Heroin

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For other uses, see Heroin (disambiguation). Heroin_sentence_0

Heroin_table_infobox_0

Heroin INN: DiacetylmorphineHeroin_table_caption_0
Clinical dataHeroin_header_cell_0_0_0
PronunciationHeroin_header_cell_0_1_0 Heroin: /ˈhɛroʊɪn/Heroin_cell_0_1_1
Other namesHeroin_header_cell_0_2_0 Diacetylmorphine, acetomorphine, (dual) acetylated morphine, morphine diacetate, Diamorphine (BAN UK)Heroin_cell_0_2_1
AHFS/Drugs.comHeroin_header_cell_0_3_0 Heroin_cell_0_3_1
Dependence liabilityHeroin_header_cell_0_4_0 HighHeroin_cell_0_4_1
Addiction liabilityHeroin_header_cell_0_5_0 HighHeroin_cell_0_5_1
Routes of administrationHeroin_header_cell_0_6_0 Intravenous, inhalation, transmucosal, by mouth, intranasal, rectal, intramuscular, subcutaneous, intrathecalHeroin_cell_0_6_1
Drug classHeroin_header_cell_0_7_0 OpioidHeroin_cell_0_7_1
ATC codeHeroin_header_cell_0_8_0 Heroin_cell_0_8_1
Legal statusHeroin_header_cell_0_9_0
Legal statusHeroin_header_cell_0_10_0 Heroin_cell_0_10_1
Pharmacokinetic dataHeroin_header_cell_0_11_0
BioavailabilityHeroin_header_cell_0_12_0 <35% (by mouth), 44–61% (inhaled)Heroin_cell_0_12_1
Protein bindingHeroin_header_cell_0_13_0 0% (morphine metabolite 35%)Heroin_cell_0_13_1
MetabolismHeroin_header_cell_0_14_0 liverHeroin_cell_0_14_1
Onset of actionHeroin_header_cell_0_15_0 Within minutesHeroin_cell_0_15_1
Elimination half-lifeHeroin_header_cell_0_16_0 2–3 minutesHeroin_cell_0_16_1
Duration of actionHeroin_header_cell_0_17_0 4 to 5 hoursHeroin_cell_0_17_1
ExcretionHeroin_header_cell_0_18_0 90% kidney as glucuronides, rest biliaryHeroin_cell_0_18_1
IdentifiersHeroin_header_cell_0_19_0
CAS NumberHeroin_header_cell_0_20_0 Heroin_cell_0_20_1
PubChem CIDHeroin_header_cell_0_21_0 Heroin_cell_0_21_1
DrugBankHeroin_header_cell_0_22_0 Heroin_cell_0_22_1
ChemSpiderHeroin_header_cell_0_23_0 Heroin_cell_0_23_1
UNIIHeroin_header_cell_0_24_0 Heroin_cell_0_24_1
ChEBIHeroin_header_cell_0_25_0 Heroin_cell_0_25_1
ChEMBLHeroin_header_cell_0_26_0 Heroin_cell_0_26_1
CompTox Dashboard (EPA)Heroin_header_cell_0_27_0 Heroin_cell_0_27_1
ECHA InfoCardHeroin_header_cell_0_28_0 Q60168#P2566Heroin_cell_0_28_1
Chemical and physical dataHeroin_header_cell_0_29_0
FormulaHeroin_header_cell_0_30_0 C21H23NO5Heroin_cell_0_30_1
Molar massHeroin_header_cell_0_31_0 369.417 g·molHeroin_cell_0_31_1
3D model (JSmol)Heroin_header_cell_0_32_0 Heroin_cell_0_32_1

Heroin, also known as and among other names, is an opioid used as a recreational drug for its euphoric effects. Heroin_sentence_1

Medical grade diamorphine is used as a pure hydrochloride salt which is distinguished from black tar heroin, a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin. Heroin_sentence_2

Diamorphine is used medically in several countries to relieve pain, such as during childbirth or a heart attack, as well as in opioid replacement therapy. Heroin_sentence_3

It is typically injected, usually into a vein, but it can also be smoked, snorted, or inhaled. Heroin_sentence_4

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. Heroin_sentence_5

The onset of effects is usually rapid and lasts for a few hours. Heroin_sentence_6

Common side effects include respiratory depression (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and addiction. Heroin_sentence_7

Side effects of use by injection can include abscesses, infected heart valves, blood-borne infections, and pneumonia. Heroin_sentence_8

After a history of long-term use, opioid withdrawal symptoms can begin within hours of the last use. Heroin_sentence_9

When given by injection into a vein, heroin has two to three times the effect of a similar dose of morphine. Heroin_sentence_10

It typically comes as a white or brown powder. Heroin_sentence_11

Treatment of heroin addiction often includes behavioral therapy and medications. Heroin_sentence_12

Medications can include buprenorphine, methadone, or naltrexone. Heroin_sentence_13

A heroin overdose may be treated with naloxone. Heroin_sentence_14

An estimated 17 million people as of 2015 use opiates, of which heroin is the most common, and opioid use resulted in 122,000 deaths. Heroin_sentence_15

The total number of heroin users worldwide as of 2015 is believed to have increased in Africa, the Americas, and Asia since 2000. Heroin_sentence_16

In the United States, approximately 1.6 percent of people have used heroin at some point, with 950,000 using it in the last year. Heroin_sentence_17

When people die from overdosing on a drug, the drug is usually an opioid and often heroin. Heroin_sentence_18

Heroin was first made by C. Heroin_sentence_19 R. Alder Wright in 1874 from morphine, a natural product of the opium poppy. Heroin_sentence_20

Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs, and it is generally illegal to make, possess, or sell without a license. Heroin_sentence_21

About 448 tons of heroin were made in 2016. Heroin_sentence_22

In 2015, Afghanistan produced about 66% of the world's opium. Heroin_sentence_23

Illegal heroin is often mixed with other substances such as sugar, starch, caffeine, quinine, or other opioids like fentanyl. Heroin_sentence_24

Uses Heroin_section_0

Recreational Heroin_section_1

Bayer's original trade name (see 'History' section) of heroin is typically used in non-medical settings. Heroin_sentence_25

It is used as a recreational drug for the euphoria it induces. Heroin_sentence_26

Anthropologist Michael Agar once described heroin as "the perfect whatever drug." Heroin_sentence_27

Tolerance develops quickly, and increased doses are needed in order to achieve the same effects. Heroin_sentence_28

Its popularity with recreational drug users, compared to morphine, reportedly stems from its perceived different effects. Heroin_sentence_29

Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine. Heroin_sentence_30

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. Heroin_sentence_31

Morphine and heroin were also much more likely to produce euphoria and other "positive" subjective effects when compared to these other opioids. Heroin_sentence_32

Medical uses Heroin_section_2

In the United States, heroin is not accepted as medically useful. Heroin_sentence_33

Under the generic name diamorphine, heroin is prescribed as a strong pain medication in the United Kingdom, where it is administered via oral, subcutaneous, intramuscular, intrathecal, intranasal or intravenous routes. Heroin_sentence_34

It may be prescribed for the treatment of acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain and chronic pain, including end-stage terminal illnesses. Heroin_sentence_35

In other countries it is more common to use morphine or other strong opioids in these situations. Heroin_sentence_36

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. Heroin_sentence_37

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. Heroin_sentence_38

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. Heroin_sentence_39

Epidural diamorphine (2.5–5 mg) is a suitable alternative. Heroin_sentence_40

Diamorphine continues to be widely used in palliative care in the UK, where it is commonly given by the subcutaneous route, often via a syringe driver if patients cannot easily swallow morphine solution. Heroin_sentence_41

The advantage of diamorphine over morphine is that diamorphine is more fat soluble and therefore more potent by injection, so smaller doses of it are needed for the same effect on pain. Heroin_sentence_42

Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary for palliative care. Heroin_sentence_43

It is also used in the palliative management of bone fractures and other trauma, especially in children. Heroin_sentence_44

In the trauma context, it is primarily given by nose in hospital; although a prepared nasal spray is available. Heroin_sentence_45

It has traditionally been made by the attending physician, generally from the same "dry" ampoules as used for injection. Heroin_sentence_46

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. Heroin_sentence_47

Maintenance therapy Heroin_section_3

Main article: Heroin-assisted treatment Heroin_sentence_48

A number of European countries prescribe heroin for treatment of heroin addiction. Heroin_sentence_49

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. Heroin_sentence_50

Diamorphine may be used as a maintenance drug to assist the treatment of opiate addiction, normally in long-term chronic intravenous (IV) heroin users. Heroin_sentence_51

It is only prescribed following exhaustive efforts at treatment via other means. Heroin_sentence_52

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. Heroin_sentence_53

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. Heroin_sentence_54

The UK Department of Health's Rolleston Committee Report 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. Heroin_sentence_55

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. Heroin_sentence_56

The law was made more restrictive in 1968. Heroin_sentence_57

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. Heroin_sentence_58

In 1994, Switzerland began a trial diamorphine maintenance program for users that had failed multiple withdrawal programs. Heroin_sentence_59

The aim of this program was to maintain the health of the user by avoiding medical problems stemming from the illicit use of diamorphine. Heroin_sentence_60

The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000, based on the apparent success of the program. Heroin_sentence_61

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. Heroin_sentence_62

It has also been shown to save money, despite high treatment expenses, as it significantly reduces costs incurred by trials, incarceration, health interventions and . Heroin_sentence_63

Patients appear twice daily at a treatment center, where they inject their dose of diamorphine under the supervision of medical staff. Heroin_sentence_64

They are required to contribute about 450 Swiss francs per month to the treatment costs. Heroin_sentence_65

A national referendum in November 2008 showed 68% of voters supported the plan, introducing diamorphine prescription into federal law. Heroin_sentence_66

The previous trials were based on time-limited executive ordinances. Heroin_sentence_67

The success of the Swiss trials led German, Dutch, and Canadian cities to try out their own diamorphine prescription programs. Heroin_sentence_68

Some Australian cities (such as Sydney) have instituted legal diamorphine supervised injecting centers, in line with other wider harm minimization programs. Heroin_sentence_69

Since January 2009, Denmark has prescribed diamorphine to a few addicts that have tried methadone and buprenorphine without success. Heroin_sentence_70

Beginning in February 2010, addicts in Copenhagen and Odense became eligible to receive free diamorphine. Heroin_sentence_71

Later in 2010, other cities including Århus and Esbjerg joined the scheme. Heroin_sentence_72

It was supposed that around 230 addicts would be able to receive free diamorphine. Heroin_sentence_73

However, Danish addicts would only be able to inject heroin according to the policy set by Danish National Board of Health. Heroin_sentence_74

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". Heroin_sentence_75

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. Heroin_sentence_76

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. Heroin_sentence_77

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." Heroin_sentence_78

Routes of administration Heroin_section_4

Heroin_table_general_1

Recreational uses:

Medicinal uses:Heroin_cell_1_0_0

Contraindications:Heroin_cell_1_1_0
Central nervous system:

Neurological:


Psychological:


Cardiovascular & Respiratory:


Gastrointestinal:


Musculoskeletal:


Skin:


Miscellaneous:Heroin_cell_1_2_0

The onset of heroin's effects depends upon the route of administration. Heroin_sentence_79

Smoking is the fastest route of drug administration, although intravenous injection results in a quicker rise in blood concentration. Heroin_sentence_80

These are followed by suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing). Heroin_sentence_81

A 2002 study suggests that a fast onset of action increases the reinforcing effects of addictive drugs. Heroin_sentence_82

Ingestion does not produce a rush as a forerunner to the high experienced with the use of heroin, which is most pronounced with intravenous use. Heroin_sentence_83

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. Heroin_sentence_84

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. Heroin_sentence_85

Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. Heroin_sentence_86

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. Heroin_sentence_87

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. Heroin_sentence_88

Examples include the overdose deaths of Sid Vicious, Janis Joplin, Tim Buckley, Hillel Slovak, Layne Staley, Bradley Nowell, Ted Binion, and River Phoenix. Heroin_sentence_89

By mouth Heroin_section_5

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. Heroin_sentence_90

Heroin is entirely converted to morphine by means of first-pass metabolism, resulting in deacetylation when ingested. Heroin_sentence_91

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%. Heroin_sentence_92

The maximum plasma concentration of morphine following oral administration of heroin was around twice as much as that of oral morphine. Heroin_sentence_93

Injection Heroin_section_6

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_sentence_94

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_sentence_95

Heroin in the east-coast United States is most commonly found in the hydrochloride salt form, requiring just water (and no heat) to dissolve. Heroin_sentence_96

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. Heroin_sentence_97

Users who have used this route of administration often develop a deep vein thrombosis. Heroin_sentence_98

Intravenous users can use a various single dose range using a hypodermic needle. Heroin_sentence_99

The dose of heroin used for recreational purposes is dependent on the frequency and level of use: thus a first-time user may use between 5 and 20 mg, while an established addict may require several hundred mg per day. Heroin_sentence_100

As with the injection of any drug, if a group of users share a common needle without sterilization procedures, blood-borne diseases, such as HIV/AIDS or hepatitis, can be transmitted. Heroin_sentence_101

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. Heroin_sentence_102

Many countries now supply small sterile spoons and filters for single use in order to prevent the spread of disease. Heroin_sentence_103

Smoking Heroin_section_7

Smoking heroin refers to vaporizing it to inhale the resulting fumes, rather than burning and inhaling the smoke. Heroin_sentence_104

It is commonly smoked in glass pipes made from glassblown Pyrex tubes and light bulbs. Heroin_sentence_105

Heroin may be smoked from aluminium foil, which is heated by an underneath flame, with the resulting smoke inhaled through a tube of rolled up foil, a method also known as "chasing the dragon". Heroin_sentence_106

Insufflation Heroin_section_8

Another popular route to intake heroin is 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. Heroin_sentence_107

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. Heroin_sentence_108

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. Heroin_sentence_109

Snorting heroin becomes an often unwanted route, once a user begins to inject the drug. Heroin_sentence_110

The user may still get high on the drug from snorting, and experience a nod, but will not get a rush. Heroin_sentence_111

A "rush" is caused by a large amount of heroin entering the body at once. Heroin_sentence_112

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. Heroin_sentence_113

Heroin for pain has been mixed with sterile water on site by the attending physician, and administered using a syringe with a nebulizer tip. Heroin_sentence_114

Heroin may be used for fractures, burns, finger-tip injuries, suturing, and wound re-dressing, but is inappropriate in head injuries. Heroin_sentence_115

Suppository Heroin_section_9

Little research has been focused on the suppository (anal insertion) or pessary (vaginal insertion) methods of administration, also known as "plugging". Heroin_sentence_116

These methods of administration are commonly carried out using an oral syringe. Heroin_sentence_117

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. Heroin_sentence_118

The rectum or the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining their walls. Heroin_sentence_119

Adverse effects Heroin_section_10

Heroin is classified as a hard drug in terms of drug harmfulness. Heroin_sentence_120

Like most opioids, unadulterated heroin may lead to adverse effects. Heroin_sentence_121

The purity of street heroin varies greatly, leading to overdoses when the purity is higher than they expected. Heroin_sentence_122

Short term effects Heroin_section_11

Users report an intense rush, an acute transcendent state of euphoria, which occurs while diamorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Heroin_sentence_123

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. Heroin_sentence_124

While other opioids of recreational use produce only morphine, heroin also leaves 6-MAM, also a psycho-active metabolite. Heroin_sentence_125

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. Heroin_sentence_126

Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness. Heroin_sentence_127

The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities. Heroin_sentence_128

Nausea, vomiting, and severe itching may also occur. Heroin_sentence_129

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. Heroin_sentence_130

Slowed breathing can also lead to coma and permanent brain damage. Heroin_sentence_131

Heroin abuse has also been associated with myocardial infarction. Heroin_sentence_132

Long term effects Heroin_section_12

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. Heroin_sentence_133

Studies have shown some deterioration of the brain's white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations. Heroin_sentence_134

Heroin also produces profound degrees of tolerance and physical dependence. Heroin_sentence_135

Tolerance occurs when more and more of the drug is required to achieve the same effects. Heroin_sentence_136

With physical dependence, the body adapts to the presence of the drug, and withdrawal symptoms occur if use is reduced abruptly. Heroin_sentence_137

Injection Heroin_section_13

Intravenous use of heroin (and any other substance) with needles and syringes or other related equipment may lead to: Heroin_sentence_138

Heroin_unordered_list_0

Withdrawal Heroin_section_14

Main article: Opioid withdrawal Heroin_sentence_139

The 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. Heroin_sentence_140

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, fever, cramp-like pains, and involuntary spasms in the limbs (thought to be an origin of the term "kicking the habit"). Heroin_sentence_141

Overdose Heroin_section_15

Further information: US drug overdose death rates and totals over time Heroin_sentence_142

Heroin overdose is usually treated with the opioid antagonist, naloxone. Heroin_sentence_143

This reverses the effects of heroin and causes an immediate return of consciousness but may result in withdrawal symptoms. Heroin_sentence_144

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. Heroin_sentence_145

Between 2012 and 2015, heroin was the leading cause of drug related deaths in the United States. Heroin_sentence_146

Since then fentanyl is a more common cause of drug related deaths. Heroin_sentence_147

Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours. Heroin_sentence_148

Death usually occurs due to lack of oxygen resulting from the lack of breathing caused by the opioid. Heroin_sentence_149

Heroin overdoses can occur because of an unexpected increase in the dose or purity or because of diminished opioid tolerance. Heroin_sentence_150

However, many fatalities reported as overdoses are probably caused by interactions with other depressant drugs such as alcohol or benzodiazepines. Heroin_sentence_151

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. Heroin_sentence_152

Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 600 mg. Heroin_sentence_153

Illicit heroin is of widely varying and unpredictable purity. Heroin_sentence_154

This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended. Heroin_sentence_155

Also, tolerance typically decreases after a period of abstinence. Heroin_sentence_156

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. Heroin_sentence_157

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. Heroin_sentence_158

Heroin_unordered_list_1

  • Heroin_item_1_5
  • Heroin_item_1_6
  • Heroin_item_1_7

Pharmacology Heroin_section_16

When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine. Heroin_sentence_159

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 than morphine itself. Heroin_sentence_160

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 receptors, resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor. Heroin_sentence_161

Analgesia follows from the activation of the μ receptor G-protein coupled receptor, which indirectly hyperpolarizes the neuron, reducing the release of nociceptive neurotransmitters, and hence, causes analgesia and increased pain tolerance. Heroin_sentence_162

Unlike hydromorphone and oxymorphone, however, administered intravenously, heroin creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective "body high" to some, but also instances of pruritus (itching) when they first start using. Heroin_sentence_163

Normally GABA, released from inhibitory neurones, inhibits the release of dopamine. Heroin_sentence_164

Opiates, like heroin and morphine, decrease the inhibitory activity of such neurones. Heroin_sentence_165

This causes increased release of dopamine in the brain which is the reason for euphoric and rewarding effects of heroin. Heroin_sentence_166

Both morphine and 6-MAM are μ-opioid agonists that bind to receptors present throughout the brain, spinal cord, and gut of all mammals. Heroin_sentence_167

The μ-opioid receptor also binds endogenous opioid peptides such as β-endorphin, Leu-enkephalin, and Met-enkephalin. Heroin_sentence_168

Repeated use of heroin results in a number of physiological changes, including an increase in the production of μ-opioid receptors (upregulation). Heroin_sentence_169

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 withdrawal syndrome. Heroin_sentence_170

Depending on usage it has an onset 4–24 hours after the last dose of heroin. Heroin_sentence_171

Morphine also binds to δ- and κ-opioid receptors. Heroin_sentence_172

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. Heroin_sentence_173

The third subtype of third opioid type is the mu-3 receptor, which may be a commonality to other six-position monoesters of morphine. Heroin_sentence_174

The contribution of these receptors to the overall pharmacology of heroin remains unknown. Heroin_sentence_175

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). Heroin_sentence_176

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. Heroin_sentence_177

Chemistry Heroin_section_17

Diamorphine is produced from acetylation of morphine derived from natural opium sources, generally using acetic anhydride. Heroin_sentence_178

The major metabolites of diamorphine, 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. Heroin_sentence_179

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-acetylcholine and codeine. Heroin_sentence_180

However, chromatographic techniques can easily distinguish and measure each of these substances. Heroin_sentence_181

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 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. Heroin_sentence_182

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. Heroin_sentence_183

History Heroin_section_18

See also: History of opium in China Heroin_sentence_184

The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BC. Heroin_sentence_185

The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to the alkaloids codeine and morphine. Heroin_sentence_186

Diamorphine was first synthesized in 1874 by C. Heroin_sentence_187 R. Alder Wright, an English chemist working at St. Mary's Hospital Medical School in London who had been experimenting combining morphine with various acids. Heroin_sentence_188

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. Heroin_sentence_189

He sent the compound to F. M. Pierce of Owens College in Manchester for analysis. Heroin_sentence_190

Pierce told Wright: Heroin_sentence_191

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. Heroin_sentence_192

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. Heroin_sentence_193

Instead, the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself. Heroin_sentence_194

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"). Heroin_sentence_195

Bayer scientists were not the first to make heroin, but their scientists discovered ways to make it, and Bayer led the commercialization of heroin. Heroin_sentence_196

In 1895, Bayer marketed diacetylmorphine as an over-the-counter drug under the trademark name Heroin. Heroin_sentence_197

It was developed chiefly as a morphine substitute for cough suppressants that did not have morphine's addictive side-effects. Heroin_sentence_198

Morphine at the time was a popular recreational drug, and Bayer wished to find a similar but non-addictive substitute to market. Heroin_sentence_199

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. Heroin_sentence_200

From 1898 through to 1910, diamorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant. Heroin_sentence_201

In the 11th edition of Encyclopædia Britannica (1910), the article on morphine states: "In the cough of 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." Heroin_sentence_202

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. Heroin_sentence_203

In 1924, the United States Congress banned its sale, importation, or manufacture. Heroin_sentence_204

It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States. Heroin_sentence_205

The Health Committee of the League of Nations banned diacetylmorphine in 1925, although it took more than three years for this to be implemented. Heroin_sentence_206

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. Heroin_sentence_207

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. Heroin_sentence_208

Use of heroin by jazz musicians in particular was prevalent in the mid-twentieth century, including Billie Holiday, saxophonists Charlie Parker and Art Pepper, guitarist Joe Pass and piano player/singer Ray Charles; a "staggering number of jazz musicians were addicts". Heroin_sentence_209

It was also a problem with many rock musicians, particularly from the late 1960s through the 1990s. Heroin_sentence_210

Pete Doherty is also a self-confessed user of heroin. Heroin_sentence_211

Nirvana lead singer Kurt Cobain's heroin addiction was well documented. Heroin_sentence_212

Pantera frontman, Phil Anselmo, turned to heroin while touring during the 1990s to cope with his back pain. Heroin_sentence_213

James Taylor, John Lennon, Eric Clapton, Johnny Winter, Keith Richards and Janis Joplin also used heroin. Heroin_sentence_214

Many musicians have made songs referencing their heroin usage. Heroin_sentence_215

Society and culture Heroin_section_19

Names Heroin_section_20

"Diamorphine" is the Recommended International Nonproprietary Name and British Approved Name. Heroin_sentence_216

Other synonyms for heroin include: diacetylmorphine, and morphine diacetate. Heroin_sentence_217

Heroin is also known by many street names including dope, H, smack, junk, horse, skag, and brown, among others. Heroin_sentence_218

Legal status Heroin_section_21

Asia Heroin_section_22

In Hong Kong, diamorphine is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. Heroin_sentence_219

It is available by prescription. Heroin_sentence_220

Anyone supplying diamorphine without a valid prescription can be fined $5,000,000 (HKD) and imprisoned for life. Heroin_sentence_221

The penalty for trafficking or manufacturing diamorphine is a $5,000,000 (HKD) fine and life imprisonment. Heroin_sentence_222

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. Heroin_sentence_223

Europe Heroin_section_23

In the Netherlands, diamorphine is a List I drug of the Opium Law. Heroin_sentence_224

It is available for prescription under tight regulation exclusively to long-term addicts for whom methadone maintenance treatment has failed. Heroin_sentence_225

It cannot be used to treat severe pain or other illnesses. Heroin_sentence_226

In the United Kingdom, diamorphine is available by prescription, though it is a restricted Class A drug. Heroin_sentence_227

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. Heroin_sentence_228

The treatment of chronic non-malignant pain must be supervised by a specialist. Heroin_sentence_229

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". Heroin_sentence_230

When used in the palliative care of cancer patients, diamorphine is often injected using a syringe driver. Heroin_sentence_231

In Switzerland, heroin is produced in injectable or tablet form under the name Diaphin by a private company under contract to the Swiss government. Heroin_sentence_232

Swiss-produced heroin has been imported into Canada with government approval. Heroin_sentence_233

Australia Heroin_section_24

In Australia diamorphine is listed as a schedule 9 prohibited substance under the Poisons Standard (October 2015). Heroin_sentence_234

A schedule 9 drug is outlined in the Poisons Act 1964 as "Substances which may be abused or misused, the manufacture, possession, sale or use of which should be prohibited by law except when required for medical or scientific research, or for analytical, teaching or training purposes with approval of the CEO." Heroin_sentence_235

North America Heroin_section_25

In Canada, diamorphine is a controlled substance under Schedule I of the Controlled Drugs and Substances Act (CDSA). Heroin_sentence_236

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. Heroin_sentence_237

Possession of diamorphine for the purpose of trafficking is an indictable offense and subject to imprisonment for life. Heroin_sentence_238

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. Heroin_sentence_239

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. Heroin_sentence_240

In 2020, the US state of Oregon would become the first state to decriminalize the use of heroin after voters passed Ballot Measure 110. Heroin_sentence_241

This measure will allow initiative will allow people with small amounts to avoid arrest. Heroin_sentence_242

Turkey Heroin_section_26

See also: Illegal drug trade in Turkey Heroin_sentence_243

Turkey maintains strict laws against the use, possession or trafficking of illegal drugs. Heroin_sentence_244

If convicted under these offences, one could receive a heavy fine or a prison sentence of 4 to 24 years. Heroin_sentence_245

Abuse of prescription medication Heroin_section_27

Abused prescription medicine such as opioid can lead to heroin addiction. Heroin_sentence_246

The number of death from illegal opioid overdose follows the increasing number of death caused by prescription opioid overdoses. Heroin_sentence_247

Prescription opioids are relatively easy to obtain. Heroin_sentence_248

This may ultimately lead to heroin injection because heroin is cheaper than prescribed pills. Heroin_sentence_249

Economics Heroin_section_28

Production Heroin_section_29

Diamorphine is produced from acetylation of morphine derived from natural opium sources. Heroin_sentence_250

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 of the morphine base by addition of ammonium chloride. Heroin_sentence_251

The solid morphine base is then filtered out. Heroin_sentence_252

The morphine base is then reacted with acetic anhydride, which forms heroin. Heroin_sentence_253

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. Heroin_sentence_254

Heroin purity has been classified into four grades. Heroin_sentence_255

No.4 is the purest form – white powder (salt) to be easily dissolved and injected. Heroin_sentence_256

No.3 is "brown sugar" for smoking (base). Heroin_sentence_257

No.1 and No.2 are unprocessed raw heroin (salt or base). Heroin_sentence_258

Trafficking Heroin_section_30

See also: Opium § Modern production and usage Heroin_sentence_259

Traffic is heavy worldwide, with the biggest producer being Afghanistan. Heroin_sentence_260

According to a U.N. sponsored survey, in 2004, Afghanistan accounted for production of 87 percent of the world's diamorphine. Heroin_sentence_261

Afghan opium kills around 100,000 people annually. Heroin_sentence_262

In 2003 The Independent reported: Heroin_sentence_263

Opium production in that country has increased rapidly since, reaching an all-time high in 2006. Heroin_sentence_264

War in Afghanistan once again appeared as a facilitator of the trade. Heroin_sentence_265

Some 3.3 million Afghans are involved in producing opium. Heroin_sentence_266

At present, opium poppies are mostly grown in Afghanistan (224,000 hectares (550,000 acres)), and in Southeast Asia, especially in the region known as the Golden Triangle straddling Burma (57,600 hectares (142,000 acres)), Thailand, Vietnam, Laos (6,200 hectares (15,000 acres)) and Yunnan province in China. Heroin_sentence_267

There is also cultivation of opium poppies in Pakistan (493 hectares (1,220 acres)), Mexico (12,000 hectares (30,000 acres)) and in Colombia (378 hectares (930 acres)). Heroin_sentence_268

According to the 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. Heroin_sentence_269

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. Heroin_sentence_270

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. Heroin_sentence_271

According to the Royal Canadian Mounted Police, 90% of the heroin seized in Canada (where the origin was known) came from Afghanistan. Heroin_sentence_272

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. Heroin_sentence_273

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 most strict. Heroin_sentence_274

The penalty applies even to citizens of countries where the penalty is not in place, sometimes causing controversy when foreign visitors are arrested for trafficking, for example, the arrest of nine Australians in Bali, the death sentence given to Nola Blake in Thailand in 1987, or the hanging of an Australian citizen Van Tuong Nguyen in Singapore. Heroin_sentence_275

Trafficking history Heroin_section_31

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. Heroin_sentence_276

At first, heroin flowed from countries where it was still legal into countries where it was no longer legal. Heroin_sentence_277

By the mid-1920s, heroin production had been made illegal in many parts of the world. Heroin_sentence_278

An illegal trade developed at that time between heroin labs in China (mostly in Shanghai and Tianjin) and other nations. Heroin_sentence_279

The weakness of the government in China and conditions of civil war enabled heroin production to take root there. Heroin_sentence_280

Chinese triad gangs eventually came to play a major role in the illicit heroin trade. Heroin_sentence_281

The French Connection route started in the 1930s. Heroin_sentence_282

Heroin trafficking was virtually eliminated in the US during World War II because of temporary trade disruptions caused by the war. Heroin_sentence_283

Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium. Heroin_sentence_284

After World War II, the Mafia took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily. Heroin_sentence_285

The Mafia took advantage of Sicily's location along the historic route opium took westward into Europe and the United States. Heroin_sentence_286

Large-scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s. Heroin_sentence_287

The elimination of Chinese production happened at the same time that Sicily's role in the trade developed. Heroin_sentence_288

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. Heroin_sentence_289

In the late 1960s and early 1970s, the CIA supported anti-Communist Chinese Nationalists settled near the Sino-Burmese border and Hmong tribesmen in Laos. Heroin_sentence_290

This helped the development of the Golden Triangle opium production region, which supplied about one-third of heroin consumed in the US after the 1973 American withdrawal from Vietnam. Heroin_sentence_291

In 1999, Burma, the heartland of the Golden Triangle, was the second-largest producer of heroin, after Afghanistan. Heroin_sentence_292

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. Heroin_sentence_293

By 1980, 60 percent of the heroin sold in the US originated in Afghanistan. Heroin_sentence_294

It increased international production of heroin at lower prices in the 1980s. Heroin_sentence_295

The trade shifted away from Sicily in the late 1970s as various criminal organizations violently fought with each other over the trade. Heroin_sentence_296

The fighting also led to a stepped-up government law enforcement presence in Sicily. Heroin_sentence_297

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. Heroin_sentence_298

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. Heroin_sentence_299

The number of addicts seeking treatment also increased significantly during this period. Heroin_sentence_300

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. Heroin_sentence_301

Many people 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. Heroin_sentence_302

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. Heroin_sentence_303

Based on heroin production statistics 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. Heroin_sentence_304

Street price Heroin_section_32

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. Heroin_sentence_305

The price of white heroin is reported only by a few European countries and ranged between €27 and €110 per gram. Heroin_sentence_306

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. Heroin_sentence_307

Harm reduction Heroin_section_33

Main articles: Harm reduction, Safe injection sites, and Needle exchange programs Heroin_sentence_308

Harm reduction is a public health philosophy that seeks to reduce the harms associated with the use of illicit drugs. Heroin_sentence_309

One aspect of harm reduction initiatives focuses on the behaviour of individual users. Heroin_sentence_310

In the case of diamorphine, this includes promoting safer means of taking the drug, such as smoking, nasal use, oral or rectal insertion. Heroin_sentence_311

This attempts to avoid the higher risks of overdose, infections, and blood-borne viruses associated with injecting the drug. Heroin_sentence_312

Other measures include using a small amount of the drug first to gauge the strength and minimize the risks of overdose. Heroin_sentence_313

For the same reason, poly drug use (the use of two or more drugs at the same time) is discouraged. Heroin_sentence_314

Injecting diamorphine users are encouraged to use new needles, syringes, spoons/steri-cups, and filters every time they inject and not share these with other users. Heroin_sentence_315

Users are also encouraged to not use it on their own, as others can assist in the event of an overdose. Heroin_sentence_316

Governments that support a harm reduction approach usually fund needle and syringe exchange programs, which supply new needles and syringes on a confidential basis, as well as education on proper filtering before injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing diamorphine 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 the use of shoelaces or belts). Heroin_sentence_317

Another harm reduction measure employed for example in Europe, Canada, and Australia are safe injection sites where users can inject diamorphine and cocaine under the supervision of medically trained staff. Heroin_sentence_318

Safe injection sites are low threshold and allow social services to approach problem users that would otherwise be hard to reach. Heroin_sentence_319

In the UK the Criminal Justice System has a protocol in place that requires that any individual that is arrested and is suspected of having a substance misuse problem be offered the chance to enter a treatment program. Heroin_sentence_320

This has had the effect of drastically reducing an area's crime rate as individuals arrested for theft in order to supply the funds for their drugs are no longer in the position of having to steal to purchase heroin because they have been placed onto a methadone program, quite often more quickly than would have been possible had they not been arrested. Heroin_sentence_321

This aspect of harm reduction is seen as being beneficial to both the individual and the community at large, who are then protected from the possible theft of their goods. Heroin_sentence_322

During the late 1980s and early 1990s, Swiss authorities ran the ZIPP-AIDS (Zurich Intervention Pilot Project), handing out free syringes in the officially tolerated drug scene in Platzspitz park. Heroin_sentence_323

In 1994, Zurich started a pilot project using prescription heroin in heroin-assisted treatment (HAT) which allowed users to obtain heroin and inject it under medical supervision. Heroin_sentence_324

The HAT program proved to be cost-beneficial to society and improve patients overall health and social stability and has since been introduced in multiple European countries. Heroin_sentence_325

Research Heroin_section_34

Researchers are attempting to reproduce the biosynthetic pathway that produces morphine in genetically engineered yeast. Heroin_sentence_326

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. Heroin_sentence_327

See also Heroin_section_35

Heroin_unordered_list_2


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Heroin.