Heroin
Heroin, also known as diacetylmorphine and diamorphine among other names,[1] is a morphinan opioid substance synthesized from the dried latex of the Papaver somniferum plant; it is mainly used as a recreational drug for its euphoric effects. Medical-grade diamorphine is used as a pure hydrochloride salt. Various white and brown powders sold illegally around the world as heroin are routinely diluted with cutting agents. Black tar heroin is a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin.[3] Heroin is used medically in several countries to relieve pain, such as during childbirth or a heart attack, as well as in opioid replacement therapy.[8][9][10]
For other uses, see Heroin (disambiguation).Clinical data
Heroin: /ˈhɛroʊɪn/
Very high[2]
Very high[3]
Intravenous, inhalation, transmucosal, by mouth, intranasal, rectal, intramuscular, subcutaneous, intrathecal
- AU: S9 (Prohibited substance)
- BR: Class F1 (Prohibited narcotics)
- CA: Schedule I
- DE: Anlage I, II and III
- NZ: Class A
- UK: Class A
- US: Schedule I
- UN: Narcotic Schedules I and IV
<35% (by mouth), 44–61% (inhaled)[4]
0% (morphine metabolite 35%)
Within minutes[5]
2–3 minutes[6]
4 to 5 hours[7]
90% kidney as glucuronides, rest biliary
- 70D95007SX
- HCl: 8H672SHT8E
C21H23NO5
369.417 g·mol−1
It is typically injected, usually into a vein, but it can also be snorted, smoked, or inhaled. In a clinical context, the route of administration is most commonly intravenous injection; it may also be given by intramuscular or subcutaneous injection, as well as orally in the form of tablets.[11][3][12][13] The onset of effects is usually rapid and lasts for a few hours.[3]
Common side effects include respiratory depression (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and addiction.[12] Use by injection can also result in abscesses, infected heart valves, blood-borne infections, and pneumonia.[12] After a history of long-term use, opioid withdrawal symptoms can begin within hours of the last use.[12] When given by injection into a vein, heroin has two to three times the effect of a similar dose of morphine.[3] It typically appears in the form of a white or brown powder.[12]
Treatment of heroin addiction often includes behavioral therapy and medications.[12] Medications can include buprenorphine, methadone, or naltrexone.[12] A heroin overdose may be treated with naloxone.[12] An estimated 17 million people as of 2015 use opiates, of which heroin is the most common,[14][15] and opioid use resulted in 122,000 deaths.[16] The total number of heroin users worldwide as of 2015 is believed to have increased in Africa, the Americas, and Asia since 2000.[17] In the United States, approximately 1.6 percent of people have used heroin at some point.[12][18] When people die from overdosing on a drug, the drug is usually an opioid and often heroin.[14][19]
Heroin was first made by C. R. Alder Wright in 1874 from morphine, a natural product of the opium poppy.[20] Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs,[21] and it is generally illegal to make, possess, or sell without a license.[22] About 448 tons of heroin were made in 2016.[17] In 2015, Afghanistan produced about 66% of the world's opium.[14] Illegal heroin is often mixed with other substances such as sugar, starch, caffeine, quinine, or other opioids like fentanyl.[3][23]
Uses
Recreational
Bayer's original trade name of heroin is typically used in non-medical settings. It is used as a recreational drug for the euphoria it induces. Anthropologist Michael Agar once described heroin as "the perfect whatever drug."[24] Tolerance develops quickly, and increased doses are needed in order to achieve the same effects. Its popularity with recreational drug users, compared to morphine, reportedly stems from its perceived different effects.[25]
Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine. When compared to the opioids hydromorphone, fentanyl, oxycodone, and pethidine (meperidine), former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to misuse and causing dependence. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids.[26]
Medical uses
In the United States, heroin is not accepted as medically useful.[3]
Chemistry
Diamorphine is produced from acetylation of morphine derived from natural opium sources, generally using acetic anhydride.[83]
The major metabolites of diamorphine, 6-MAM, morphine, morphine-3-glucuronide, and morphine-6-glucuronide, may be quantitated in blood, plasma or urine to monitor for use, 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-Monoacetylcodeine and codeine.[84] 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. Furthermore, some testing procedures employ a hydrolysis step before quantitation that converts many of the metabolic products to morphine, yielding a result that may be 2 times larger than with a method that examines each product individually.[85]
Society and culture
Names
"Diamorphine" is the Recommended International Nonproprietary Name and British Approved Name.[105][106] Other synonyms for heroin include: diacetylmorphine, and morphine diacetate. Heroin is also known by many street names including dope, H, smack, junk, horse, scag, brown, and unga, among others.[107][108]
Research
Researchers are attempting to reproduce the biosynthetic pathway that produces morphine in genetically engineered yeast.[151] In June 2015 the S-reticuline could be produced from sugar and R-reticuline could be converted to morphine, but the intermediate reaction could not be performed.[152]