What is Heroin? By T. Richardson, MD, FASAM Heroin is an opiate compound that is derived from the poppy plant (Papaver Somniferum), an erect herbaceous annual or biennial plant. This plant grows to be 50 to 150 centimeters tall. The stems are slightly branched, the leaves are large, erect and oblong and the petals which are white, pink, purple and violet are 4 to 8 centimeters in length. After flowering, the petals drop in a few days leaving bulbous green capsules atop the stalks. These capsules are the pods. Incisions are made in the pods and milky fluid that oozes out is air dried. This must be done before the seeds are discharged.  Contents of the poppy pod fluid: Between 4 to 21% is morphine and 1 to 25% is codeine. There are at least 20 other alkaloids in the fluid. Heroin does not occur naturally, but is a semisynthetic opiate formed by the acetylation of morphine. Heroin is diacetylmorphine; it is hydrolyzed to monoacetylmorphine (responsible for pharmacologic effects) which is hydrolyzed to morphine. This is why a urine drug screen from a person using heroin shows: - Free Morphine
- Morphine Glucuronide
- Free Codeine
- 6-Monoacetylmorphine (only seen with heroin use)
How many people use heroin? A variety of epidemiological tools have been used to attempt to assess the prevalence of heroin use and addiction. These include the Dawn Survey, the Household Users Survey and the High School Student Survey, as well as many other instruments carried out by state and regional governments. These instruments indicate that there are approximately two million in the United States who have used heroin. It is estimated that at least one million have used heroin frequently. The best estimate for the number of heroin addicts, that is people who have used heroin regularly with multiple daily use of the drug, coupled with the development of tolerance, physical dependence and drug seeking behavior, is about 600,000.
Heroin intoxication is most commonly associated with the following: - Miosis (pin point pupils)
- Nodding
- Hypotension
- Depressed Respiration
- Bradycardia (slow heart rate)
- Euphoria
- A Feeling of Floating
- Analgesia (Decreased pain sensation)
Heroin exerts its action by binding to receptors on cell membranes of neurons (brain cells) and other cells. These opiate receptors are multiple in type and function. They have been divided into the following subtypes (mu, kappa, delta and lambda). Mu agonists, like heroin, are generally administered by injection, smoking or nasal snorting. Kappa receptor activation produces analgesia, but unlike mu and delta agonists, are not self-administered by laboratory animals.
The heroin intoxication state is described as an intense, almost "orgasmic" sense of wellbeing, referred to as a "high" or "rush." This euphoric state appears to be responsible for the continuation of self-administration and the inability to think logically or appreciate the imminent risk or powerlessness to deter drug-taking even when the dose of heroin causes nausea and vomiting. This reaction does not negate the user's feeling of well being and interest in repeating the experience.
Many of the complications of heroin are due to the route of use not the drug: - Dermatologic (skin) abscess, tracks and lymphangitis (inflammation of veins);
- Pulmonary (lungs) aspiration, pneumonia lung abscess and pulmonary emboli (blood clots in the lungs); and
- Liver hepatitis, B,C,D,E, and G.
Heroin addicts continue to use heroin in spite of negative consequences to avoid the MU receptor withdrawal syndrome. This withdrawal syndrome begins within 12 hours of abrupt discontinuation of chronic administration, of heroin, and its stages are outlined below: Heroin Withdrawal-Early Phase - Lacrimation (excessive production of tears
- Yawning
- Rhinorrhea (Runny nose)
- Sweating
Heroin Withdrawal-Middle Phase - Restless sleep
- Dilated pupils
- Anorexia (Loss of appetite)
- Goose flesh
- Irritability
- Tremors
Heroin Withdrawal-Late Phase - Increase in all previous signs and symptoms
- Increased heart rate
- Increased blood pressure
- Nausea and vomiting
- Diarrhea
- Abdominal cramps
- Labile mood
- Depression
- Musclespasm
- Weakness
- Bone Pain
The heroin withdrawal syndrome peak is 48 hours and the duration is 5 to 10 days. Treatment For years, dating back to the seventies, methadone represented an important modality for the treatment of opiate and opioid drugs like hydrocodone, oxycodone and other synthetic narcotics withdrawal. Methadone became the normal maintenance of treatment because only approximately 20% of opiate and opioid addicts are able to stay off the substances. However, there is a new drug (Buprenorphine) available that is effective for detoxification and maintenance therapy. Buprenorphine in a sublingual tablet form was approved by the FOA in October 2002. The medication is effective in detoxification from heroin, prescription pain pills and methadone. This makes treatment available to so many more addicted people.
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