Heroin

Death may occur when opiates are combined with depressants such as benzodiazepines, alcohol or other GABAergic substances. Taking large amounts of these substances together is strongly discouraged.

Heroin
The skeletal formula of Diacetylmorphine.
Chemical Nomenclature
Common names	Heroin, H, smack, dope
Substitutive name	Diacetylmorphine, morphine diacetate, diamorphine
Systematic name	(5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol diacetate
Class Membership
Psychoactive class	Depressant
Chemical class	Opioid
Routes of Administration
Smoked Dosage WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section. DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy. Duration Onset 5 - 10 seconds Peak 5 - 6 minutes Afterglow 3 - 5 hours Insufflated Dosage WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section. DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy. Duration Total 3 - 5 hours Onset 30 - 120 seconds Peak 30 - 180 minutes Offset 1 - 2 hours Afterglow 0 - 3 hours Intravenous Dosage WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section. DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy. Duration Total 3 - 5 hours Onset 10 - 20 seconds

Summary sheet: Heroin

Above is heroin in its typical and most common form: a dusty brown powder.

Heroin (diacetylmorphine, morphine diacetate, diamorphine) is a semi-synthetic opioid analgesic originally synthesized by C.R. Alder Wright in 1874 by adding two acetyl groups to the morphine alkaloid from the latex of the poppy plant (Papaver somniferum). Although heroin is actually a traditional trade name for a product containing diacetylmorphine, the name has since been widely adopted for all intents and purposes.

In its pure form, heroin is active at doses of 5mg and above; however, the drug is most commonly found in a preparation containing significant impurities. This means that accurate dosing is particularly difficult.

Heroin is used as a recreational drug for the relaxation and intense euphoria it induces. As with other opioids, heroin is used as both an analgesic and a recreational drug. Frequent and regular administration is associated with tolerance and physical dependence.

Chemistry

Heroin, or diacetylmorphine, is an opioid of the morphinan class. Heroin and other molecules of this class contain a polycyclic core of three benzene rings fused in a zig-zag pattern called a phenanthrene. A fourth nitrogen containing ring is fused to the phenanthrene at R₉ and R₁₃, with the nitrogen member looking at R₁₇ of the combined structure. This structure is called morphinan.

Heroin, along with other morphinans, contains an ether bridge between two of its rings, connecting R₄ and R₅ through an oxygen group. Heroin contains two acetate (CH3COO−) groups bonded to R₃ and R₆ of its structure, and a methyl group located on the nitrogen atom at R₁₇. On the same ring containing the 6-acetyl group, heroin contains a double bond.

Heroin's chemical structure is closely related to morphine. Heroin is the 3,6-diacetyl derivative of the diol morphine, meaning it contains acetate functional groups at the same locations hydroxy groups are found in morphine (3,6). Heroin is analogous to the other morphinans including dihydrocodeine, codeine, ethylmorphine, hydrocodone, and oxycodone.

It was first synthesized by Alder Wright in 1874 when attempting to combine morphine with various acids. The synthesis was achieved through boiling anhydrous morphine with morphine alkaloid with acetic anhydride.

Pharmocology

Heroin itself is an inactive drug, but it converts into morphine when inserted into the body. When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine. When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood–brain barrier because of the presence of the acetyl groups which render it much more fat soluble than morphine itself.

Once in the brain, it is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM). It is then deacetylated into morphine, which binds to μ-opioid receptors, resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects. Heroin itself exhibits relatively low affinity for the μ receptor.

These appear to stem from the way in which opioids appear to mimic endogenous endorphins. Endorphins are responsible for analgesia (reducing pain), causing sleepiness, and feelings of pleasure. They can be released in response to pain, strenuous exercise, orgasm, or excitement. This mimicking of natural endorphins results in the drug's effects.

Subjective effects

The effects listed below are based upon the subjective effects index and personal experiences of PsychonautWiki contributors. The listed effects will rarely (if ever) occur all at once, but heavier dosages will increase the chances and are more likely to induce a full range of effects.

Physical effects

• Euphoria - The physical euphoria experienced on this substance is extremely intense when compared to other opioids such as codeine or tramadol. The sensation itself can be described as feelings of intense physical comfort, warmth, and blissful euphoria.
• Pain relief
• Respiratory depression
• Itchiness
• Constipation
• Cough suppression
• Difficulty urinating
• Nausea
• Sedation
• Pupil constriction

Cognitive effects

• Euphoria - The cognitive euphoria experienced on this substance is extremely intense when compared to other opioids such as codeine or tramadol. The sensation itself can be described as powerful and overwhelming feelings of emotional bliss, contentment, and happiness.
• Anxiety suppression
• Compulsive redosing

Visual effects

• Internal hallucinations - One may experience a state of semi-consciousness and hypnagogia during heavy dosage nodding which results in dream-like states and up to level 3 imagery. This is often accompanied by ill-defined geometry.

Toxicity and harm potential

Radar plot showing relative physical harm, social harm, and dependence of heroin

Like most opioids, unadulterated heroin does not cause many long-term complications other than dependence and constipation. Outside of the extremely powerful addiction and physical dependence, the harmful or toxic aspects of heroin usage are exclusively associated with not taking appropriate precautions in regards to its administration, overdosing and using impure products.

Heroin can cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious.

Due to the nature of the unregulated drug market, illicit heroin is of widely varying and unpredictable purity. A user may prepare what they consider to be a moderate dose while actually taking far more than intended in the event of obtaining a purer product than they are used to. Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours and is a direct result of respiratory depression leading onto anoxia (oxygen deprivation) resulting from the breathing reflex being suppressed by agonism of µ-opioid receptors. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 600mg.

It is strongly recommended that one use harm reduction practices when using this drug.

Tolerance and addiction potential

As with other opiate-based painkillers, the chronic use of heroin can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.

Studies have shown that the subjective euphoria of diacetylmorphine use (the reinforcing component of addiction) is proportional in its intensity to the rate at which the blood level of the drug increases. Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the fastest. It is followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing).

Tolerance to many of the effects of heroin develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly.

Interactions

Heroin is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.

Legal issues

• Australia: Heroin is controlled in Australia, but there is conflicting information about its exact legal status. Heroin was listed in Schedule I of the Narcotic Drugs Act of 1967; however, it is unclear whether the control system has changed since then.
• Brazil: Heroin is listed as a controlled substance, making the production, distribution, or possession illegal.
• Canada: Heroin is Schedule I in Canada. However, a unanimous Supreme Court decision in 2011 declared that there is a right under Section 7 of the Charter to have access to clean injection sites.
• Czech Republic: The Czech Republic has decriminalized 1.5g or less of heroin and the punishment is similar in scale to a parking ticket. Sales, production, and larger quantity possession are still crimes.
• Finland: Heroin is a controlled substance, making the production, distribution, and possession illegal without a license.
• Germany: In May 2009, Germany made it legal to prescribe heroin to addicts who are over 23 years old, have been addicted for at least 5 years, and have tried 2 other therapies to get off heroin.
• Latvia: Heroin is a Schedule I drug.
• New Zealand: Heroin is Class A in New Zealand.
• Norway: Heroin is Schedule I in Norway and illegal to buy or possess without a special license. There have been some projects to establish needle rooms in Norway by the government where heroin addicts are allowed to get fresh needles for injecting heroin.
• Portugal: The personal use of heroin was decriminalized by Law 30/2000 in July 2001. Possession of less than 1g is not regarded as a criminal offence although the substance is liable to be seized and the possessor can be referred to mandatory treatment. Sale or possession of quantities greater than the personal possession limit are criminal offences punishable by jail time.
• Switzerland: Heroin is legally available for addicts under an ongoing experiment but is otherwise illegal to possess.
• U.K.: Heroin is Schedule II/Class A and is illegal to buy, sell or possess without a license.
• U.S.: Heroin is Schedule I in the United States. This means it is illegal to manufacture, buy, possess, or distribute without a DEA license.

See also

• Responsible use
• Opioids
• Codeine
• Morphine
• Heroin (Wikipedia)
• Heroin (Erowid)
• Heroin experiences (Erowid)