Heroin - hĕˈrəwən, opiate drug synthesized from morphine (see narcotic). Originally produced in 1874, it was thought to be not only nonaddictive but useful as a cure for respiratory illness and morphine addiction, and capable of relieving morphine withdrawal symptoms. Later it was discovered to have the same pharmacologic effects as morphine and to be just as addictive. In many parts of the world, it is used as an analgesic (for relief of pain), particularly for the terminally ill. Although in the United States the manufacture and importation of the drug are prohibited and it is not used medically, heroin predominates in illicit narcotics traffic because it provides more potency for less bulk than morphine and is thus easier to smuggle.

See also drug addiction and drug abuse.

Effects and Addiction

Heroin is a central nervous system depressant that relieves pain and induces sleep. It produces a dreamlike state of warmth and well-being. It may also cause constricted pupils, nausea, and respiratory depression, which in its extremes can result in death. Heroin activates brain regions that produce euphoric sensations and brain regions that produce physical dependence—hence its notorious ability to produce both psychological and physical addiction. Its addictiveness is characterized by persistent craving for the drug, tolerance (the need for larger and larger doses to get the same results), and painful and dangerous withdrawal. Withdrawal symptoms include panic, nausea, muscle cramps, chills, and insomnia. Heroin use during pregnancy increases the risk of miscarriage and stillbirth. Infants exposed to heroin in the womb go through withdrawal at birth and exhibit various developmental problems. Besides the danger of overdose, addicts are susceptible to malnutrition, hepatitis, pneumonia, and AIDS.

Heroin Use

Heroin is usually injected intravenously, but may also be injected intramuscularly or under the skin, smoked, or sniffed; effects last three to six hours. In some cases addicts gather in places called "shooting galleries," often located in vacant buildings, which supply the necessary paraphernalia (e.g., hypodermic needle and spoon to heat and liquefy the heroin). Sharing of heroin needles significantly increases the risk of acquiring AIDS (from contaminated blood left in the syringe). Different distributors of heroin often assign "brand names" to their products to enhance rumors of their strength ("Death Wish," "DOA") or effects ("Evening's Delight," "Magic"). Because the drug's strength and purity are unmonitored, each administration brings with it the possibility of overdose, illness from contaminants, or death. Multiple drug use involving heroin is increasingly common and results in many emergency-room visits. For example "speedballing," the use of heroin with cocaine intravenously, moderates the expected post-cocaine "crash." Instances of overdose are also increasing among the growing group of middle-class users that emerged in the 1990s as a potent powdered heroin became available.

Heroin Production

Most heroin originates from opium poppy farms in SE Asia (the "Golden Triangle": primarily in Myanmar), SW Asia (primarily Afghanistan and Pakistan), and Latin American (primarily Colombia). The opium gum is converted to morphine in labs near the fields and then to heroin in labs within or near the producing country. After importation, drug dealers cut, or dilute, the heroin (1 part heroin to 9 to 99 parts dilutor) with sugars, starch, or powdered milk before selling it to addicts; quinine is also added to imitate the bitter taste of heroin so the addict cannot tell how much heroin is actually present. It is sold in single-dose bags of 0.1 gram (0.03 oz.), each costing between $5 and $46 (1992). One pound of diluted heroin yields approximately 4,500 doses.

Heroin and Crime

Heroin use has long been associated with crime because its importation and distribution are illegal and because many addicted people turn to theft and prostitution to obtain money to buy the drug. In addition, violent competition between drug dealers has resulted in many murders and the deaths of innocent bystanders. From 1979 through 1990 arrests for heroin manufacture, sale, or possession in the United States held steady, but in the 1990s arrests rose as the drug's popularity began to increase once more.

The heroin trade can be enormously lucrative to those in the upper echelons. For decades the Mafia has been involved in heroin trafficking operations, including the "French Connection" of the 1950s and 1960s and the more recent "Pizza Connection," which used pizza parlors as fronts. Other trafficking groups are more loosely based on ethnic or national ties; for example, groups of Chinese, Thai, Nigerian, or Mexican nationals have operated in different parts of the country. In contrast to those in the higher tiers, many dealers on the street level are addicted or imprisoned frequently, and their financial gains are limited. U.S. laws and law enforcement efforts focus on interrupting the flow of heroin into the country as well as the arrest of distributors and persons who commit crimes to support their habits.

Treatment of Heroin Addiction

Treatment approaches vary with the motivation, background, and support system of the addict. Treatment of withdrawal may include palliative medication. Methadone maintenance is a controversial treatment that substitutes methadone for heroin then gradually decreases the dose until the user is drug free. Levomethadyl acetate (LAAM) and buprenorphine also have been approved for maintenance treatment of heroin addiction. Other treatment approaches may include psychological counseling, 12-step peer support groups such as Narcotics Anonymous, and educational and vocational services in residential or nonresidential settings.

Bibliography

See publications of the Drugs & Crime Data Center and Clearinghouse, the Bureau of Justice Statistics Clearinghouse, and the National Clearinghouse for Alcohol and Drug Information.

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