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Heroin: Difference between revisions
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'''Diacetylmorphine''' or '''morphine diacetate''' (also known as '''heroin''' | '''Diacetylmorphine''' or '''morphine diacetate''' (also known as '''diamorphine''' and '''heroin''' as well as colloquially as '''H''', '''dope''', '''smack''', '''junk''', '''brown''', '''boy''', and others) is a semi-synthetic [[psychoactive class::opioid]] substance of the [[chemical class::morphinan]] class. It is a derivative of [[morphine]], a natural product of the opium poppy (''Papaver somniferum'').{{citation needed}} Heroin is known for its highly addictive properties and it makes up a large portion of the illicit traffic in narcotics. | ||
Heroin was first synthesized from morphine by a British chemist in 1874 and was introduced as a commercial product by the Bayer Company of Germany in 1898.<ref>Wright, C.R.A. | Heroin was first synthesized from morphine by a British chemist in 1874 and was introduced as a commercial product by the Bayer Company of Germany in 1898.<ref name="Wright1874">{{cite journal | vauthors=((Wright, C. R. A.)) | journal=J. Chem. Soc. | title=XLIX.—On the action of organic acids and their anhydrides on the natural alkaloïds. Part I | volume=27 | issue=0 | pages=1031–1043 | date= 1874 | url=http://xlink.rsc.org/?DOI=JS8742701031 | issn=0368-1769 | doi=10.1039/JS8742701031}}</ref> Although the name heroin is a trade name, it has since been widely adopted for all intents and purposes and may describe a recreational depressant that may or may not contain pure diacetylmorphine. | ||
[[Subjective effects]] include [[sedation]], [[pain relief]], [[muscle relaxation]], and [[euphoria]]. | [[Subjective effects]] include [[sedation]], [[pain relief]], [[muscle relaxation]], and [[euphoria]]. | ||
In its pure form, heroin is active at doses of 5 mg and above; however, the substance is most commonly found in a preparation containing significant impurities. These impurities can result from including processing faults during synthesis, the addition of harmful or benign cutting agents, or the substitution of significantly more potent and dangerous analogous substances such as [[fentanyl]] adulterated into the end-product before distribution.<ref>Much of Heroin Supply Adulterated with Fentanyl | | In its pure form, heroin is active at doses of 5 mg and above; however, the substance is most commonly found in a preparation containing significant impurities. These impurities can result from including processing faults during synthesis, the addition of harmful or benign cutting agents, or the substitution of significantly more potent and dangerous analogous substances such as [[fentanyl]] adulterated into the end-product before distribution.<ref>{{Citation |title=Much of Heroin Supply Adulterated with Fentanyl | publisher=Department of Mental Health and Addiction Services | url=https://mha.ohio.gov/Portals/0/assets/Research/OSAM-TRI/092015-OSAMogram-heroin-fentanyl-update.pdf}}</ref><ref>{{cite journal | vauthors=((Roberts, J. R.)) | journal=Emergency Medicine News | title=InFocus: Fentanyl-Laced Heroin | volume=36 | issue=4 | pages=13–15 | date= April 2014 | url=http://journals.lww.com/00132981-201404000-00005 | issn=1054-0725 | doi=10.1097/01.EEM.0000446051.11866.98}}</ref><ref>{{Citation | vauthors=((Bever, F.)) | year=2015 | title=Illicit Version Of Painkiller Fentanyl Makes Heroin Deadlier | url=https://www.npr.org/sections/health-shots/2015/08/26/434618809/ilicit-version-of-painkiller-fentanyl-makes-heroin-deadlier}}</ref><ref>What You Need to Know About Fentanyl-Laced Heroin | http://www.projectknow.com/what-you-need-to-know-about-fentanyl-laced-heroin/</ref><ref>{{Citation | vauthors=((Gorman, R.)) | year=2014 | title=Killer white heroin responsible for as many as 100 deaths in the US | url=https://www.dailymail.co.uk/news/article-2549944/Killer-heroin-fentanyl-epidemic-responsible-100-deaths-country-rising-half-month.html}}</ref> The heroin found on streets may have a significant variation in purity, but on average is about 5%. This makes accurate dosing particularly difficult. | ||
It is highly advised to use [[harm reduction practices]] if using this substance. | It is highly advised to use [[harm reduction practices]] if using this substance. | ||
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==History and culture== | ==History and culture== | ||
{{HistoryStub}} | {{HistoryStub}} | ||
Diacetylmorphine was originally synthesized by C.R. Alder Wright in 1874 when attempting to combine morphine with various acids. The synthesis was achieved through boiling anhydrous morphine with morphine alkaloid with acetic anhydride.<ref | Diacetylmorphine was originally synthesized by C.R. Alder Wright in 1874 when attempting to combine morphine with various acids. The synthesis was achieved through boiling anhydrous morphine with morphine alkaloid with acetic anhydride.<ref name="Wright1874" /> | ||
Although the name heroin is a traditional trade name for a Bayer product containing diacetylmorphine, the name has since been widely adopted for all intents and purposes and may describe a recreational depressant that may or may not contain pure diacetylmorphine. | Although the name heroin is a traditional trade name for a Bayer product containing diacetylmorphine, the name has since been widely adopted for all intents and purposes and may describe a recreational depressant that may or may not contain pure diacetylmorphine. | ||
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==Pharmacology== | ==Pharmacology== | ||
Heroin itself is an inactive drug, but it is metabolized into [[morphine]] when inserted into the body.<ref>The therapeutic use of heroin: a review of the pharmacological literature | http://www.nrcresearchpress.com/doi/ | Heroin itself is an inactive drug, but it is metabolized into [[morphine]] when inserted into the body.<ref name="Sawynok1986">{{cite journal | vauthors=((Sawynok, J.)) | journal=Canadian Journal of Physiology and Pharmacology | title=The therapeutic use of heroin: a review of the pharmacological literature | volume=64 | issue=1 | pages=1–6 | date=1 January 1986 | url=http://www.nrcresearchpress.com/doi/10.1139/y86-001 | issn=0008-4212 | doi=10.1139/y86-001}}</ref> When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine.<ref name="Sawynok1986" /> 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 fat-soluble, and thus more potent, than [[morphine]] itself.<ref>{{cite journal | vauthors=((Klous, M. G.)), ((Brink, W. V. den)), ((Ree, J. M. V.)), ((Beijnen, J. H.)) | journal=Drug and Alcohol Dependence | title=Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients | volume=80 | issue=3 | pages=283–295 | date=12 December 2005 | url=https://www.sciencedirect.com/science/article/pii/S0376871605001511 | issn=0376-8716 | doi=10.1016/j.drugalcdep.2005.04.008}}</ref> | ||
Once in the brain, it is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM). 6-MAM is found in some commercially prepared batches of black tar heroin, often found on the west coast of the United States. It is then deacetylated into morphine, which binds to [[μ-opioid receptors]]. Heroin itself exhibits relatively low affinity for the μ receptor, suggesting that much of the psychoactive effects of the substance come from the metabolites of heroin rather than the diacetylmorphine itself.<ref>Evidence from opiate binding studies that heroin acts through its metabolites | [[File:6-MAM.svg|250px|thumbnail|Skeletal structure of 6-Monoacetylmorphine.]] | ||
Once in the brain, it is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM). 6-MAM is found in some commercially prepared batches of black tar heroin, often found on the west coast of the United States. It is then deacetylated into morphine, which binds to [[μ-opioid receptors]]. Heroin itself exhibits relatively low affinity for the μ receptor, suggesting that much of the psychoactive effects of the substance come from the metabolites of heroin rather than the diacetylmorphine itself.<ref>{{cite journal | vauthors=((Inturrisi, C. E.)), ((Schultz, M.)), ((Shin, S.)), ((Umans, J. G.)), ((Angel, L.)), ((Simon, E. J.)) | journal=Life Sciences | title=Evidence from opiate binding studies that heroin acts through its metabolites | volume=33 Suppl 1 | pages=773–776 | date= 1983 | issn=0024-3205 | doi=10.1016/0024-3205(83)90616-1}}</ref> | |||
The recreational effects of this compound, including [[cognitive euphoria]] and [[physical euphoria]], occur because opioids structurally mimic endogenous endorphins which are naturally produced within the body and are also active on the μ-opioid receptor set in the brain. The way in which synthetic opioids such as heroin structurally mimic these natural endorphins results in their [[physical euphoria|euphoric]], [[pain relief]] and [[anxiolytic]] effects. This is because natural endorphins are responsible for reducing pain, causing sleepiness, and feelings of pleasure. The endorphins can be released in response to pain, strenuous exercise, orgasm, or general excitement. | The recreational effects of this compound, including [[cognitive euphoria]] and [[physical euphoria]], occur because opioids structurally mimic endogenous endorphins which are naturally produced within the body and are also active on the μ-opioid receptor set in the brain. The way in which synthetic opioids such as heroin structurally mimic these natural endorphins results in their [[physical euphoria|euphoric]], [[pain relief]] and [[anxiolytic]] effects. This is because natural endorphins are responsible for reducing pain, causing sleepiness, and feelings of pleasure. The endorphins can be released in response to pain, strenuous exercise, orgasm, or general excitement. | ||
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==Subjective effects== | ==Subjective effects== | ||
{{Preamble/SubjectiveEffects}} | {{Preamble/SubjectiveEffects}} | ||
{{effects/base | {{effects/base | ||
|{{effects/physical| | |{{effects/physical| | ||
*'''[[Effect::Sedation]]''' - This leads to the trademark "nodding off" effect seen in heroin users, where the head falls, the eyes close, and the user slips uncontrollably into momentary unconsciousness.<ref>Urban Dictionary: | *'''[[Effect::Sedation]]''' - This leads to the trademark "nodding off" effect seen in heroin users, where the head falls, the eyes close, and the user slips uncontrollably into momentary unconsciousness.<ref>{{Citation | title=Urban Dictionary: nodding off | url=https://www.urbandictionary.com/define.php?term=nodding%20off}}</ref> This can lead to falling into microsleeps while sitting or standing up. | ||
*'''[[Effect::Physical euphoria]]''' - The physical euphoria experienced on this substance is extremely intense when compared to other opioids such as [[codeine]] or [[tramadol]]. The sensation itself can be described as extreme feelings of intense physical comfort, warmth, and all-encompassing bliss. | *'''[[Effect::Physical euphoria]]''' - The physical euphoria experienced on this substance is extremely intense when compared to other opioids such as [[codeine]] or [[tramadol]]. The sensation itself can be described as extreme feelings of intense physical comfort, warmth, and all-encompassing bliss. | ||
*'''[[Effect::Pain relief]]''' | *'''[[Effect::Pain relief]]''' | ||
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====Hallucinatory states==== | ====Hallucinatory states==== | ||
*'''[[Effect::Internal hallucination]]''' - One may experience a state of semi-consciousness and [[hypnagogia]] during heavy dosage nodding which results in dream-like states and up to level 3 [[Lucid_dreaming#Internally_sourced_sensory_input|imagery]]. This is often accompanied by ill-defined [[geometry]]. | *'''[[Effect::Internal hallucination]]''' - One may experience a state of semi-consciousness and [[hypnagogia]] during heavy dosage nodding which results in dream-like states and up to level 3 [[Lucid_dreaming#Internally_sourced_sensory_input|imagery]]. This is often accompanied by ill-defined [[geometry]]. | ||
}} | }} | ||
{{effects/auditory| | |||
*'''[[Effect::Auditory acuity suppression]]''' | |||
*'''[[Effect::Auditory distortion]]''' - Some users experience rumbling in the ears and/or tinnitus with this substance. Effect may last for long periods after the experience due to the ototoxicity of opioids | |||
}}}} | |||
===Experience reports=== | ===Experience reports=== | ||
Anecdotal reports which describe the effects of this compound within our [[experience index]] include: | Anecdotal reports which describe the effects of this compound within our [[experience index]] include: | ||
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Additional experience reports can be found here: | Additional experience reports can be found here: | ||
*[https://www.erowid.org/experiences/subs/exp_Heroin.shtml Erowid Experience Vaults: | *[https://www.erowid.org/experiences/subs/exp_Heroin.shtml Erowid Experience Vaults: Heroin] | ||
==Forms== | ==Forms== | ||
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====Black tar heroin==== | ====Black tar heroin==== | ||
{{Warning/Black tar heroin}} | |||
[[File:Tar.jpeg - Copy.jpg|thumbnail|200px|Above is "black tar" heroin as commonly seen on the west coast of the U.S..]] | [[File:Tar.jpeg - Copy.jpg|thumbnail|200px|Above is "black tar" heroin as commonly seen on the west coast of the U.S..]] | ||
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The actual chemical contents of black tar heroin can vary from the white powder form. Black tar might contain a variable mixture of morphine derivatives, predominantly 6-MAM (6-monoacetylmorphine) which is another result of crude acetylation that occurs in the clandestine manufacturing process. | The actual chemical contents of black tar heroin can vary from the white powder form. Black tar might contain a variable mixture of morphine derivatives, predominantly 6-MAM (6-monoacetylmorphine) which is another result of crude acetylation that occurs in the clandestine manufacturing process. | ||
When injected into any type of tissue, this form of heroin results in an increased risk of wound botulism<ref>Wound Botulism Associated With Black Tar Heroin Among Injecting Drug Users | When injected into any type of tissue, this form of heroin results in an increased risk of wound botulism<ref>{{cite journal | vauthors=((Passaro, D. J.)), ((Werner, S. B.)), ((McGee, J.)), ((Mac Kenzie, W. R.)), ((Vugia, D. J.)) | journal=JAMA | title=Wound Botulism Associated With Black Tar Heroin Among Injecting Drug Users | volume=279 | issue=11 | pages=859–863 | date=18 March 1998 | url=https://doi.org/10.1001/jama.279.11.859 | issn=0098-7484 | doi=10.1001/jama.279.11.859}}</ref>. Wound botulism can be fatal and leads to amputations and death at a higher rate of black tar heroin users. Because of the consistency of the substance (tar-like), it can pose a greater risk for collapsing, damaging, or infecting veins. This damage to veins leads to a higher chance of subcutaneous and intradermal injection<ref>{{cite journal | vauthors=((Ciccarone, D.)), ((Bourgois, P.)) | journal=Substance Use & Misuse | title=Explaining the Geographical Variation of HIV Among Injection Drug Users in the United States | volume=38 | issue=14 | pages=2049–2063 | date= January 2003 | url=http://www.tandfonline.com/doi/full/10.1081/JA-120025125 | issn=1082-6084 | doi=10.1081/JA-120025125}}</ref> which is not advocated from a harm reduction point of view. For users who do choose to inject this substance, it is advised to follow the procedures found in the [[safer injection guide]]. | ||
==Toxicity and harm potential== | ==Toxicity and harm potential== | ||
[[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of heroin<ref>Development of a rational scale to assess the harm of drugs of potential misuse | [[File:HarmCausedByDrugsTable.svg|thumb|upright=1.35|Table from the 2010 ISCD study ranking various drugs (legal and illegal) based on statements by drug-harm experts. Heroin was found to be the second overall most dangerous drug.<ref name="Nutt_2010">{{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 = 1558–1565 | date = November 2010 | pmid = 21036393 | doi = 10.1016/S0140-6736(10)61462-6 | s2cid = 5667719 | citeseerx = 10.1.1.690.1283 }}</ref>]] | ||
[[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of heroin<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]] | |||
Like many other opioids, unadulterated heroin at appropriate dosages does not cause many long-term complications other than physical and psychological dependence and [[constipation]]. Outside of the extremely powerful addiction and physical dependence, the harmful or toxic aspects of opioid usage are exclusively associated with not taking [[responsible use|the necessary precautions]] in regards to [[injected|its administration]], [[dosage|overdosing]] and using impure heroin products that contain harmful additives. | Like many other opioids, unadulterated heroin at appropriate dosages does not cause many long-term complications other than physical and psychological dependence and [[constipation]]. Outside of the extremely powerful addiction and physical dependence, the harmful or toxic aspects of opioid usage are exclusively associated with not taking [[responsible use|the necessary precautions]] in regards to [[injected|its administration]], [[dosage|overdosing]] and using impure heroin products that contain harmful additives. | ||
Heavy dosages of heroin can result in severe [[respiratory depression]] which can result in dangerous or even fatal levels of anoxia (oxygen deprivation). This occurs because the breathing reflex is suppressed by [[agonists|agonism]] of [[µ-opioid receptors]] - this effect is proportional to the dosage of the substance consumed. | Heavy dosages of heroin can result in severe [[respiratory depression]] which can result in dangerous or even fatal levels of anoxia (oxygen deprivation). This occurs because the breathing reflex is suppressed by [[agonists|agonism]] of [[µ-opioid receptors]] - this effect is proportional to the dosage of the substance consumed. | ||
Due to the nature of the unregulated drug market, illicit heroin is of widely varying and unpredictable purity. A user may prepare what they consider to be a moderate dose while actually taking far more than intended in the event of obtaining a purer product than they are used to, or may be cut unknowingly with more potent and dangerous substances such as [[fentanyl]].<ref> | Due to the nature of the unregulated drug market, illicit heroin is of widely varying and unpredictable purity. A user may prepare what they consider to be a moderate dose while actually taking far more than intended in the event of obtaining a purer product than they are used to, or may be cut unknowingly with more potent and dangerous substances such as [[fentanyl]].<ref>{{Citation | vauthors=((Zalkind, S.)) | year=2016 | title=“Death pill”: fentanyl disguised as other drugs linked to spike in US overdoses | url=https://www.theguardian.com/society/2016/may/10/fentanyl-drug-overdoses-xanax-painkillers}}</ref> Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours and is a direct result of [[Respiratory depression|respiratory depression]] leading onto anoxia (oxygen deprivation) resulting from the breathing reflex being suppressed by [[agonists|agonism]] of [[µ-opioid receptors]]. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 600mg.<ref>{{Citation | title=The heroin overdose mystery and other occupational hazards of heroin addiction | url=https://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm}}</ref> | ||
Heroin can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the [[recovery position]]). | Heroin can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the [[recovery position]]). | ||
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It is strongly recommended that one use [[responsible drug use|harm reduction practices]] such as [[volumetric dosing]], when using this substance to ensure the administration of the intended dose (especially due to the unusually high risk of an overdose this substance presents.) | It is strongly recommended that one use [[responsible drug use|harm reduction practices]] such as [[volumetric dosing]], when using this substance to ensure the administration of the intended dose (especially due to the unusually high risk of an overdose this substance presents.) | ||
====Bodily harm==== | |||
Many opioid drugs, especially oxycodone and [[heroin]], are known to be [https://en.wikipedia.org/wiki/Ototoxicity ototoxic], causing hearing loss, tinnitus and balance issues. In some cases the damage can be irreversible.<ref>Opioid-Associated Hearing Loss: A 20-Year Review from the New Jersey Poison Center https://pubmed.ncbi.nlm.nih.gov/32468345/</ref> | |||
Opioids can cause [[Difficulty urinating|urinary retention, or difficulty urinating]] and [[constipation]] with chronic and repeated use. Some users find relief in blowing hard into their palm or doing squats before using the toilet, as this compresses core muscles onto the bladder. | |||
===Dependence and abuse potential=== | ===Dependence and abuse potential=== | ||
As with other [[opioids]], the chronic use of heroin can be considered | As with other [[opioids]], the chronic use of heroin can be considered extremely addictive with a high potential for abuse and is capable of causing psychological and physical dependence among certain users. When psychological or physical addiction has developed, mental and physical [[Opioids#Discontinuation|withdrawal symptoms]] and cravings may occur if a person suddenly stops their usage. | ||
Tolerance to many of the effects of heroin [[Time to full tolerance::develops with prolonged and repeated use]]. The rate at which this occurs develops at different rates for different effects, with tolerance to the constipation-inducing effects developing particularly slowly for instance. This results in users having to administer increasingly large doses to achieve the same psychoactive effects of a previously lower dose. After heroin tolerance has developed, it takes about [[Time to half tolerance::3 - 7 days]] for the tolerance to be reduced to half and [[Time to zero tolerance::1 - 2 weeks]] to be back at baseline (in the absence of further consumption). Heroin presents cross-tolerance with [[Cross-tolerance::all other [[opioids]]]], meaning that after the consumption of heroin all [[opioid]]s will have a reduced effect. | Tolerance to many of the effects of heroin [[Time to full tolerance::develops with prolonged and repeated use]]. The rate at which this occurs develops at different rates for different effects, with tolerance to the constipation-inducing effects developing particularly slowly for instance. This results in users having to administer increasingly large doses to achieve the same psychoactive effects of a previously lower dose. After heroin tolerance has developed, it takes about [[Time to half tolerance::3 - 7 days]] for the tolerance to be reduced to half and [[Time to zero tolerance::1 - 2 weeks]] to be back at baseline (in the absence of further consumption). Heroin presents cross-tolerance with [[Cross-tolerance::all other [[opioids]]]], meaning that after the consumption of heroin all [[opioid]]s will have a reduced effect. | ||
The risk of fatal heroin overdoses rise sharply after a period of cessation and [[relapse]], largely because of reduced tolerance.<ref>Why Heroin Relapse Often Ends In Death - Lauren F Friedman (Business Insider) | http://www.businessinsider.com.au/philip-seymour-hoffman-overdose-2014-2</ref> When users dose their old doses, they no longer have the physical tolerance to handle the sedative effects of heroin and overdose occurs. To account for this lack of physical tolerance, it is safer to only dose a fraction of one's usual [[dosage]] if using after a prolonged period of sobriety. It has also been found that the environment one is in can play a role in tolerance: in one scientific study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.<ref>Siegel, S., Hinson, R., Krank, M., | The risk of fatal heroin overdoses rise sharply after a period of cessation and [[relapse]], largely because of reduced tolerance.<ref>Why Heroin Relapse Often Ends In Death - Lauren F Friedman (Business Insider) | http://www.businessinsider.com.au/philip-seymour-hoffman-overdose-2014-2</ref> When users dose their old doses, they no longer have the physical tolerance to handle the sedative effects of heroin and overdose occurs. To account for this lack of physical tolerance, it is safer to only dose a fraction of one's usual [[dosage]] if using after a prolonged period of sobriety. It has also been found that the environment one is in can play a role in tolerance: in one scientific study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.<ref>{{cite journal | vauthors=((Siegel, S.)), ((Hinson, R. E.)), ((Krank, M. D.)), ((McCully, J.)) | journal=Science | title=Heroin “Overdose” Death: Contribution of Drug-Associated Environmental Cues | volume=216 | issue=4544 | pages=436–437 | date=23 April 1982 | url=https://www.science.org/doi/10.1126/science.7200260 | issn=0036-8075 | doi=10.1126/science.7200260}}</ref> | ||
Studies have shown that the subjective [[cognitive euphoria]] and [[physical euphoria]] of heroin use, which is the reinforcing component of addiction, is proportional in its' intensity to the rate at which the blood level concentrations of the drug increases.<ref>Relative Reinforcing Strength of | Studies have shown that the subjective [[cognitive euphoria]] and [[physical euphoria]] of heroin use, which is the reinforcing component of addiction, is proportional in its' intensity to the rate at which the blood level concentrations of the drug increases.<ref>{{cite journal | vauthors=((Winger, G.)), ((Hursh, S. R.)), ((Casey, K. L.)), ((Woods, J. H.)) | journal=Journal of Pharmacology and Experimental Therapeutics | title=Relative Reinforcing Strength of ThreeN-Methyl-d-Aspartate Antagonists with Different Onsets of Action | volume=301 | issue=2 | pages=690–697 | date=1 May 2002 | url=https://jpet.aspetjournals.org/content/301/2/690 | issn=0022-3565 | doi=10.1124/jpet.301.2.690}}</ref> Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the fastest. It is followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing). | ||
===Dangerous interactions=== | ===Dangerous interactions=== | ||
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==Legal status== | ==Legal status== | ||
*'''Australia:''' Heroin is controlled in Australia, but there is conflicting information about its exact legal status. Heroin was listed in Schedule I of the Narcotic Drugs Act of 1967; however, it is unclear whether the control system has changed since then.{{citation needed}} | *'''Australia:''' Heroin is controlled in Australia, but there is conflicting information about its exact legal status. Heroin was listed in Schedule I of the Narcotic Drugs Act of 1967; however, it is unclear whether the control system has changed since then.{{citation needed}} Personal quantities under 1 gram have been decriminalized in the Australian Capital Territory (ACT) as of 28 October 2023.<ref>https://www.health.act.gov.au/about-our-health-system/population-health/drug-law-reform</ref> | ||
*'''Austria:''' Diacetylmorphine is illegal to possess, produce and sell under the SMG (Suchtmittelgesetz Österreich).{{citation needed}} | *'''Austria:''' Diacetylmorphine is illegal to possess, produce and sell under the SMG (Suchtmittelgesetz Österreich).{{citation needed}} | ||
*'''Brazil:''' Heroin is listed as a controlled substance, making the production, distribution, or possession illegal. {{citation needed}} | *'''Brazil:''' Heroin is listed as a controlled substance, making the production, distribution, or possession illegal. {{citation needed}} | ||
*'''Canada:''' Heroin is Schedule I in Canada. However, a unanimous Supreme Court decision in 2011 declared that there is a right under Section 7 of the Charter to have access to clean injection sites.<ref> | *'''Canada:''' Heroin is a Schedule I substance in Canada. However, a unanimous Supreme Court decision in 2011 declared that there is a right under Section 7 of the Charter of Rights and Freedoms to have access to clean injection sites.<ref>{{Citation | year=2011 | title=Vancouver Insite drug-injection facility can stay open | url=https://www.bbc.com/news/world-us-canada-15130282}}</ref><ref>http://scc.lexum.org/en/2011/2011scc44/2011scc44.html</ref> | ||
*'''Czech Republic:''' The Czech Republic has decriminalized 1.5g or less of heroin and the punishment is similar in scale to a parking ticket. Sales, production, and larger quantity possession are still crimes.<ref> | *'''Czech Republic:''' The Czech Republic has decriminalized 1.5g or less of heroin and the punishment is similar in scale to a parking ticket. Sales, production, and larger quantity possession are still crimes.<ref>{{Citation | title=New drug guidelines are Europe’s most liberal | url=https://www.praguepost.com/news/3194-new-drug-guidelines-are-europes-most-liberal.html}}</ref> | ||
*'''Finland:''' Heroin is a controlled substance, making the production, distribution, and possession illegal without a license.{{citation needed}} | *'''Finland:''' Heroin is a controlled substance, making the production, distribution, and possession illegal without a license.{{citation needed}} | ||
*'''Germany:''' Heroin is controlled under BtMG Anlage I, II and III, making it illegal to manufacture, import, possess, sell, or transfer it without a license. There is an exception for preparations, that are approved for addiction treatment, which can be prescribed on a narcotic prescription form.<ref>http://www.gesetze-im-internet.de/btmg_1981/anlage_i.html</ref><ref>http://www.gesetze-im-internet.de/btmg_1981/anlage_ii.html</ref><ref>http://www.gesetze-im-internet.de/btmg_1981/anlage_iii.html</ref> | *'''Germany:''' Heroin is controlled under BtMG Anlage I, II and III, making it illegal to manufacture, import, possess, sell, or transfer it without a license. There is an exception for preparations, that are approved for addiction treatment, which can be prescribed on a narcotic prescription form.<ref>{Citation | title=Anlage I BtMG - Einzelnorm | url=http://www.gesetze-im-internet.de/btmg_1981/anlage_i.html}}</ref><ref>{{Citation | title=Anlage II BtMG - Einzelnorm | url=http://www.gesetze-im-internet.de/btmg_1981/anlage_ii.html}}</ref><ref>{{Citation | title=Anlage III BtMG - Einzelnorm | url=http://www.gesetze-im-internet.de/btmg_1981/anlage_iii.html}}</ref> | ||
*'''Italy''': Heroin is a Schedule I drug.<ref>[http://www.salute.gov.it/imgs/C_17_pagineAree_3729_0_file.pdf] Tabella 1 delle sostanze stupefacenti e psicotrope, page 12. (text in italian).</ref> | *'''Italy''': Heroin is a Schedule I drug.<ref>[http://www.salute.gov.it/imgs/C_17_pagineAree_3729_0_file.pdf] Tabella 1 delle sostanze stupefacenti e psicotrope, page 12. (text in italian).</ref> | ||
*'''Latvia:''' Heroin is a Schedule I drug.<ref>Noteikumi par Latvijā kontrolējamajām narkotiskajām vielām, psihotropajām vielām un prekursoriem | *'''Latvia:''' Heroin is a Schedule I drug.<ref>{{Citation | title=Zaudējis spēku - Noteikumi par Latvijā kontrolējamajām narkotiskajām vielām, psihotropajām vielām un prekursoriem | url=https://likumi.lv/doc.php?id=121086}}</ref> | ||
*'''New Zealand:''' Heroin is Class A in New Zealand.{{citation needed}} | *'''New Zealand:''' Heroin is Class A in New Zealand.{{citation needed}} | ||
*'''Norway:''' Heroin is Schedule I in Norway and illegal to buy or possess without a special license. There have been some projects to establish needle rooms in Norway by the government where heroin addicts are allowed to get fresh needles for injecting heroin.{{citation needed}} | *'''Norway:''' Heroin is Schedule I in Norway and illegal to buy or possess without a special license. There have been some projects to establish needle rooms in Norway by the government where heroin addicts are allowed to get fresh needles for injecting heroin.{{citation needed}} | ||
*'''Portugal:''' The personal use of heroin was decriminalized by Law 30/2000 on July 2001. Possession of less than 1g is not regarded as a criminal offense although the substance is liable to be seized and the possessor can be referred to mandatory treatment. Sale or possession of quantities greater than the personal possession limit are criminal offenses punishable by jail time.{{citation needed}} | *'''Portugal:''' The personal use of heroin was decriminalized by Law 30/2000 on July 2001. Possession of less than 1g is not regarded as a criminal offense although the substance is liable to be seized and the possessor can be referred to mandatory treatment. Sale or possession of quantities greater than the personal possession limit are criminal offenses punishable by jail time.{{citation needed}} | ||
*'''Russia:''' Heroin is a Schedule I controlled substance.<ref>Постановление Правительства РФ от 01.10.2012 N 1002 (ред. от 09.08.2019) | https://www.consultant.ru/cons/cgi/online.cgi?req=doc&base=LAW&n=331879&dst=100070&date=03.12.2019</ref> | *'''Russia:''' Heroin is a Schedule I controlled substance.<ref>{{Citation | title=Постановление Правительства РФ от 01.10.2012 N 1002 (ред. от 09.08.2019) | url=https://www.consultant.ru/cons/cgi/online.cgi?req=doc&base=LAW&n=331879&dst=100070&date=03.12.2019}}</ref> | ||
*'''Switzerland''': Heroin is a controlled substance specifically named under Verzeichnis D. It is legally available for addicts under an ongoing experiment but is otherwise illegal to possess.<ref>{{cite web|url=https://www.admin.ch/opc/de/classified-compilation/20101220/index.html|title=Verordnung des EDI über die Verzeichnisse der Betäubungsmittel, psychotropen Stoffe, Vorläuferstoffe und Hilfschemikalien|publisher=Bundeskanzlei [Federal Chancellery of Switzerland]|access-date=January 1, 2020|language=de}}</ref> | *'''Switzerland''': Heroin is a controlled substance specifically named under Verzeichnis D. It is legally available for addicts under an ongoing experiment but is otherwise illegal to possess.<ref>{{cite web|url=https://www.admin.ch/opc/de/classified-compilation/20101220/index.html|title=Verordnung des EDI über die Verzeichnisse der Betäubungsmittel, psychotropen Stoffe, Vorläuferstoffe und Hilfschemikalien|publisher=Bundeskanzlei [Federal Chancellery of Switzerland]|access-date=January 1, 2020|language=de}}</ref> | ||
*'''United Kingdom:''' Heroin is Schedule II/Class A and is illegal to buy, sell or possess without a license.{{citation needed}} | *'''United Kingdom:''' Heroin is Schedule II/Class A and is illegal to buy, sell or possess without a license.{{citation needed}} | ||
*'''United States:''' Heroin is Schedule I in the United States. This means it is illegal to manufacture, buy, possess, or distribute without a DEA license.{{citation needed}} | *'''United States:''' Heroin is Schedule I in the United States. This means it is illegal to manufacture, buy, possess, or distribute without a DEA license.{{citation needed}} | ||
*'''Poland''': Heroin is illegal to produce, sell and possess under "wykaz środków odurzających i substancji psychotropowych".{{citation needed}} | |||
==See also== | ==See also== | ||
| Line 155: | Line 166: | ||
*[http://en.wikipedia.org/wiki/Heroin Heroin (Wikipedia)] | *[http://en.wikipedia.org/wiki/Heroin Heroin (Wikipedia)] | ||
*[https://www.erowid.org/chemicals/heroin/heroin.shtml Heroin (Erowid Vault)] | *[https://www.erowid.org/chemicals/heroin/heroin.shtml Heroin (Erowid Vault)] | ||
*[https://isomerdesign.com/PiHKAL/explore.php?id=9295 Heroin ( | *[https://isomerdesign.com/PiHKAL/explore.php?id=9295 Heroin (Isomer Design)] | ||
*[https://go.drugbank.com/drugs/DB01452 Heroin (DrugBank)] | |||
*[https://drugs-forum.com/wiki/Heroin Heroin (Drugs-Forum)] | |||
==Literature== | ==Literature== | ||