Heroin
Systematic (IUPAC) name
(5α,6α)-7,8-didehydro-4,5-epoxy- 17-methylmorphinan-3,6-diol diacetate
Identifiers
CAS number	561-27-3
ATC code	N02AA09
PubChem	5462328
Chemical data
Formula	C21H23NO5
Mol. mass	369. IUPAC Nomenclature is a system of naming Chemical compounds and of describing the science of Chemistry in general CAS registry numbers are unique numerical identifiers for Chemical compounds Polymers biological sequences mixtures and Alloys They are also referred to The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs It is controlled by the WHO Collaborating Centre for Drug A section of the Anatomical Therapeutic Chemical Classification System. PubChem is a Database of chemical Molecules The system is maintained by the National Center for Biotechnology Information (NCBI a component A chemical formula is a way of expressing information about the Atoms that constitute a particular Chemical compound, and how the relationship between those atoms changes Carbon (kɑɹbən is a Chemical element with the symbol C and its Atomic number is 6 Hydrogen (ˈhaɪdrədʒən is the Chemical element with Atomic number 1 Nitrogen (ˈnaɪtɹəʤɪn is a Chemical element that has the symbol N and Atomic number 7 and Atomic weight 14 Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the The molecular mass (abbreviated m of a substance, more commonly referred to as molecular weight and abbreviated as MW, is the Mass of one 41
Pharmacokinetic data
Bioavailability	<35% (oral), 44–61% (inhaled)[1]
Protein binding	0% (morphine metabolite 35%)
Metabolism	hepatic
Half life	3–5 min (IV, inhaled)[2]
Excretion	90% renal as glucuronides, rest biliary
Therapeutic considerations
Pregnancy cat.	Category X
Legal status	Prohibited (S9)(AU) Schedule I(CA) Class A(UK) Schedule I(US)
Dependence Liability	Extremely High
Routes	Inhalation, Transmucosal, Intravenous, Oral, Intranasal, Rectal, Intramuscular

Heroin (INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from morphine, a derivative of the opium poppy. In Pharmacology, bioavailability is used to describe the fraction of an administered Dose of unchanged drug that reaches the Systemic circulation, one of A drug's efficiency may be affected by the degree to which it binds to the proteins within Blood plasma. Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in Drug metabolism is the Metabolism of drugs, their Biochemical modification or degradation usually through specialized enzymatic systems The liver is a vital organ in the human body and is present in Vertebrates and some other animals The biological half-life of a substance is the time it takes for a substance (drug radioactive nuclide or other to lose half of its pharmacologic physiologic or radiologic activity Excretion is the process of eliminating waste products of Metabolism and other non-useful materials The kidneys are complicated organs that have numerous biological roles A glucuronide, also known as glucuronoside, is any substance produced by linking Glucuronic acid to another substance via a Glycosidic bond. A bile duct is any of a number of long tube-like structures that carry Bile. The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical if it is used as directed by the mother during The regulation of therapeutic goods, that is drugs and therapeutic devices, varies by jurisdiction The Standard for the Uniform Scheduling of Drugs and Poisons, abbreviated SUSDP, is a document used in the regulation of drugs and poisons in Australia. For a topic outline on this subject see List of basic Australia topics. The Controlled Drugs and Substances Act is Canada 's federal drug control statute Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page The Misuse of Drugs Act 1971 (c38 is an Act of Parliament, by which the United Kingdom aims to control the possession and supply of numerous drugs The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The United States of America —commonly referred to as the In Pharmacology and Toxicology, a route An International Nonproprietary Name ( INN; also known as rINN, for recommended International Nonproprietary Name or pINN for proposed A British Approved Name ( BAN) is the official non-proprietary or generic name given to a Pharmaceutical Substance, as defined in the British Pharmacopoeia An opioid is a chemical Substance that has a Morphine -like action in the body Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in The opium poppy, Papaver somniferum, is the type of Poppy from which Opium and many refined opiates such as Morphine, Thebaine It is the 3,6-diacetyl ester of morphine (hence diacetylmorphine). An acetate, or ethanoate, is either a salt or Ester of Acetic acid. The white crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride.

As with other opiates, heroin is used both as a pain-killer and a recreational drug. For other uses see Opiate (disambiguation, or for the class of drugs see Opioid. Recreational drug use is the use of Psychoactive drugs for Recreational purposes rather than for work, medical or spiritual purposes

One of the most common methods of heroin use is via intravenous injection (typically known as "shooting up"). Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. If taken orally, heroin undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine. The first-pass effect (also known as first-pass metabolism or presystemic metabolism) is a phenomenon of Drug metabolism whereby the Concentration Acetylation (or in IUPAC nomenclature ethanoylation) describes a reaction that introduces an Acetyl Functional group into an Organic compound A prodrug is a pharmacological substance ( drug) that is administered in an inactive (or significantly less active form ^[1] When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood-brain barrier due to the presence of the acetyl groups, which render it much more lipid-soluble than morphine itself. The blood-brain barrier (BBB is a metabolic or cellular structure in the Central nervous system (CNS that restricts the passage of various chemical substances and microscopic ^[2] Once in the brain, it is deacetylated into 3- and 6-monoacetylmorphine and morphine, which bind to μ-opioid receptors resulting in intense euphoria, decreased pain perception, and anxiolytic effects (relief of anxiety). 6-monoacetylmorphine (6-MAM is one of 2 active Metabolites of Heroin (diacetylmorphine the other being the much less active 3-monoacetylmorphine The μ opioid receptors (MOR are a class of Opioid An anxiolytic is a drug prescribed for the treatment of Symptoms of Anxiety.

Frequent administration has a high potential for causing addiction and may quickly lead to tolerance. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as If a sustained use of heroin for as little as three days is stopped abruptly, withdrawal symptoms can appear. This is much shorter than the withdrawal effects experienced from other common painkillers such as oxycodone and hydrocodone. Oxycodone is an Opioid Analgesic Medication synthesized from Thebaine. Hydrocodone or dihydrocodeinone is a semi-synthetic Opioid derived from two of the naturally occurring Opiates Codeine and Thebaine ^[3][4]

Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs. The Single Convention on Narcotic Drugs is an international Treaty to prohibit production and supply of specific (nominally Narcotic) Drugs and of drugs ^[5] It is illegal to manufacture, possess, or sell heroin in Belgium, Denmark, Germany, the Netherlands, the United States and the UK. The Kingdom of Belgium is a Country in northwest Europe. It is a founding member of the European Union and hosts its headquarters as well as those The Kingdom of Denmark ( ˈd̥ænmɑɡ̊ (archaic ˈd̥anmɑːɡ̊ commonly known as Denmark, is a country in the Scandinavian region of northern Europe Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. The Netherlands ( Dutch:, ˈnedərlɑnt is the European part of the Kingdom of the Netherlands, which consists of the Netherlands the Netherlands The United States of America —commonly referred to as the However, under the name diamorphine, heroin is a legal prescription drug in the United Kingdom, and in the Netherlands, heroin is available for prescription as the generic drug diacetylmorfine to long-term Heroin addicts. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Netherlands ( Dutch:, ˈnedərlɑnt is the European part of the Kingdom of the Netherlands, which consists of the Netherlands the Netherlands Popular street names for heroin include black tar, smack, junk, skag, horse, brain, chaw, chiva, china white, dust and others. Black Tar Heroin is a variety of Heroin produced primarily in Mexico, but similar in appearance and texture to so called Home Bake Heroin from New Zealand These are specific references to heroin and not used to describe any other drug. Dope could be used to refer to heroin, but may also indicate other drugs, from laudanum a century ago to nearly any contemporary recreational drug. Laudanum (ˈlȯd-nəm or ˈlȯ-də-nəm also known as Opium Tincture or Tincture of Opium, is an Alcoholic herbal preparation

Contents 1 History 2 Usage and effects 3 Regulation 4 Production and trafficking: The Golden Triangle 4.1 Manufacturing 4.2 History of heroin traffic 4.3 Trafficking 5 Risks of non-medical use 6 Harm reduction approaches to heroin 7 Withdrawal 8 Heroin prescription 9 Drug interactions 10 Popular Culture 10.1 Film & television 10.2 Literature 10.3 Music 11 See also 12 References 13 Literature 14 External links

History

The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BC. The opium poppy, Papaver somniferum, is the type of Poppy from which Opium and many refined opiates such as Morphine, Thebaine Mesopotamia (from the Greek meaning "land between the rivers" is an area geographically located between the Tigris and Euphrates rivers largely corresponding ^[6] The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two ingredients, codeine and morphine. Codeine ( INN) or methylmorphine is an Opiate used for its Analgesic, antitussive and antidiarrheal properties Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in

Heroin was first synthesized in 1874 by C. R. Alder Wright, an English chemist working at St. Mary's Hospital Medical School in London, England. St Mary's Hospital is a Hospital located in Paddington, London, England. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride over a stove for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine. The compound was sent to F. M. Pierce of Owens College in Manchester for analysis, who reported the following to Wright:

Doses . . . were subcutaneously injected into young dogs and rabbits . In Pharmacology and Toxicology, a route . . with the following general results . . . great prostration, fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis. For the band see Saliva (band; for the village in Azerbaijan see Səliva. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. In Animal physiology, respiration is the transport of Oxygen from the outside air to the cells within tissues and the transport of Carbon dioxide Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4° (rectal failure). ^[7]

Wright's invention, however, did not lead to any further developments, and heroin only became popular after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann. Felix Hoffmann ( January 21, 1868 &ndash February 8, 1946) was a German Chemist, who first synthesized medically useful Hoffmann, working at the Bayer pharmaceutical company in Elberfeld, Germany, was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing codeine, a constituent of the opium poppy, similar to morphine pharmacologically but less potent and less addictive. For other uses see Bayer (disambiguation or Beyer or Buyer. Bayer AG (German ˈbaɪə () is a German See also Elberfeld Indiana. For the baseball player with this name see Kid Elberfeld. Codeine ( INN) or methylmorphine is an Opiate used for its Analgesic, antitussive and antidiarrheal properties But instead of producing codeine, the experiment produced an acetylated form of morphine that was actually 1. 5-2 times more potent than morphine itself. Bayer would name the substance "heroin", probably from the word heroisch, German for heroic, because in field studies people using the medicine felt "heroic". ^[8]

From 1898 through to 1910 heroin was marketed as a non-addictive morphine substitute and cough suppressant. Bayer marketed heroin as a cure for morphine addiction before it was discovered that heroin is rapidly metabolized into morphine, and as such, "heroin" was basically only a quicker acting form of morphine. The company was somewhat embarrassed by this new finding and it became a historical blunder for Bayer. ^[9]

As with aspirin, Bayer lost some of its trademark rights to heroin following the German defeat in World War I. Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All ^[10]

In the United States the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of heroin and other opiates. The Harrison Narcotics Tax Act (Ch 1) was a United States federal law that regulated and taxed the production importation and distribution of Opiates. The law did allow heroin to be prescribed and sold for medical purposes. In particular, recreational users could often still be legally supplied with heroin and use it. In 1924, the United States Congress passed additional legislation banning the sale, importation or manufacture of heroin in the United States. It is now a Schedule I substance, and is thus illegal in the United States.

Usage and effects

Indicated for: Relief of Extreme Pain Recreational uses: Euphoria Relaxation Other uses: Pain relief Cough suppressant anti-diarrheal

Contraindications: Alcohol Barbiturates and Benzodiazepines Stimulants Other opioids (depends heavily on tolerance)

Side effects Severe:[3] Respiratory arrest, coma, death Central nervous system: Drowsiness Disorientation Delirium Cardiovascular & Respiratory: Lowered heart rate Weak pulse Hypotension Hypoventilation Shallow breathing Respiratory depression Eyes, Ears, nose, and mouth: Dry mouth Pupil constriction ("pinpoint pupils") Miosis Gastrointestinal: Nausea Vomiting (protracted) Constipation Dyspepsia Urinary System: Urinary retention Musculoskeletal: Analgesia Ataxia Muscle spasticity Neurological: Analgesia Physical dependence Psychological: Anxiolysis Confusion Euphoria Psychological dependence Somnolence Skin: Itching Flushing/Rash Diamorphine ampoules for medicinal use

Heroin is used as a recreational drug for the intense euphoria it produces, an effect that diminishes with increased tolerance. Recreational drug use is the use of Psychoactive drugs for Recreational purposes rather than for work, medical or spiritual purposes Euphoria is a medically recognized emotional state related to Pleasure and Happiness. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm A cough medicine is a medicinal drug used to treat Coughing and related conditions In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug, Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic Stimulant drugs are Drugs that temporarily increase alertness and awareness An opioid is a chemical Substance that has a Morphine -like action in the body An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness. Death is the termination of the biological functions that define living Organisms It refers both to a specific In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Somnolence (or " drowsiness " is a state of near- Sleep, a strong desire for sleep or sleeping for unusually long periods (c Orientation is a function of the Mind involving awareness of three dimensions Time, Place and Person. Delirium is an acute and relatively sudden (developing over hours to days decline in attention-focus perception and Cognition. This is an article about the rock music band "Circulatory System" In Animal physiology, respiration is the transport of Oxygen from the outside air to the cells within tissues and the transport of Carbon dioxide Measuring heart rate The Pulse rate (which in most people is identical to the heart rate can be measured at any point on the body where an Artery 's pulsation In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. In Medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate ( hypo means "below" to perform needed Shallow breathing, thoracic breathing, or chest breathing is the drawing of minimal breath into the lungs usually by drawing air into the chest area using the Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations Anatomically a nose is a protuberance in Vertebrates that houses the Nostrils or nares which admit and expel air for respiration in conjunction with the The mouth, buccal cavity, or oral cavity is the first portion of the Alimentary canal that receives food and begins digestion by mechanically breaking up Miosis is Constriction of the Pupil of the Eye. This is a normal response to an increase in light but can also be associated with certain Pathological Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Dyspepsia (from the Greek "δυς-" (Dys- and "πέψη" (Pepse known in plain English as indigestion, meaning hard The urinary system (also called Excretory system or the genitourinary system (GUS is the Organ system that produces stores and eliminates Urine. Urinary retention also known as ischuria is a lack of ability to Urinate. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the In Biology, the skeleton is a strong and often a rigid framework that supports the body of an animal holding it upright and giving it shape and strength (Also skeletal Ataxia (from Greek α- as a negative prefix + -τάξις, meaning "lack of order" is a neurological sign and symptom consisting Spasticity or muscular hypertonicity is a disorder of the body Motor system, and especially the central nervous system (CNS in which certain Muscles continually Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and An anxiolytic is a drug prescribed for the treatment of Symptoms of Anxiety. Confusion, of a Pathological degree usually refers to loss of orientation (ability to place oneself correctly in the world by time location and personal identity and Euphoria is a medically recognized emotional state related to Pleasure and Happiness. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as Somnolence (or " drowsiness " is a state of near- Sleep, a strong desire for sleep or sleeping for unusually long periods (c The skin is the outer covering of living tissue of an animal (or plant Euphoria is a medically recognized emotional state related to Pleasure and Happiness. In Physiology, tolerance occurs when an organism builds up a resistance to the effects of a substance after repeated exposure Its popularity with recreational drug users, compared to morphine, reportedly stems from its perceived different effects. Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in ^[12] However, this perception is not supported by the results of clinical research studies. In controlled studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opiates, subjects showed no preference for either drug. Equipotent, injected doses had comparable action courses, with no difference in their ability to induce euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness. ^[13] Data acquired from short-term addiction studies did not indicate that heroin tolerance develops more rapidly than tolerance to morphine. The findings have been discussed in relation to the physicochemical properties of heroin and morphine and the metabolism of heroin. When compared to other 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. Hydromorphone, a more common synonym for dihydromorphinone hydrochloride (trade names Palladone IR, Palladone SR, Dilaudid and numerous others Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. Oxycodone is an Opioid Analgesic Medication synthesized from Thebaine. Pethidine ( INN) or meperidine ( USAN) (commonly referred to as Demerol but also referred to as isonipecaine lidol pethanol piridosal Algil Alodan Pethidine ( INN) or meperidine ( USAN) (commonly referred to as Demerol but also referred to as isonipecaine lidol pethanol piridosal Algil Alodan Morphine and heroin were also much more likely to produce euphoria, and other subjective effects when compared to most opioid analgesics. An opioid is a chemical Substance that has a Morphine -like action in the body ^[14][15] Heroin can be administered several ways, including snorting and injection, and may be smoked by inhaling its vapors when heated, i. In Pharmacology and Toxicology, a route Insufflation (Latin insufflatio "blowing on or into" is the practice of inhaling substances into a Body cavity. An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through e. "chasing the dragon. "Chasing the dragon" (a Slang phrase of Cantonese origin from Hong Kong) refers to inhaling the smoke from heated Morphine, "

Some users mix heroin with cocaine in a "speedball" or "snowball" combination that usually is injected intravenously, smoked, or snorted, producing a more intense rush than heroin alone, but is more dangerous because the combination of the short-acting stimulant with the longer-acting depressant increases the risk of seizure, or overdose with one or both drugs. Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant Speedballing (alternatively known as snowballing) is a term commonly referring to the Intravenous use of heroin or morphine and Cocaine together in

Once in the brain, heroin is rapidly metabolized to 6-acetylmorphine and morphine by removal of the acetyl groups and thus serves as a prodrug. Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. Morphine is unable to cross the blood-brain barrier as quickly as heroin, which gives heroin a comparably shorther onset of action. In either case, a morphine binds to opioid receptors, inducing the opioid high.

The onset of heroin's effects depends upon the route of administration. In Pharmacology and Toxicology, a route Orally, heroin is completely metabolized in vivo to morphine before crossing the blood-brain barrier; the effects are the same as with oral morphine. In vivo ( Latin: within the living means that which takes place inside an organism. Snorting results in an onset within 3 to 5 minutes; smoking results in an almost immediate effect that builds in intensity; intravenous injection induces a rush and euphoria usually taking effect within 30 seconds; intramuscular and subcutaneous injection take effect within 3 to 5 minutes.

Heroin is metabolized into morphine, a μ-opioid receptor agonist. The μ opioid receptors (MOR are a class of Opioid An agonist is a term used to describe a type of ligand or drug that binds and alters the activity of a receptor. It acts on endogenous μ-opioid receptors that are present throughout the brain, spinal cord and gut in all mammals. The word endogenous means "arising from within" the opposite of Exogenous. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected Mammals ( class Mammalia) are a class of Vertebrate Animals characterized by the presence of Sweat glands, including sweat glands The μ-opioid receptor also binds endogenous opioid peptides such as β-endorphin, Leu-enkephalin, and Met-enkephalin. Opioid Peptides are short sequences of Amino acids which mimic the effect of Opiates in the Brain. Beta- Endorphin is an Endogenous Opioid Peptide Neurotransmitter found in the Neurons of both the central and Leu-enkephalin is an Endogenous Opioid peptide Neurotransmitter found naturally in the brains of many animals including humans Met-enkephalin is an Endogenous Opioid peptide Neurotransmitter found naturally in the brains of many animals including humans Repeated use of heroin results in a number of physiological changes, including decreases in the number of μ-opioid receptors. These physiological alterations lead to tolerance and dependance, and the cessation of heroin use results in extremely uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia. This set of symptoms is called the opiate withdrawal syndrome. Withdrawal, also known as withdrawal/abstinence syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes Physical dependence is It has an onset 6 to 8 hours after the last dose of heroin. Morphine also binds to δ- and κ-opioid receptors. The δ-opioid receptors, also known as delta opioid receptor or simply delta receptor, abbreviated DOR, is an Opioid receptor that has The κ-Opioid receptor is a type of Opioid receptor which binds the peptide opioid Dynorphin as the primary Endogenous ligand. There has also been some controversy regarding whether heroin binds to a subtype of μ-opioid receptors that is not targeted by morphine but is activated by the morphine metabolite morphine-6β-glucuronide. ^[16]

The heroin dose used for recreational purposes depends strongly on the frequency of use. A first-time user typically ingests between 5 and 20 mg of heroin, but an individual who is heavily dependent on the drug may require several hundred mg per day. ^[17]

Large doses of heroin can be fatal. The drug has been used for suicide or as a murder weapon. The serial killer Dr Harold Shipman used it on his victims as did Dr John Bodkin Adams (see his victim, Edith Alice Morrell). Harold Frederick "Fred" Shipman (14 January 1946 &ndash 13 January 2004 was an English General practitioner and convicted Serial killer John Bodkin Adams ( January 21, 1899 &ndash July 4, 1983) was an Irish-born British General practitioner, convicted Edith Alice Morrell (1868 – 13 November 1950) was a resident of Eastbourne and patient of the suspected Serial killer John Bodkin Adams It can sometimes be difficult to determine whether a heroin death was an accident, suicide or murder as with the deaths of Sid Vicious, Joseph Krecker, Janis Joplin, Tim Buckley, Jim Morrison, Layne Staley, and Bradley Nowell which have been attributed to heroin overdose. John Simon Ritchie (born May 10, 1957, died February 2, 1979) better known as Sid Vicious, was an English Punk Janis Lyn Joplin ( January 19, 1943  – October 4, 1970) was an American singer songwriter and music arranger from Timothy Charles Buckley III (February 14 1947 – June 29 1975 was an experimental Vocalist and Musician who incorporated Jazz, Psychedelia James Douglas Morrison (December 8 1943—July 3 1971 was an American Poet, Singer, Songwriter, Writer, and Film director Layne Thomas Staley ( August 22, 1967 - April 5, 2002) was the lead singer and co-lyricist of the rock group Alice in Chains and the Bradley James "John" Nowell ( February 22 1968 – May 25 1996) was an American musician who served as Lead ^[18]

Regulation

In the Netherlands, diamorphine(heroin) is a List I drug of the Opium Law. The Netherlands ( Dutch:, ˈnedərlɑnt is the European part of the Kingdom of the Netherlands, which consists of the Netherlands the Netherlands The Opium Law (or Opium Wet in Dutch is the section of the Dutch Law which covers nearly all psychotropic drugs It is available for prescription under tight regulation to long-term heroin addicts, to whom methadone maintenance treatment has failed. Heroin is exclusively available for prescription to long-term heroin addicts, and cannot be used to treat severe pain or other illnesses.

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

In Canada, heroin is a controlled substance under Schedule I of the Controlled Drugs and Substances Act (CDSA). The Controlled Drugs and Substances Act is Canada 's federal drug control statute Any person who seeks or obtains heroin without disclosing authorization 30 days prior to obtaining another prescription from a practitioner is guilty of an indictable offense and subject to imprisonment for a term not exceeding seven years. Possession of heroin for the purpose of trafficking is guilty of an indictable offense and subject to imprisonment for life.

In Hong Kong, heroin is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. Hong Kong ( officially the Hong Kong Special Administrative Region, is a territory located on China 's south coast on the Pearl River Delta, and borders It it available by prescription. Anyone who supplies heroin without a valid prescription can be fined $10,000 (HKD). The penalty for trafficking or manufacturing heroin is a $5,000,000 (HKD) fine and life imprisonment. Possession of heroin without a license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.

In the United Kingdom, heroin is available by prescription, though it is a restricted Class A drug. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Misuse of Drugs Act 1971 (c38 is an Act of Parliament, by which the United Kingdom aims to control the possession and supply of numerous drugs According to the 50th edition of the British National Formulary (BNF), diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction, acute pulmonary oedema, and chronic pain. The British National Formulary (BNF contains a wide spectrum of information on prescribing and Pharmacology, among others indications Side effects and In chemistry hydrochlorides are salts resulting or regarded as resulting from the reaction of Hydrochloric acid with an organic base (mostly Amines Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process The treatment of chronic non-malignant pain must be supervised by a specialist. Malignant (from the Latin roots mal- = "bad" and -genus = "born" is a medical term used to describe a severe and progressively worsening disease The BNF notes that all opioid analgesics cause dependence and tolerance but that this is "no deterrent in the control of pain in terminal illness". When used in the palliative care of cancer patients, heroin is often injected using a syringe driver. Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms A syringe driver or syringe pump is a small Infusion pump, used to gradually administer small amounts of fluid (with or without medication to a patient

Production and trafficking: The Golden Triangle

Manufacturing

Heroin is produced for the black market by refining opium. The first step of this process involves isolation of morphine from opium. Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in This crude morphine is then acetylated by heating with acetic anhydride. Purification of the obtained crude heroin and conversion to the the hydrochloride salt results in a water-soluble form of the drug that is a white or yellowish powder.

Crude opium is carefully dissolved in hot water but the resulting hot soup is not boiled. Mechanical impurities - twigs - are scooped together with the foam. The mixture is then made alkaline by gradual addition of lime. Lime causes a number of unwelcome components present in opium to precipitate out of the solution. (The impurities include inactive alkaloids, resins, proteins). The precipitate is removed by filtration through a cloth, washed with additional water and discarded. The filtrates containing the water-soluble calcium salt of morphine (calcium morphinate) are then acidified by careful addition of ammonium chloride. Ammonium chloride ( N[[Hydrogen H]]4 Cl) (also Sal Ammoniac, salmiac, nushadir salt, zalmiak, sal armagnac This causes freebase morphine to precipitate. The morphine precipitate is collected by filtration and dried before the next step. The crude morphine (which makes only about 10% of the weight of opium) is then heated together with acetic anhydride at 85 °C (185 °F) for six hours. Acetic anhydride is the Chemical compound with the formula (CH3CO2O The reaction mixture is then cooled, diluted with water, made alkaline with sodium carbonate, and the precipitated crude heroin is filtered and washed with water. This crude water-insoluble freebase product (which by itself is usable, for smoking) is further purified and decolourised by dissolution in hot alcohol, filtration with activated charcoal and concentration of the filtrates. The concentrated solution is then acidified with hydrochloric acid, diluted with ether, and the precipitated heroin hydrochloride is collected by filtration. This precipitate is the so-called "no. 4 heroin", commonly known as "china white". Heroin freebase cut with a small amount of caffeine (to help vaporise it more efficiently), typically brown in appearance, is known as called "no. 3 heroin". These two forms of heroin are the standard products exported to the Western market. Heroin no. 3 predominates on the European market, where heroin no. 4 is relatively uncommon. Another form of heroin is "black tar" which is common in the western United States and is produced in Mexico. Black Tar Heroin is a variety of Heroin produced primarily in Mexico, but similar in appearance and texture to so called Home Bake Heroin from New Zealand

The initial stage of opium refining - the isolation of morphine - is relatively easy to perform in rudimentary settings - even by substituting suitable fertilizers for pure chemical reagents. However, the later steps (acetylation, purification, and conversion to the hydrochloride salt) are more involved - they use large quantities of chemicals and solvents and they require both skill and patience. The final step is particularly tricky as the highly flammable ether can easily ignite during positive-pressure filtration (the explosion of vapor-air mixture can obliterate the refinery). If the ether does ignite, the result is a catastrophic explosion.

History of heroin traffic

The origins of the present international illegal heroin trade can be traced back to laws passed in many countries in the early 1900s that closely regulated the production and sale of opium and its derivatives including heroin. At first, heroin flowed from countries where it was still legal into countries where it was no longer legal. By the mid-1920s, heroin production had been made illegal in many parts of the world. An illegal trade developed at that time between heroin labs in China (mostly in Shanghai and Tianjin) and other nations. The weakness of government in China and conditions of civil war enabled heroin production to take root there. Chinese triad gangs eventually came to play a major role in the heroin trade. Triad ( also known as) is a term that describes many branches of Chinese underground society and/or organizations based in Hong Kong and Macau and also

Heroin trafficking was virtually eliminated in the U. S. during World War II due to temporary trade disruptions caused by the war. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium. After the second world war, the Mafia took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily. The Mafia took advantage of Sicily's location along the historic route opium took from Iran westward into Europe and the United States. Large scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s. The elimination of Chinese production happened at the same time that Sicily's role in the trade developed.

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

Between the end of World War II and the 1970s, much of the opium consumed in the west was grown in Iran, but in the late 1960s, under pressure from the U. For a topic outline on this subject see List of basic Iran topics. S. and the United Nations, Iran engaged in anti-opium policies. The United Nations ( UN) is an International organization whose stated aims are to facilitate cooperation in International law, International security While opium production never completely ended in Iran, the decline in production in those countries led to the development of a major new cultivation base in the so-called "Golden Triangle" region in South East Asia. The Golden Triangle is one of Asia 's two main illicit Opium -producing areas In 1970-71, high-grade heroin laboratories opened in the Golden Triangle. This changed the dynamics of the heroin trade by expanding and decentralizing the trade. Opium production also increased in Afghanistan due to the efforts of Turkey and Iran to reduce production in their respective countries. Lebanon, a traditional opium supplier, also increased its role in the trade during years of civil war.

Soviet-Afghan war led to increased production in the Pakistani-Afghani border regions. It increased international production of heroin at lower prices in the 1980s. The trade shifted away from Sicily in the late 1970s as various criminal organizations violently fought with each other over the trade. The fighting also led to a stepped up government law enforcement presence in Sicily. All of this combined to greatly diminish the role of the country in the international heroin trade.

Trafficking

See also: Opium production

Traffic is heavy worldwide, with the biggest producer being Afghanistan. Opium is a Narcotic formed from the Latex (ie sap released by lacerating (or "scoring" the immature seed pods of opium poppies ( ^[19] According to U. N. sponsored survey,^[20] as of 2004, Afghanistan accounted for production of 87 percent of the world's heroin. ^[21] Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War once again appeared as a facilitator of the trade. ^[22]

At present, opium poppies are mostly grown in Afghanistan, and in Southeast Asia, especially in the region known as the Golden Triangle straddling Myanmar, Thailand, Vietnam, Laos and Yunnan province in the People's Republic of China. Afghanistan /æfˈgænɪstæn/ officially the Islamic Republic of Afghanistan ( Pashto: د افغانستان اسلامي جمهوریت, Burma, officially the Union of Myanmar ( pjìdàunzṵ mjàmmà nàinŋàndɔ̀ is the largest country by geographical area in mainland Southeast Asia. The Kingdom of Thailand (ˈtaɪlænd ราชอาณาจักรไทย, râːtɕʰa-ʔaːnaːtɕɑ̀k-tʰɑj Vietnam (ˌviːɛtˈnɑːm Việt Nam) officially Laos (ˈlɑːoʊs or /ˈlaʊs/ officially the Lao People's Democratic Republic, is a Landlocked country in Southeast Asia, bordered by Burma Talk People's Republic of China) PEOPLE'S REPUBLIC OF CHINA ARTICLE GUIDELINES There is also cultivation of opium poppies in the Sinaloa region of Mexico and in Colombia. Sinaloa is one of the 31 states of Mexico. Geography Sinaloa is bordered to the north by Sonora and Chihuahua; to the south The United Mexican States ( or commonly Mexico (ˈmɛksɪkoʊ () is a federal constitutional Republic in North America. Colombia (kəˈlʌmbɪə officially the Republic of Colombia () is a country in northwestern South America. The majority of the heroin consumed in the United States comes from Mexico and Colombia. Up until 2004, Pakistan was considered one of the biggest opium-growing countries. However, the efforts of Pakistan's Anti-Narcotics Force have since reduced the opium growing area by 59% as of 2001. History The Pakistan Narcotics Board (PNB was established in the Revenue Division in 1957 to fulfil Pakistan s obligations under the International Opium Convention Year 2001 ( MMI) was a Common year starting on Monday according to the Gregorian calendar.

Conviction for trafficking in heroin carries the death penalty in most South-east Asia and some East Asia and Middle Eastern countries (see Use of death penalty worldwide for details), among which Malaysia, Singapore and Thailand are the most strict. The Middle East is a Subcontinent with no clear boundaries often used as a synonym to Near East, in opposition to Far East. At one time Capital punishment was used in almost every part of the globe but over the last few decades many Countries have abolished it For the biogeographical region see Malesia Malaysia (məˈleɪʒə or /məˈleɪziə/ is a country that consists of thirteen states and Singapore The Kingdom of Thailand (ˈtaɪlænd ราชอาณาจักรไทย, râːtɕʰa-ʔaːnaːtɕɑ̀k-tʰɑj 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 or the hanging of an Australian citizen Van Tuong Nguyen in Singapore, both in 2005. The Bali Nine is the name given to a group of nine Australian citizens arrested on 17 April 2005 in Denpasar on the island of Bali, Indonesia, in a plan For a topic outline on this subject see List of basic Australia topics. Van Tuong Nguyen ( Vietnamese: Nguyễn Tường Vân, baptised Caleb) ( 17 August 1980 – 2 December

Sandra Gregory has written an autobiography covering her experience of getting caught with Heroin at a Thai airport. Sandra Gregory (born 1965 is the author of Forget You Had a Daughter, an autobiographical book about how she was caught trying to smuggle Heroin and

Risks of non-medical use

• For intravenous users of heroin (and any other substance), the use of non-sterile needles and syringes and other related equipment leads to several serious risks:
  • the risk of contracting blood-borne pathogens such as HIV and hepatitis
  • the risk of contracting bacterial or fungal endocarditis and possibly venous sclerosis
  • abscesses
• Poisoning from contaminants added to "cut" or dilute heroin
• Chronic constipation
• Addiction and increasing tolerance
• Physical dependence can result from prolonged use of all opioids, resulting in withdrawal symptoms on cessation of use
• Decreased kidney function (although it is not currently known if this is due to adulterants used in the cut)^[23]

Many countries and local governments have begun funding programs that supply sterile needles to people who inject illegal drugs in an attempt to reduce these contingent risks and especially the contraction and spread of blood-borne diseases. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. A pathogen (from Greek πάθος pathos "suffering passion" and γἰγνομαι (γεν- gignomai (gen- "I give birth to" infectious Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Hepatitis (plural hepatitides) implies injury to the Liver characterized by the presence of Inflammatory cells in the tissue of Endocarditis is an Inflammation of the inner layer of the Heart, the Endocardium. An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process Pollution is the introduction of contaminants into an environment that causes instability disorder harm or discomfort to the physical systems or living organisms they are in A cutting agent is a chemical used to "cut" ( adulterate) illicit drugs with something less expensive than the drug itself Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation Sterilization (or sterilisation, see spelling differences) refers to any process that effectively kills or eliminates transmissible agents (such as Fungi The Drug Policy Alliance reports that up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of drug use by injection. But despite the immediate public health benefit of needle exchanges, some see such programs as tacit acceptance of illicit drug use. Public health is "the science and art of preventing disease prolonging life and promoting health through the organised efforts and informed choices of society organisations A hypodermic needle-exchange program is a sometimes controversial Social policy, based on the philosophy of Harm reduction where injection The United States federal government does not operate needle exchanges, although some state and local governments do support needle exchange programs.

A heroin overdose is usually treated with an opioid antagonist, such as naloxone (Narcan), or naltrexone, which has high affinity for opioid receptors but does not activate them. The term drug overdose (or simply overdose or OD) describes the Ingestion or application of a Drug or other substance in quantities A receptor antagonist is a type of receptor ligand or Drug that does not provoke a biological response itself upon binding to a receptor, but blocks Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose Naltrexone is an Opioid receptor antagonist used primarily in the management of Alcohol dependence and Opioid dependence. Opioid receptors are a group of G-protein coupled receptors with Opioids as Ligands The Endogenous Opioids are Dynorphins This reverses the effects of heroin and other opioid agonists and causes an immediate return of consciousness and the beginning of withdrawal symptoms when administered intravenously. Withdrawal, also known as withdrawal/abstinence syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes Physical dependence is The half-life of naloxone is much shorter than that of most opioid agonists, so that antagonist typically has to be administered multiple times until the opiate has been metabolized by the body. Half-Life (computer-game page here It's already listed in the disambiguation page Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose

Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours due to anoxia because the breathing reflex is suppressed by µ-opioids. An overdose is immediately reversible with an opioid antagonist injection. An opioid antagonist is an Receptor antagonist that acts on Opioid receptors Naloxone and Naltrexone are commonly used opioid antagonist Heroin overdoses can occur due to an unexpected increase in the dose or purity or due to diminished opiate tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other depressant drugs like alcohol or benzodiazepines. Depressant is a chemical agent that diminishes the function or activity of a specific part of the body (see also Sedative) The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic ^[24] It should also be noted that since heroin can cause nausea and vomiting, a significant number of deaths attributed to heroin overdose are caused by aspiration of vomitus by an unconscious victim.

The LD₅₀ for a physically addicted person is prohibitively high, to the point that there is no general medical consensus on where to place it. In Toxicology, the median lethal dose, LD50 (abbreviation for “Lethal Dose 50%” or LCt50 (Lethal Concentration & Time of a In fact, there is no upper limit to the amount of tolerance that can occur in a heavy user. Several studies done in the 1920s gave users doses of 1,600–1,800 mg of heroin, and no adverse effects were reported. Even for a non-user, the LD₅₀ can be placed above 350 mg though some sources give a figure of between 75 and 375 mg for a 75 kg person. ^[25]

Street heroin is of widely varying and unpredictable purity. This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended. Also, tolerance typically decreases after a period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in a dangerous overdose.

It has been speculated that an unknown portion of heroin related deaths are the result of an overdose or allergic reaction to quinine, which may sometimes be used as a cutting agent. Quinine (ˈkwaɪnaɪn kwɪˈniːn ˈkwiːniːn is a natural white Crystalline Alkaloid having Antipyretic (fever-reducing antimalarial, ^[26]

A final factor contributing to overdoses is place conditioning. Heroin use is a highly ritualized behavior. While the mechanism has yet to be clearly elucidated, longtime heroin users display increased tolerance to the drug in locations where they have repeatedly administered heroin. When the user injects in a different location, this environment-conditioned tolerance does not occur, resulting in a greater drug effect. The user's typical dose of the drug, in the face of decreased tolerance, becomes far too high and can be toxic, leading to overdose. ^[27]

A small percentage of heroin smokers and and occasionally IV users may develop symptoms of toxic leukoencephalopathy. Toxic leukoencephalopathy or toxic spongiform leukoencephalopathy is a condition that is characterized by progressive damage (-pathy of the White matter (leuko- The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon adulterant that is only active when heated. Adulterants are Chemical substances which should not be contained within other substances (eg ^[28][29][30] Symptoms include slurred speech and difficulty walking.

Harm reduction approaches to heroin

Proponents of the harm reduction philosophy seek to minimize the harms that arise from the recreational use of heroin. Harm reduction is a Philosophy of Public health, intended to be a progressive alternative to the prohibition of certain potentially dangerous Safer means of taking the drug, such as smoking or nasal, oral and rectal insertion, are encouraged, due to injection having higher risks of overdose, infections and blood-borne viruses. Where the strength of the drug is unknown, users are encouraged to try a small amount first to gauge the strength, to minimize the risks of overdose. For the same reason, poly drug use (the use of two or more drugs at the same time) is discouraged. Users are also encouraged to not use heroin on their own, as others can assist in the event of an overdose. Heroin users who choose to inject should always use new needles, syringes, spoons/steri-cups and filters every time they inject and not share these with other users. Governments that support a harm reduction approach often run Needle & Syringe exchange programs, which supply new needles and syringes on a confidential basis, as well as education on proper filtering prior to injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing heroin for injection may also be supplied including citric acid sachets/vitamin C sachets, steri-cups, filters, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop use of shoe laces or belts). A hypodermic needle-exchange program is a sometimes controversial Social policy, based on the philosophy of Harm reduction where injection

Withdrawal

The withdrawal syndrome from heroin may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Black Tar Heroin is a variety of Heroin produced primarily in Mexico, but similar in appearance and texture to so called Home Bake Heroin from New Zealand Symptoms may include: sweating, malaise, anxiety, depression, priapism, extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, yawning, tears, sleep difficulties (insomnia), cold sweats, chills, severe muscle and bone aches; nausea and vomiting, diarrhea, cramps, and fever. Malaise is a feeling of general discomfort or uneasiness an "out of sorts" feeling often the first indication of an infection or other disease Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Priapism (πριαπισμός is a potentially harmful and painful medical condition in which the erect Penis does not return to its flaccid state despite A yawn (from the Middle English yanen, an alteration of yonen or yenen, which in turn comes from the Old English geonian Tears are the liquid product of a process of lacrimation to clean and lubricate the Eyes The word lacrimation may also be used in a medical or literary sense Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Cramps, sometimes called Charley horses are unpleasant often painful sensations caused by contraction or over shortening of Muscles Cramps can be caused by cold Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris ^[31] Many users also complain of a painful condition, the so-called "itchy blood", which often results in compulsive scratching that causes bruises and sometimes ruptures the skin, leaving scabs. Abrupt termination of heroin use often causes muscle spasms in the legs (restless leg syndrome); hence "kicking" has been used as a slang term for heroin withdrawal. Restless legs syndrome (RLS Wittmaack-Ekbom's syndrome, or sometimes but inaccurately referred to as Nocturnal myoclonus) is a condition that is characterized Discontinuation of heroin can also cause goose bumps, and this symptom is the basis for the expression "going cold turkey". Goose bumps, also called goose flesh, chill bumps, chicken skin, people bumps, or the medical term cutis anserina, The intensity of the withdrawal syndrome is variable depending on the dosage of the drug used and the frequency of use. Very severe withdrawal can be precipitated by administering an opioid antagonist to a heroin addict.

Three general approaches are available to ease the physical part of opioid withdrawal. The first is to substitute a longer-acting opioid such as methadone or buprenorphine for heroin or another short-acting opioid and then slowly taper the dose. Methadone ( Dolophine Amidone Methadose Physeptone Heptadon and many others is a synthetic Opioid, used medically as an Analgesic, Antitussive Buprenorphine (or colloquially "Bupe" is a semi-synthetic Opiate with partial agonist and antagonist actions

In the second approach, benzodiazepines such as diazepam (Valium) may temporarily ease the anxiety, muscle spasms, and insomnia associated with opioid withdrawal. The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic Diazepam (daɪˈæzɨpæm first marketed as Valium by Hoffmann-La Roche, is a Benzodiazepine derivative Drug. The most common benzodiazepine employed is oxazepam (Serax). Oxazepam (marketed under brand names Alepam, Murelax, Opamox, Oxascand, Serax, Serepax, Seresta, Sobril The use of benzodiazepines must be carefully monitored because these drugs have abuse potential, and many opioid users also use other central nervous system depressants, especially alcohol. Depressant is a chemical agent that diminishes the function or activity of a specific part of the body (see also Sedative) Also, although extremely unpleasant, opioid withdrawal is seldom fatal, whereas complications related to withdrawal from benzodiazepines, barbiturates and alcohol (such as epileptic seizures, cardiac arrest, and delirium tremens) can prove hazardous and are potentially life-threatening. Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of Delirium tremens (colloquially the DTs, " the horrors " " the fear "" the shakes "" jazz hands ""

Many symptoms of opioid withdrawal are due to rebound hyperactivity of the sympathetic nervous system, which can be suppressed with clonidine (Catapres), a centrally-acting alpha-2 agonist primarily used to treat hypertension. The Sympathetic Nervous System ( SNS) is a branch of the Autonomic nervous system along with the Enteric nervous system and Parasympathetic nervous Clonidine is a direct-acting α2 Adrenergic agonist prescribed historically as an Antihypertensive agent Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Another drug sometimes used to relieve the "restless legs" symptom of withdrawal is baclofen, a muscle relaxant. Baclofen (brand names Kemstro and Lioresal) is a derivative of gamma-aminobutyric acid (GABA primarily used to treat Spasticity. This article refers to skeletal muscle relaxants For information on Smooth muscle relaxants see Antispasmodic. Diarrhea can likewise be treated with the peripherally active opioid drug loperamide. Loperamide, a synthetic Piperidine derivative is a drug effective against Diarrhea resulting from Gastroenteritis or Inflammatory

Methadone is another μ-opioid agonist most often used to substitute for heroin in treatment for heroin addiction. Compared to heroin, methadone is well (but slowly) absorbed by the gastrointestinal tract and has a much longer duration of action of approximately 24 hours. Thus methadone maintenance avoids the rapid cycling between intoxication and withdrawal associated with heroin addiction. Methadone maintenance is the use of Methadone over a prolonged time as treatment for someone who is addicted to Heroin or has severe Pain Intoxication is the state of being affected by one or more psychoactive drugs. In this way, methadone has shown success as a substitute for heroin; despite bearing about the same addiction potential as heroin, it is recommended for those who have repeatedly failed to complete withdrawal or have recently relapsed. Patients properly stabilized on methadone display few subjective effects to the drug (i. e. , it does not make them "high"), and are unable to obtain a "high" from other opioids except with very high doses. Methadone, since it is longer-acting, produces withdrawal symptoms that appear later than with heroin, but usually last considerably longer and can in some cases be more intense. Methadone withdrawal symptoms can potentially persist for over a month, compared to heroin where significant physical symptoms subside within 4 days.

Buprenorphine is another opiate that was recently licensed for opioid substitution treatment. Buprenorphine (or colloquially "Bupe" is a semi-synthetic Opiate with partial agonist and antagonist actions As a μ-opioid receptor partial agonist, patients develop a less tolerance to it than to heroin or methadone due to a "ceiling effect. The μ opioid receptors (MOR are a class of Opioid An agonist is a term used to describe a type of ligand or drug that binds and alters the activity of a receptor. " Patients are unable to obtain a "high" from other opioids during buprenorphine treatment except with very high doses. It also has less severe withdrawal symptoms than heroin when discontinued abruptly, although the duration of the withdrawal syndrome is often longer than that seen with heroin. It is usually administered sublingually (dissolved under the tongue) every 24-48 hrs. Buprenorphine is also a κ opioid receptor antagonist, which led to speculation that the drug might have additional antidepressant effects; however, no significant difference was found in symptoms of depression between patients receiving buprenorphine and those receiving methadone. The κ-Opioid receptor is a type of Opioid receptor which binds the peptide opioid Dynorphin as the primary Endogenous ligand. ^[32]

Researchers at Johns Hopkins University have been testing a sustained-release "depot" form of buprenorphine that can relieve cravings and withdrawal symptoms for up to six weeks. ^[33] A sustained-release formulation would allow for easier administration and adherence to treatment, and reduce the risk of diversion or misuse.

Three opioid antagonists are available: naloxone and the longer-acting naltrexone and nalmefene. An antagonist (from Greek ανταγωνιστής - antagonistes, "opponent competitor rival" is a character or Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose Naltrexone is an Opioid receptor antagonist used primarily in the management of Alcohol dependence and Opioid dependence. Nalmefene (Revex is an Opioid receptor antagonist used primarily in the management of Alcohol dependence, and also has been investigated These medications block the ability of heroin, as well as the other opioids to bind to the receptor site. Recent studies have suggested that the addition of naltrexone may improve the success rate in treatment programs when combined with the traditional therapy.

Scientists at the University of Chicago undertook preliminary development of a heroin vaccine in monkeys during the 1970s, but it was abandoned. The University of Chicago is a Private university located principally in the Hyde Park neighborhood of Chicago. A monkey is any member of either the New World monkeys or Old World monkeys two of the three groupings of Simian Primates the third group being There were two main reasons for this. Firstly, when immunized monkeys had an increase in dose of x16, their antibodies became saturated and the monkey had the same effect from heroin as non-immunized monkeys. Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily In Chemistry, saturation has five different meanings In Physical chemistry, saturation is the point at which a Solution of a substance Secondly, until they reached the x16 point immunized monkeys would substitute other drugs to get a heroin-like effect. These factors suggested that immunized human users would simply either take massive quantities of heroin, or switch to other drugs.

There is also a controversial treatment for heroin addiction based on an Iboga-derived African drug, ibogaine. Ibogaine is a naturally-occurring Psychoactive compound found in a number of plants principally in a member of the dogbane family known as iboga ( Many people travel abroad for ibogaine treatments that generally interrupt substance use disorders for 3-6 months or more in up to 80% of patients. ^[34] Relapse may occur when the person returns home to their normal environment however, where drug seeking behavior may return in response to social and environmental cues. Ibogaine treatments are carried out in several countries including Mexico and Canada as well as, in South and Central America and Europe. Opioid withdrawal therapy is the most common use of ibogaine. Some patients find ibogaine therapy more effective when it is given several times over the course of a few months or years. A synthetic derivative of ibogaine, 18-methoxycoronaridine was specifically designed to overcome cardiac and neurotoxic effects seen in some ibogaine research but, the drug has not yet found its way into clinical research. (--18-Methoxycoronaridine (18-MC is a derivative of Ibogaine invented in 1996 by the research team around the pharmacologist Stanley D .

Heroin prescription

The UK Department of Health's Rolleston Committee report in 1926 established the British approach to heroin prescription to users, which was maintained for the next forty years: dealers were prosecuted, but doctors could prescribe heroin to users when withdrawing from it would cause harm or severe distress to the patient. This "policing and prescribing" policy effectively controlled the perceived heroin problem in the UK until 1959 when the number of heroinists doubled every sixteenth month during a period of ten years, 1959-1968. ^[35]. The failure changed the attitudes; in 1964 only specialized clinics and selected approved doctors were allowed to prescribe heroin to users. The law was made more restrictive in 1968. Begining in the 1970s, the emphasis shifted to abstinence and the use of methadone, until now only a small number of users in the UK are prescribed heroin. ^[36]

In 1994 Switzerland began a trial heroin maintence program for users that had failed multiple withdrawal programs. The aim of this program is to maintain the health of the user in order to avoid medical problems stemming from the use of illicit street heroin. Reducing drug-related crime and preventing overdoses were two other goals. Illegal drugs are related to crime in multiple ways Most directly it is a crime to use possess manufacture or distribute drugs classified as having a potential for abuse The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000 based on the apparent success of the program. Participants are allowed to inject heroin in specially designed pharmacies for 15 Swiss Francs per dose. ^[37]

The success of the Swiss trials led German, Dutch,^[38] and Canadian^[39] cities to try out their own heroin prescription programs. ^[40] Some Australian cities (such as Sydney) have instituted legal heroin supervised injecting centers, in line with other wider harm minimization programs. The Guidelines for the operation and use of consumption rooms define Injecting rooms as "legally sanctioned and supervised facilities designed to reduce the health and public order Harm reduction is a Philosophy of Public health, intended to be a progressive alternative to the prohibition of certain potentially dangerous Although heroin is decriminalized inside the injection room, the drug is not available by prescription, and remains illegal outside the injecting room.

Drug interactions

Opioids are strong central nervous system depressants, but regular users develop physiological tolerance. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. In Physiology, tolerance occurs when an organism builds up a resistance to the effects of a substance after repeated exposure In combination with other central nervous system depressants, heroin may still kill even experienced users, particularly if their tolerance to the drug has reduced or the strength of their usual dose has increased.

Toxicology studies of heroin-related deaths reveal frequent involvement of other central nervous system depressants, including alcohol, benzodiazepines such as temazepam (Restoril; Normison), and, to a rising degree, methadone. Toxicology (from the Greek words toxicos and logos) is the study of the adverse effects of Chemicals on living organisms Temazepam (marketed under brand names Restoril, Euhypnos, Normison, Remestan, Tenox and Norkotral) is an intermediate-acting Ironically, benzodiazepines are often used in the treatment of heroin addiction while they cause much more severe withdrawal symptoms.

Cocaine sometimes proves to be fatal when used in combination with heroin. Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant Though "speedballs" (when injected) or "moonrocks" (when smoked) are a popular mix of the two drugs among users, combinations of stimulants and depressants can have unpredictable and sometimes fatal results. Speedballing (alternatively known as snowballing) is a term commonly referring to the Intravenous use of heroin or morphine and Cocaine together in Stimulant drugs are Drugs that temporarily increase alertness and awareness In the United States in early 2006, a rash of deaths was attributed to either a combination of fentanyl and heroin, or pure fentanyl masquerading as heroin particularly in the Detroit Metro Area; one news report refers to the combination as 'laced heroin', though this is likely a generic rather than a specific term. Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. ^[41]

Popular Culture

Film & television

The 1996 Danny Boyle film Trainspotting, based on the book by Irvine Welsh, depicts heroin users in the areas around Edinburgh in Scotland. Danny Boyle (born 20 October 1956 is an English director and Film producer, best known for his work on films such as Trainspotting Trainspotting is a 1996 Scottish film directed by Danny Boyle based on the novel Trainspotting by Irvine Welsh Irvine Welsh (born 27 September 1958 Leith, Edinburgh) is a contemporary Scottish novelist, best known for his novel Trainspotting Edinburgh ( ˈɛdɪnb(ərə Dùn Èideann) is the Capital of Scotland and is its second largest city after Glasgow. Scotland ( Gaelic: Alba) is a Country in northwest Europethat occupies the northern third of the island of Great Britain. Other movies that deal with heroin users include Quentin Tarantino's Pulp Fiction in which Vincent Vega played by John Travolta struggles with heroin addiction, the 1955 Frank Sinatra film The Man with the Golden Arm; the 1969 film More; the 1971 Al Pacino film The Panic in Needle Park; the 1981 true story Christiane F. - Wir Kinder vom Bahnhof Zoo; The Basketball Diaries, based on the diary of author, poet, and musician Jim Carroll during his heroin addiction; the 1997 film Gridlock'd starring Tupac Shakur and Tim Roth as heroin users struggling to get into rehab; the 1998 television movie Gia about drug-addicted supermodel Gia Carangi; and the 2000 film Requiem for a Dream. Francis Albert "Frank" Sinatra (December 12 1915 &ndash May 14 1998 was an American singer and actor The Man with the Golden Arm is a 1955 Drama film, based on the novel of the same name by Nelson Algren, which tells the story of a For the 1998 Academy-Award-nominated Stop motion short see More (short. Alfredo James “Al” Pacino (born April 25 1940 is an Academy - BAFTA - Golden Globe - Emmy - & Screen Actors Guild Award-Winning The Panic in Needle Park is a 1971 American film directed by Jerry Schatzberg and starring Al Pacino in his second film appearance Christiane F - Wir Kinder vom Bahnhof Zoo portrays the drug scene in Berlin in the 1970s following tape recordings of Christiane F The Basketball Diaries is a 1995 Drama film based on the book of the same name by Jim Carroll. This article is not about corporate consultant and author Jim Carroll Gridlock'd is a 1997 film starring Tupac Shakur, Tim Roth, and Thandie Newton. Tupac Amaru Shakur (June 16 1971 &mdash September 13 1996 also known by his Stage names 2Pac and Makaveli, was an American rapper Tim Roth (born Timothy Simon Smith; 14 May 1961 is an English film Actor and director. Gia is a 1998 HBO Television film about the life of model Gia Marie Carangi starring Angelina Jolie, Gia Marie Carangi ( January 29, 1960 – November 18, 1986) was an American fashion model during the late 1970s and early 1980s Requiem for a Dream is an Academy Award -nominated 2000 Film adaptation of the 1978 novel of the same name. Throughout the third season of Fox's 24, the show's protagonist, Jack Bauer, struggles with using heroin. 24 is an Emmy and Golden Globe award-winning American action Drama Television series. Jack Bauer is the Protagonist of the United States Television series 24, in which he has trained and worked in various capacities In American Gangster (2007), Denzel Washington portrays the 1970s drug kingpin, Frank Lucas, who smuggled heroin on military transport flights from Vietnam for eventual distribution on the East Coast. American Gangster is a 2007 Crime film directed by Ridley Scott and starring Denzel Washington and Russell Crowe Frank Lucas is the name of Frank Lucas (politician (born 1960 U Candy is a 2006 Australian film starring Heath Ledger that depicts the life of a heroin addict. Candy is a 2006 Australian romantic drama film adapted from Luke Davies 's novel entitled Candy A Novel of Love and Heath Andrew Ledger (4 April 1979 – 22 January 2008 was an Australian television and film actor Also, in the Broadway musical Rent and the movie adaptation of Rent, two of the main characters, Mimi and Roger, were both once heroin addicts, Roger having come off a year of withdrawal the year prior to when the musical/movie takes place, and Mimi struggling to quit throughout the course of the story. Rent is a Rock musical, with music and lyrics by Jonathan Larson based on Giacomo Puccini 's Opera La Bohème Rent is a 2005 film adaptation of the Broadway musical of the same name.

Little Fish is a 2005 Australian film directed by Rowan Woods and stars Cate Blanchett and Hugo Weaving. Catherine Élise "Cate" Blanchett (born 14 May 1969 is an Academy Award -winning Australian Actress and Stage director. Hugo Wallace Weaving (born 4 April 1960 is a Nigerian-born English, although naturalised Australian film stage and voice actor best known for films such as The film focusses on the devastating effects of heroin addiction throughout the stages of addiction and the struggle to come clean upon both the user and those affected around them.

The 1989 miniseries Traffik is set in three countries (the UK, Germany, and Pakistan) and follows the lives of people in each country who all play different roles in the trafficking of heroin, from the UK politician who is trying to stem the flow of heroin into the UK (but whose daughter is addicted), the businessman and his wife who run a trafficking business in Germany, the Pakistan businessman who controls the shipping out of his country, and the farmers who grow the opium crops. Traffik is a 1989 television serial about the illegal drug trade.

In 2000 the miniseries was adapted into the American film Traffic with the setting shifted to America and Mexico and the focus moved from heroin to the cocaine trade. Traffic is a 2000 Crime drama Film directed by Steven Soderbergh.

The Australian drama serial A Country Practice had a major heroin storyline during 1988. A Country Practice was one of the longest-running Australian Television drama series It involved the character of Sophie Elliott (portrayed by Katrina Sedgewick) having a heroin addiction. She eventually developed AIDS and she died. These episodes drew huge ratings and were widely praised by Australian medical authorities for the way they tackled the subject.

In 2004, the TV show LOST featured a character who is a heroin addict named Charlie Pace. Lost is an Emmy and Golden Globe award-winning American serial drama television series. Charlie Hieronymus Pace is a Fictional character present in the first four seasons on the ABC television series Lost played by Dominic Monaghan Charlie was a member of a fictional band named Drive Shaft before crashing on the island and it is revealed that he became addicted during his band's success. Charlie Hieronymus Pace is a Fictional character present in the first four seasons on the ABC television series Lost played by Dominic Monaghan Charlie's addiction to heroin is a minor but prominent subplot throughout the first and second season of the series.

Literature

Before the film Trainspotting, there was Irvine Welsh's novel of the same name. Trainspotting is the first novel by Scottish writer Irvine Welsh. A 2007 book entitled The Heroin Diaries by author and musician Nikki Sixx from Motley Crue and Sixx:A.M. chronicles his heroin addiction in his diary between the years 1986-1987, as well as his chronic extreme hedonism, attitudes, drug use and his inevitable route to dying and coming back to life. The Heroin Diaries Soundtrack is a Concept album written by Nikki Sixx, James Michael and DJ Ashba and recorded by their band Nikki Sixx (born Frank Carlton Serafino Feranna Jr December 11, 1958, San Jose California) is an American bassist, Mötley Crüe ( IPA pronunciation: /'mɒtliː SixxAM is a Hard rock / heavy metal band formed in 2007 by Nikki Sixx, DJ Ashba, and James Michael. Author William S. Burroughs also wrote about his experiences with heroin in numerous books, starting with the 1953 semi-autobiographical Junkie (aka Junky). William Seward Burroughs II ( – ˈbʌroʊz was an American Novelist, Essayist, Social critic, painter and Spoken word Year 1953 ( MCMLIII) was a Common year starting on Thursday (link will display full calendar of the Gregorian calendar. An autobiography, from the Greek αὐτός autos "self" βίος bios "life" and γράφειν graphein "to write" See Junk (novel for the book of similar title by Melvin Burgess. Even earlier, in 1922, Aleister Crowley wrote Diary of a Drug Fiend. Aleister Crowley, born Edward Alexander Crowley (ˈkroʊli (12 October 1875 – 1 December 1947 was a British Occultist Writer, mountaineer Diary of a Drug Fiend, published in 1922 was Aleister Crowley 's first published novel and is also reportedly the earliest known reference to the Abbey of Thelema Allen Hoey's 2006 novel, Chasing the Dragon, examines the use of heroin among jazz musicians in the 1950s. Allen Hoey (born October 21 1952 in Kingston New York) is an American Poet, Novelist

Music

The well-known jazz artist Miles Davis was a heroin addict from about 1950 to 1954. Miles Dewey Davis III (May 26 1926 &ndash September 28 1991 was an American Jazz Trumpeter, Bandleader, and Composer. His album Kind of Blue (recorded in 1959) is supposed to sound like a heroin high feels. Kind of Blue is an album by American Jazz musician Miles Davis, released August 17 1959 on Columbia Records, in both ^[42] This album is widely regarded as one of the best jazz albums ever. ^[43][44]

John Lennon wrote the song "Cold Turkey" in 1969 about his and Yoko Ono's attempts to get off the drug, which the pair started using after she suffered a miscarriage. John Winston Ono Lennon, MBE (born " Cold Turkey " is a song written by John Lennon, and recorded by The Plastic Ono Band. Year 1969 ( MCMLXIX) was a Common year starting on Wednesday (link will display full calendar of the Gregorian calendar. born in Tokyo on February 18 1933 is a Japanese Artist and Musician. David Bowie's first single "Space Oddity" was seemingly about his experiences with heroin, as his 1980 single "Ashes to Ashes" included the lines that refer to Major Tom as ". David Bowie (ˈboʊiː born David Robert Jones on 8 January 1947 is an English Musician, actor producer, and arranger. This article is about the song For the album which includes this song see Space Oddity (album. " Ashes to Ashes " is a single by David Bowie, released in 1980 . . a junkie/strung out on heaven's high/hitting an all-time low". ^[45]

The Rolling Stones' 1973 song "Coming Down Again" was written by Keith Richards about his experiences with heroin, as was "Before They Make Me Run". " Coming Down Again " is a song by The Rolling Stones featured on their 1973 album Goats Head Soup. Keith Richards (born 18 December 1943 is an English Guitarist, Songwriter, Singer, producer and a founding member of The Rolling " Before They Make Me Run " is a song by the English rock band The Rolling Stones, featured on their 1978 album Some Girls Mick Jagger wrote the song "Monkey Man", and with Marianne Faithfull wrote "Sister Morphine". The song " Monkey Man " by the English Rock and roll band The Rolling Stones featured on their 1969 album Let It Bleed Marianne Faithfull (born December 29 1946) is an English Singer, Songwriter, actress and Diarist whose " Sister Morphine " is a song originally released as a single by British singer Marianne Faithfull and later popularized by the Rock and roll band The band's 1971 album Sticky Fingers featured a drug reference in every track. Year 1971 ( MCMLXXI) was a Common year starting on Friday (link will display full calendar of the 1971 Gregorian calendar. Sticky Fingers is an album by English rock band The Rolling Stones, released in April 1971 ^[45]

A number of songs by the Velvet Underground refer to heroin, including "I'm Waiting For The Man" and the aptly-named "Heroin". This article is about the band For their self-titled album see The Velvet Underground (album; for the book see The Velvet Underground (book " I'm Waiting for the Man " is a song by the American rock band The Velvet Underground, written by Lou Reed. " Heroin " is a song by The Velvet Underground, released on their 1967 debut album The Velvet Underground and Nico. The Stranglers' single "Golden Brown", from the late 1970s, referred to a batch of brown heroin from Afghanistan that arrived in the UK around that time. The Stranglers are an English rock music group formed on 11 September 1974 in Guildford, Surrey. " Golden Brown " is a song by the English rock band The Stranglers. Another UK band, The Only Ones released a one hit wonder, "Another Girl, Another Planet", in which every single line could be interpreted as a reference to a girl or heroin. The Only Ones are an English Rock and roll band They were initially active in the late 1970s and were associated with Punk rock, yet straddled the musical " Another Girl Another Planet " is a song by English Power pop / new wave group The Only Ones, the second track on their 1978 eponymous "^[45]

Dee Dee Ramone(nee Douglas Colvin) of the US punk band The Ramones used the drug and wrote the song "Chinese Rocks", thought the rest of the band initially rejected the song as being too blatantly about drug use. Dee Dee Ramone ( Douglas Glenn Colvin) ( September 18, 1951 - June 5, 2002) was a German American Songwriter The Ramones were an American rock band often regarded as the first Punk rock group "Chinese Rocks" or "Chinese Rock" is a song written in 1976 by New York City punk legends Dee Dee Ramone and Richard Hell The Heartbreakers performed the first and more famous version of the song. This article is about the punk group For information on Tom Petty's backing band see The Heartbreakers. The songs "Mr. Brownstone" and "Bad Obsession" by Guns N' Roses also deal with heroin. " Mr Brownstone " is a Song performed by Guns N' Roses. " Bad Obsession " is a song by Guns N' Roses. It was written by Izzy Stradlin (the band's then- Rhythm guitarist) and West Arkeen Guns N' Roses is an American rock band formed in Los Angeles, California in 1985

The Red Hot Chili Peppers have numerous drug refences in their music, most famously "Under the Bridge", a song about Anthony Kiedis's experiences in the chicano-run areas of Los Angeles where he used to score. Red Hot Chili Peppers are " Under the Bridge " is a song by the American Alternative rock band Red Hot Chili Peppers, released on March 13 1992 as the second single from the group's Anthony Kiedis (kiːdɪs "kee-dis" (born November 1 1962 is an American musician and the lead singer of the Red Hot Chili Peppers. Chicano (feminine Chicana) is a politically-loaded word for a Mexican American (in the sense of native-born Americans of Mexican ancestry as opposed to Mexican Los Angeles (lɑˈsændʒələs los ˈaŋxeles in Spanish) is the largest City in the state of California and the American West "Knock Me Down" was another Red Hot Chili Peppers song about heroin, this time about the band's first guitarist Hillel Slovak who died after overdosing on a mix of cocaine and heroin. " Knock Me Down " is a single from the Red Hot Chili Peppers album Mother's Milk. Hillel Slovak (הלל סלובק 13 April, 1962 &ndash June 25, 1988 Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant The metal/rock band System of a Down wrote the song "She's Like Heroin". System of a Down (commonly referred to as System or abbreviated as SOAD) is an Armenian American rock band formed in 1994 in Hypnotize is the fifth Album by System of a Down and the second half of the Mezmerize / Hypnotize Double album Also, Black Sabbath wrote a song, "Hand of Doom", which talks about the negative effects of heroin. Black Sabbath are an This article is about the Black Sabbath song A different song with the same name was recorded by Manowar.

The A Perfect Circle song "Weak and Powerless" is about heroin addiction, as is The Darkness song "Givin' Up" from their debut album Permission to Land. A Perfect Circle ( APC) is an Alternative rock supergroup formed by guitarist Billy Howerdel and Tool frontman Maynard James Keenan " Weak and Powerless " is the first single by the Alternative rock band A Perfect Circle, from their second album Thirteenth Step The Darkness were a multi- BRIT Award -winning British Hard rock / Glam rock band Permission to Land is the debut album of The Darkness. It was released on July 7, 2003 and became an almost-instant success reaching No Nikki Sixx also wrote a song about his heroin addiction, which is included on their 1987 album "Girls, Girls, Girls" titled "Dancing on Glass". ^[45]

Ville Valo, frontman of Finnish rock band HIM, wrote "Killing Loneliness" about Brandon Novak's addiction to heroin. Ville Hermanni Valo ( (born 22 November 1976 is a Finnish Singer, Songwriter, and frontman of the Finnish rock band HIM "Killing Loneliness" is the second single released by HIM, a Finnish band and was released in February 2006 in Germany and in April in the UK 2006 Brandon Novak (born December 10, 1978) is a skateboarder and friend of Bam Margera from Baltimore, Maryland and is a prominent member In an interview Valo stated that when he asked Novak why he used the drug, Novak replied "It was my way of 'Killing Loneliness'"

The London Suede recorded many songs about heroin, and drug culture in general. Suede (or The London Suede in the United States) were an English rock band of the 1990s and the early 2000s that helped start the Britpop musical They have two different songs, Heroine (from Dog Man Star) and Heroin (b-side to the Attitude single), which refer to lead singer Brett Anderson's addiction to the drug. Dog Man Star is the second album by Suede, released by Nude Records in 1994 Brett Lewis Anderson (born September 29, 1967) is an English Singer-songwriter, best-known as the former lead vocalist of Britpop

The Used song, "Let It Bleed" refers to frontman, Bert McCracken's heroin addiction before the band started. The Used is a rock band from Orem Utah, USA. Their sound has been classified under many genres and subgenres of rock The song starts with "This poison's my intoxication, I broke the needle off in my skin". Another song by The Used that also refer McCracken's past addiction to crystal meth is Say Days Ago from their debut album The Used. The Used is a rock band from Orem Utah, USA. Their sound has been classified under many genres and subgenres of rock The Used is a rock band from Orem Utah, USA. Their sound has been classified under many genres and subgenres of rock

80's pop superstar Boy George was caught up in using heroin which was highly publicized in the media. Boy George (born George Alan O'Dowd 14 June 1961 in Eltham London) is an English Singer-songwriter, who was part of the English New He also wrote and recorded a song of his experience with the drug titled "You Are My Heroin" in 1988.

Rozz Williams' final album before his suicide, The Whorse's Mouth, dealt with his heroin addiction. The Whorse's Mouth is an experimental Spoken word studio album by Rozz Williams. ^[46] Kill Hannah's song "Lips Like Morphine" (from their album of the same name) refers to the lead singer's want of an addictive woman that will "knock" him out with one touch. Kill Hannah is an Alternative rock band formed in Chicago Illinois and is currently signed to Roadrunner Records. Lips Like Morphine was first released on May 16, 2006 by the Chicago based band Kill Hannah and then again released in August on the band's

Many songs by singer song writer Elliott Smith such as "A Fond Farewell", and "King' Crossing" refer to his addiction with heroin. Steven Paul "Elliott" Smith (August 6 1969 – October 21 2003 was an American Singer-songwriter and Musician. From a Basement on the Hill is the sixth Studio album by the late Singer-songwriter Elliott Smith.

Goldfrapp made the song Ride a White Horse, which many claim refers to Alison Goldfrapp's heroin usage. Goldfrapp are a British Electronic music group known for their visual theatrics and contribution to the popularization of Electronic dance music. " Ride a White Horse " is a song about smack performed by British group Goldfrapp. Alison Goldfrapp (born Alison Elizabeth Margaret Goldfrap on May 13 1966, in Enfield, London) is an English Singer

Other notable artists who have had experiences with or who wrote about heroin include Sid Vicious, Dave Mustaine, Pete Doherty, Lynyrd Skynyrd, Eric Clapton, Jerry Garcia, Pete Townshend, Ezra Crack, Trent Reznor, Layne Staley, David Reilly, Nikki Sixx, John Frusciante, Steven Tyler, Kurt Cobain, Scott Weiland, Brian Jones, Chet Baker, Tim Buckley, Jesse Ed Davis, Dave Matthews, Brad Nowell, Johnny Thunders, Janis Joplin, Jimmy Page, Charlie Parker, Jim Morrison, Ray Charles, Billie Holiday, Phil Lynott, Frankie Lymon, Mike Bloomfield, Miles Davis, Courtney Love, Mike McCready, Phil Anselmo, B.G., James Brown, Gil Scott-Heron, Amy Winehouse, Jay-Z Raekwon the Chef, and Ghostface Killah. David Scott Mustaine (born September 13, 1961 in La Mesa, California USA) is the lead/rhythm Guitarist, Songwriter Lynyrd Skynyrd (ˌlɛnɚdˈskɪnɝd is an American Southern rock band Eric Patrick Clapton, CBE (born 30 March 1945 is an English Blues-rock Guitarist, singer Songwriter and Composer Jerome John "Jerry" Garcia (August 1 1942 &ndash August 9 1995 was a Musician, Songwriter, Artist, and Lead guitarist and Peter Dennis Blandford Townshend (born 19 May 1945 in Chiswick, London) is an English rock Guitarist, Singer, Ezra Kire is an American Singer, Guitarist, and Songwriter, sometimes known as Ezra Crack, Ezra Glory, and sometimes Trent Reznor (born Michael Trent Reznor on May 17 1965 is an American Musician, singer producer, and Multi-instrumentalist. Layne Thomas Staley ( August 22, 1967 - April 5, 2002) was the lead singer and co-lyricist of the rock group Alice in Chains and the David Reilly may refer to David Reilly (singer David Reilly (computer scientist Nikki Sixx (born Frank Carlton Serafino Feranna Jr December 11, 1958, San Jose California) is an American bassist, John Anthony Frusciante (pronounced) (born March 5 1970 is an American Guitarist, singer songwriter and record producer Stephen Victor Tallarico (born March 26 1948 in Yonkers New York) better known as Steven Tyler (and often nicknamed The Demon of Kurt Donald Cobain (February 20 1967 – c April 5 1994 was an American musician who served as lead singer, Guitarist, and songwriter for the Seattle Scott Weiland (born Scott Richard Kline on October 27, 1967) is an American Musician, lyricist and Vocalist, most Lewis Brian Hopkin Jones (28 February 1942 – 3 July 1969 was a founding member and Guitarist of the English Rock group The Rolling Stones. Chesney Henry "Chet" Baker Jr ( Yale Oklahoma, 23 December 1929 - Amsterdam, 13 May 1988) was an American Timothy Charles Buckley III (February 14 1947 – June 29 1975 was an experimental Vocalist and Musician who incorporated Jazz, Psychedelia Jesse Edwin Davis ( September 21, 1944 – June 22 1988) was an American Guitarist. David John Matthews (born January 9, 1967) is a South African now naturalized American, Grammy award-winning Bradley James "John" Nowell ( February 22 1968 – May 25 1996) was an American musician who served as Lead Johnny Thunders, born John Anthony Genzale Jr ( July 15, 1952 - April 23, 1991) was an Italian American Rock and roll Janis Lyn Joplin ( January 19, 1943  – October 4, 1970) was an American singer songwriter and music arranger from James Patrick Page, OBE (born 9 January 1944 is an English Guitarist, Composer and record producer James Douglas Morrison (December 8 1943—July 3 1971 was an American Poet, Singer, Songwriter, Writer, and Film director Ray Charles Robinson ( September 23, 1930 – June 10, 2004) known by his Stage name Ray Charles, was an American Billie Holiday (born Eleanora Fagan; April 7 1915 – July 17 1959 was an American Jazz singer and songwriter Philip Parris Lynott (20 August 1949 – 4 January 1986 was a Singer, Bassist, Instrumentalist, and Songwriter, who first came to prominence Franklin Joseph "Frankie" Lymon ( September 30, 1942 &ndash February 27, 1968) was an African-American Rock and For the astronaut see Michael J Bloomfield. Michael Bernard Bloomfield ( July 28 1943, Chicago, Illinois Miles Dewey Davis III (May 26 1926 &ndash September 28 1991 was an American Jazz Trumpeter, Bandleader, and Composer. Courtney Michelle Love (born Courtney Michelle Harrison on July 9 1964 is an American Rock musician and Golden Globe-nominated actress Michael David McCready (born April 5 1966 in Pensacola, Florida) is an American Guitarist and Songwriter. Philip Hansen "Phil" Anselmo (born June 30, 1968 in New Orleans, Louisiana) is an American Musician who is best James Joseph Brown Jr (May 3 1933 – December 25 2006 commonly referred to as "The Godfather of Soul" the "King of Funk" and "The Gil Scott-Heron (born April 1 1949) is an American Poet, Musician, and Author known primarily for his late 1960s and Corey Woods, known by his stage name Raekwon, is an American East Coast Rapper and a member of the Wu-Tang Clan. Dennis Coles, better known by his Stage name Ghostface Killah, is an American rapper and member of the Wu-Tang Clan.

See also

• Morphine
• Opioids
• Black Tar Heroin
• Cheese (recreational drug)
• China White
• HIV in Yunnan
• Drugs and prostitution
• Ibogaine
• Monoacetylmorphine
• Dipropanoylmorphine
• Diacetyldihydromorphine
• Recreational drug use
• Psychoactive drug
• The Great Binge
• Opium
• Polish heroin
• Poppy
• Drug injection
• Illegal drug trade
• Illicit drug use in Australia
• Entomotoxicology
• Trainspotting

References

Literature

• Diary Of A Drug Fiend by Aleister Crowley (1922)
• Heroin (1998) ISBN 1-56838-153-0
• Heroin Century (2002) ISBN 0-415-27899-6
• This is Heroin (2002) ISBN 1-86074-424-9
• The Heroin User's Handbook by Francis Moraes (paperback 2004) ISBN 1-55950-216-9
• The Little Book of Heroin by Francis Moraes (paperback 2000) ISBN 0-914171-98-4
• Heroin: A True Story of Addiction, Hope and Triumph by Julie O'Toole (paperback 2005) ISBN 1-905379-01-3
• The Heroin Diaries: A Year in the Life of a Shattered Rockstar by Nikki Sixx (2007) ISBN 978-0743486-28-6

External links

• EMCDDA drugs profiles: heroin (2007)
• Geopium: Geopolitics of Illicit Drugs in Asia, especially opium and heroin production and trafficking in and around Afghanistan and Burma (Articles and maps and French and English)
• Drugs Factfile what you really need to know
• The mismanagement of methadone
• National Alliance of Advocates for Buprenorphine Treatment - non-profit education website for treatment of Heroin addiction
• NIDA InfoFacts on Heroin
• ONDCP Drug Facts
• United States Department of State fact sheet: anti-narcotics efforts in Pakistan - dated June 7, 2002
• BBC Article entitled 'When Heroin Was Legal'. References to the United Kingdom and the United States
• Harm reduction strategies in relation to heroin and other illicit drugs
• Heroin news page - Alcohol and Drugs History Society

Aleister Crowley, born Edward Alexander Crowley (ˈkroʊli (12 October 1875 – 1 December 1947 was a British Occultist Writer, mountaineer Francis Moraes, whose online pseudonym is Dr H, is an American writer Author of three Opiate related non-fiction books and numerous articles Events 1099 - The First Crusade: The Siege of Jerusalem begins See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. The Alcohol and Drugs History Society is a scholarly organization whose members study the history of a variety of illegal regulated and unregulated Drugs such as Opium

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