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Drug Alcohol Depend. Life Sci. Expert Opin Drug Saf. Righteous Dopefiend. Harm Reduction Journal.

Clinical Radiology. Arhivirano s originala pdf , 9. Pristupljeno 5. Seattle Tiems. Little, Brown, and Company. People Magazine. Hip Hop DX.

Arhivirano s originala , 9. The Independent. Arhivirano s originala , 1. Pristupljeno 8. She spent five years in prison for aiding her husband's narcotic smuggling trade.

Having to get used to the public life again after living like a 'ghost' since her release, the making of her partner's life on the big screen has brought back many memories, some good and some bad.

Annual report: the state of the drugs problem in Europe PDF. World drug report PDF. United Nations Publications. Barbiturati Benzodiazepini Etanol alkohol Nebenzodiazepini.

MDMA Ekstazi. Kodein Heroin Hidrokodon Morfin opijum Oksikodon. Analgetici N02A , N02B. Kodein Morfin Opijum Laudanum Paregorik.

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The UK Department of Health's Rolleston Committee Report [34] in established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing.

In the Brain Committee recommended that only selected approved doctors working at approved specialised centres be allowed to prescribe diamorphine and benzoylmethylecgonine cocaine to users.

The law was made more restrictive in Beginning in the s, the emphasis shifted to abstinence and the use of methadone; currently only a small number of users in the UK are prescribed diamorphine.

In , Switzerland began a trial diamorphine maintenance program for users that had failed multiple withdrawal programs. The aim of this program was to maintain the health of the user by avoiding medical problems stemming from the illicit use of diamorphine.

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

The trials proved diamorphine maintenance to be superior to other forms of treatment in improving the social and health situation for this group of patients.

They are required to contribute about Swiss francs per month to the treatment costs. The previous trials were based on time-limited executive ordinances.

The success of the Swiss trials led German, Dutch, [40] and Canadian [41] cities to try out their own diamorphine prescription programs. Since January , Denmark has prescribed diamorphine to a few addicts that have tried methadone and subutex without success.

It was supposed that around addicts would be able to receive free diamorphine. However, Danish addicts would only be able to inject heroin according to the policy set by Danish National Board of Health.

In July , the German Bundestag passed a law allowing diamorphine prescription as a standard treatment for addicts; a large-scale trial of diamorphine prescription had been authorized in the country in On August 26, Health Canada issued regulations amending prior regulations it had issued under the Controlled Drugs and Substances Act ; the "New Classes of Practitioners Regulations", the "Narcotic Control Regulations", and the "Food and Drug Regulations", to allow doctors to prescribe diamorphine to people who have a severe opioid addiction who have not responded to other treatments.

The onset of heroin's effects depends upon the route of administration. Studies have shown that the subjective pleasure of drug use the reinforcing component of addiction is proportional to the rate at which the blood level of the drug increases.

Ingestion does not produce a rush as forerunner to the high experienced with the use of heroin, which is most pronounced with intravenous use. While the onset of the rush induced by injection can occur in as little as a few seconds, the oral route of administration requires approximately half an hour before the high sets in.

Thus, with both higher the dosage of heroin used and faster the route of administration used, the higher potential risk for psychological addiction.

Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer Harold Shipman used diamorphine on his victims, and the subsequent Shipman Inquiry led to a tightening of the regulations surrounding the storage, prescribing and destruction of controlled drugs in the UK.

Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin lethal overdose was accidental, suicide or homicide.

Chronic use of heroin and other opioids has been shown to be a potential cause of hyponatremia , resultant because of excess vasopressin secretion.

Use of heroin by mouth is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent.

Heroin's oral bioavailability is both dose-dependent as is morphine's and significantly higher than oral use of morphine itself, reaching up to The maximum plasma concentration of morphine following oral administration of heroin was around twice as much as that of oral morphine.

Injection , also known as "slamming", "banging", "shooting up", "digging" or "mainlining", is a popular method which carries relatively greater risks than other methods of administration.

Heroin base commonly found in Europe , when prepared for injection, will only dissolve in water when mixed with an acid most commonly citric acid powder or lemon juice and heated.

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

Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, users resort to more dangerous areas of the body, such as the femoral vein in the groin.

Users who have used this route of administration often develop a deep vein thrombosis. The use of a common dispenser for water for the use in the preparation of the injection, as well as the sharing of spoons and filters can also cause the spread of blood-borne diseases.

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

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

It is commonly smoked in glass pipes made from glassblown Pyrex tubes and light bulbs. Heroin may be smoked from aluminium foil, which is heated by an underneath flame, with the resulting smoke inhaled through a tube of rolled up foil, a method also known as " chasing the dragon ".

Another popular route to intake heroin is insufflation snorting , where a user crushes the heroin into a fine powder and then gently inhales it sometimes with a straw or a rolled-up banknote , as with cocaine into the nose, where heroin is absorbed through the soft tissue in the mucous membrane of the sinus cavity and straight into the bloodstream.

This method of administration redirects first-pass metabolism , with a quicker onset and higher bioavailability than oral administration, though the duration of action is shortened.

This method is sometimes preferred by users who do not want to prepare and administer heroin for injection or smoking, but still experience a fast onset.

Snorting heroin becomes an often unwanted route, once a user begins to inject the drug. The user may still get high on the drug from snorting, and experience a nod, but will not get a rush.

A "rush" is caused by a large amount of heroin entering the body at once. When the drug is taken in through the nose, the user does not get the rush because the drug is absorbed slowly rather than instantly.

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

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

These methods of administration are commonly carried out using an oral syringe. Heroin can be dissolved and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed.

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

Heroin is classified as a hard drug in terms of drug harmfulness. Like most opioids , unadulterated heroin may lead to adverse effects. The purity of street heroin varies greatly, leading to overdoses when the purity is higher than they expected.

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

Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin — although a more likely explanation is the rapidity of onset.

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

However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other.

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

Nausea , vomiting , and severe itching may also occur. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life-threatening.

Slowed breathing can also lead to coma and permanent brain damage. Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed.

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

Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects.

With physical dependence , the body adapts to the presence of the drug , and withdrawal symptoms occur if use is reduced abruptly. Intravenous use of heroin and any other substance with needles and syringes or other related equipment may lead to:.

The withdrawal syndrome from heroin may begin within as little as two hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose, and more typically begins within 6—24 hours after cessation.

Symptoms may include sweating , malaise , anxiety, depression, akathisia , priapism , extra sensitivity of the genitals in females, general feeling of heaviness, excessive yawning or sneezing, rhinorrhea , insomnia , cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps, watery eyes, [63] fever, cramp-like pains, and involuntary spasms in the limbs thought to be an origin of the term "kicking the habit" [64].

Heroin overdose is usually treated with the opioid antagonist , naloxone. This reverses the effects of heroin and causes an immediate return of consciousness but may result in withdrawal symptoms.

The half-life of naloxone is shorter than some opioids, such that it may need to be given multiple times until the opioid has been metabolized by the body.

Between and it was the leading cause of drug related deaths in the United States. Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours.

Death usually occurs due to lack of oxygen resulting from the lack of breathing caused by the opioid. Heroin overdoses can occur because of an unexpected increase in the dose or purity or because of diminished opioid tolerance.

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

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

Also, tolerance typically decreases after a period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in an overdose.

It has been speculated that an unknown portion of heroin-related deaths are the result of an overdose or allergic reaction to quinine , which may sometimes be used as a cutting agent.

Drug overdoses killed more than 70, in the US in , with heroin involved in 15, of those deaths. US yearly overdose deaths involving heroin.

US yearly deaths from all opioid drugs. Included in this number are opioid analgesics, along with heroin and illicit synthetic opioids.

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

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

Normally GABA , released from inhibitory neurones, inhibits the release of dopamine. Opiates, like heroin and morphine, decrease the inhibitory activity of such neurones.

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

The contribution of these receptors to the overall pharmacology of heroin remains unknown. A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses, includes the clinically used strong analgesics nicomorphine Vilan , and dipropanoylmorphine ; there is also the latter's dihydromorphine analogue, diacetyldihydromorphine Paralaudin.

Two other 3,6 diesters of morphine invented in —75 along with diamorphine, dibenzoylmorphine and acetylpropionylmorphine , were made as substitutes after it was outlawed in and, therefore, sold as the first " designer drugs " until they were outlawed by the League of Nations in Diamorphine is produced from acetylation of morphine derived from natural opium sources, generally using acetic anhydride.

The major metabolites of diamorphine, 6-MAM, morphine, morphineglucuronide and morphineglucuronide, may be quantitated in blood, plasma or urine to monitor for abuse, confirm a diagnosis of poisoning or assist in a medicolegal death investigation.

Most commercial opiate screening tests cross-react appreciably with these metabolites, as well as with other biotransformation products likely to be present following usage of street-grade diamorphine such as 6-acetylcodeine and codeine.

However, chromatographic techniques can easily distinguish and measure each of these substances. When interpreting the results of a test, it is important to consider the diamorphine usage history of the individual, since a chronic user can develop tolerance to doses that would incapacitate an opiate-naive individual, and the chronic user often has high baseline values of these metabolites in his system.

The opium poppy was cultivated in lower Mesopotamia as long ago as BC. Diamorphine was first synthesized in by C. Alder Wright , an English chemist working at St.

Mary's Hospital Medical School in London who had been experimenting combining morphine with various acids.

He boiled anhydrous morphine alkaloid with acetic anhydride for several hours and produced a more potent, acetylated form of morphine which is now called diacetylmorphine or morphine diacetate.

He sent the compound to F. Pierce of Owens College in Manchester for analysis. Pierce told Wright:. Doses… were subcutaneously injected into young dogs and rabbit… with the following general results… great prostration, fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis.

Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular.

Wright's invention did not lead to any further developments, and diamorphine became popular only after it was independently re-synthesized 23 years later by chemist Felix Hoffmann.

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

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

In , Bayer marketed diacetylmorphine as an over-the-counter drug under the trademark name Heroin. Morphine at the time was a popular recreational drug, and Bayer wished to find a similar but non-addictive substitute to market.

However, contrary to Bayer's advertising as a "non-addictive morphine substitute," heroin would soon have one of the highest rates of addiction among its users.

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

In , the United States Congress banned its sale, importation, or manufacture. It is now a Schedule I substance , which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States.

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

In the meantime, the first designer drugs , viz. Bayer lost some of its trademark rights to heroin as well as aspirin under the Treaty of Versailles following the German defeat in World War I.

Pete Doherty is also a self-confessed user of heroin. Many musicians have made songs referencing their heroin usage.

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

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

It cannot be used to treat severe pain or other illnesses. In the United Kingdom, diamorphine is available by prescription, though it is a restricted Class A drug.

According to the 50th edition of the British National Formulary BNF , diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction , acute pulmonary oedema , and chronic pain.

The treatment of chronic non- malignant pain must be supervised by a specialist. The BNF notes that all opioid analgesics cause dependence and tolerance but that this is "no deterrent in the control of pain in terminal illness".

When used in the palliative care of cancer patients, diamorphine is often injected using a syringe driver. In Switzerland, heroin is produced in injectable or tablet form under the name Diaphin by a private company under contract to the Swiss government.

In Australia diamorphine is listed as a schedule 9 prohibited substance under the Poisons Standard October Possession of diamorphine for the purpose of trafficking is an indictable offense and subject to imprisonment for life.

Turkey maintains strict laws against the use, possession or trafficking of illegal drugs. If convicted under these offences, one could receive a heavy fine or a prison sentence of 4 to 24 years.

Abused prescription medicine such as opioid can lead to heroin addiction. Diamorphine is produced from acetylation of morphine derived from natural opium sources.

One such method of heroin production involves isolation of the water-soluble components of raw opium, including morphine, in a strongly basic aqueous solution, followed by recrystallization of the morphine base by addition of ammonium chloride.

The solid morphine base is then filtered out. The morphine base is then reacted with acetic anhydride , which forms heroin.

This highly impure brown heroin base may then undergo further purification steps, which produces a white-colored product; the final products have a different appearance depending on purity and have different names.

Traffic is heavy worldwide, with the biggest producer being Afghanistan. According to a U. In The Independent reported: [] [].

The following year the Taliban banned poppy cultivation, Opium production in that country has increased rapidly since, reaching an all-time high in War in Afghanistan once again appeared as a facilitator of the trade.

At present, opium poppies are mostly grown in Afghanistan , hectares , acres , and in Southeast Asia, especially in the region known as the Golden Triangle straddling Burma 57, hectares , acres , Thailand , Vietnam , Laos 6, hectares 15, acres and Yunnan province in China.

There is also cultivation of opium poppies in Pakistan hectares 1, acres , Mexico 12, hectares 30, acres and in Colombia hectares acres.

Conviction for trafficking heroin carries the death penalty in most Southeast Asian , some East Asian and Middle Eastern countries see Use of death penalty worldwide for details , among which Malaysia , Singapore and Thailand are the most strict.

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

The origins of the present international illegal heroin trade can be traced back to laws passed in many countries in the early s 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 mids, 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 illicit heroin trade. The French Connection route started in the s. Heroin trafficking was virtually eliminated in the U.

Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium. The Mafia took advantage of Sicily's location along the historic route opium took westward into Europe and the United States.

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

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

In , Burma, the heartland of the Golden Triangle, was the second largest producer of heroin, after Afghanistan. By , 60 percent of heroin sold in the U.

The trade shifted away from Sicily in the late s 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. Following the discovery at a Jordanian airport of a toner cartridge that had been modified into an improvised explosive device , the resultant increased level of airfreight scrutiny led to a major shortage drought of heroin from October until April This was reported in most of mainland Europe and the UK which led to a price increase of approximately 30 percent in the cost of street heroin and an increased demand for diverted methadone.

The number of addicts seeking treatment also increased significantly during this period. Other heroin droughts shortages have been attributed to cartels restricting supply in order to force a price increase and also to a fungus that attacked the opium crop of District Court of conspiracy, distribution of heroin for importation into the United States and narco-terrorism.

Harm reduction is a public health philosophy that seeks to reduce the harms associated with the use of illicit drugs. One aspect of harm reduction initiatives focuses on the behaviour of individual users.

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

This attempts to avoid the higher risks of overdose, infections and blood-borne viruses associated with injecting the drug. Other measures include using a small amount of the drug first to gauge the strength, and minimize the risks of overdose.

For the same reason, poly drug use the use of two or more drugs at the same time is discouraged. Users are also encouraged to not use it on their own, as others can assist in the event of an overdose.

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

Safe injection sites are low threshold and allow social services to approach problem users that would otherwise be hard to reach. This has had the effect of drastically reducing an area's crime rate as individuals arrested for theft in order to supply the funds for their drugs are no longer in the position of having to steal to purchase heroin because they have been placed onto a methadone program, quite often more quickly than would have been possible had they not been arrested.

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

Researchers are attempting to reproduce the biosynthetic pathway that produces morphine in genetically engineered yeast. From Wikipedia, the free encyclopedia.

For other uses, see Heroin disambiguation. Opioid drug primarily used recreationally. IUPAC name. Interactive image. Main article: Heroin-assisted treatment.

Main article: Opioid withdrawal. Further information: US drug overdose death rates and totals over time. See also: History of opium in China.

See also: Illegal drug trade in Turkey. Main articles: Harm reduction , Safe injection sites , and Needle exchange programs.

Elsevier Health Sciences. Archived from the original on 7 March Retrieved 12 April Archived from the original on 19 October Retrieved 19 October Basic Clin.

Sudbury, Mass. Archived from the original on 18 March Retrieved 29 August ViroPharma Limited. Archived from the original on 30 March Retrieved 30 March Archived from the original on 10 September Journal of Pain Research.

Drug and Alcohol Review. National Institute on Drug Abuse. October National Institutes on Drug Abuse. Archived PDF from the original on 30 December Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use….

Impure heroin is usually dissolved, diluted, and injected into veins, muscles, or under the skin. World Drug Report Vienna, Austria. Archived PDF from the original on 9 August Retrieved 1 August August Archived from the original on 21 April Retrieved 10 December United Nations.

May Archived PDF from the original on 27 July Archived from the original on 10 December United Nations Sustainable Development.

Archived from the original on 14 April United Nations Publications. International Narcotics Control Board.

December Archived from the original PDF on 10 May Retrieved 5 May Archived from the original on 21 June Retrieved 21 June Drugs in Society: Causes, Concepts, and Control.

Cole, Claire. Centre for Public Health. Archived from the original on 17 November Retrieved 22 October What a great New York drug heroin was, I thought.

Like any city, but more than most, New York is an information overload, a constant perceptual tornado that surrounds you most places you walk on the streets.

Heroin is the audio-visual technology that helps manage that overload by dampening it in general and allowing a focus on some part of it that the human perceptual equipment was, in fact, designed to handle.

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