https://web.archive.org/web/20120511193410/http://www.myaddiction.com/heroin.html|archive-date=11 May 2012}}</ref> fever, cramp-like pains, and involuntary spasms in the limbs (thought to be an origin of the term "kicking the habit"<ref>{{cite book | title=The Street Addict Role: A Theory of Heroin Addiction | publisher=SUNY Press | vauthors = Stephens R | year=1991 | page=7 | isbn=978-0-7914-0619-9}}</ref>).<ref>{{cite web | url=http://www.discoveryplace.info/narcotic-drug-withdrawal | title=Narcotic Drug Withdrawal | publisher=Discovery Place | access-date=18 April 2014 | url-status=dead | archive-url=https://web.archive.org/web/20140419025851/http://www.discoveryplace.info/narcotic-drug-withdrawal | archive-date=19 April 2014}}</ref><ref>{{Cite web|url=https://medlineplus.gov/ency/article/000949.htm|title=Opiate and opioid withdrawal: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=20 November 2019|archive-url=https://web.archive.org/web/20191208070501/https://medlineplus.gov/ency/article/000949.htm|archive-date=8 December 2019|url-status=live}}</ref> |
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*[[drug tolerance|Tolerance]] |
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*[[Drug addiction|Addiction (physical dependence)]] |
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==Overdose== |
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'''''Psychological:''''' |
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{{further|US drug overdose death rates and totals over time}} |
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*[[Substance dependence#Psychological drug tolerance|Addiction (psychological dependence)]] |
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[[Heroin overdose]] is usually treated with the [[opioid antagonist]] [[naloxone]]. This reverses the effects of heroin and causes an immediate return of consciousness but may result in [[drug withdrawal|withdrawal]] symptoms. The [[half-life]] of naloxone is shorter than some opioids, such that it may need to be given multiple times until the opioid has been metabolized by the body. |
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*[[Anxiolysis]] |
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*[[Confusion]] |
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*[[Euphoria (emotion)|Euphoria]] |
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*[[Somnolence]] |
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Between 2012 and 2015, heroin was the leading cause of drug-related deaths in the United States.<ref name="CDC2018Death">{{cite web |title=Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016 |url=https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf |website=CDC |access-date=21 December 2018 |date=12 December 2018 |archive-url=https://web.archive.org/web/20181213221854/https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf |archive-date=13 December 2018 |url-status=live }}</ref> Since then, [[fentanyl]] has been a more common cause of drug-related deaths.<ref name=CDC2018Death/> |
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'''''Cardiovascular & Respiratory:''''' |
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*[[Bradycardia]] |
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*[[Hypotension]] |
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*[[Hypoventilation]] |
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*[[Shallow breathing]] |
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*Respiratory depression |
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Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours. Death usually occurs due to [[hypoxia (medical)|lack of oxygen]] resulting from the lack of breathing caused by the opioid. Heroin 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]] drugs such as alcohol or [[benzodiazepine]]s.<ref>{{cite journal | vauthors = Darke S, Zador D | title = Fatal heroin 'overdose': a review | journal = Addiction | volume = 91 | issue = 12 | pages = 1765–72 | date = December 1996 | pmid = 8997759 | doi = 10.1046/j.1360-0443.1996.911217652.x }}</ref> 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 person. Some sources quote the [[median lethal dose]] (for an average 75 kg opiate-naive individual) as being between 75 and 600 mg.<ref>{{cite web |url=http://lincoln.pps.k12.or.us/lscheffler/ToxicSubstances%20in%20water.htm |title=Toxic Substances in water |publisher=Lincoln.pps.k12.or.us |access-date=20 October 2010 |url-status=dead |archive-url=https://web.archive.org/web/20110430180739/http://lincoln.pps.k12.or.us/lscheffler/ToxicSubstances%20in%20water.htm |archive-date=30 April 2011}}</ref><ref>{{cite web| vauthors = Breecher E |title=The Consumers Union Report on Licit and Illicit Drugs|url=http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm|url-status=live|archive-url=https://web.archive.org/web/20070208092708/http://www.druglibrary.org/Schaffer/Library/studies/cu/cu12.htm|archive-date=8 February 2007}}</ref> 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 an overdose. It has been speculated that an unknown portion of heroin-related deaths are the result of an overdose or allergic reaction to [[quinine]], which may sometimes be used as a cutting agent.<ref>{{cite book | vauthors = Brecher EM | collaboration = Editors of Consumer Reports Magazine | date = 1972 | chapter-url = http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm | chapter = Chapter 12. The "heroin overdose" mystery and other occupational hazards of addiction | title = The Consumers Union Report on Licit and Illicit Drugs | archive-url = https://web.archive.org/web/20070208092708/http://www.druglibrary.org/Schaffer/Library/studies/cu/cu12.htm | archive-date=8 February 2007 | publisher = Schaffer Library of Drug Policy }}</ref> |
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'''''Gastrointestinal:''''' |
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*[[Nausea]] |
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*[[Wiktionary:protracted|Protracted]] [[vomiting]] |
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*[[Constipation]] |
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*[[Dyspepsia]] (heartburn) |
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==Pharmacology== |
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'''''Musculoskeletal:''''' |
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[[File:Heroin black tar.jpg|thumb|[[Black tar heroin]] ]] |
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*[[Analgesia]] |
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When taken orally, heroin undergoes extensive [[first-pass metabolism]] via [[acetylation|deacetylation]], making it a [[prodrug]] for the systemic delivery of morphine.<ref name="Sawynok 1986">{{cite journal | vauthors = Sawynok J | title = The therapeutic use of heroin: a review of the pharmacological literature | journal = Canadian Journal of Physiology and Pharmacology | volume = 64 | issue = 1 | pages = 1–6 | date = January 1986 | pmid = 2420426 | doi = 10.1139/y86-001 }}</ref> When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the [[blood–brain barrier]] because of the presence of the acetyl groups, which render it much more [[lipophilicity|fat soluble]] than morphine itself.<ref name="Klous 2005">{{cite journal | vauthors = Klous MG, Van den Brink W, Van Ree JM, Beijnen JH | title = Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients | journal = Drug and Alcohol Dependence | volume = 80 | issue = 3 | pages = 283–95 | date = December 2005 | pmid = 15916865 | doi = 10.1016/j.drugalcdep.2005.04.008 }}</ref> 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]]s, resulting in the drug's euphoric, [[analgesia|analgesic]] (pain relief), and [[anxiolytic]] (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor.<ref>{{cite journal | vauthors = Inturrisi CE, Schultz M, Shin S, Umans JG, Angel L, Simon EJ | title = Evidence from opiate binding studies that heroin acts through its metabolites | journal = Life Sciences | volume = 33 | issue = Suppl 1 | pages = 773–6 | year = 1983 | pmid = 6319928 | doi = 10.1016/0024-3205(83)90616-1 }}</ref> Analgesia follows from the activation of the μ receptor [[G-protein coupled receptor]], which indirectly hyperpolarizes the neuron, reducing the release of [[nociception|nociceptive]] neurotransmitters, and hence, causes analgesia and increased pain tolerance.<ref>{{cite book | vauthors = Hitchings A, Lonsdale D, Burrage D, Baker E |title=Top 100 drugs: clinical pharmacology and practical prescribing |date=2014 |publisher=Churchill Livingstone |isbn=978-0-7020-5516-4}}</ref> |
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*[[Ataxia]] |
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*[[Muscle spasticity]] |
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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 [[Itch|pruritus]] (itching) when they first start using.<ref>{{cite web|url=http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=35525|title=Histamine release by morphine and diamorphine in man | archive-url=https://web.archive.org/web/20100812062454/http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=35525 | archive-date=12 August 2010 }}</ref><ref name="pmid14746612">{{cite journal | vauthors = Del Giudice P | title = Cutaneous complications of intravenous drug abuse | journal = The British Journal of Dermatology | volume = 150 | issue = 1 | pages = 1–10 | date = January 2004 | pmid = 14746612 | doi = 10.1111/j.1365-2133.2004.05607.x | s2cid = 32380001 | url = http://bcbsma.medscape.com/viewarticle/468419_4 |archive-url=https://archive.today/20121123175249/http://bcbsma.medscape.com/viewarticle/468419_4|archive-date=23 November 2012|url-status=live }}</ref> |
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'''''Skin:''''' |
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*Itching |
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*Flushing/Rash |
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Normally, [[GABA]], which is released from inhibitory neurones, inhibits the release of dopamine. Opiates, like heroin and morphine, decrease the inhibitory activity of such neurones. This causes increased release of dopamine in the brain which is the reason for euphoric and rewarding effects of heroin.<ref>{{cite book | vauthors = Papich MG |title=Saunders Handbook of Veterinary Drugs |date=2016 |publisher=W.B. Saunders |isbn=978-0-323-24485-5 |pages=183–184 |doi=10.1016/B978-0-323-24485-5.00175-3|chapter=Codeine|edition=Fourth }}</ref> |
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'''''Miscellaneous:''''' |
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*Dry mouth ([[xerostomia]]) |
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*[[Miosis]] ([[pupil]] constriction) |
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*[[Urinary retention]] |
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Both morphine and 6-MAM are [[μ-opioid receptor|μ-opioid]] [[agonist]]s that bind to receptors present throughout the brain, [[spinal cord]], and [[gut (zoology)|gut]] of all [[mammal]]s. The μ-opioid receptor also binds endogenous [[opioid peptide]]s such as [[β-endorphin]], [[leu-enkephalin]], and [[met-enkephalin]]. Repeated use of heroin results in a number of physiological changes, including an increase in the production of μ-opioid receptors (upregulation).<ref>{{cite journal | vauthors = Hammers A, Asselin MC, Hinz R, Kitchen I, Brooks DJ, Duncan JS, Koepp MJ | title = Upregulation of opioid receptor binding following spontaneous epileptic seizures | journal = Brain | volume = 130 | issue = Pt 4 | pages = 1009–16 | date = April 2007 | pmid = 17301080 | doi = 10.1093/brain/awm012 | doi-access = free }}</ref> These physiological alterations lead to tolerance and dependence, so that stopping heroin use results in uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called the opioid [[drug withdrawal|withdrawal]] syndrome. Depending on usage it has an onset 4–24 hours after the last dose of heroin. Morphine also binds to [[δ-opioid receptor|δ]]- and [[κ-opioid receptor]]s. |
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[[File:Diamorphine ampoules.JPG|thumb|Diamorphine ampoules for medicinal use]] |
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|} |
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The onset of heroin's effects depends upon the [[route of administration]]. 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.<ref>[http://jpet.aspetjournals.org/content/301/2/690.full.pdf Journal of Pharmacology and Experimental Therapeutics (JPET) | Onset of Action and Drug Reinforcement]</ref> Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the most quickly, followed by smoking, [[suppository]] (anal or vaginal insertion), [[Insufflation (medicine)|insufflation]] (snorting), and [[ingestion]] (swallowing). |
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There is also evidence that 6-MAM binds to a subtype of μ-opioid receptors that are also activated by the morphine metabolite morphine-6β-glucuronide but not morphine itself.<ref>{{cite journal | vauthors = Brown GP, Yang K, King MA, Rossi GC, Leventhal L, Chang A, Pasternak GW | title = 3-Methoxynaltrexone, a selective heroin/morphine-6beta-glucuronide antagonist | journal = FEBS Letters | volume = 412 | issue = 1 | pages = 35–8 | date = July 1997 | pmid = 9257684 | doi = 10.1016/S0014-5793(97)00710-2 | s2cid = 45475657 | doi-access = free | bibcode = 1997FEBSL.412...35B }}</ref> The third subtype of third opioid type is the 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. |
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Ingestion does not produce a [[Rush (psychology)|rush]] 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. |
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A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses, includes the clinically used strong analgesics [[nicomorphine]] (Vilan), and [[dipropanoylmorphine]]; there is also the latter's [[dihydromorphine]] analogue, [[diacetyldihydromorphine]] (Paralaudin). Two other 3,6 diesters of morphine invented in 1874–75 along with diamorphine, [[dibenzoylmorphine]] and [[acetylpropionylmorphine]], 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. |
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{{nowrap|Large doses of heroin}} can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer [[Harold Shipman|Dr Harold Shipman]] used it on his victims, as did [[John Bodkin Adams|Dr John Bodkin Adams]] (see his victim: [[Edith Alice Morrell]]). |
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==Chemistry== |
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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]], [[Janis Joplin]], [[Tim Buckley]], [[Layne Staley]], [[Bradley Nowell]], [[Ted Binion]], and [[River Phoenix]].<ref>"[http://www.timesonline.co.uk/article/0,,11069-2329203,00.html First murder charge over heroin mix that killed 400 - World - Times Online]", TimesOnline.co.uk.</ref><!-- more information needed! --> |
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Diamorphine is produced from [[acetylation]] of [[morphine]] derived from natural opium sources, generally using [[acetic anhydride]].<ref name="auto">{{cite web|url=http://www.unodc.org/pdf/research/Bulletin07/bulletin_on_narcotics_2007_Zerell.pdf|title=Documentation of a heroin manufacturing process in Afghanistan. BULLETIN ON NARCOTICS, Volume LVII, Nos. 1 and 2, 2005|publisher=United Nations Office on Drugs and Crime|access-date=20 October 2010|url-status=live|archive-url=https://web.archive.org/web/20100705045725/http://www.unodc.org/pdf/research/Bulletin07/bulletin_on_narcotics_2007_Zerell.pdf|archive-date=5 July 2010}}</ref> |
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The major metabolites of diamorphine, [[6-Monoacetylmorphine|6-MAM]], morphine, [[morphine-3-glucuronide]], and [[morphine-6-glucuronide]], may be quantitated in blood, plasma or urine to monitor for use, 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 diamorphine such as [[6-Monoacetylcodeine]] and [[codeine]].<ref>{{Cite web |title=Opiates - Mayo Clinic Laboratories |url=https://www.mayocliniclabs.com/test-catalog/drug-book/specific-drug-groups/opiates |access-date=2022-08-06 |website=www.mayocliniclabs.com}}</ref> However, [[Chromatography|chromatographic]] techniques can easily distinguish and measure each of these substances. When interpreting the results of a test, it is important to consider the diamorphine usage history of the individual, since a chronic user can develop [[Drug tolerance|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 before quantitation that converts many of the metabolic products to morphine, yielding a result that may be 2 times larger than with a method that examines each product individually.<ref>{{cite book | vauthors = Baselt R |title=Disposition of Toxic Drugs and Chemicals in Man |edition=9th |publisher=Biomedical Publications |location=Seal Beach, CA |year=2011 |pages=793–7 |isbn=978-0-9626523-8-7}}</ref> |
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Chronic use of heroin and other opioids, has potentially been shown to be a cause of [[hyponatremia]], resultant because of excess [[vasopressin]] secretion. |
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== |
==History== |
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[[File:BayerHeroin.png|thumb|upright|Advertisement for [[Bayer]] Heroin]] |
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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.<ref>Sepulfreak. "Erowid Experience Vaults: Heroin - Catching the Waves - 41495." Erowid. 08 July 2005. Web. 09 Jan. 2011.<http://www.erowid.org/experiences/exp.php?ID=41495>.</ref> Heroin is entirely converted to [[morphine]] 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.<ref>>"Oral Diacetylmorphine (heroin) Yields Greater Morphine Morphine Bioavailability than Oral Morphine: Bioavailability Related to Dosage and Prior Opioid Exposure." PubMed. Dec. 2008. Web. 09 Jan. 2011. [http://www.ncbi.nlm.nih.gov/pubmed/18945270].</ref> |
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{{see also|History of opium in China}} |
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===Injection=== |
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[[Image:Injecting Heroin.JPG|thumb|right|Injecting Heroin With Latex Tourniquet]] |
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[[Drug injection|Injection]], 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]]. 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.<ref>[http://www.erowid.org/chemicals/heroin/heroin_dose1.shtml Notes on heroin dosage & tolerance]. Erowid's Vault, 2001.</ref> As with the injection of any drug, if a group of users [[needle sharing|share a common needle]] without sterilization procedures, blood-borne diseases, such as [[HIV]] or [[hepatitis]], can be transmitted. |
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The [[opium poppy]] was cultivated in lower [[Mesopotamia]] as long ago as 3400 BC.<ref>{{cite web|url=https://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html|title=Opium Throughout History|publisher=PBS Frontline|access-date=22 October 2006|url-status=live|archive-url=https://web.archive.org/web/20060923053042/http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html|archive-date=23 September 2006}}</ref> The chemical analysis of [[opium]] in the 19th century revealed that most of its activity could be ascribed to the [[alkaloids]] [[codeine]] and [[morphine]]. |
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===Smoking=== |
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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 [[glassblowing|glassblown]] [[Pyrex|Pyrex tubes]] 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]]" (whereas smoking [[methamphetamine]] is known as "chasing the ''white'' dragon"). |
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Diamorphine was first synthesized in 1874 by [[C. R. Alder Wright]], an English chemist working at [[St Mary's Hospital (London)|St. Mary's Hospital]] Medical School in London who had been experimenting combining morphine with various acids. He boiled anhydrous morphine alkaloid with [[acetic anhydride]] for several hours and produced a more potent, [[acetylated]] form of morphine which is now called ''diacetylmorphine'' or ''morphine diacetate''. He sent the compound to F. M. Pierce of Owens College in Manchester for analysis. Pierce told Wright: |
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===Insufflation=== |
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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]], as with [[cocaine]]) into the nose where heroin is absorbed through the soft tissue in the [[mucous membrane]] of the [[sinus cavity]] and straight into the bloodstream. This method of administration redirects [[first pass metabolism]], with a quicker onset and higher [[bioavailability]] 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. |
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{{blockquote|Doses… were subcutaneously injected into young dogs and rabbit… with the following general results… great prostration, fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable salivation being produced in dogs, and a slight tendency to vomiting in some cases, but no actual [[emesis]]. Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished and rendered irregular. Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4°.<ref>{{cite web|url=http://adhpage.dilaudid.net/heroin.html|title=On the action of organic acids and their anhydrides on the natural alkaloids| vauthors = Wright CR |date=12 August 2003|archive-url=https://web.archive.org/web/20040606103721/http://adhpage.dilaudid.net/heroin.html|archive-date=6 June 2004}} Note: this is an annotated excerpt of {{cite journal| vauthors = Wright CR | year = 1874| title = On the action of organic acids and their anhydrides on the natural alkaloids| journal = [[Journal of the Chemical Society]]| volume = 27| pages = 1031–1043 |url=https://babel.hathitrust.org/cgi/pt?id=mdp.39015077817453&view=1up&seq=1039 | doi = 10.1039/js8742701031}}</ref>}} |
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===Suppository=== |
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Little research has been focused on the [[suppository]] (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. |
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[[File:Bayer Heroin bottle.jpg|thumb|left|upright|Bayer Heroin bottle]] |
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==Regulation== |
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Wright's invention did not lead to any further developments, and diamorphine became popular only after it was independently re-synthesized 23 years later by chemist [[Felix Hoffmann]].<ref name="Bio">{{cite web|title=Felix Hoffmann|url=https://www.sciencehistory.org/historical-profile/felix-hoffmann|website=Science History Institute|access-date=18 March 2018|date=June 2016|archive-url=https://web.archive.org/web/20180321130305/https://www.sciencehistory.org/historical-profile/felix-hoffmann|archive-date=21 March 2018|url-status=live}}</ref> Hoffmann was working at [[Bayer]] pharmaceutical company in [[Elberfeld]], Germany, and his supervisor [[Heinrich Dreser]] instructed him to acetylate morphine with the objective of producing codeine, a constituent of the opium poppy that is 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. Hoffmann synthesized heroin on August 21, 1897, just eleven days after he had synthesized [[aspirin]].<ref>{{cite book |last1=Schaefer |first1=Bernd |title=Natural Products in the Chemical Industry |date=2015 |publisher=[[Springer Science+Business Media|Springer]] |isbn=978-3-642-54461-3 |page=316 |url=https://books.google.com/books?id=DbO4CQAAQBAJ&pg=PA316 |access-date=19 December 2022}}</ref> |
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{{Unreferenced section|date=August 2008}} |
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In the [[Netherlands]], diacetylmorphine is a List I drug of the [[Opium Law]]. It is available for prescription under tight regulation exclusively to long-term addicts for whom [[methadone maintenance]] treatment has failed. It cannot be used to treat severe [[pain]] or other illnesses. |
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The head of Bayer's research department reputedly coined the drug's new name of "heroin", based on the German ''heroisch'' which means "heroic, strong" (from the ancient Greek word "heros, ήρως"). Bayer scientists were not the first to make heroin, but their scientists discovered ways to make it, and Bayer led the commercialization of heroin.<ref>{{cite web | vauthors = Edwards J | work = Business Insider | date = 17 November 2011 | url = http://www.businessinsider.com/yes-bayer-promoted-heroin-for-children-here-are-the-ads-that-prove-it-2011-11 | title = Yes, Bayer Promoted Heroin for Children – Here Are The Ads That Prove It | archive-url = https://web.archive.org/web/20150501031210/http://www.businessinsider.com/yes-bayer-promoted-heroin-for-children-here-are-the-ads-that-prove-it-2011-11 | archive-date = 1 May 2015 }}</ref> |
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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. |
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Bayer marketed diacetylmorphine as an [[over-the-counter drug]] under the trademark name Heroin.<ref name="etymonline.com">{{cite web|url=http://www.etymonline.com/index.php?term=heroin|title=Online Etymology Dictionary|publisher=Etymonline.com|access-date=20 October 2010|url-status=live|archive-url=https://web.archive.org/web/20110515083725/http://www.etymonline.com/index.php?term=heroin|archive-date=15 May 2011}}</ref> It was developed chiefly as a [[morphine]] substitute for [[Cough medicine|cough suppressants]] that did not have morphine's addictive side-effects. Morphine 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 [[addiction]] among its users.<ref>{{cite web|url=http://www.drugrehabtreatment.com/most-addictive-drugs.html|title=The Most Addictive Drugs|archive-url=https://web.archive.org/web/20100213101818/http://www.drugrehabtreatment.com/most-addictive-drugs.html|archive-date=13 February 2010}}</ref> |
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In Canada, diacetylmorphine is a controlled substance under Schedule I of the [[Controlled Drugs and Substances Act]] (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. |
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From 1898 through to 1910, diamorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant.<ref name="TimesUnion">{{cite news | vauthors = Moore D | work = [[Times Union (Albany)|Times Union]] | date = 24 August 2014 | url = http://www.timesunion.com/518life/article/Heroin-A-brief-history-of-unintended-consequences-5705610.php | title = Heroin: A brief history of unintended consequences | archive-url = https://web.archive.org/web/20150419071311/http://www.timesunion.com/518life/article/Heroin-A-brief-history-of-unintended-consequences-5705610.php | archive-date=19 April 2015 }}</ref> In the 11th edition of ''[[Encyclopædia Britannica]]'' (1910), the article on morphine states: "In the cough of [[Tuberculosis|phthisis]] minute doses [of morphine] are of service, but in this particular disease morphine is frequently better replaced by codeine or by heroin, which checks irritable coughs without the narcotism following upon the administration of morphine." |
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In Hong Kong, diacetylmorphine is regulated under Schedule 1 of [[Hong Kong|Hong Kong's]] Chapter 134 ''Dangerous Drugs Ordinance''. It is available by prescription. Anyone who supplies diacetylmorphine without a valid prescription can be fined $10,000 ([[Hong Kong dollar|HKD]]). 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. |
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In the US, the [[Harrison Narcotics Tax Act]] 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 controlled substance|Schedule I substance]], which makes it illegal for non-medical use in signatory nations of the [[Single Convention on Narcotic Drugs]] treaty, including the United States. |
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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]] (BNF), diamorphine [[hydrochloride]] may be used in the treatment of acute pain, [[myocardial infarction]], acute [[pulmonary oedema]], and [[chronic pain]]. The treatment of chronic non-[[malignant]] 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]] of cancer patients, diacetylmorphine is often injected using a [[syringe driver]]. |
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The Health Committee of the [[League of Nations]] 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]] and [[dihydromorphine]], 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.{{citation needed|date=April 2015}} |
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==Production and trafficking== |
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===Production=== |
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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.<ref>{{cite web|url=http://www.unodc.org/pdf/research/Bulletin07/bulletin_on_narcotics_2007_Zerell.pdf |title=Documentation of a heroin manufacturing process in Afghanistan. BULLETIN ON NARCOTICS, Volume LVII, Nos. 1 and 2, 2005|publisher=United Nations Office on Drugs and Crime|format=PDF |date= |accessdate=2010-10-20}}</ref> |
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Bayer lost some of its trademark rights to heroin (as well as [[aspirin]]) under the 1919 [[Treaty of Versailles]] following the German defeat in [[World War I]].<ref>{{Cite book|title=Science and Its Times: Understanding the Social Significance of Scientific Discovery| vauthors = Schlager N, Lauer J |date=2001|publisher=Gale Group |isbn=078763932X|location=Detroit|pages=[https://archive.org/details/scienceitstimesu0000unse/page/360 360]|oclc=43836551|url-access=registration|url=https://archive.org/details/scienceitstimesu0000unse/page/360}}</ref><ref>{{cite news |title=Happy birthday to the wonder drug that changed our lives |url=https://www.theguardian.com/uk/1999/mar/06/1 |work=The Guardian|date=6 March 1999 }}</ref> |
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===Trafficking=== |
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[[File:drugroutemap.gif|thumb|400px|International drug routes]] |
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{{See also|Opium#Modern production and usage}} |
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Use of heroin by jazz musicians in particular was prevalent in the mid-twentieth century, including [[Billie Holiday]], saxophonists [[Charlie Parker]] and [[Art Pepper]], trumpeter and vocalist [[Chet Baker]], guitarist [[Joe Pass]] and piano player/singer [[Ray Charles]]; a "staggering number of jazz musicians were addicts".<ref name="MartinWaters2008">{{cite book|url=https://books.google.com/books?id=e64R7pJ3zJsC&pg=PA168|title=Essential Jazz: The First 100 Years| vauthors = Martin H, Waters K |date=25 January 2008|publisher=Cengage Learning|isbn=978-0-495-50525-9|page=168|access-date=26 August 2012|url-status=live|archive-url=https://web.archive.org/web/20131203231043/http://books.google.com/books?id=e64R7pJ3zJsC&pg=PA168|archive-date=3 December 2013}}</ref> It was also a problem with many rock musicians, particularly from the late 1960s through the 1990s. [[Pete Doherty]] is also a self-confessed user of heroin.<ref>{{cite web | vauthors = Michaels S | date = 28 June 2012 | work = The Guardian | title = Pete Doherty skips T in the Park to enter rehab | url = https://www.theguardian.com/music/2012/jun/28/pete-doherty-t-park-rehab }}</ref> [[Nirvana (band)|Nirvana]] lead singer [[Kurt Cobain]]'s heroin addiction was well documented.<ref>{{cite book | vauthors = Azerrad M |title=Come as You Are: The Story of Nirvana. |date=1993 |publisher=Doubleday |location=New York |isbn=978-0-385-47199-2 |edition=1st | page = 241 }}</ref> [[Pantera]] frontman [[Phil Anselmo]] turned to heroin while touring during the 1990s to cope with his back pain.<ref>{{cite news|url=http://www.blabbermouth.net/news.aspx?mode=Article&newsitemID=125509|title=Philip Anselmo Opens Up About His Heroin Addiction, Pantera's Breakup|date=19 August 2009|work=Blabbermouth.net|access-date=12 October 2013|archive-url=https://web.archive.org/web/20200111133613/https://www.blabbermouth.net/news.aspx%3Fmode%3DArticle%26newsitemID%3D125509|archive-date=11 January 2020|url-status=live}}</ref> [[James Taylor]], [[Jimmy Page]], [[John Lennon]], [[Eric Clapton]], [[Johnny Winter]], [[Keith Richards]], [[Shaun Ryder]], [[Shane MacGowan]] and [[Janis Joplin]] also used heroin. Many musicians have made songs referencing their heroin usage.<ref>{{cite news|url=https://www.theguardian.com/music/2004/jul/09/velvetrevolver.gunsnroses|title=I died. I do remember that| vauthors = Sweeting A |date=9 July 2004|work=The Guardian|location=London|url-status=live|archive-url=https://web.archive.org/web/20161230054611/https://www.theguardian.com/music/2004/jul/09/velvetrevolver.gunsnroses|archive-date=30 December 2016}}</ref><ref>{{cite book | vauthors = Brown P | title=The Love You Make: An Insider's Story of The Beatles | orig-date=1983 | date = 2002 | page = 331 |location=New York | publisher = McGraw-Hill / New American Library |isbn=978-0-07-008159-8 }}</ref><ref name="nuaa">{{cite web|url=http://www.nuaa.org.au/nuaa/News/media/UN52/UN52-loaded_great_heroin_songs.pdf|title=Loaded – Great heroin songs of the rock era| vauthors = Bates M |date=December 2008|pages=26–27|archive-url=https://web.archive.org/web/20080409082048/http://www.nuaa.org.au/nuaa/News/media/UN52/UN52-loaded_great_heroin_songs.pdf <!-- Bot retrieved archive -->|archive-date=9 April 2008|access-date=17 January 2008}}</ref><ref>Liner notes, Music Bank box set. 1999.</ref><ref>{{cite web | vauthors = Howard G | date = 18 September 2009 |url=http://www.slate.com/articles/news_and_politics/obit/2009/09/death_of_a_poet.html|title=Death of a Poet: Saying goodbye to Jim Carroll. | work = Slate |access-date=2 January 2014|url-status=live|archive-url=https://web.archive.org/web/20140102224352/http://www.slate.com/articles/news_and_politics/obit/2009/09/death_of_a_poet.html|archive-date=2 January 2014 }}</ref> |
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Traffic is heavy worldwide, with the biggest producer being Afghanistan.<ref>{{cite web |
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| last =Nazemroaya |
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| first =Mahdi Darius |
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| year =2006 |
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| month =October 17 |
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|url=http://www.globalresearch.ca/index.php?context=viewArticle&code=NAZ20061017&articleId=3516 |
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|title=The War in Afghanistan: Drugs, Money Laundering and the Banking System |
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|publisher=GlobalResearch.ca |
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|accessdate=2006-10-22 |
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}}</ref> According to a U.N. sponsored survey,<ref>{{cite web |
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|url=http://www.unodc.org/pdf/afg/afghanistan_opium_survey_2004.pdf |
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|title=Afghanistan opium survey - 2004 |
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|publisher= |
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|accessdate=2006-10-22 |
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|format=PDF}}</ref> {{as of|2004|lc=on}}, Afghanistan accounted for production of 87 percent of the world's diacetylmorphine.<ref>{{cite news |
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| last =McGirk |
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| first =Tim |
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| year = 2004 |
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| month =August 2 |
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| url =http://www.time.com/time/asia/magazine/printout/0,13675,501040809-674806,00.html |
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| title =Terrorism's Harvest: How al-Qaeda is tapping into the opium trade to finance its operations and destabilize Afghanistan |
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| publisher =Time Magazine Asia |
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| accessdate =2006-10-22 |
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}}</ref> Afghan opium kills around 100,000 people annually.<ref>"[http://www.cnn.com/2009/WORLD/asiapcf/10/21/un.heroin.trade/index.html?eref=ib_topstories World failing to dent heroin trade, U.N. warns]". CNN.com. October 21, 2009.</ref> |
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==Society and culture== |
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The cultivation of opium in Afghanistan reached its peak in 1999, when {{convert|350|sqmi|km2}} of poppies were sown. The following year the Taliban banned poppy cultivation, a move which cut production by 94 percent. By 2001 only {{convert|30|sqmi|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 {{convert|285|sqmi|km2}}, with Afghanistan supplanting Burma to become the world's largest opium producer once more.<ref>OPIUM WARS WITHIN, Jackie Jura ~ an independent researcher monitoring local, national and international events ~ http://www.orwelltoday.com/afghanheroin.shtml</ref> |
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Opium production in that country has increased rapidly since, reaching an all-time high in 2006. [[War in Afghanistan (2001–present)|War in Afghanistan]] once again appeared as a facilitator of the trade.<ref>{{cite news |
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| last =Gall |
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| first =Carolotta |
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| year =2006 |
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| month =September 3 |
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| url =http://www.nytimes.com/2006/09/03/world/asia/03afghan.html?ex=1314936000&en=77aca21e09c8576e&ei=5088&partner=rssnyt&emc=rss |
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| title =Opium Harvest at Record Level in Afghanistan |
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| publisher =New York Times - Asia Pacific |
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| accessdate =2006-10-22 |
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}}</ref> Some 3.3 million Afghans are involved in producing opium.<ref>"[http://www.guardian.co.uk/afghanistan/story/0,,2157313,00.html UN horrified by surge in opium trade in Helmand]". The Guardian.</ref> |
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===Names=== |
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At present, opium poppies are mostly grown in [[Afghanistan]], and in [[Southeast Asia]], especially in the region known as the Golden Triangle straddling [[Myanmar]], [[Thailand]], [[Vietnam]], [[Laos]] and [[Yunnan]] province in the People's Republic of China. There is also cultivation of opium poppies in the [[Sinaloa]] region of [[Mexico]] and in [[Colombia]]. The majority of the heroin consumed in the United States comes from [[Mexico]] and [[Colombia]]. Up until 2004, [[Pakistan]] was considered one of the biggest opium-growing countries. |
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"Diamorphine" is the [[Recommended International Nonproprietary Name]] and [[British Approved Name]].<ref name="Heroin's rINN">{{cite book | vauthors = Rang HP, Ritter JM, Flower RJ, Henderson G |title=Rang & Dale's Pharmacology|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-7020-5497-6|page=515|edition=8th|url=https://books.google.com/books?id=iOLTBQAAQBAJ&pg=PA515|access-date=12 April 2016|quote=While 'diamorphine' is the recommended International Nonproprietary Name (rINN), this drug is widely known as heroin.|url-status=live|archive-url=https://web.archive.org/web/20170307152341/https://books.google.com/books?id=iOLTBQAAQBAJ&pg=PA515|archive-date=7 March 2017}}</ref><ref>{{cite book | vauthors = Rang HP, Ritter JM, Flower RJ, Henderson G |title=Rang & Dale's pharmacology|date=2011|publisher=Churchill Livingstone|edition=7th|location=Edinburgh, UK|isbn=978-0-7020-3471-8}}</ref> Other synonyms for heroin include: diacetylmorphine, and morphine diacetate. Heroin is also known by many street names including dope, H, smack, junk, horse, scag, brown, and unga, among others.<ref>{{cite web|url=http://thecyn.com/heroin-rehab/street-names/|title=Nicknames and Street Names for Heroin|publisher=Thecyn.com|access-date=12 October 2013|url-status=dead|archive-url=https://web.archive.org/web/20131014153652/http://thecyn.com/heroin-rehab/street-names/|archive-date=14 October 2013}}</ref><ref>{{cite news |title=Unga: Silent Drug Turning Successful Youth Into Instant Zombies |url=https://www.kenyans.co.ke/news/65741-unga-silent-drug-thats-turning-successful-youth-instant-zombies |access-date=15 June 2024 |work=www.kenyans.co.ke |date=13 June 2021 |language=EN}}</ref> |
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===Legal status=== |
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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]] and [[Thailand]] 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 [[Bali Nine|nine Australians in Bali]], the [[death sentence]] given to [[Nola Blake]] in Thailand in 1987, or the hanging of an Australian citizen [[Van Tuong Nguyen]] in Singapore. |
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====Asia==== |
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In Hong Kong, diamorphine is regulated under Schedule 1 of [[Hong Kong]]'s Chapter 134 ''Dangerous Drugs Ordinance''. It is available by prescription. Anyone supplying diamorphine without a valid prescription can be fined $5,000,000 ([[Hong Kong dollar|HKD]]) and imprisoned for life. The penalty for trafficking or manufacturing diamorphine is a $5,000,000 (HKD) fine and life imprisonment. Possession of diamorphine without a license from the Department of Health is illegal with a $1,000,000 (HKD) fine and 7 years of jail time.<ref>{{cite web|title=Heroin, the Poppy|url=http://www.addiction-recovery-expose.com/heroin.html|website=Addiction Recovery Expose|publisher=Randolph Online Solutions Inc|access-date=27 May 2012|url-status=dead|archive-url=https://web.archive.org/web/20120822084042/http://www.addiction-recovery-expose.com/heroin.html|archive-date=22 August 2012}}</ref><ref>{{cite web|title=Hong Kong Police – The Dangerous Drug Ordinance – Chapter 134|url=https://www.police.gov.hk/ppp_en/04_crime_matters/drug/law_pen.html|website=The Hong Kong Police website|publisher=The Hong Kong Police|access-date=5 January 2020|url-status=live|archive-url=https://web.archive.org/web/20191005070448/https://www.police.gov.hk/ppp_en/04_crime_matters/drug/law_pen.html|archive-date=5 October 2019}}</ref> |
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[[File:HeroinWorld-en.svg|thumb|400px|Primary worldwide producers of heroin]] |
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====Europe==== |
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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 society|triad]] gangs eventually came to play a major role in the illicit heroin trade. The [[French Connection]] route started in the 1930s. |
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In the Netherlands, diamorphine is a List I drug of the [[Opium Law]]. It is available for prescription under tight regulation exclusively to long-term addicts for whom [[methadone maintenance]] treatment has failed. It cannot be used to treat severe [[pain]] or other illnesses.<ref>{{cite web|title=Canada now allows prescription heroin in severe opioid addiction|url=https://www.cbc.ca/news/canada/british-columbia/canada-now-allows-prescription-heroin-in-severe-opioid-addiction-1.3753312|website=cbc.ca|publisher=CBC News|access-date=11 November 2018|archive-url=https://web.archive.org/web/20190115200403/https://www.cbc.ca/news/canada/british-columbia/canada-now-allows-prescription-heroin-in-severe-opioid-addiction-1.3753312|archive-date=15 January 2019|url-status=live}}</ref> |
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In the United Kingdom, diamorphine is available by prescription, though it is a restricted [[Class A drug]]. According to the 50th edition of the [[British National Formulary]] (BNF), diamorphine [[hydrochloride]] may be used in the treatment of acute pain, [[myocardial infarction]], acute [[pulmonary oedema]], and [[chronic pain]]. The treatment of chronic non-[[malignant]] 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]] of cancer patients, diamorphine is often injected using a [[syringe driver]].<ref>{{cite web|title=Heroin|url=http://www.nacada.go.ke/drugs/heroin/|publisher=NACADA|access-date=27 May 2012 |archive-url=https://web.archive.org/web/20121203073833/http://www.nacada.go.ke/drugs/heroin/ |archive-date=3 December 2012}}</ref> |
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Heroin trafficking was virtually eliminated in the U.S. during [[World War II]] 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. |
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In Switzerland, heroin is produced in injectable or tablet form under the name Diaphin by a private company under contract to the Swiss government.<ref>{{Cite web|url=https://www.swissinfo.ch/eng/good-crop--bad-crop_-federal-dealer--on-20-years-of-heroin-scheme/37953750|title='Federal dealer' on 20 years of heroin scheme| vauthors = Ochsenbein G |website=SWI swissinfo.ch|date=14 February 2014 |language=en|access-date=13 December 2018|archive-url=https://web.archive.org/web/20181215221901/https://www.swissinfo.ch/eng/good-crop--bad-crop_-federal-dealer--on-20-years-of-heroin-scheme/37953750|archive-date=15 December 2018|url-status=live}}</ref> Swiss-produced heroin has been imported into Canada with government approval.<ref>{{Cite web|url=https://www.canada.ca/en/health-canada/services/drugs-health-products/access-drugs-exceptional-circumstances/list-drugs-urgent-public-health-need.html|title=List of Drugs for an Urgent Public Health Need|publisher=Health Canada|date=28 June 2017|access-date=13 December 2018|archive-url=https://web.archive.org/web/20181206220049/https://www.canada.ca/en/health-canada/services/drugs-health-products/access-drugs-exceptional-circumstances/list-drugs-urgent-public-health-need.html|archive-date=6 December 2018|url-status=live}}</ref> |
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After World War II, the [[Mafia]] 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.<ref>Eric C. Schneider, '''Smack: Heroin and the American City''', University of Pennsylvania Press, 2008, chapter one</ref> |
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====Australia==== |
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Large scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s.{{Citation needed|date=December 2008}} The elimination of Chinese production happened at the same time that Sicily's role in the trade developed. |
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In Australia, diamorphine is listed as a schedule 9 prohibited substance under the [[Standard for the Uniform Scheduling of Medicines and Poisons|Poisons Standard]] (October 2015).<ref name="Poisons Standard">Poisons Standard October 2015 {{cite web |url=https://www.comlaw.gov.au/Details/F2015L01534 |title=Poisons Standard October 2015 |date=30 September 2015 | publisher = Commonwealth of Australia |access-date=6 January 2016 |url-status=live |archive-url=https://web.archive.org/web/20160119074606/https://www.comlaw.gov.au/Details/F2015L01534/ |archive-date=19 January 2016}}</ref> The state of [[Western Australia]], in its ''Poisons Act 1964'' (Reprint 6: amendments as at 10 Sep 2004), described a schedule 9 drug as: "Poisons that are drugs of abuse, the manufacture, possession, sale or use of which should be prohibited by law except for amounts which may be necessary for educational, experimental or research purposes conducted with the approval of the Governor."<ref>{{cite act |title=The Poisons Act 1964 |article=20 (2) (i) |page=16 |date=10 September 2004 |legislature=[[Parliament of Western Australia]] |url=https://www.legislation.wa.gov.au/legislation/former/Swans.nsf/(DownloadFiles)/Poisons+Act+1964.pdf/$file/Poisons+Act+1964.pdf |access-date=2023-11-15 |archive-url=https://web.archive.org/web/20231116050739/https://www.legislation.wa.gov.au/legislation/former/Swans.nsf/%28DownloadFiles%29/Poisons+Act+1964.pdf/$file/Poisons+Act+1964.pdf |archive-date=2023-11-16 |url-status=live}}</ref> |
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====North America==== |
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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. |
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In Canada, diamorphine is a controlled substance<ref>{{cite news|title=Medically prescribed heroin more cost-effective than methadone, study suggests|url=https://www.thestar.com/news/canada/article/1144818--medically-prescribed-heroin-more-cost-effective-than-methadone-study-suggests|work=[[The Toronto Star]]|access-date=27 May 2012| vauthors = Ubelacker S |date=12 March 2012|url-status=live|archive-url= https://web.archive.org/web/20120416015457/http://www.thestar.com/news/canada/article/1144818--medically-prescribed-heroin-more-cost-effective-than-methadone-study-suggests|archive-date=16 April 2012}}</ref> under Schedule I of the [[Controlled Drugs and Substances Act]] (CDSA).<ref>{{cite web|title=Heroin Legal Status|url=http://www.erowid.org/chemicals/heroin/heroin_law.shtml|website=Vaults of Erowid|publisher=[[Erowid]] |access-date=27 May 2012|url-status=live|archive-url=https://web.archive.org/web/20120514101729/http://www.erowid.org/chemicals/heroin/heroin_law.shtml|archive-date=14 May 2012}}</ref> Any person seeking or obtaining diamorphine without disclosing authorization 30 days before 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 diamorphine for the purpose of trafficking is an indictable offense and subject to imprisonment for life. |
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In the United States, diamorphine is a Schedule I drug according to the [[Controlled Substances Act]] of 1970, making it illegal to possess without a DEA license.<ref name="DOJ 1308.11">{{cite web | title = Title 21 of the Code of Federal Regulations (21 CFR) 1308.11 | url = http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_11.htm | archive-url = https://web.archive.org/web/20090827043725/http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_11.htm | archive-date=27 August 2009 | date = 18 October 2012 }}</ref> Possession of more than 100 grams of diamorphine or a mixture containing diamorphine is punishable with a minimum mandatory sentence of 5 years of imprisonment in a federal prison. |
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In late 1960s and early 70s, the [[CIA]] supported anti-Communist Chinese Nationalists settled near [[China|Sino]]-[[Burma|Burmese]] border and [[Hmong people|Hmong]] tribesmen in [[Laos]]. This helped the development of the [[Golden Triangle (Southeast Asia)|Golden Triangle]] opium production region, which supplied about one-third of heroin consumed in US after 1973 American withdrawal from Vietnam. As of 1999, [[Myanmar]] (formerly [[Burma]]), the heartland of the Golden Triangle remained the second largest producer of heroin, after [[Afghanistan]].<ref name="Afghan_Burmese_heroin">{{cite news|url=http://news.bbc.co.uk/1/hi/uk/1590827.stm|title=War Views: Afghan heroin trade will live on.|date=October 200q|work=Richard Davenport-Hines|publisher=BBC|accessdate=2008-10-30}}</ref> |
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In 2021, the US state of Oregon became the first state to decriminalize the use of heroin after voters passed [[Oregon Ballot Measure 110|Ballot Measure 110]] in 2020.<ref>{{cite news |url=https://www.washingtonpost.com/nation/2020/11/04/election-drugs-oregon-new-jersey/ |title=Oregon decriminalizes possession of hard drugs, as four other states legalize recreational marijuana |newspaper=The Washington Post |date=5 November 2020 }}</ref> This measure will allow people with small amounts to avoid arrest.<ref>{{Cite web|url=http://www.theguardian.com/us-news/2020/nov/03/oregon-drugs-decriminalize-arizona-new-jersey-marijuana|title=Oregon becomes first US state to decriminalize possession of hard drugs|date=4 November 2020|website=The Guardian}}</ref> |
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Soviet-Afghan war led to increased production in the Pakistani-Afghani border regions, as U.S.-backed [[mujaheddin]] militants raised money for arms from selling opium, contributing heavily to the modern [[Golden Crescent]] creation. By 1980, 60% of heroin sold in the U.S. originated in Afghanistan.<ref name="Afghan_Burmese_heroin"/> 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. |
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=== |
====Turkey==== |
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{{See also|Illegal drug trade in Turkey}} |
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The [[European Monitoring Centre for Drugs and Drug Addiction]] reports that the retail price of brown heroin varies from [[Euro|€]]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.<ref>{{cite book |author=European Monitoring Centre for Drugs and Drug Addiction |title=Annual report: the state of the drugs problem in Europe |year=2008 |publisher=Office for Official Publications of the European Communities |location=Luxembourg |isbn=978-92-9168-324-6 |page=70 |url=http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf }}</ref> |
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[[Turkey]] maintains strict laws against the use, possession or [[Illegal drug trade|trafficking of illegal drugs]]. If convicted under these offences, one could receive a heavy fine or a prison sentence of 4 to 24 years.<ref>{{cite web|url=https://www.gov.uk/foreign-travel-advice/turkey/local-laws-and-customs|title=Turkey Travel Advice|access-date=20 March 2013|publisher=[[GOV.UK]] |archive-url=https://web.archive.org/web/20130607023012/https://www.gov.uk/foreign-travel-advice/turkey/local-laws-and-customs|archive-date=7 June 2013|url-status=live}}</ref> |
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====Misuse of prescription medication==== |
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The [[United Nations Office on Drugs and Crime]] claims in its 2008 World Drug Report that typical US retail prices are [[United States Dollar|US$]]172 per gram.<ref>{{cite book |author=United Nations Office on Drugs and Crime |title=World drug report |year=2008 |publisher=United Nations Publications |location= |isbn=978-92-1-148229-4 |page=49 |url=http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf }}</ref> |
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Misused prescription medicine, such as opioids, can lead to heroin use and dependence.<ref name="Abuse">{{Cite news|url=https://www.drugabuse.gov/publications/research-reports/heroin/how-heroin-linked-to-prescription-drug-abuse|title=How is heroin linked to prescription drug abuse? |author = National Institute on Drug Abuse |access-date=28 November 2017|language=en-US|archive-url=https://web.archive.org/web/20171201035612/https://www.drugabuse.gov/publications/research-reports/heroin/how-heroin-linked-to-prescription-drug-abuse|archive-date=1 December 2017|url-status=dead}}</ref> The number of death from illegal opioid overdose follows the increasing number of death caused by prescription opioid overdoses.<ref>{{Cite web|url=https://www.cdc.gov/drugoverdose/data/analysis.html|title=Opioid Data Analysis {{!}} Drug Overdose {{!}} CDC Injury Center|website=www.cdc.gov|language=en-us|access-date=28 November 2017|archive-url=https://web.archive.org/web/20180130110545/https://www.cdc.gov/drugoverdose/data/analysis.html|archive-date=30 January 2018|url-status=live}}</ref> Prescription opioids are relatively easy to obtain.<ref>{{Cite news|url=https://www.cbsnews.com/news/whats-a-pill-mill/|title=What's A Pill Mill?|access-date=28 November 2017|language=en|archive-url=https://web.archive.org/web/20171201041552/https://www.cbsnews.com/news/whats-a-pill-mill/|archive-date=1 December 2017|url-status=live}}</ref> This may ultimately lead to heroin injection because heroin is cheaper than prescribed pills.<ref name="Abuse"/> |
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== |
===Economics=== |
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<!--IMAGE-->[[File:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg|thumb|250px|Data from ''[[The Lancet]]'' shows diacetylmorphine to be the most addictive and most harmful of twenty popular [[recreational drugs]].<ref name="Nutt">{{cite journal |last1=Nutt |first1=D |last2=King |first2=LA |last3=Saulsbury |first3=W |last4=Blakemore |first4=C |title=Development of a rational scale to assess the harm of drugs of potential misuse |journal=Lancet |volume=369 |issue=9566 |pages=1047–53 |year=2007 |pmid=17382831 |doi=10.1016/S0140-6736(07)60464-4}}</ref>]] |
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{{Main|Harm reduction|Safe injection sites|Needle exchange programs}} |
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[[Harm reduction]] 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 disease|blood-borne viruses]] 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]] (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. |
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====Production==== |
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Governments that support a harm reduction approach usually fund [[needle-exchange programme|needle & syringe exchange programmes]], 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). |
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Diamorphine is produced from [[acetylation]] of morphine derived from natural opium sources. One such method of heroin production involves isolation of the water-soluble components of raw opium, including morphine, in a strongly basic aqueous solution, followed by [[recrystallization (chemistry)|recrystallization]] of the morphine base by addition of [[ammonium chloride]]. The solid morphine base is then filtered out. The morphine base is then reacted with [[acetic anhydride]], which forms heroin. This highly impure brown heroin base may then undergo further purification steps, which produces a white-colored product; the final products have a different appearance depending on purity and have different names.<ref name="auto"/> Heroin purity has been classified into four grades. No.4 is the purest form – white powder (salt) to be easily dissolved and injected. No.3 is "brown sugar" for smoking (base). No.1 and No.2 are unprocessed raw heroin (salt or base).<ref>{{cite web |title=Heroin—Illicit Drug Report |publisher=Government of Australia |access-date=31 March 2014 |year=2004 |url=http://www.crimecommission.gov.au/sites/default/files/iddr_0304_heroin.pdf |url-status=dead |archive-url=https://web.archive.org/web/20140212170007/https://www.crimecommission.gov.au/sites/default/files/iddr_0304_heroin.pdf |archive-date=12 February 2014}}</ref> |
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====Trafficking==== |
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Another harm reduction measure employed for example in [[Europe]], [[Canada]] and [[Australia]] are [[safe injection sites]] where users can inject diacetylmorphine and [[cocaine]] 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.<ref>{{cite journal |last1=Kimber |first1=Jo |last2=Dolan |first2=Kate |last3=Wodak |first3=Alex |title=Survey of drug consumption rooms: service delivery and perceived public health and amenity impact |journal=Drug and Alcohol Review |volume=24 |issue=1 |pages=21–4 |year=2005 |pmid=16191717 |doi=10.1080/09595230500125047}}</ref> |
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[[File:CIA Map of International illegal drug connections.gif|thumb|400px|International drug routes]] |
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{{See also|Opium#Modern production and use}} |
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Traffic is heavy worldwide, with the biggest producer being [[Afghanistan]]. According to a U.N. sponsored survey,<ref name="UNODCSurvey">{{cite web|url=http://www.unodc.org/pdf/afg/afghanistan_opium_survey_2004.pdf|title=Afghanistan opium survey – 2004|publisher=United Nations Office on Drugs and Crime|access-date=22 October 2006|url-status=live|archive-url=https://web.archive.org/web/20061024170057/http://www.unodc.org/pdf/afg/afghanistan_opium_survey_2004.pdf|archive-date=24 October 2006}}</ref> in 2004, Afghanistan accounted for production of 87 percent of the world's diamorphine.<ref>{{cite news| vauthors = McGirk T | date =2 August 2004| url =http://www.time.com/time/asia/magazine/printout/0,13675,501040809-674806,00.html| title =Terrorism's Harvest: How al-Qaeda is tapping into the opium trade to finance its operations and destabilize Afghanistan| magazine =[[Time Asia]]| access-date =22 October 2006| url-status=dead| archive-url =https://web.archive.org/web/20070123133151/http://www.time.com/time/asia/magazine/printout/0,13675,501040809-674806,00.html| archive-date =23 January 2007}}</ref> Afghan opium kills around 100,000 people annually.<ref>{{cite news |url=http://www.cnn.com/2009/WORLD/asiapcf/10/21/un.heroin.trade/index.html |title=World failing to dent heroin trade, U.N. warns |work=CNN|date=21 October 2009 |access-date=20 July 2012 |url-status=live |archive-url=https://web.archive.org/web/20121106182829/http://www.cnn.com/2009/WORLD/asiapcf/10/21/un.heroin.trade/index.html |archive-date=6 November 2012}}</ref> |
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==Popular culture== |
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===Actors=== |
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A number of actors are known for their use of heroin. Among them are: |
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* [[John Belushi]], died of an overdose in 1982.<ref>http://articles.sun-sentinel.com/keyword/john-belushi</ref> |
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* [[Robert Downey, Jr.]] <ref>{{cite news| url=http://news.bbc.co.uk/2/hi/americas/413283.stm | work=BBC News | title=Addicted Downey Jnr jailed | date=1999-08-06}}</ref> |
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* [[Chris Farley]], died of an overdose in 1997.<ref>http://www.chron.com/disp/story.mpl/life/books/reviews/5808378.html</ref> |
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* [[Artie Lange]]<ref>http://articles.nydailynews.com/2009-06-16/gossip/17925487_1_lange-second-chance-sober</ref> |
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* [[MacKenzie Phillips]] <ref>{{cite news| url=http://www.telegraph.co.uk/news/newstopics/celebritynews/6221455/Mackenzie-Phillips-incest-and-heroin-claim-from-Mamas-and-Papas-founders-daughter.html | location=London | work=The Daily Telegraph | first=Alastair | last=Jamieson | title=Mackenzie Phillips: incest and heroin claim from Mamas and Papas founder's daughter | date=2009-09-23}}</ref> |
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* [[Tom Sizemore]] <ref>{{cite news| url=http://www.independent.co.uk/arts-entertainment/interview-tom-sizemore--saving-tom-sizemore-1196331.html | location=London | work=The Independent | first=Nick | last=Hasted | title=Interview: Tom Sizemore - Saving Tom Sizemore | date=1998-09-06}}</ref> |
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In 2003 ''[[The Independent]]'' reported:<ref>Andy McSmith and Phil Reeves. "Afghanistan regains its Title as World's biggest Heroin Dealer" in ''[[The Independent]]'', 22 June 2003</ref><ref>{{cite news | vauthors = North A |url=http://news.bbc.co.uk/2/hi/south_asia/3476377.stm |title=The drugs threat to Afghanistan |work=BBC |date=10 February 2004 |access-date=28 July 2013 |url-status=live |archive-url=https://web.archive.org/web/20131015080956/http://news.bbc.co.uk/2/hi/south_asia/3476377.stm |archive-date=15 October 2013}}</ref> |
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===Film and television=== |
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{{blockquote|The cultivation of opium [in Afghanistan] reached its peak in 1999, when {{convert|350|sqmi|km2}} of poppies were sown ... The following year the Taliban banned poppy cultivation, ... a move which cut production by 94 percent ... By 2001 only {{convert|30|sqmi|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 {{convert|285|sqmi|km2}}, with Afghanistan supplanting Burma to become the world's largest opium producer once more.}} |
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* The film, ''[[American Gangster (film)|American Gangster]]'', is loosely based on real life drug dealer [[Frank Lucas (drug lord)|Frank Lucas]], who sold heroin.<ref>{{cite web |date=2007-12-09|url = http://www.voice-online.co.uk/content.php?show=12509|title = The Real American Gangster|publisher = voice-online| accessdate = 2008-03-08 | last= Janelle Oswald|quote=She spent five years in prison for aiding her husband's narcotic smuggling trade. Having to get used to the public life again after living like a 'ghost' since her release, the making of her partner's life on the big screen has brought back many memories, some good and some bad.}}</ref> |
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* The film ''[[Gia]]'', based on a true story of model [[Gia Carangi]], is about her addiction and use of heroin and how it affected her.<ref>{{cite news |url=http://news.independent.co.uk/world/americas/article311535.ece |title= Gia: The tragic tale of the world's first supermodel |first=Paul |last=Vallely |date=2005-09-10 |accessdate=2009-05-12 |work=[[The Independent]] | location=London}}</ref> |
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* The film ''[[Trainspotting (film)|Trainspotting]]'' chronicles the exploits of a group of heroin addicts in Edinburgh, Scotland, during the 1990's. |
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Opium production in that country has increased rapidly since, reaching an all-time high in 2006. [[War in Afghanistan (2001–2021)|War in Afghanistan]] once again appeared as a facilitator of the trade.<ref>{{cite news| vauthors = Gall C | date =3 September 2006| url =https://www.nytimes.com/2006/09/03/world/asia/03afghan.html| title =Opium Harvest at Record Level in Afghanistan| work =The New York Times| access-date =22 October 2006| url-status=live| archive-url =https://web.archive.org/web/20071228015047/http://www.nytimes.com/2006/09/03/world/asia/03afghan.html| archive-date =28 December 2007}}</ref> Some 3.3 million Afghans are involved in producing opium.<ref>{{cite news | vauthors = Walsh D |url=https://www.theguardian.com/afghanistan/story/0,,2157313,00.html |title=UN horrified by surge in opium trade in Helmand |newspaper=Guardian |date= 30 August 2007|access-date=20 July 2012 |location=London}}</ref> |
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===Musicians=== |
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[[File:Afghanistan opium poppy cultivation 1994-2007b.PNG|thumb|right|300px|[[Opium production in Afghanistan|Afghanistan opium poppy cultivation]], 1994–2016 (hectares)]] |
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Use of heroin by musicians has been recorded in the following cases. |
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At present, opium poppies are mostly grown in Afghanistan ({{convert|224000|hectare}}), and in Southeast Asia, especially in the region known as the [[Golden Triangle (Southeast Asia)|Golden Triangle]] straddling [[Burma]] ({{convert|57600|hectare}}), [[Thailand]], [[Vietnam]], [[Laos]] ({{convert|6200|hectare}}) and [[Yunnan]] province in China. There is also cultivation of opium poppies in Pakistan ({{convert|493|hectare}}), Mexico ({{convert|12000|hectare}}) and in [[Colombia]] ({{convert|378|hectare}}).<ref name="UNODC2014">{{cite web | url=https://www.unodc.org/documents/crop-monitoring/Colombia/censo_INGLES_2014_WEB.pdf | title=Coca cultivation survey | publisher=United Nations Office on Drugs and Crime (UNODC) | website=Report | date=July 2015 | access-date=28 May 2016 | author=Government of Colombia | pages=67 | url-status=live | archive-url=https://web.archive.org/web/20160413083056/https://www.unodc.org/documents/crop-monitoring/Colombia/censo_INGLES_2014_WEB.pdf | archive-date=13 April 2016}}</ref> According to the [[Drug Enforcement Administration|DEA]], the majority of the heroin consumed in the United States comes from Mexico (50%) and Colombia (43–45%) via Mexican criminal cartels such as [[Sinaloa Cartel]].<ref>{{cite web | url = http://www.theyucatantimes.com/2014/11/50-of-the-heroin-consumed-in-the-united-states-is-produced-in-mexico/ | title = 50% of the Heroin consumed in the United States is produced in Mexico | archive-url = https://web.archive.org/web/20151102193328/http://www.theyucatantimes.com/2014/11/50-of-the-heroin-consumed-in-the-united-states-is-produced-in-mexico/ | archive-date=2 November 2015 | work = The Yucatan Times | date = 26 November 2014 }}</ref> However, these statistics may be significantly unreliable, the DEA's 50/50 split between Colombia and Mexico is contradicted by the amount of hectares cultivated in each country and in 2014, the DEA claimed most of the heroin in the US came from Colombia.<ref name="InSight">{{cite web | url=http://www.insightcrime.org/news-analysis/mexico-cartel-takeover-of-us-heroin-market-questionable | title=Sinaloa Cartel's Takeover of US Heroin Market Questionable | publisher=InSight Crime | website=Website | date=26 May 2016 | access-date=28 May 2016 | vauthors = Yagoub M | url-status=live | archive-url=https://web.archive.org/web/20160527122359/http://www.insightcrime.org/news-analysis/mexico-cartel-takeover-of-us-heroin-market-questionable | archive-date=27 May 2016}}</ref> |
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{{As of|2015}}, the Sinaloa Cartel is the most active [[drug cartel]] involved in smuggling illicit drugs such as heroin into the United States and trafficking them throughout the United States.<ref name="DEA 2015 assessment">{{cite web|title=2015 National Drug Threat Assessment Summary|url=http://www.dea.gov/docs/2015%20NDTA%20Report.pdf|website=Drug Enforcement Administration|publisher=United States Department of Justice: Drug Enforcement Administration|access-date=10 April 2016|pages=1–2|date=October 2015|quote=Mexican TCOs pose the greatest criminal drug threat to the United States; no other group is currently positioned to challenge them. These Mexican poly-drug organizations traffic heroin, methamphetamine, cocaine, and marijuana throughout the United States, using established transportation routes and distribution networks. ... While all of these Mexican TCOs transport wholesale quantities of illicit drugs into the United States, the Sinaloa Cartel appears to be the most active supplier. The Sinaloa Cartel leverages its expansive resources and dominance in Mexico to facilitate the smuggling and transportation of drugs throughout the United States.|url-status=dead|archive-url=https://web.archive.org/web/20160410100038/http://www.dea.gov/docs/2015%20NDTA%20Report.pdf|archive-date=10 April 2016}}</ref> According to the [[Royal Canadian Mounted Police]], 90% of the heroin seized in Canada (where the origin was known) came from Afghanistan.<ref name="RMCP">{{cite web | url=https://ottawacitizen.com/news/politics/u-s-raises-alarm-over-afghan-heroin-flowing-through-canada | title=U.S. raises alarm over Afghan heroin flowing through Canada | newspaper=[[Ottawa Citizen]] | date=20 November 2014 | access-date=28 May 2016 | vauthors = Berthiaume L | url-status=live | archive-url=https://web.archive.org/web/20160615054458/http://ottawacitizen.com/news/politics/u-s-raises-alarm-over-afghan-heroin-flowing-through-canada | archive-date=15 June 2016}}</ref> Pakistan is the destination and transit point for 40 percent of the opiates produced in Afghanistan, other destinations of Afghan opiates are Russia, Europe and Iran.<ref name="NYT2014">{{cite web | url=https://www.nytimes.com/2014/10/27/opinion/afghanistans-unending-addiction.html | title=Afghanistan's Unending Addiction | work=The New York Times | date=26 October 2014 | access-date=28 May 2016 | author=Editorial Board | url-status=live | archive-url=https://web.archive.org/web/20160814143949/http://www.nytimes.com/2014/10/27/opinion/afghanistans-unending-addiction.html | archive-date=14 August 2016}}</ref><ref>{{cite web|url=https://www.unodc.org/pakistan/en/country-profile.html|title=Country Profile: Pakistan|publisher=[[United Nations Office on Drugs and Crime]]|access-date=5 January 2015|url-status=live|archive-url=https://web.archive.org/web/20150405032932/http://www.unodc.org/pakistan/en/country-profile.html|archive-date=5 April 2015}}</ref> |
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A 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 and [[Thailand]] are the strictest. 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 [[Bali Nine|nine Australians in Bali]], the [[death sentence]] given to [[Nola Blake]] in Thailand in 1987, or the hanging of an Australian citizen [[Van Tuong Nguyen]] in Singapore. |
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* [[Steven Adler]]<ref>http://books.google.com/books?id=pPSPe0DWrioC&pg=PA181&lpg=PA181&dq=steven+adler+heroin&source=bl&ots=7-GFXBBYa9&sig=lphOjZYVlEn1EpUw05K88UOmjPc&hl=en&ei=3BM6Tp2-HYKFtgf9lJWJAw&sa=X&oi=book_result&ct=result&resnum=6&ved=0CD4Q6AEwBTgK#v=onepage&q=steven%20adler%20heroin&f=false</ref> |
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* [[B.G. (rapper)|B.G.]], a [[rap]] artist from New Orleans, raps about his previous addiction to heroin (via injection) in numerous songs.<ref name="HipHopDX">{{cite web|last=Koslow|first=Jessica|title=B.G.: Heroin & Cash|url=http://www.hiphopdx.com/index/interviews/id.414/title.bg-heroin-cash|publisher=Hip Hop DX|accessdate=26 July 2010}}</ref> |
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* [[Tommy Bolin]]<ref>[http://www.tbolin.com/articles/rollingstone_1977.html ''Rolling Stone'']</ref> |
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* [[Boy George]]<ref>[http://www.people.com/people/archive/article/0,,20096963,00.html ''People Magazine'']</ref> |
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* [[Ray Charles]] Charles began using heroin as a teenager. He went into rehab in 1965 and stayed clean for the rest of his life. |
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* [[Kurt Cobain]]<ref>[http://www.burntout.com/kurt/biography/ Burnt Out]</ref> |
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* [[Darby Crash]]<ref>[http://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=1223]''Find a Grave''</ref> |
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* [[Robbin Crosby]]: Guitarist for the 80's [[Glam Metal]] band [[RATT]] died of a heroin overdose. |
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* [[Miles Davis]]<ref>[http://www.historyjazz.com/milesdavis.html Miles Davis]</ref> |
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* [[Bob Dylan]]<ref>news.bbc.co.uk/today/hi/today/newsid_9492000/9492886.stm</ref> |
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* [[Marianne Faithfull]]<ref>{{cite web|last=Duerden|first=Nick|title=Marianne Faithfull: 'Drugs are completely irrelevant to me now'|url=http://www.independent.co.uk/news/people/profiles/marianne-faithfull-drugs-are-completely-irrelevant-to-me-now-2230472.html |work=The Independent |date=Sunday, 6 March 2011 |accessdate=8 August 2011}}</ref> |
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* [[John Frusciante]]<ref>[http://www.nyrock.com/interviews/rhcp_int.htm]</ref> |
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* [[Jerry Garcia]], guitarist for the [[Grateful Dead]], 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.<ref name="LeshBook">{{cite book|last=Lesh|first=Phil|title=Searching for the Sound: My Life with the Grateful Dead|year=2005|publisher=Little, Brown, and Company|isbn=0-316-00998-9}}</ref><ref name="StrangeTrip">{{cite journal|last=Dougherty|first=Steve|title=What a Long, Strange Trip|journal=People Magazine|date=21|year=1995|month=August|volume=44|url=http://www.people.com/people/archive/article/0,,20101375,00.html|accessdate=26 July 2010}}</ref> |
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* [[Brett Gurewitz]], guitarist for [[Bad Religion]]<ref>http://www.bostonphoenix.com/boston/music/other_stories/documents/02183828.htm</ref> |
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* [[Billie Holiday]]<ref>[http://www.pbs.org/wnet/americanmasters/episodes/billie-holiday/about-the-singer/68/ Billie Holiday]</ref> |
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* [[Steve Jones]], guitarist for the [[Sex Pistols]]<ref>http://www.thedailybeast.com/newsweek/1996/08/25/rockers-models-and-the-new-allure-of-heroin.html</ref> |
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* [[Janis Joplin]]<ref>[http://www.nytimes.com/books/99/05/02/specials/joplin-obit2.html ''New York Times'']</ref><ref name="Times Online">[http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/music/article4567970.ece Times Online]</ref> |
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*[[Anthony Kiedis]]<ref>http://www.mtv.com/bands/b/books/news_feature_041018/</ref> |
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* [[Courtney Love]]<ref>[http://articles.orlandosentinel.com/1993-01-04/news/9301040217_1_courtney-love-singer-courtney-nirvana ''Orlando Sentinel'']</ref> |
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* [[Jim Morrison]]<ref name="Times Online"/><ref>[http://www.dailymail.co.uk/tvshowbiz/article-466947/The-shocking-truth-pal-Jim-Morrison-REALLY-died.html ''Daily Mail'']</ref> |
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* [[Mike Ness]], singer/guitarist for [[Social Distortion]]<ref>http://books.google.com/books?id=QurB9YiFO9QC&pg=PA63&lpg=PA63&dq=mike+ness+heroin&source=bl&ots=rpi5eUhKyz&sig=dGdZ_zYR_iBow5I6s8ayvedAjtQ&hl=en&ei=YRU6TtOlA4SDtgfP0aznAg&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCAQ6AEwAjgK#v=onepage&q=mike%20ness%20heroin&f=false</ref> |
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* [[Jerry Nolan]], drummer for the [[New York Dolls]] and [[The Heartbreakers]]<ref>http://www.rollingstone.com/music/artists/johnny-thunders-and-the-heartbreakers/biography</ref> |
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*[[Bradley Nowell]], died of an overdose in 1996.<ref>http://www.avclub.com/articles/part-7-1996-layne-staley-and-bradley-nowell-are-th,49874/</ref> |
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* [[Charlie Parker]]<ref>[http://www.vh1.com/artists/az/parker_charlie/bio.jhtml VH1]</ref> |
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* [[Kristen Pfaff]], bassist for [[Hole (band)|Hole]] died of an overdose in 1994.<ref>http://community.seattletimes.nwsource.com/archive/?date=19940619&slug=1916375</ref> |
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* [[John_Phillips_(musician)|John Phillips ]]<ref>[http://www.telegraph.co.uk/culture/music/6228133/John-Phillips-a-lifetime-of-debauched-and-reckless-behaviour.html ''Telegraph'']</ref> |
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*Joe Queer, singer/guitarist of [[The Queers]].<ref>http://www.mysteryisland.net/thequeers</ref> |
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*[[Dee Dee Ramone]] of the [[Ramones]] died of a heroin overdose in 2002 after a long history with the drug.<ref>http://www.nytimes.com/2002/06/07/arts/dee-dee-ramone-pioneer-punk-rocker-dies-at-50.html</ref> |
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*[[Trent Reznor]]<ref>http://www.mtv.com/bands/n/nin/news_feature_050509/</ref> |
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* [[Keith Richards]]<ref>[http://www.dailymail.co.uk/tvshowbiz/article-550988/Keith-Richards-I-smoke-weed-time--remember-happened-yesterday.html ''Daily Mail'']</ref> |
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* [[Casey Royer]]<ref>http://www.huffingtonpost.com/2011/03/14/casey-royer-arrested-for-_n_835583.html</ref> |
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* Michael Rudetsky, keyboardist who collaborated with [[Culture Club]].<ref>[http://www.people.com/people/archive/article/0,,20096963,00.html ''People Magazine''], "Long Island musician found dead of a heroin overdose at Boy George's home in [[London]]"</ref> |
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* [[Slash (musician)|Slash]] <ref>{{cite book|last=Davis|first=Stephen|title=Watch You Bleed: The Saga of Guns N' Roses|year=2008|publisher=Gotham Books|location=New York|isbn=978-1-592-40377-6|pages=280}}</ref> |
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*[[Hillel Slovak]], guitarist for the [[Red Hot Chili Peppers]] died of a heroin overdose in 1988.<ref> Hillel Slovak </ref> |
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* [[Nikki Sixx]] of [[Mötley Crüe]] released diaries from his time as a heroin addict titled: ''[[The Heroin Diaries: A Year in the Life of a Shattered Rock Star]]''.<ref name="nikkisixx">{{cite web|title=Nikki Sixx's The Heroin Diaries #7 on The New York Times Best Seller List |url=http://www2.prnewswire.com/cgi-bin/stories.pl?ACCT=ind_focus.story&STORY=/www/story/09-27-2007/0004671540&EDATE=THU+Sep+27+2007,+02:31+PM}}</ref> An [[The Heroin Diaries Soundtrack|album]] was also produced based on the book.<ref name="nikkisixx"/> |
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* [[Layne Staley]], singer for [[Alice in Chains]] died of an overdose in 2002.<ref>[http://www.mtv.com/news/articles/1470138/layne-staleys-last-interview-revealed.jhtml ''MTV'']</ref> |
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* [[Mike Starr]], bassist for [[Alice in Chains]] died of an overdose in 2011.<ref>http://www.guardian.co.uk/music/2011/mar/10/deadliest-music-genre-grunge-mike-starr</ref> |
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* [[James Taylor]]<ref>[http://www.classicbands.com/taylor.html Classic Bands]</ref> |
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* [[Johnny Thunders]]<ref>http://www.gibson.com/backstage/200610/johnnythunders.htm</ref> |
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* [[Sid Vicious]] of the [[Sex Pistols]] died of a heroin overdose, and allegedly stabbed his girlfriend to death while both were strung out on heroin.<ref>{{cite news|url=http://news.bbc.co.uk/onthisday/hi/dates/stories/february/2/newsid_2523000/2523601.stm|title=Sid Vicious dies from drugs overdose | date=1979-02-02 | accessdate=2010-01-05 | work=BBC News}}</ref> |
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* [[Scott Weiland]]<ref>http://www.mtv.com/news/articles/1599025/scott-weilands-new-solo-lp-inspired-by-marital-woes-brothers-death.jhtml</ref> |
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* [[Rozz Williams]]'s final album before his suicide, ''[[The Whorse's Mouth]]'', dealt with his heroin addiction.<ref>{{cite web |url= {{Allmusic|class=artist|id=p42400/biography|pure_url=yes}}|title= Rozz Williams|accessdate=2008-04-11 |author= Ankeny, Jason|publisher= [[Allmusic]]}}</ref> |
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* [[Andrew Wood (singer)|Andrew Wood]], died of an overdose in 1990.<ref>http://www.allmusic.com/artist/andrew-wood-p139483/biography</ref> |
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=== |
====Trafficking history==== |
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[[File:HeroinWorld-en.svg|thumb|400px|Primary worldwide producers of heroin]] |
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Songs about heroin include: |
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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 the government in China and conditions of civil war enabled heroin production to take root there. Chinese [[Triad society|triad]] gangs eventually came to play a major role in the illicit heroin trade. The [[French Connection]] route started in the 1930s. |
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* "[[Heroin (song)|Heroin]]" by the [[Velvet Underground]] |
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* "[[Mr Brownstone]]" by [[Guns N Roses]]<ref>[http://www.guardian.co.uk/music/2004/jul/09/velvetrevolver.gunsnroses]</ref> |
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* "[[Space Oddity (song)|Space Oddity]]", [[David Bowie]]'s first single, was seemingly about his experience with heroin, as his 1980 single "[[Ashes to Ashes (David Bowie song)|Ashes to Ashes]]" included lines that refer to Major Tom as "...a junkie/strung out on heaven's high/hitting an all-time low."<ref name="nuaa">{{cite web |
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| author = Matthew Bates |
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| title = Loaded - Great heroin songs of the rock era |
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| url = http://www.nuaa.org.au/nuaa/News/media/UN52/UN52-loaded_great_heroin_songs.pdf |
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| format = PDF |
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| pages = 26–27 |
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| date = 2008-12 |
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| accessdate = 2008-01-17 |archiveurl = http://web.archive.org/web/20080409082048/http://www.nuaa.org.au/nuaa/News/media/UN52/UN52-loaded_great_heroin_songs.pdf <!-- Bot retrieved archive --> |archivedate = 2008-04-09}}</ref> |
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Heroin trafficking was virtually eliminated in the US during [[World War II]] 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, [[Sicilian Mafia|the Mafia]] took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily which was located along the historic route opium took westward into Europe and the United States.<ref>Eric C. Schneider, ''Smack: Heroin and the American City'', University of Pennsylvania Press, 2008, chapter one</ref> Large-scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s.{{Citation needed|date=December 2008}} The elimination of Chinese production happened at the same time that Sicily's role in the trade developed. |
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===Writers=== |
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Writers known to have used heroin are; |
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* [[Claude Brown]], in ''[[Manchild in the Promised Land]]''<ref>[http://www.racematters.org/manchildinthepromisedland.htm Race Matters]</ref> |
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* [[William S. Burroughs]] <ref>[http://www.independent.co.uk/arts-entertainment/films/features/william-s-burroughs-revealing-the-man-within-2112736.html ''Independent'']</ref> |
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* [[Jim Carroll]], in [[The Basketball Diaries]] |
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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 the late 1960s and early 1970s, the [[CIA]] supported anti-Communist Chinese Nationalists settled near the [[China|Sino]]-Burmese border and [[Hmong people|Hmong]] tribesmen in [[Laos]]. This helped the development of the [[Golden Triangle (Southeast Asia)|Golden Triangle]] opium production region, which supplied about one-third of heroin consumed in the US after the 1973 American withdrawal from Vietnam. In 1999, Burma, the heartland of the Golden Triangle, was the second-largest producer of heroin, after [[Afghanistan]].<ref name="Afghan_Burmese_heroin">{{cite news|url=http://news.bbc.co.uk/1/hi/uk/1590827.stm|title=War Views: Afghan heroin trade will live on.|date=October 2001|work=Richard Davenport-Hines|publisher=BBC|access-date=30 October 2008|url-status=live|archive-url=https://web.archive.org/web/20090115095732/http://news.bbc.co.uk/1/hi/uk/1590827.stm|archive-date=15 January 2009}}</ref> |
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==References== |
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{{Reflist|colwidth=30em}} |
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The Soviet-Afghan war led to increased production in the Pakistani-Afghan border regions, as US-backed [[mujaheddin]] militants raised money for arms from selling opium, contributing heavily to the modern [[Golden Crescent]] creation. By 1980, 60 percent of the heroin sold in the US originated in Afghanistan.<ref name="Afghan_Burmese_heroin"/> 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. |
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==Further reading== |
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* ''Diary Of A Drug Fiend'' by [[Aleister Crowley]] (1922) |
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Following the discovery at a Jordanian airport of a [[toner cartridge]] that had been modified into an [[improvised explosive device]], the resultant increased level of airfreight scrutiny led to a major shortage (drought) of heroin from October 2010 until April 2011. This was reported in most of mainland Europe and the UK which led to a price increase of approximately 30 percent in the cost of street heroin and increased demand for diverted [[methadone]]. The number of addicts seeking treatment also increased significantly during this period. Other heroin droughts (shortages) have been attributed to cartels restricting supply in order to force a price increase and also to a fungus that attacked the opium crop of 2009. Many people{{weasel inline|date=April 2014}} thought that the American government had introduced pathogens into the Afghanistan atmosphere in order to destroy the opium crop and thus starve insurgents of income.{{citation needed|date=April 2014}} |
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* [[Junkie (novel)]] by [[William S. Burroughs]] (1953) ISBN 0-14-200316-6 |
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* ''Heroin'' (1998) ISBN 1-56838-153-0 |
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On 13 March 2012, [[Haji Bagcho]], with ties to the [[Taliban]], was convicted by a US District Court of conspiracy, distribution of heroin for importation into the United States and [[narco-terrorism]].<ref>{{cite web|title=Haji Bagcho Sentenced To Life in Prison on Narco-Terrorism, Drug Trafficking Charges – Funded Taliban, Responsible for Almost 20 Percent of World's Heroin Production, More Than a Quarter-Billion in Drug Proceeds, Property Forfeited|url=http://aikenleader.villagesoup.com/news/story/haji-bagcho-sentenced-to-life-in-prison-on-narco-terrorism-drug-trafficking-charges/838118|website=The Aiken Leader|access-date=7 June 2012|url-status=dead|archive-url=https://web.archive.org/web/20120615215354/http://aikenleader.villagesoup.com/news/story/haji-bagcho-sentenced-to-life-in-prison-on-narco-terrorism-drug-trafficking-charges/838118|archive-date=15 June 2012}}</ref><ref name="justice2006">{{cite web|title=Haji Bagcho Convicted by Federal Jury in Washington, D.C., on Drug Trafficking and Narco-terrorism Charges – Afghan National Trafficked More Than 123,000 Kilograms of Heroin in 2006|date=13 March 2012 |url=https://www.justice.gov/opa/pr/2012/March/12-crm-320.html|publisher=US Department of Justice|access-date=7 June 2012|url-status=live|archive-url=https://web.archive.org/web/20120713015227/http://www.justice.gov/opa/pr/2012/March/12-crm-320.html|archive-date=13 July 2012}}</ref><ref name="surfky1">{{cite web|title=Haji Bagcho Sentenced to Life in Prison on Trafficking/Narco-Terrorism Charges|url=http://surfky.com/index.php/news/national/15973-haji-bagcho-sentenced-to-life-in-prison-on-traffickingnarco-terrorism-charges|publisher=Surfky News|access-date=7 June 2012 |archive-url=https://web.archive.org/web/20140116103054/http://surfky.com/index.php/news/national/15973-haji-bagcho-sentenced-to-life-in-prison-on-traffickingnarco-terrorism-charges |archive-date=16 January 2014}}</ref><ref name="foster1">{{cite web| vauthors = Foster Z |title=Haji Bagcho, One of World's Largest Heroin Traffickers, Convicted on Drug Trafficking, Narco-Terrorism Charges|date=23 March 2012 |url=http://terrorism-online.blogspot.com/2012/03/haji-bagcho-one-of-worlds-largest.html|publisher=War on Terrorism Online|access-date=7 June 2012|url-status=live|archive-url=https://web.archive.org/web/20140116143405/http://terrorism-online.blogspot.com/2012/03/haji-bagcho-one-of-worlds-largest.html|archive-date=16 January 2014}}</ref><ref name="tucker1">{{cite news| vauthors = Tucker E |title=Afghan heroin trafficker gets life in US prison |url=http://www.katu.com/news/national/158797915.html |access-date=7 June 2012 |newspaper=Associated Press |date=12 June 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130514223906/http://www.katu.com/news/national/158797915.html |archive-date=14 May 2013}}</ref> Based on heroin production statistics<ref>{{cite web|title=2007 WORLD DRUG REPORT|url=http://www.unodc.org/pdf/research/wdr07/WDR_2007.pdf|publisher=United Nations Office on Drugs and Crime|access-date=26 July 2012|url-status=live|archive-url=https://web.archive.org/web/20120912022032/http://www.unodc.org/pdf/research/wdr07/WDR_2007.pdf|archive-date=12 September 2012}}</ref> compiled by the [[United Nations Office on Drugs and Crime]], in 2006, Bagcho's activities accounted for approximately 20 percent of the world's total production for that year.<ref name="justice2006"/><ref name="surfky1"/><ref name="foster1"/><ref name="tucker1"/> |
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* ''Heroin Century'' (2002) ISBN 0-415-27899-6 |
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* ''This is Heroin'' (2002) ISBN 1-86074-424-9 |
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====Street price==== |
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* ''The Heroin User's Handbook'' by [[Francis Moraes]] (paperback 2004) ISBN 1-55950-216-9 |
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The [[European Monitoring Centre for Drugs and Drug Addiction]] reports that the retail price of brown heroin varies from €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.<ref>{{cite book |author=European Monitoring Centre for Drugs and Drug Addiction |title=Annual report: the state of the drugs problem in Europe |year=2008 |publisher=Office for Official Publications of the European Communities |location=Luxembourg |isbn=978-92-9168-324-6 |page=70 |url=http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf |url-status=live |archive-url=https://web.archive.org/web/20130425191815/http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf |archive-date=25 April 2013}}</ref> |
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* ''The Little Book of Heroin'' by Francis Moraes (paperback 2000) ISBN 0-914171-98-4 |
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* ''Heroin: A True Story of Addiction, Hope and Triumph'' by Julie O'Toole (paperback 2005) ISBN 1-905379-01-3 |
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The [[United Nations Office on Drugs and Crime]] claims in its 2008 World Drug Report that typical US retail prices are US$172 per gram.<ref>{{cite book |author=United Nations Office on Drugs and Crime |title=World drug report |year=2008 |publisher=United Nations Publications |isbn=978-92-1-148229-4 |page=49 |url=http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf |url-status=live |archive-url=https://web.archive.org/web/20081215184124/http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf |archive-date=15 December 2008}}</ref> |
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* ''The Heroin Diaries: A Year in the Life of a Shattered Rockstar'' by Nikki Sixx (2007) ISBN 978-0-7434-8628-6 |
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* ''Heroin: The Myths and the Facts'' by Richard Ashley (1972), St. Martin's Press, Library of Congress No. 72-89417 |
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==Research== |
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*"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 |
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Researchers are attempting to reproduce the biosynthetic pathway that produces [[morphine]] in [[genetically engineered]] [[yeast]].<ref>{{cite magazine|url=https://www.newscientist.com/article/dn27546-home-brew-heroin-soon-anyone-will-be-able-to-make-illegal-drugs/|title=Home-brew heroin: soon anyone will be able to make illegal drugs|magazine=New Scientist| vauthors = Le Page M |date=18 May 2015|url-status=live|archive-url=https://web.archive.org/web/20160413033207/https://www.newscientist.com/article/dn27546-home-brew-heroin-soon-anyone-will-be-able-to-make-illegal-drugs/|archive-date=13 April 2016}}</ref> In June 2015 the ''S''-reticuline could be produced from sugar and ''R''-reticuline could be converted to morphine, but the intermediate reaction could not be performed.<ref>{{cite journal|url=https://www.science.org/content/article/final-step-sugar-morphine-conversion-deciphered|title=Final step in sugar-to-morphine conversion deciphered|journal=[[Science (journal)|Science]]| vauthors = Service RF |date=25 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150821122148/http://news.sciencemag.org/biology/2015/06/final-step-sugar-morphine-conversion-deciphered|archive-date=21 August 2015}}</ref> |
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* ''Seeds of Terror: How Heroin is Bankrolling the Taliban and Al Qaeda'', by [[Gretchen Peters (journalist)|Gretchen Peters]], publ. Thomas Dunne Books (2009) |
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==See also== |
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{{Portal|Medicine|Chemistry}} |
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<!-- alphabetical order please [[WP:SEEALSO]] --> |
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* {{Annotated link |Allegations of CIA drug trafficking}} |
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* {{Annotated link |Cheese (recreational drug)}} |
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* {{Annotated link |The Politics of Heroin in Southeast Asia|''The Politics of Heroin in Southeast Asia''}} |
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{{div col end}} |
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<!-- alphabetical order please [[WP:SEEALSO]] --> |
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==References== |
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{{Reflist}} |
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==External links== |
==External links== |
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*{{Curlie|Health/Addictions/Substance_Abuse/Drugs/Opiates/}} |
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* [http://www.unodc.org/unodc/en/drugs/afghan-opium-survey.html UNODC - United Nations Office on Drugs and Crime - Afghan Opium Survey 2009] |
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* [https://web.archive.org/web/20110806073908/http://www.nida.nih.gov/Infofacts/heroin.html NIDA InfoFacts on Heroin] |
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* [http://www.geopium.org/ Geopium: Geopolitics of Illicit Drugs in Asia, especially opium and heroin production and trafficking in and around Afghanistan and Burma (Articles and maps and French and English)] |
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* [http://www.NAABT.org/ National Alliance of Advocates for Buprenorphine Treatment - non-profit education website for treatment of Heroin addiction] |
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* [http://www.nida.nih.gov/Infofacts/heroin.html NIDA InfoFacts on Heroin] |
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* [http://www.whitehousedrugpolicy.gov/drugfact/heroin/ ONDCP Drug Facts] |
* [http://www.whitehousedrugpolicy.gov/drugfact/heroin/ ONDCP Drug Facts] |
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* [http://druginfo.nlm.nih.gov/drugportal/dpdirect.jsp?name=Heroin U.S. National Library of Medicine: Drug Information Portal – Heroin] |
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* [http://usinfo.state.gov/is/Archive_Index/Pakistans_Cultivation_of_Opium_Drops.html United States Department of State fact sheet: anti-narcotics efforts in Pakistan] - dated June 7, 2002 |
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* [http://news.bbc.co.uk/1/hi/magazine/4647018.stm BBC Article entitled 'When Heroin Was Legal'. References to the United Kingdom and the United States] |
* [http://news.bbc.co.uk/1/hi/magazine/4647018.stm BBC Article entitled 'When Heroin Was Legal'. References to the United Kingdom and the United States] |
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* [https://purl.fdlp.gov/GPO/gpo57130 Drug-poisoning Deaths Involving Heroin: United States, 2000–2013] [[United States Department of Health and Human Services|U.S. Department of Health and Human Services]], [[Centers for Disease Control and Prevention]], [[National Center for Health Statistics]]. |
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* [http://historyofalcoholanddrugs.typepad.com/alcohol_and_drugs_history/heroin/index.html Heroin news page] - [[Alcohol and Drugs History Society]] |
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* [https://fas.org/sgp/crs/misc/R44599.pdf Heroin Trafficking in the United States] (2016) by Kristin Finklea, [[Congressional Research Service]]. |
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* [http://druginfo.nlm.nih.gov/drugportal/dpdirect.jsp?name=Heroin U.S. National Library of Medicine: Drug Information Portal - Heroin] |
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