Heroin, Opiates, and the Analgesics

Heroin and the opiates derive from the poppy plant, Papaver somniferum, which displays a beautiful flower when in full bloom. Opium is the sticky, tarry substance produced within this plant’s seed pod.

For the past 6,000 years, the opium poppy has been cultivated for use in various medicinal preparations. Some of the earliest medicinals from this plant were probably in the form of teas. We have evidence that people began smoking opium about 3,000 years ago in areas of Asia, Egypt, and Europe. In the Middle Ages, a preparation of opium called laudanum gained popularity in Europe. In 1803 the psychoactive substance morphine was isolated from an opium base, and in 1898 the semisynthetic heroin was refined from morphine.

The opiates have many medical uses, and many have been used for years as painkillers (analgesics). Also, because they cause respiratory depression and constipation, various preparations have been used as cough suppressants or antidiarrheals. To meet medical demands each year, the U.S. pharmaceutical industry imports more than 500 tons of opium or its equivalent in poppy straw concentrate for the production of prescription opiates.

Today we have dozens of opiates. Some, such as heroin, are produced and sold illegally; others are produced legally but find their way into illegal markets on the streets. The opiates fall into three general categories: naturally occurring (opium, morphine, codeine, and thebaine), semisynthetic (heroin, hydromorphone, oxycodone, hydrocodone, and buprenorphine), and synthetic (meperidine, methadone, LAAM, dextropropoxyphene, fentanyl, and pentazocine).

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Opium. This product is made from the thick, glue-like liquid that oozes from the plant’s seed pod. Producers dry it into a ball (gum opium) or pound it into a powder (opium powder). Opium is the active ingredient in various medicines used for the treatment of diarrhea (trade names: Paregoric, Parepectolin, Donnagel-PG). It’s also available in a couple of pain remedies (trade names: Pantopon, B&O Supprettes). AKA: O, Big O, Zero, Dreams, Gem, Hop, Tar, Skee, Toys, Chinese Molasses, Gong, Black Stuff, Black Pills. AKA for paregoric: Blue Velvet.

Morphine. This substance was named after Morpheus, the Greek god of dreams who was often depicted with a handful of opium poppies. Morphine is the principal psychoactive chemical in opium, ranging in concentrations from 4% to 21%. It is probably the most effective painkiller (analgesic) known to humans. In fact, it provides a standard against which new analgesics are measured. Morphine is prescribed mainly for the treatment of pain and sometimes as an adjunct to anesthesia. Trade names: Morphine Sulphate, Morphine Sulphate Injection, MS Contin, Oramorph SR, Duramorph, Roxanol. AKA: M, Morph, M.S., Dreamer, Miss Emma.

Codeine. This psychoactive alkaloid occurs in opium in concentrations ranging from 0.7% to 2.5%. Compared to morphine, it produces less sedation and respiratory depression and less analgesia. It is prescribed for relief of moderate pain or as an effective cough suppressant. Codeine has become the most widely used naturally occurring opiate in medical treatment in the world. Trade names: Codeine Phosphate Injection, Acetaminophen with Codeine, Aspirin with Codeine, Fiorinal with Codeine, Phenaphen with Codeine, Synalgos, Tylenol with Codeine, Robitussin AC, Empirin with Codeine. AKA: Schoolboys, Pops.

Thebaine. This chemical occurs in small quantities in opium. It’s similar chemically to morphine and codeine but has stimulant rather than depressant effects. Thebaine has no therapeutic value but is the precursor to a variety of other psychoactive or therapeutic compounds. These include hydrocodone, oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, and buprenorphone.

Heroin. This drug was first synthesized from morphine in 1898 by the Bayer Company in Germany. It got its name from the German heroisch, which means “powerful.” This semisynthetic enters the brain more quickly than morphine because chemically it’s more soluble in fat. Once in the brain, it turns back into morphine. Heroin is most commonly available in powder form. Its color varies from pure white to dark brown. Sellers package it by the “bag,” each of which contains one dose equal to about 100 milligrams. In recent years, the purity of heroin on the street has improved. In 1980, the national average purity of heroin was 3.6%. In 1993, it was 37%. Another form of heroin known as “black tar” has hit the streets in recent years. Some varieties are gummy and sticky, whereas others are as hard as coal. It ranges in color from brown to black. This product hails from Mexico, where crude processing methods prevail, thus the dark color. Its purity ranges from 20% to 80%. AKA: H, Big H, Horse, Smack, White Lady, White Stuff, Junk, Dope, Mojo, Downtown, Brown, Mexican Brown, Mud.

Hydromorphone. This semisynthetic opiate has an analgesic potency two to eight times that of morphine. Trade names: Dilaudid, Dilaudid-HP Injection, Hydromorphone Hydrochloride. AKA: D, Dilly, Fours, Lords.

Hydrocodone. This semisynthetic opiate works as an analgesic and as a cough remedy (antitussive). Trade names: Anexsia, Hycodan, Hycomine, Lorcet, Lortab, Tussionex, Vicodin.

Oxycodone. This substance is more potent than codeine and more addictive. Trade names: Percodan, Percocet, Tylox.

Meperidine. Compared to morphine, this synthetic opiate produces similar analgesia but has a shorter duration of action and reduced antitussive and antidiarrheal effects. Trade name: Demerol.

Fentanyl. This synthetic opiate acts as a highly potent form of heroin. It has medical uses as an analgesic and as an anesthetic (trade name for anesthetic fentanyl: Sublimaze). At least 12 analogs of this drug have been created. Some have medical uses as analgesics, such as alfentyl (trade name: Alfenta) and sufentanil (trade name: Sufenta). Drug marketers have produced numerous fentanyls that are sold on the street. Some of these are 100 times more potent than street-quality heroin. AKA: China White, Tango and Cash.

Pentazocine. This synthetic provides mild analgesia. Trade names: Talwin, Talacin.

Methadone and related synthetics. Methadone acts like heroin or morphine but doesn’t resemble the opiates in chemical form. Medically, it’s used in heroin detoxification and maintenance programs. Methadone’s effects last longer than heroin’s—up to 24 hours—so it’s ideal for once-a-day maintenance doses (AKA: Dollies, Dolls, Wafers, Ten-Eight-Twenty). A chemical cousin to methadone, levo-alphacetylmethadol (LAAM) produces similar effects to methadone but lasts even longer. In 1994 this drug was approved as an alternative treatment for narcotics addiction (trade name: ORLAAM). Currently, researchers are testing yet another drug, the semisynthetic opiate buprenorphine, for use in treatment of narcotics addiction (trade name: Buprenex). Another relative of methadone, propoxyphene, acts as a weak analgesic and is not much stronger than aspirin (trade names: Darvon-N, Darvon Compound-65, Darvocet-N 100, Wygesic). AKA: Pinks-and-Greys.

Other synthetics. This group includes alphaprodine (trade name: Nisentil), which is prescribed for pain; diphenoxylate (Lomotil) for diarrhea; levorphanol (Levo-Dromoran) for pain; loperamide (Immodium) for diarrhea; buteorphanol (Stadol) for pain; and nalbuphine (Nubain) for pain.

Combinations. Users have combined this group of drugs with many other substances. Some of the more popular combinations (along with the street names for each) include heroin and cocaine (Speedball, Whizz Bang, Dynamite, Murder One), heroin and tobacco (Duster), heroin and marijuana (Atom Bomb, A-Bomb), heroin or another opiate with amphetamines, opium with marijuana (O.J.), Talwin with the antihistamine pyribenzamine (T’s and Blues).

How They’re Used

A large percentage of heroin users go for the high by injection, either intravenously (“mainlining”), subcutaneously (“skin popping”), or intramuscularly. As the purity of heroin has increased, however, more occasional users, called “chippers,” have entered dreamland by snorting or smoking the powder. Opium users almost always smoke the substance.

Hardcore heroin addicts will seek most any analgesic when the smack supply runs short. A favorite is Dilaudid. If the substance comes in tablet form, as Dilaudid does, users will often grind it into powder, dissolve it in water, and shoot it. Otherwise, both chippers and hardcore addicts will take analgesics the way they were intended, that is, orally in tablets, capsules, or liquid preparations.

The high from most of the opiates lasts from two to six hours. However, at one extreme fentanyl lasts only an hour or so, and at the other LAAM lasts a couple of days. The high from fentanyl injection is the quickest of all the analgesics to reach peak levels in the brain (two to four seconds). Heroin is slower, taking a couple of minutes, and morphine takes about five minutes. The high from snorting heroin takes even longer to reach peak levels, and anyone who takes analgesics orally must wait the longest for the high to hit, about a half hour or so.

Researchers find two patterns of abuse. In one pattern, users start on the streets with illicit opiates. These users start as chippers, some of whom graduate to greater and greater use and some of whom don’t. Typically, they begin by snorting, smoking, pill popping, or drinking liquid preparations such as cough syrups or Paragoric. Those who graduate go to skin popping or mainlining. In the other pattern, users get started on analgesics in a medical setting and, over a period of time, develop “a habit.” They become addicted to their prescribed medication. Typically, these users begin “doctor shopping.” They bounce from doctor to doctor seeking scripts for painkillers, often faking symptoms with the premeditated poise of great actors and actresses. Many who follow this pattern of addiction will, at some point, begin seeking illicit opiates on the street.

Popularity

About 5.5% of Americans have used illicit analgesics. About 2.1% have used illicit analgesics within the past year, and about 0.9% have used them within the past month. That’s about 1.9 million current users.

About 2.5 million Americans have used heroin at some time in their lives. About 455,000 have used it within the past year.

The Joy of It

When we take opiates, it’s as if Morpheus enters our very being. Everything becomes dream-like. Our cares and troubles float away. Our eyelids, like those of the meditating Buddha, rest serenely in a half-closed position. We feel comfortable. We become drowsy and sleepy, and sometimes we nod off into our very own slumberland. We feel as if we’ve entered a warm, safe place—a place where we’re protected, cared for, and tenderly held—a place very much like the womb.

Mainliners get a rush, a climactic sensation that some compare to orgasm. Although this rush resembles the jolt from cocaine or methamphetamine, it’s not as powerfully orgasmic. Mainliners also typically experience a period of nausea along with, or just after, the rush. This discomfort is sometimes resolved by dedicating a few minutes to the act of vomiting.

The opiates were originally called “narcotics,” a word derived from the Greek narcotikos, meaning “benumbing” or “causing sleep.” These numbing sensations, the absence of pain, and the warm, dreamy feelings create a powerful attraction for the recreational use of these drugs.

The Problems It Causes

Lung problems. The opiates cause a decrease in breathing rate and depth. In fact, breathing becomes dangerously impaired at higher doses. In addition, if you smoke opiates, you increase your chances of smoke-related lung problems. You might experience hacking cough, bronchitis, and other difficulties.

Gastrointestinal problems. The opiates cause constipation. Many heavy users can’t move their bowels for days and sometimes go for even a week or more without any bowel movements. This problem resolves with abstinence.

Sexual dysfunction. Users experience a decreased sexual desire and a decreased ability to perform sexually. Males often can’t get an erection (impotence). This problem usually resolves when opiates are discontinued. However, a small percentage who used opiates addictively, and in combination with other substances, report that their impotence continued long after they had quit all the drugs. Female addicts can experience lack of menstrual period (amenorrhea), which resolves when opiates are discontinued.

Malnutrition. Heavy users tend to be malnourished or undernourished. The reason is uncertain. It may happen because heavy users don’t attend to the body’s need for food or because they spend too much time and energy acquiring more of the drug.

Danger of infection. If you shoot heroin or other opiates, you run the risk of various infections. These include infections on the skin (abscesses) or under the skin (cellulitis) at injection sites, infection of the veins (thrombophlebitis), inflammation of the veins (often caused by injecting particles that were not ground fine enough to completely dissolve), infection of the liver (hepatitis B), infection of the heart valves (endocarditis), AIDS, and brain and lung abscesses.

Danger of overdose. With opiates, the danger of overdose looms large. The problem arises mainly because these drugs depress the respiration. Death from depressed respiration usually occurs within minutes after an injection. The user falls into a coma and never revives.

Usually, overdose occurs after a single injection. It happens because the dose from that injection is higher than the user could tolerate. With street heroin varying in purity from 10% to 80%, this becomes a real problem. Also with fentanyl and its analogs the danger is even greater because of the greater potency of these synthetics. Since fentanyl came on the scene, it has caused many deaths from overdose. Methadone, too, has led to many overdose deaths due to use in non-medical settings. A note on Darvon: It has numerous toxic side effects and, as reported by medical examiners in the United States, is one of the top 10 drugs in causing drug abuse deaths.

Withdrawal

Withdrawal begins with a runny nose, watery eyes, yawning, and sweating. Then you experience chills and goose bumps (where the term “cold turkey” came from), along with flu-like symptoms, including nausea, vomiting, and diarrhea. You also get muscle aches and spasms and the typical leg-kicking response due to leg spasms (which gave rise to the phrase “kicking the habit”). You also feel pains in the muscles and bones. You’re unable to sleep. You might feel anxiety, tension, anger, or hostility. Finally, you feel like nothing is enjoyable in life, and you crave opiates.

The physical symptoms peak at two to four days and disappear within seven to 10 days. The mental symptoms—feeling like nothing’s enjoyable and the craving of opiates—will continue. In fact, these two symptoms are connected. You know that opiates will take away any bad feelings and make life enjoyable again. You know this at a gut level. It happens in your mind, but it feels as if your whole body craves. These mental symptoms will last a few months at least, maybe even a year or more. However, they continue to diminish in frequency and intensity as long as you remain in recovery.