Heroin
14034
225948279
2008-07-16T04:06:18Z
70.55.102.26
/* Music */
{{otheruses}}
{{drugbox
| IUPAC_name = (5α,6α)-7,8-didehydro-4,5-epoxy-<br>17-methylmorphinan-3,6-diol diacetate
| image = Heroin-2D-skeletal.png
| image2 = Heroin-3D-balls.png
| CAS_number = 561-27-3
| ATC_prefix = N02
| ATC_suffix = AA09
| PubChem = 5462328
| DrugBank =
| C=21 | H=23 | N=1 | O=5
| molecular_weight = 369.41
| bioavailability = <35% (oral), 44–61% (inhaled)[http://www.blackwell-synergy.com/doi/abs/10.1111/j.1742-7843.2006.pto_233.x]
| protein_bound = 0% ([[morphine]] metabolite 35%)
| metabolism = [[hepatic]]
| elimination_half-life = 3–5 min (IV, inhaled)[http://www.blackwell-synergy.com/doi/abs/10.1111/j.1742-7843.2006.pto_233.x]
| excretion = 90% [[renal]] as [[glucuronide]]s, rest [[biliary]]
| pregnancy_category = Category X
| legal_AU = S9
| legal_CA = Schedule I
| legal_NZ = Class A
| legal_SG = Class A
| legal_UK = Class A
| legal_US = Schedule I
| legal_status =
| dependency_liability =Extremely High
| routes_of_administration = Inhalation, Transmucosal, Intravenous, Oral, Intranasal, Rectal, Intramuscular}}
'''Heroin ''' ([[International Nonproprietary Name|INN]]: '''diacetylmorphine''', [[British Approved Name|BAN]]: '''diamorphine''') is a [[opioid|semi-synthetic opioid]] synthesized from [[morphine]], a derivative of the [[opium poppy]]. It is the 3,6-[[acetate|diacetyl]] ester of morphine (hence ''diacetylmorphine''). The white crystalline form is commonly the hydrochloride salt '''diacetylmorphine hydrochloride''', however heroin freebase may also appear as a white powder.
As with other [[opiates]], heroin is used both as a [[analgesic|pain-killer]] and a [[recreational drug]].
One of the most common methods of heroin use is via [[Intravenous therapy#Needle and syringe|intravenous injection]] (typically known as "shooting up"). If taken orally, heroin undergoes extensive [[first-pass metabolism]] via de[[acetylation]], making it a [[prodrug]] for the systemic delivery of morphine.<ref name="Sawynok 1986">Sawynok J. "The therapeutic use of heroin: a review of the pharmacological literature." ''Canadian Journal of Physiology and Pharmacology''. 1986 Jan;'''64'''(1):1-6. PMID 2420426</ref> When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the [[blood-brain barrier]] due to the presence of the acetyl groups, which render it much more lipid-soluble than morphine itself.<ref name="Klous 2005">Klous MG, Van den Brink W, Van Ree JM, Beijnen JH. "Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients." ''Drug and Alcohol Dependence''. 2005 December 12;'''80'''(3):283-95. PMID 15916865. {{doi|10.1016/j.drugalcdep.2005.04.008}}</ref> Once in the brain, it is deacetylated into 3- and 6-[[monoacetylmorphine]] and morphine, which bind to [[Mu opioid receptor|μ-opioid receptor]]s resulting in intense euphoria, decreased pain perception, and [[anxiolytic]] effects (relief of anxiety).
Frequent administration has a high potential for causing [[addiction]] and may quickly lead to tolerance. If a sustained use of heroin for as little as three days is stopped abruptly, withdrawal symptoms can appear. This is much shorter than the withdrawal effects experienced from other common painkillers such as [[oxycodone]] and [[hydrocodone]].<ref>{{cite journal|author=David Shewan, Phil Dalgarno|title=Evidence for controlled heroin use? high levels of negative health and social outcomes among non-treatment heroin users in Glasgow|url=http://www.gcal.ac.uk/news/downloads/BJHPpublished.pdf|journal=British Journal of Health Psychology|year=2005|doi=10.1348/135910704X14582|pages=33–48|volume= 10}}</ref><ref>{{cite news|author=Hamish Warburton, Paul J Turnbull, Mike Hough|title=Occasional and controlled heroin use: Not a problem?|url=http://www.jrf.org.uk/bookshop/details.asp?pubID=747|date=2005}}</ref>
Internationally, heroin is controlled under Schedules I and IV of the [[Single Convention on Narcotic Drugs]].<ref>{{cite web
| year = December 2004| url = http://www.incb.org/pdf/e/list/46thedition.pdf
| title = Yellow List: List of Narcotic Drugs Under International Control| format = PDF
| publisher = [[International Narcotics Control Board]]
| accessmonthday = May 5 | accessyear = 2006
}} ''Referring URL = http://www.incb.org/incb/yellow_list.html''</ref> It is illegal to manufacture, possess, or sell heroin in [[Belgium]], [[Denmark]], [[Germany]], the [[Netherlands]], the [[United States]], [[Australia]] and the UK. However, under the name '''diamorphine''', heroin is a legal prescription drug in the [[United Kingdom]], and in the [[Netherlands]], heroin is available for prescription as the generic drug '''diacetylmorfine''' to long-term Heroin addicts. Popular street names for heroin include ''[[black tar heroin|black tar]]'', ''smack'', ''junk'', ''skag'', ''horse'', ''brain'', chaw, chiva, china white, dust and others. These are specific references to heroin and not used to describe any other drug.
<!-- Please do not add more names to the above short list (which came from www.erowid.org) - consider adding to "List of street names of drugs" article instead
-->
==History==
[[Image:BayerHeroin.png|thumb|left|Old advertisement for [[Bayer]] Heroin.]]
[[Image:Bayer Heroin bottle.jpg|thumb|left|Bayer Heroin bottle.]]
The [[opium poppy]] was cultivated in lower [[Mesopotamia]] as long ago as 3400 BC.<ref>{{cite web
|url=http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html
|title=Opium Throughout History
|publisher=PBS Frontline
|accessdate=2006-10-22
}}</ref> The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two ingredients, [[codeine]] and [[morphine]].
Heroin was first synthesized in 1874 by C.R. Alder Wright, an English chemist working at [[St Mary's Hospital (London)|St. Mary's Hospital]] Medical School in London, England. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride over a stove for several hours and produced a more potent, acetylated form of morphine, now called ''diacetylmorphine''. The compound was sent to F.M. Pierce of Owens College in Manchester for analysis, who reported the following to Wright:
:''Doses ... were [[Route of administration|subcutaneously injected]] into young dogs and rabbits ... 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 [[vomit]]ing in some cases, but no actual emesis. [[Respiration (physiology)|Respiration]] was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4° (rectal failure)''.<ref>{{cite web
|url=http://adhpage.dilaudid.net/heroin.html
|title=On the Action of Organic Acids and their Anhydrides on the Natural Alkaloids
|last = Wright
|first = C.R.A.
|date=[[2003-08-12]]
|archiveurl=http://web.archive.org/web/20040606103721/http://adhpage.dilaudid.net/heroin.html
|archivedate=2004-06-06
}} Note: this is an annotated excerpt of {{cite journal
| last = Wright
| first = C.R.A.
| year = 1874
| title = On the Action of Organic Acids and their Anhydrides on the Natural Alkaloids
| journal = [[Journal of the Chemical Society]]
| volume = 27
| pages = 1031–1043
| doi = 10.1039/js8742701031
}}</ref>
Wright's invention, however, did not lead to any further developments, and heroin only became popular after it was independently re-synthesized 23 years later by another chemist, [[Felix Hoffmann]]. Hoffmann, working at the [[Bayer]] pharmaceutical company in [[Elberfeld, Germany]], was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing [[codeine]], a constituent of the opium poppy, similar to morphine pharmacologically but less potent and less addictive. But instead of producing codeine, the experiment produced an acetylated form of morphine that was actually 1.5-2 times more potent than morphine itself. Bayer would name the substance "heroin", probably from the word ''heroisch'', German for heroic, because in field studies people using the medicine felt "heroic".<ref>owden, Mary Ellen. Pharmaceutical Achievers. Philadelphia: Chemical Heritage Foundation, 2002.</ref>
From 1898 through to 1910 heroin was marketed as a non-addictive morphine substitute and cough suppressant. Bayer marketed heroin as a cure for morphine addiction before it was discovered that heroin is rapidly metabolized into morphine, and as such, "heroin" was basically only a quicker acting form of morphine. The company was somewhat embarrassed by this new finding and it became a historical blunder for Bayer.<ref>{{cite web
|year=1998
|month=September 13
|url=http://opioids.com/heroin/heroinhistory.html
|title= How aspirin turned hero
|publisher=Sunday Times
|accessdate=2006-10-22
}}</ref>
As with [[aspirin]], Bayer lost some of its trademark rights to heroin following the German defeat in [[World War I]].<ref>{{cite web
|url=http://history.sandiego.edu/gen/text/versaillestreaty/all440.html
|date=[[1919-06-28]]
|title=Treaty of Versailles
|accessdate=2007-05-05
|pages=Part X, Section IV, Annex, paragraph 5
}}</ref>
In the United States the [[Harrison Narcotics Tax Act]] was passed in 1914 to control the sale and distribution of heroin and other opiates. The law did allow heroin to be prescribed and sold for medical purposes. In particular, recreational users could often still be legally supplied with heroin and use it. In 1924, the United States Congress passed additional legislation banning the sale, importation or manufacture of heroin in the United States. It is now a Schedule I substance, and is thus illegal in the United States.
==Usage and effects==
{{Expert-verify|date=April 2007}}
===Recreational===
[[Image:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg|thumb|right|Data from [[The Lancet]] shows Heroin to be the most dependence causing and most harmful of 20 drugs.<ref name="Nutt">{{cite journal |author=Nutt D, King LA, Saulsbury W, Blakemore C |title=Development of a rational scale to assess the harm of drugs of potential misuse |journal=Lancet |volume=369 |issue=9566 |pages=1047–53 |year=2007 |pmid=17382831 |doi=10.1016/S0140-6736(07)60464-4}}</ref>]]
{| bgcolor="#ffffff" border="1" cellpadding="3" cellspacing="0" align="right" width="167px" style="border-collapse: collapse; clear: right; margin: 0 0 0 0.5em"
|-
|'''Indicated for:'''<br/>
*Relief of Extreme Pain
'''[[Recreational drug use|Recreational]] uses:'''<br/>
*[[Euphoria (emotion)|Euphoria]]
*[[Relaxation]]
'''Other uses:'''<br/>
*[[Pain]] relief
*[[Cough suppressant]]
*anti-[[diarrhea]]l
|-
|'''[[Contraindication]]s:'''<br/>
*[[Ethanol|Alcohol]]
*[[Barbiturate]]s and [[Benzodiazepines]]
*[[Stimulant]]s
*Other [[opioid]]s (depends heavily on tolerance)
|-
|'''[[Adverse drug reaction|Side effects]]'''{{Fact|date=July 2007}}
<div style="background: #ffcc99">
'''''{{red|Severe:}}'''''[http://www.drugs.com/enc/heroin-overdose.html]
*[[Respiratory arrest]], [[coma]], [[death]]
</div>
</div>
'''''[[Central nervous system]]:'''''
*[[Drowsiness]]
*[[Disorientation]]
*[[Delirium]]
'''''[[Cardiovascular]] & [[Respiration (physiology)|Respiratory]]:'''''
*Lowered [[heart rate]]
*[[Weak pulse]]
*[[Hypotension]]
*[[Hypoventilation]]
*[[Shallow breathing]]
*Respiratory depression
'''''[[Eyes]], [[Ears]], [[nose]], and [[mouth]]:'''''
*Dry mouth
*[[Pupil constriction]] ("pinpoint pupils")
*[[Miosis]]
'''''[[Gastrointestinal]]:'''''
*[[Nausea]]
*[[Vomiting]] (protracted)
*[[Constipation]]
*[[Dyspepsia]]
'''''[[Urinary System]]:'''''
*[[Urinary retention]]
'''''[[Muscle|Musculo]][[skeletal]]:'''''
*[[Analgesia]]
*[[Ataxia]]
*[[Muscle spasticity]]
'''''[[Neurological]]:'''''
*[[Analgesia]]
*[[Physical dependence]]
'''''[[Psychological]]:'''''
*[[Anxiolysis]]
*[[Confusion]]
*[[Euphoria (emotion)|Euphoria]]
*[[Psychological addiction#Psychological dependency|Psychological dependence]]
*[[Somnolence]]
'''''[[Skin]]:'''''
*Itching
*Flushing/Rash
[[Image:Diamorphine ampoules.JPG|thumb|left|Diamorphine ampoules for medicinal use]]
|}
Heroin is used as a recreational drug for the profound relaxation and intense [[Euphoria (emotion)|euphoria]] it produces, although the latter effect diminishes with increased [[Physiological tolerance|tolerance]]. Its popularity with recreational drug users, compared to [[morphine]], reportedly stems from its perceived different effects.<ref>{{cite journal
| author = Tschacher W, Haemmig R, Jacobshagen N.
| year = 2003
| title = Time series modeling of heroin and morphine drug action
| journal = [[Psychopharmacology]]
| pmid = 12404073
| url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12404073&query_hl=23&itool=pubmed_DocSum
| doi = 10.1007/s00213-002-1271-3
}}</ref> However, this perception is not supported by the results of clinical research studies.
In controlled studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opiates, subjects showed no preference for either drug. Equipotent, injected doses had comparable action courses, with no difference in their ability to induce euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.<ref>W. R. Martin 1 and H. F. Fraser 1</ref> Data acquired from short-term addiction studies did not indicate that heroin tolerance develops more rapidly than tolerance to morphine. The findings have been discussed in relation to the physicochemical properties of heroin and morphine and the metabolism of heroin. When compared to other 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 abuse and addiction. Morphine and heroin were also much more likely to produce euphoria, and other subjective effects when compared to most [[opioid]] analgesics.<ref>1 National Institute of Mental Health, Addiction Research Center, U. S. Public Health Service Hospital, Lexington, Kentucky</ref><ref>Journal of Pharmacology And Experimental Therapeutics, Vol. 133, Issue 3, pp. 388-399, 1961</ref> Heroin can be [[route of administration|administered]] several ways, including [[Insufflation#Medical uses|snort]]ing and [[injection (medicine)|injection]], and may be smoked by inhaling its vapors when heated, i.e. "[[chasing the dragon]]."
Some users mix heroin with [[cocaine]] in a "[[Speedball (drug)|speedball]]" or "snowball" combination that usually is injected intravenously, smoked, or snorted, producing a more intense rush than heroin alone, but is more dangerous because the combination of the short-acting stimulant with the longer-acting depressant increases the risk of seizure, or overdose with one or both drugs.
Once in the brain, heroin is rapidly [[metabolism|metabolized]] to 6-acetylmorphine and morphine by removal of the acetyl groups and thus serves as a prodrug. Morphine is unable to cross the blood-brain barrier as quickly as heroin, which gives heroin a comparably shorther onset of action. In either case, a morphine binds to opioid receptors, inducing the opioid high.
The onset of heroin's effects depends upon the [[route of administration]]. Orally, heroin is completely metabolized [[in vivo]] to morphine before crossing the blood-brain barrier; the effects are the same as with oral morphine. Snorting results in an onset within 3 to 5 minutes; smoking results in an almost immediate effect that builds in intensity; intravenous injection induces a rush and euphoria usually taking effect within 30 seconds; intramuscular and subcutaneous injection take effect within 3 to 5 minutes.
Heroin is metabolized into morphine, a [[Mu opioid receptor|μ-opioid receptor]] [[agonist]]. It acts on [[endogenous]] μ-opioid receptors that are present throughout the [[brain]], [[spinal cord]] and [[gut]] in all [[mammal]]s. The μ-opioid receptor also binds endogenous [[opioid peptide]]s such as [[Beta-endorphin|β-endorphin]], [[Leu-enkephalin]], and [[Met-enkephalin]]. Repeated use of heroin results in a number of physiological changes, including decreases in the number of μ-opioid receptors. These physiological alterations lead to tolerance and dependence, and the cessation of heroin use results in extremely uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia. This set of symptoms is called the opiate [[withdrawal]] syndrome. It has an onset 6 to 8 hours after the last dose of heroin. Morphine also binds to [[delta opioid receptor|δ]]- and [[kappa opioid receptor|κ]]-opioid receptors. There has also been some controversy regarding whether heroin binds to a subtype of μ-opioid receptors that is not targeted by morphine but is activated by the morphine metabolite morphine-6β-glucuronide.<ref>Brown et al., FEBS Lett 412:35, 1997. http://www.ncbi.nlm.nih.gov/pubmed/9257684</ref>
The heroin dose used for recreational purposes depends strongly on the frequency of use. A first-time user typically ingests between 5 and 20 mg of heroin, but an individual who is heavily dependent on the drug may require several hundred mg per day.<ref>[http://www.erowid.org/chemicals/heroin/heroin_dose1.shtml Notes on heroin dosage & tolerance]. Erowid's Vault, 2001.</ref>
Large doses of heroin can be fatal. The drug has been used for suicide or as a murder weapon. The serial killer [[Harold Shipman|Dr Harold Shipman]] used it on his victims as did [[John Bodkin Adams|Dr John Bodkin Adams]] ([[Edith Alice Morrell|see his victim, Edith Alice Morrell]]). It can sometimes be difficult to determine whether a heroin death was an accident, suicide or murder as with the deaths of [[Sid Vicious]], [[Janis Joplin]], [[Tim Buckley]], [[Jim Morrison]]{{Fact|date=May 2008}}, [[Layne Staley]], and [[Bradley Nowell]] which have been attributed to heroin overdose.<ref>[http://www.timesonline.co.uk/article/0,,11069-2329203,00.html First murder charge over heroin mix that killed 400 - World - Times Online<!-- Bot generated title -->]</ref><!-- more information needed! -->
===Medical===
In situations where the addictive quality is of little concern, e.g. terminal illness, diamorphine is a valuable drug. The slow and often very painful end to a cancer sufferer's life can be greatly relieved by the careful use of diamorphine to relieve the pain and worry. In this situation the drug can allow a sufferer to live their last few weeks more actively and independently than would otherwise be possible.
==Regulation==
In the [[Netherlands]], diamorphine (heroin) is a List I drug of the [[Opium Law]]. It is available for prescription under tight regulation to long-term heroin addicts, to whom methadone maintenance treatment has failed. Heroin is exclusively available for prescription to long-term heroin addicts, and cannot be used to treat severe pain or other illnesses.
In the United States, heroin is a schedule I drug according to the Controlled Substances Act of 1970, making it illegal to possess without a DEA license. Possession of more than 100 grams of heroin or a mixture containing heroin is punishable with a minimum mandatory sentence of 5 years of imprisonment in a federal prison.
In Canada, heroin is a controlled substance under Schedule I of the [[Controlled Drugs and Substances Act]] (CDSA). Any person who seeks or obtains heroin without disclosing authorization 30 days prior to obtaining another prescription from a practitioner is guilty of an indictable offense and subject to imprisonment for a term not exceeding seven years. Possession of heroin for the purpose of trafficking is guilty of an indictable offense and subject to imprisonment for life.
In Hong Kong, heroin is regulated under Schedule 1 of [[Hong Kong|Hong Kong's]] Chapter 134 ''Dangerous Drugs Ordinance''. It is available by prescription. Anyone who supplies heroin without a valid prescription can be fined $10,000 ([[Hong Kong dollar|HKD]]). The penalty for trafficking or manufacturing heroin is a $5,000,000 (HKD) fine and life imprisonment. Possession of heroin without a license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.
In the [[United Kingdom]], heroin 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, heroin is often injected using a [[syringe driver]].
==Production and trafficking: The Golden Triangle==
[[Image:HeroinWorld.png|thumb|left|Primary worldwide producers of heroin.]]
===Manufacturing===
Heroin is produced for the black market by refining opium. The first step of this process involves isolation of [[morphine]] from opium. This crude morphine is then acetylated by heating with acetic anhydride. Purification of the obtained crude heroin and conversion to the hydrochloride salt results in a water-soluble form of the drug that is a white or yellowish powder.
Crude opium is carefully dissolved in hot water but the resulting hot soup is not boiled. Mechanical impurities - twigs - are scooped together with the foam. The mixture is then made alkaline by gradual addition of lime. Lime causes a number of unwelcome components present in opium to precipitate out of the solution. (The impurities include inactive alkaloids, resins, proteins). The precipitate is removed by filtration through a cloth, washed with additional water and discarded. The filtrates containing the water-soluble calcium salt of morphine (calcium morphinate) are then acidified by careful addition of [[ammonium chloride]]. This causes freebase morphine to precipitate. The morphine precipitate is collected by filtration and dried before the next step. The crude morphine (which makes only about 10% of the weight of opium) is then heated together with [[acetic anhydride]] at 85 °C (185 °F) for six hours. The reaction mixture is then cooled, diluted with water, made alkaline with sodium carbonate, and the precipitated crude heroin is filtered and washed with water. This crude water-insoluble freebase product (which by itself is usable, for smoking) is further purified and decolourised by dissolution in hot alcohol, filtration with activated charcoal and concentration of the filtrates. The concentrated solution is then acidified with hydrochloric acid, diluted with ether, and the precipitated heroin hydrochloride is collected by filtration. This precipitate is the so-called "no. 4 heroin", commonly known as "china white". Heroin freebase cut with a small amount of caffeine (to help vaporise it more efficiently), typically brown in appearance, is known as called "no. 3 heroin". These two forms of heroin are the standard products exported to the Western market. Heroin no. 3 predominates on the European market, where heroin no. 4 is relatively uncommon. Another form of heroin is "[[black tar heroin|black tar]]" which is common in the western United States and is produced in Mexico.
The initial stage of opium refining - the isolation of morphine - is relatively easy to perform in rudimentary settings - even by substituting suitable fertilizers for pure chemical reagents. However, the later steps (acetylation, purification, and conversion to the hydrochloride salt) are more involved - they use large quantities of chemicals and solvents and they require both skill and patience. The final step is particularly tricky as the highly flammable ether can easily ignite during positive-pressure filtration (the explosion of vapor-air mixture can obliterate the refinery). If the ether does ignite, the result is a catastrophic explosion.
===History of heroin traffic===
{{Original research|section|date=September 2007}}
The origins of the present international illegal heroin trade can be traced back to laws passed in many countries in the early 1900s 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 mid-1920s, 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 society|triad]] gangs eventually came to play a major role in the heroin trade.
Heroin trafficking was virtually eliminated in the U.S. during [[World War II]] due to temporary trade disruptions caused by the war. Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium. After the second world war, the Mafia took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily. The Mafia took advantage of Sicily's location along the historic route opium took from Iran{{Fact|date=July 2007}} westward into Europe and the United States. Large scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s. The elimination of Chinese production happened at the same time that Sicily's role in the trade developed.
Although it remained legal in some countries until after World War II, health risks, addiction, and widespread abuse led most western countries to declare heroin a controlled substance by the latter half of the 20th century.
Between the end of World War II and the 1970s, much of the opium consumed in the west was grown in [[Iran]]{{Fact|date=July 2007}}, but in the late 1960s, under pressure from the U.S. and the [[United Nations]], Iran{{Fact|date=July 2007}} engaged in anti-opium policies. While opium production never completely ended in Iran{{Fact|date=July 2007}}, the decline in production in those countries led to the development of a major new cultivation base in the so-called "[[Golden Triangle (Southeast Asia)|Golden Triangle]]" region in South East Asia. In 1970-71, high-grade heroin laboratories opened in the Golden Triangle. This changed the dynamics of the heroin trade by expanding and decentralizing the trade. Opium production also increased in Afghanistan due to the efforts of Turkey and Iran{{Fact|date=July 2007}} to reduce production in their respective countries. Lebanon, a traditional opium supplier, also increased its role in the trade during years of civil war.{{Fact|date=July 2007}}
Soviet-Afghan war led to increased production in the Pakistani-Afghani border regions. It increased international production of heroin at lower prices in the 1980s. The trade shifted away from Sicily in the late 1970s 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. All of this combined to greatly diminish the role of the country in the international heroin trade. {{Fact|date=July 2007}}
===Trafficking===
:''See also: [[Opium#Production Today|Opium production]]''
Traffic is heavy worldwide, with the biggest producer being Afghanistan.<ref>{{cite web
| last =Nazemroaya
| first =Mahdi Darius
| year =2006
| month =October 17
|url=http://www.globalresearch.ca/index.php?context=viewArticle&code=NAZ20061017&articleId=3516
|title=The War in Afghanistan: Drugs, Money Laundering and the Banking System
|publisher=GlobalResearch.ca
|accessdate=2006-10-22
}}</ref> According to U.N. sponsored survey,<ref>{{cite web
|url=http://www.unodc.org/pdf/afg/afghanistan_opium_survey_2004.pdf
|title=Afghanistan opium survey - 2004
|publisher=
|accessdate=2006-10-22
}}</ref> as of 2004, Afghanistan accounted for production of 87 percent of the world's heroin.<ref>{{cite web
| last =McGirk
| first =Tim
| year = 2004
| month =August 2
| url =http://www.time.com/time/asia/magazine/printout/0,13675,501040809-674806,00.html
| title =Terrorism's Harvest: How al-Qaeda is tapping into the opium trade to finance its operations and destabilize Afghanistan
| publisher =Time Magazine Asia
| accessdate =2006-10-22
}}</ref> Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War once again appeared as a facilitator of the trade.<ref>{{cite web
| last =Gall
| first =Carolotta
| year =2006
| month =September 3
| url =http://www.nytimes.com/2006/09/03/world/asia/03afghan.html?ex=1314936000&en=77aca21e09c8576e&ei=5088&partner=rssnyt&emc=rss
| title =Opium Harvest at Record Level in Afghanistan
| publisher =New York Times - Asia Pacific
| accessdate =2006-10-22
}}</ref>
At present, opium poppies are mostly grown in [[Afghanistan]], and in [[Southeast Asia]], especially in the region known as the Golden Triangle straddling [[Myanmar]], [[Thailand]], [[Vietnam]], [[Laos]] and [[Yunnan]] province in the [[People's Republic of China]]. There is also cultivation of opium poppies in the [[Sinaloa]] region of [[Mexico]] and in [[Colombia]]. The majority of the heroin consumed in the United States comes from Mexico and Colombia. Up until 2004, Pakistan was considered one of the biggest opium-growing countries. However, the efforts of Pakistan's [[Anti-Narcotics Force]] have since reduced the opium growing area by 59% [[as of 2001]]{{Fact|date=February 2007}}.
Conviction for trafficking in heroin carries the death penalty in most [[South-east Asia]] and some [[East Asia]] 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 [[Bali Nine|nine Australians in Bali]] or the hanging of an [[Australia]]n citizen [[Van Tuong Nguyen]] in Singapore, both in 2005.
[[Sandra Gregory]] has written an autobiography covering her experience of getting caught with Heroin at a Thai airport.
==Risks of non-medical use==
{{Refimprove|date=May 2007}}
[[Image:Heroincan.jpg|thumb|right|Heroin being cooked in an aluminum can]]
* For [[intravenous]] users of heroin (and any other substance), the use of non-sterile needles and syringes and other related equipment leads to several serious risks:
** the risk of contracting blood-borne [[pathogens]] such as [[HIV]] and [[hepatitis]]
** the risk of contracting bacterial or fungal [[endocarditis]] and possibly venous sclerosis
** [[abscesses]]
* Poisoning from [[contaminants]] added to "[[Cutting agent|cut]]" or dilute heroin
* Chronic [[constipation]]
* [[Addiction]] and increasing tolerance
* [[Physical dependence]] can result from prolonged use of all opioids, resulting in withdrawal symptoms on cessation of use
* Decreased kidney function (although it is not currently known if this is due to adulterants used in the cut)<ref>Dettmeyer RB, Preuss J, Wollersen H, Madea B. "Heroin-associated nephropathy." ''Expert Opinion on Drug Safety'' 2005 Jan;'''4'''(1):19-28. PMID 15709895. {{doi|10.1517/14740338.4.1.19}}</ref>
Many countries and local governments have begun funding programs that supply [[sterilization (microbiology)|sterile]] needles to people who inject illegal drugs in an attempt to reduce these contingent risks and especially the contraction and spread of blood-borne diseases. The Drug Policy Alliance reports that up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of drug use by injection. But despite the immediate [[public health]] benefit of [[needle-exchange programme|needle exchange]]s, some see such programs as tacit acceptance of illicit drug use. The United States federal government does not operate needle exchanges, although some state and local governments do support needle exchange programs.
A heroin [[overdose]] is usually treated with an opioid [[Receptor antagonist|antagonist]], such as [[naloxone]] ([[Narcan]]), or [[naltrexone]], which has high affinity for [[opioid receptors]] but does not activate them. This reverses the effects of heroin and other opioid agonists and causes an immediate return of consciousness and the beginning of [[withdrawal]] symptoms when administered intravenously. The [[half-life]] of [[naloxone]] is much shorter than that of most opioid agonists, so that antagonist typically has to be administered multiple times until the opiate has been metabolized by the body.
Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours due to anoxia because the breathing reflex is suppressed by µ-opioids. An overdose is immediately reversible with an [[opioid antagonist]] injection. Heroin overdoses can occur due to an unexpected increase in the dose or purity or due to diminished opiate tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other [[depressant]] drugs like alcohol or [[benzodiazepine]]s.<ref>{{cite journal | author=Shane Darke, Deborah Zador|title=Fatal Heroin 'Overdose': a Review|url=http://www.lindesmith.org/library/darke2.cfm|journal=[[Addiction (journal)|Addiction]]|year=1996|volume = 91|issue =12|pages= 1765–1772|doi=10.1111/j.1360-0443.1996.tb03800.x }}</ref> It should also be noted that since heroin can cause nausea and vomiting, a significant number of deaths attributed to heroin overdose are caused by aspiration of vomitus by an unconscious victim.
The [[LD50|LD<sub>50</sub>]] for a physically addicted person is prohibitively high,{{Fact|date=June 2007}} to the point that there is no medical consensus on where to place it. In fact, there is no upper limit to the amount of tolerance that can occur in a heavy user. Several studies done in the 1920s gave users doses of 1,600–1,800 mg of heroin, and no adverse effects were reported. Even for a non-user, the LD<sub>50</sub> can be placed above 350 mg{{Fact|date=June 2007}} though some sources give a figure of between 75 and 375 mg for a 75 kg person.<ref>[http://lincoln.pps.k12.or.us/lscheffler/ToxicSubstances%20in%20water.htm Toxic Substances in water<!-- Bot generated title -->]</ref>
Street heroin is of widely varying and unpredictable purity. 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 a dangerous 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.<ref>[http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm The "heroin overdose" mystery and other occupational hazards of addiction], Schaffer Library of Drug Policy</ref>
A final factor contributing to overdoses is [[Operant conditioning|place conditioning]]. Heroin use is a highly ritualized behavior. While the mechanism has yet to be clearly elucidated, longtime heroin users display increased tolerance to the drug in locations where they have repeatedly administered heroin. When the user injects in a different location, this environment-conditioned tolerance does not occur, resulting in a greater drug effect. The user's typical dose of the drug, in the face of decreased tolerance, becomes far too high and can be toxic, leading to overdose.<ref>{{cite journal|journal=Harm Reduct J. |year=2005 |volume=2 |issue=11 |doi=10.1186/1477-7517-2-11 |title=A case report: Pavlovian conditioning as a risk factor of heroin 'overdose' death| author=József Gerevich, Erika Bácskai, Lajos Farkas, and Zoltán Danics| url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1196296 |pages=11 |pmid=16042795}}</ref>
A small percentage of heroin smokers and occasionally IV users may develop symptoms of [[toxic leukoencephalopathy]]. The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon [[adulterant]] that is only active when heated.<ref>Hill MD, Cooper PW, Perry JR. [http://www.cmaj.ca/cgi/content/full/162/2/236 "Chasing the dragon--neurological toxicity associated with inhalation of heroin vapour: case report."] ''Canadian Medical Association Journal''. 2000 Jan 25;'''162'''(2):236-8. PMID 1067406</ref><ref>Halloran O, Ifthikharuddin S, Samkoff L. "Leukoencephalopathy from 'chasing the dragon.'" ''Neurology''. 2005 May 24;'''64'''(10):1755. PMID 15911804</ref><ref>Offiah C, Hall E. "Heroin-induced leukoencephalopathy: characterization using MRI, diffusion-weighted imaging, and MR spectroscopy." ''Clinical Radiology''. 2008 Feb;'''63'''(2):146-52. PMID 18194689</ref> Symptoms include slurred speech and difficulty walking.
==Harm reduction approaches to heroin==
Proponents of the [[harm reduction]] philosophy seek to minimize the harms that arise from the recreational use of heroin. Safer means of taking the drug, such as smoking or nasal, oral and rectal insertion, are encouraged, due to injection having higher risks of overdose, infections and blood-borne viruses.
Where the strength of the drug is unknown, users are encouraged to try a small amount first to gauge the strength, to 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 heroin on their own, as others can assist in the event of an overdose.
Heroin users who choose to inject should always use new needles, syringes, spoons/steri-cups and filters every time they inject and not share these with other users. Governments that support a harm reduction approach often run [[Needle-exchange programme|Needle & Syringe exchange programs]], which supply new needles and syringes on a confidential basis, as well as education on proper filtering prior to injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing heroin for injection may also be supplied including citric acid sachets/vitamin C sachets, steri-cups, filters, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop use of shoe laces or belts).
==Withdrawal==
[[Image:Heroin black tar.jpg|thumb|left|[[Black tar heroin]]]]
The withdrawal syndrome from heroin may begin within 6 to 24 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. Symptoms may include: [[sweating]], [[malaise]], [[anxiety]], [[clinical depression|depression]], [[priapism]], extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, [[yawning]], [[tears]], sleep difficulties ([[insomnia]]), cold sweats, chills, severe muscle and bone aches; nausea and [[vomiting]], [[diarrhea]], [[cramps]], and [[fever]].<ref>[http://www.med.umich.edu/1libr/aha/aha_subabu_bha.htm Adult Health Advisor 2005.4: Narcotic Drug Withdrawal<!-- Bot generated title -->]</ref> Many users also complain of a painful condition, the so-called "itchy blood", which often results in compulsive scratching that causes bruises and sometimes ruptures the skin, leaving scabs. Abrupt termination of heroin use often causes muscle spasms in the legs ([[restless leg syndrome]]); hence "kicking" has been used as a slang term for heroin withdrawal. Discontinuation of heroin can also cause [[goose bumps]], and this symptom is the basis for the expression "going cold turkey". The intensity of the withdrawal syndrome is variable depending on the dosage of the drug used and the frequency of use. Very severe withdrawal can be precipitated by administering an opioid antagonist to a heroin addict.
Three general approaches are available to ease the physical part of opioid withdrawal. The first is to substitute a longer-acting opioid such as [[methadone]] or [[buprenorphine]] for heroin or another short-acting opioid and then slowly taper the dose.
In the second approach, [[benzodiazepine]]s such as [[diazepam]] (Valium) may temporarily ease the anxiety, muscle spasms, and insomnia associated with opioid withdrawal. The most common benzodiazepine employed is [[oxazepam]] (Serax). The use of benzodiazepines must be carefully monitored because these drugs have abuse potential, and many opioid users also use other central nervous system [[depressants]], especially alcohol. Also, although extremely unpleasant, opioid withdrawal is seldom fatal, whereas complications related to withdrawal from benzodiazepines, [[barbiturates]] and alcohol (such as epileptic [[seizures]], [[cardiac arrest]], and [[delirium tremens]]) can prove hazardous and are potentially life-threatening.
Many symptoms of opioid withdrawal are due to rebound hyperactivity of the [[sympathetic nervous system]], which can be suppressed with [[clonidine]] (Catapres), a centrally-acting alpha-2 agonist primarily used to treat [[hypertension]]. Another drug sometimes used to relieve the "restless legs" symptom of withdrawal is [[baclofen]], a [[muscle relaxant]]. Diarrhea can likewise be treated with the peripherally active opioid drug [[loperamide]].
Methadone is another μ-opioid agonist most often used to substitute for heroin in treatment for heroin addiction. Compared to heroin, methadone is well (but slowly) absorbed by the gastrointestinal tract and has a much longer duration of action of approximately 24 hours. Thus [[methadone maintenance]] avoids the rapid cycling between [[intoxication]] and withdrawal associated with heroin addiction. In this way, methadone has shown success as a substitute for heroin; despite bearing about the same addiction potential as heroin, it is recommended for those who have repeatedly failed to complete withdrawal or have recently relapsed. Patients properly stabilized on methadone display few subjective effects to the drug (i.e., it does not make them "high"), and are unable to obtain a "high" from other opioids except with very high doses. Methadone, since it is longer-acting, produces withdrawal symptoms that appear later than with heroin, but usually last considerably longer and can in some cases be more intense. Methadone withdrawal symptoms can potentially persist for over a month, compared to heroin where significant physical symptoms subside within 4 days.
[[Buprenorphine]] is another opiate that was recently licensed for opioid substitution treatment. As a [[mu opioid receptor|μ-opioid receptor]] [[partial agonist]], patients develop a less tolerance to it than to heroin or methadone due to a "ceiling effect." Patients are unable to obtain a "high" from other opioids during buprenorphine treatment except with very high doses. It also has less severe withdrawal symptoms than heroin when discontinued abruptly, although the duration of the withdrawal syndrome is often longer than that seen with heroin. It is usually administered [[sublingual]]ly (dissolved under the tongue) every 24-48 hrs. Buprenorphine is also a [[kappa opioid receptor|κ opioid receptor]] antagonist, which led to speculation that the drug might have additional antidepressant effects; however, no significant difference was found in symptoms of depression between patients receiving buprenorphine and those receiving methadone.<ref>Dean AJ, Bell J, Christie MJ, Mattick RP. "Depressive symptoms during buprenorphine vs. methadone maintenance: findings from a randomised, controlled trial in opioid dependence." ''European Psychiatry''. 2004 Dec;'''19'''(8):510-3. PMID 15589713. {{doi|10.1016/j.eurpsy.2004.09.002}}</ref>
Researchers at [[Johns Hopkins University]] have been testing a sustained-release "depot" form of buprenorphine that can relieve cravings and withdrawal symptoms for up to six weeks.<ref>{{cite web
| last = Thomas| first = Josephine| year = May 2001
| url = http://www.nida.nih.gov/PDF/NNCollections/NNHeroin.pdf
| title = Buprenorphine Proves Effective, Expands Options For Treatment of Heroin Addiction
| format = PDF| work = NIDA Notes: Articles that address research on Heroin| pages = 23
| publisher = [[National Institute on Drug Abuse]]
| accessmonthday = May 5 | accessyear = 2006
}}</ref> A sustained-release formulation would allow for easier administration and adherence to treatment, and reduce the risk of diversion or misuse.
Three opioid [[antagonists]] are available: [[naloxone]] and the longer-acting [[naltrexone]] and [[nalmefene]]. These medications block the ability of heroin, as well as the other opioids to bind to the receptor site. Recent studies have suggested that the addition of naltrexone may improve the success rate in treatment programs when combined with the traditional therapy. {{Fact|date=February 2007}}
Scientists at the [[University of Chicago]] undertook preliminary development of a heroin vaccine in [[monkeys]] during the 1970s, but it was abandoned. There were two main reasons for this. Firstly, when immunized monkeys had an increase in dose of x16, their [[antibodies]] became [[saturation (chemistry)|saturated]] and the monkey had the same effect from heroin as non-immunized monkeys. Secondly, until they reached the x16 point immunized monkeys would substitute other drugs to get a heroin-like effect. These factors suggested that immunized human users would simply either take massive quantities of heroin, or switch to other drugs.
There is also a controversial treatment for heroin addiction based on an [[Iboga]]-derived African drug, [[ibogaine]]. Many people travel abroad for ibogaine treatments that generally interrupt substance use disorders for 3-6 months or more in up to 80% of patients.<ref> H.S. Lotsof. Ibogaine in the Treatment of Chemical Dependence Disorders: Clinical Perspectives. MAPS Bulletin 1995 V(3):19-26 </ref> Relapse may occur when the person returns home to their normal environment however, where drug seeking behavior may return in response to social and environmental cues.{{Fact|date=February 2007}} Ibogaine treatments are carried out in several countries including Mexico and Canada as well as, in South and Central America and Europe. Opioid withdrawal therapy is the most common use of ibogaine. Some patients find ibogaine therapy more effective when it is given several times over the course of a few months or years. A synthetic derivative of ibogaine, [[18-methoxycoronaridine]] was specifically designed to overcome cardiac and neurotoxic effects seen in some ibogaine research but, the drug has not yet found its way into clinical research..
== Heroin prescription ==
The UK Department of Health's Rolleston Committee report in 1926 established the British approach to [[heroin prescription]] to users, which was maintained for the next forty years: dealers were prosecuted, but doctors could prescribe heroin to users when withdrawing from it would cause harm or severe distress to the patient. This "policing and prescribing" policy effectively controlled the perceived heroin problem in the UK until 1959 when the number of heroinists doubled every sixteenth month during a period of ten years, 1959-1968. <ref>[http://www.rns.se/swedish-addiction.asp Nils Bejerot: The Swedish Addiction Epidemic in global perspective]</ref>. The failure changed the attitudes; in 1964 only specialized clinics and selected approved doctors were allowed to prescribe heroin to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone, until now only a small number of users in the UK are prescribed heroin.<ref>{{cite web
| last =Goldacre
| first =Ben
| year =1998
| url =http://www.badscience.net/?p=327
| title =Methadone and Heroin: An Exercise in Medical Scepticism
| accessdate =2006-12-18
}}</ref>
In 1994 Switzerland began a trial heroin maintenance program for users that had failed multiple withdrawal programs. The aim of this program is to maintain the health of the user in order to avoid medical problems stemming from the use of illicit street heroin. Reducing [[drug-related crime]] and preventing overdoses were two other goals. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000 based on the apparent success of the program. Participants are allowed to inject heroin in specially designed pharmacies for 15 Swiss Francs per dose.<ref>{{cite web
| last =Nadelmann
| first =Ethan
| year =1995
| month =July 10
| url =http://www.drugpolicy.org/library%5Ctlcnr.cfm
| title =Switzerland's Heroin Experiment
| publisher =Drug Policy Alliance
| accessdate =2006-10-22
}}</ref>
The success of the Swiss trials led German, Dutch,<ref>{{cite web
| year = 2005
| month =June 5
| url =http://news.bbc.co.uk/2/hi/health/4607233.stm
| title =Heroin prescription 'cuts costs'
| publisher =BBC News
| accessdate =2006-10-22
}}</ref> and Canadian<ref>{{cite web
| url =http://www.naomistudy.ca/
| title =About the study
| publisher =North American Opiate Medication Initiative
| accessdate =2006-10-22
}}</ref> cities to try out their own heroin prescription programs.<ref>{{cite web
| last =
| first =
| coauthors = Carlos Nordt, Rudolf Stabler
| year = 2006
| month ='''367''', 1830-4,
| url =http://www.cesda.net/downloads/lancet1.pdf
| title =Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis
| format =PDF
| publisher =The Lancet
| language =
| accessdate =2006-10-22
}}</ref> Some Australian cities (such as Sydney) have instituted legal heroin [[Safe injection site|supervised injecting centers]], in line with other wider [[harm minimization]] programs. Although heroin is decriminalized inside the injection room, the drug is not available by prescription, and remains illegal outside the injecting room. {{Fact|date=February 2007}}
==Drug interactions==
Opioids are strong [[central nervous system]] depressants, but regular users develop [[physiological tolerance]]. In combination with other central nervous system depressants, heroin may still kill even experienced users, particularly if their tolerance to the drug has reduced or the strength of their usual dose has increased.
[[Toxicology]] studies of heroin-related deaths reveal frequent involvement of other central nervous system depressants, including alcohol, benzodiazepines such as [[temazepam]] (Restoril; Normison), and, to a rising degree, methadone. Ironically, benzodiazepines are often used in the treatment of heroin addiction while they cause much more severe withdrawal symptoms.
[[Cocaine]] sometimes proves to be fatal when used in combination with heroin. Though "[[speedballs]]" (when injected) or "moonrocks" (when smoked) are a popular mix of the two drugs among users, combinations of [[stimulants]] and depressants can have unpredictable and sometimes fatal results. In the United States in early 2006, a rash of deaths was attributed to either a combination of [[fentanyl]] and heroin, or pure fentanyl masquerading as heroin particularly in the Detroit Metro Area; one news report refers to the combination as 'laced heroin', though this is likely a generic rather than a specific term.<ref>{{cite news
|first=Robin
|last=Brown
|title=Heroin's Hell
|publisher=[[The News Journal]]
|pages=A1,A12
|date=[[2006-05-04]]
}}</ref>
==Popular culture==
{{Trivia|date=July 2008}}
===Film & television===
The 1986 movie "[[Sid and Nancy]]", depicts the relationship and drug addiction shared between [[Sid Vicious]] and [[Nancy Spungen]].
The 1996 [[Danny Boyle]] film ''[[Trainspotting (film)|Trainspotting]]'', based on the book by [[Irvine Welsh]], depicts heroin users in the areas around [[Edinburgh]] in [[Scotland]]. Other movies that deal with heroin users include Quentin Tarantino's [[Pulp Fiction (film)|Pulp Fiction]] in which Vincent Vega played by [[John Travolta]] buys and consums heroin and another character nearly overdoses, the 1955 [[Frank Sinatra]] film ''[[The Man with the Golden Arm]]''; the 1969 film ''[[More (film)|More]]''; the 1971 [[Al Pacino]] film ''[[The Panic in Needle Park]]''; the 1981 true story ''[[Christiane F. - Wir Kinder vom Bahnhof Zoo (film)|Christiane F. - Wir Kinder vom Bahnhof Zoo]]''; ''[[The Basketball Diaries (film)|The Basketball Diaries]]'', based on the diary of author, poet, and musician [[Jim Carroll]] during his heroin addiction; the 1997 film ''[[Gridlock'd]]'' starring [[Tupac Shakur]] and [[Tim Roth]] as heroin users struggling to get into rehab; the 1998 television movie ''[[Gia]]'' about drug-addicted supermodel [[Gia Carangi]]; and the 2000 film ''[[Requiem for a Dream]]''. Throughout the third season of Fox's ''[[24 (TV series)|24]]'', the show's protagonist, ''[[Jack Bauer]]'', struggles with using heroin. In [[American Gangster (film)|American Gangster]] (2007), Denzel Washington portrays the 1970s drug kingpin, [[Frank Lucas]], who smuggled heroin on military transport flights from Vietnam for eventual distribution on the East Coast. In 2006, an American independent film ''[[Brick (film)|Brick]]'' centers on the main character (played by [[Joseph Gordon-Levitt]]) solving a mystery that involves heroin, and an Australian film ''[[Candy (2006 film)|Candy]]'' (starring [[Heath Ledger]]) depicts the life of a heroin addict. Also, in the Broadway musical ''[[Rent (musical)|Rent]]'' and the movie adaptation of ''[[Rent (film)|Rent]]'', two of the main characters, Mimi and Roger, were both once heroin addicts, Roger having come off a year of withdrawal the year prior to when the musical/movie takes place, and Mimi struggling to quit throughout the course of the story. In the movie Saw II one of the characters explains having a heroin addiction and why she is being tested to live (so to speak)
The 1989 miniseries [[Traffik]] is set in three countries (the UK, Germany, and Pakistan) and follows the lives of people in each country who all play different roles in the trafficking of heroin, from the UK politician who is trying to stem the flow of heroin into the UK (but whose daughter is addicted), the businessman and his wife who run a trafficking business in Germany, the Pakistan businessman who controls the shipping out of his country, and the farmers who grow the opium crops.
In 2000 the miniseries was adapted into the American film ''[[Traffic (2000 film)|Traffic]]'' with the setting shifted to America and Mexico and the focus moved from heroin to the cocaine trade.
In 2002, the HBO TV series [[The Wire]] featured the heroin addicts, dealers and narcotic police of Baltimore, Maryland. One character, by the street name of [[Bubbles (The Wire)|Bubbles]], accurately portrays many of the characteristics of heroin dependence.
In 2004, the TV show [[LOST]] featured a character who is a heroin addict named [[Charlie Pace]]. Charlie was a member of a fictional band named [[Drive Shaft]] before crashing on the island and it is revealed that he became addicted during his band's success. Charlie's addiction to heroin is a minor but prominent subplot throughout the first and second season of the series.
Award-winning photographer [[Jessica Dimmock]] published [http://mediastorm.org/0021.htm The Ninth Floor], a documentary (and book), telling the story of a group of young heroin addicts in New York City.
===Literature===
In 1922, [[UK|British]] [[occult]]ist [[Aleister Crowley]] wrote [[Diary of a Drug Fiend]].
[[Beat Generation]] author [[William S. Burroughs]] wrote about his experiences with heroin in numerous books, starting with the [[1953]] semi-[[autobiographical]] '''''[[Junkie (novel)|Junkie]]''''' (aka ''Junky'').
Before the film [[Trainspotting (film)]], there was Irvine Welsh's 1993 novel of the [[Trainspotting (novel)|same name]].
[[Allen Hoey]]'s 2006 novel, ''Chasing the Dragon,'' examines the use of heroin among jazz musicians in the 1950s.
A 2007 book entitled ''[[The Heroin Diaries]]'' by author and musician [[Nikki Sixx]] from [[Motley Crue]] and [[Sixx:A.M.]] chronicles his heroin addiction in his diary between the years 1986-1987, as well as his chronic extreme hedonism, attitudes, drug use and his inevitable route to dying and coming back to life.
===Music===
The well-known jazz artist [[Miles Davis]] was a heroin addict from about 1950 to 1954. [[John Lennon]] wrote the song "[[Cold Turkey]]" in [[1969]] about his and [[Yoko Ono]]'s attempts to get off the drug, which the pair started using after she suffered a miscarriage. [[David Bowie]]'s first single "[[Space Oddity]]" was seemingly about his experiences with heroin, as his 1980 single "[[Ashes to Ashes (song)|Ashes to Ashes]]" included the lines that refer to Major Tom as "''...a junkie/strung out on heaven's high/hitting an all-time low''".<ref name ="nuaa">{{cite web
| author = Matthew Bates
| title = Loaded - Great heroin songs of the rock era
| url = http://www.nuaa.org.au/nuaa/News/media/UN52/UN52-loaded_great_heroin_songs.pdf
| format = pdf
| pages = 26 - 27
| date = 2008-12
| accessdate = 2008-01-17
| language = English
}}</ref>
[[Alice in Chains]] frontman [[Layne Staley]] was also a well published Herion addict which killed him in April 2002. He wrote countless songs about his drug addict including the hit "Them Bones" as well as "God Smack," "Junkhead" and "Hate to Feel." These songs showed the bleak and helpless atmosphere of a drug addiction. He also was addicted to cocaine and used LSD and Marijuana.
[[The Rolling Stones]]' 1973 song "[[Coming Down Again]]" was written by [[Keith Richards]] about his experiences with heroin, as was "[[Before They Make Me Run]]". Mick Jagger wrote the song "[[Monkey Man (The Rolling Stones song)|Monkey Man]]", and with [[Marianne Faithfull]] wrote "[[Sister Morphine]]". The band's [[1971]] album ''[[Sticky Fingers]]'' featured a drug reference in every track.<ref name ="nuaa"/>
A number of songs by the [[Velvet Underground]] refer to heroin, including "[[I'm Waiting For The Man]]" and the aptly-named "[[Heroin (song)|Heroin]]". The [[Stranglers]]' single "[[Golden Brown]]", from the late 1970s, referred to a batch of brown heroin from [[Afghanistan]] that arrived in the UK around that time. Another UK band, [[The Only Ones]] released a one hit wonder, "[[Another Girl, Another Planet]]", in which every single line could be interpreted as a reference to a girl or heroin."<ref name ="nuaa" />
[[Bradley Nowell]] of [[Sublime (band)| Sublime]] wrote the song "[[Pool Shark (song)|Pool Shark]]", which deals with his Heroin addiction that he hated so much. But the song forshadows the late Singers fate because of the Drug.
[[Dee Dee Ramone]](nee Douglas Colvin) of the US [[Punk rock|punk]] band [[The Ramones]] used the drug and wrote the song "[[Chinese Rocks]]", though the rest of the band initially rejected the song as being too blatantly about drug use. [[The Heartbreakers]] performed the first and more famous version of the song. The songs "[[Mr. Brownstone]]" and "[[Bad Obsession]]" by [[Guns N' Roses]] also deal with heroin.
The [[Red Hot Chili Peppers]] have numerous drug refences in their music, most famously "[[Under the Bridge]]", a song about [[Anthony Kiedis]]'s experiences in the [[chicano]]-run areas of [[Los Angeles]] where he used to score. "[[Knock Me Down]]" was another Red Hot Chili Peppers song about heroin, this time about the band's first guitarist [[Hillel Slovak]] who died after overdosing on a mix of [[cocaine]] and heroin. The metal/rock band [[System of a Down]] wrote the song "[[She's Like Heroin]]". Also, [[Black Sabbath]] wrote a song, "[[Hand of Doom (song)|Hand of Doom]]", which talks about the negative effects of heroin.
The [[A Perfect Circle]] song "[[Weak and Powerless]]" is about heroin addiction, as is [[The Darkness]] song "Givin' Up" from their debut album ''[[Permission to Land]]''. Nikki Sixx also wrote a song about his heroin addiction, which is included on their 1987 album "Girls, Girls, Girls" titled "Dancing on Glass".<ref name ="nuaa"/>
American folksinger [[John Prine]] wrote the song [[Sam Stone (song)|Sam Stone]], which follows the title character's history from being prescribed [[morphine]] for a war wound to his eventual death from heroin addiction. It contains the very haunting line, "there's a hole in daddy's arm where all the money goes".
[[Ville Valo]], frontman of Finnish rock band [[HIM]], wrote "[[Killing Loneliness]]" about [[Brandon Novak|Brandon Novak's]] addiction to heroin. In an interview Valo stated that when he asked Novak why he used the drug, Novak replied "It was my way of 'Killing Loneliness'"
[[The London Suede]] recorded many songs about heroin, and drug culture in general. They have two different songs, ''Heroine'' (from [[Dog Man Star]]) and ''Heroin'' (b-side to the ''Attitude'' single), which refer to lead singer [[Brett Anderson]]'s addiction to the drug.
[[The Used]] song, "Let It Bleed" refers to frontman, Bert McCracken's heroin addiction before the band started. The song starts with "This poison's my intoxication, I broke the needle off in my skin". Another song by [[The Used]] that also refer McCracken's past addiction to crystal meth is Say Days Ago from their debut album [[The Used]].
Post-hardcore band [[Silverstein (band)|Silverstein]]'s song "My Heroine" tells the story of a drug addict, who finds that the high he gets from drugs quickly dies out and becomes panic and nausea. He personifies the drug as a beautiful woman, hence the double-entendre title.
80's pop superstar [[Boy George]] was caught up in using heroin which was highly publicized in the media. He also wrote and recorded a song of his experience with the drug titled "You Are My Heroin" in 1988.
[[Rozz Williams]]' final album before his suicide, ''[[The Whorse's Mouth]]'', dealt with his heroin addiction.<ref>{{cite web |url= http://www.allmusic.com/cg/amg.dll?p=amg&sql=11:3xfpxqq5ld0e~T1|title= Rozz Williams|accessdate=2008-04-11 |author= Ankeny, Jason|publisher= [[Allmusic]]}}</ref> [[Kill Hannah]]'s song "Lips Like Morphine" (from their [[Lips Like Morphine|album of the same name]]) refers to the lead singer's want of an addictive woman that will "knock" him out with one touch.
Many songs by singer song writer [[Elliott Smith]] such as "[[A Fond Farewell]]", and "[[King's Crossing]]" refer to his addiction with heroin.
[[Goldfrapp]] made the song [[Ride a White Horse]], which many claim refers to [[Alison Goldfrapp]]'s heroin usage.
==See also==
{{wiktionary}}
*[[Morphine]]
*[[Opioids]]
*[[Black Tar Heroin]]
*[[Cheese (recreational drug)|Cheese]] (recreational drug)
*[[Alphamethylfentanyl|China White]]
*[[HIV in Yunnan]]
*[[Drugs and prostitution]]
*[[Ibogaine]]
*[[Monoacetylmorphine]]
*[[Dipropanoylmorphine]]
*[[Diacetyldihydromorphine]]
*[[Recreational drug use]]
*[[Psychoactive drug]]
*[[The Great Binge]]
*[[Opium]]
*[[Polish heroin]]
*[[Opium poppy|Poppy]]
*[[Drug injection]]
*[[Illegal drug trade]]
*[[Illicit drug use in Australia]]
*[[Entomotoxicology]]
==References==
{{reflist|2}}
==Literature==
*''Diary Of A Drug Fiend'' by [[Aleister Crowley]] (1922)
*''Heroin'' (1998) ISBN 1-56838-153-0
*''Heroin Century'' (2002) ISBN 0-415-27899-6
*''This is Heroin'' (2002) ISBN 1-86074-424-9
*''The Heroin User's Handbook'' by [[Francis Moraes]] (paperback 2004) ISBN 1-55950-216-9
*''The Little Book of Heroin'' by Francis Moraes (paperback 2000) ISBN 0-914171-98-4
*''Heroin: A True Story of Addiction, Hope and Triumph'' by Julie O'Toole (paperback 2005) ISBN 1-905379-01-3
*''The Heroin Diaries: A Year in the Life of a Shattered Rockstar'' by Nikki Sixx (2007) ISBN 978-0743486-28-6
==External links==
{{Commons|Heroin}}
*[http://www.emcdda.europa.eu/index.cfm?fuseaction=public.Content&nnodeid=25483&sLanguageiso=EN EMCDDA drugs profiles: heroin (2007)]
*[http://www.geopium.org Geopium: Geopolitics of Illicit Drugs in Asia, especially opium and heroin production and trafficking in and around Afghanistan and Burma (Articles and maps and French and English)]
*[http://www.watton.org/drugsinfo/aboutheroin.shtml Drugs Factfile what you really need to know]
*[http://wired-vig.wired.com/wired/archive/13.04/bupe.html?pg=1&topic=bupe&topic_set= The mismanagement of methadone]
*[http://www.NAABT.org/ National Alliance of Advocates for Buprenorphine Treatment - non-profit education website for treatment of Heroin addiction]
*[http://www.nida.nih.gov/Infofacts/heroin.html NIDA InfoFacts on Heroin]
*[http://www.whitehousedrugpolicy.gov/drugfact/heroin/ ONDCP Drug Facts]
*[http://usinfo.state.gov/is/Archive_Index/Pakistans_Cultivation_of_Opium_Drops.html United States Department of State fact sheet: anti-narcotics efforts in Pakistan] - dated [[June 7]], [[2002]]
*[http://news.bbc.co.uk/1/hi/magazine/4647018.stm BBC Article entitled 'When Heroin Was Legal'. References to the United Kingdom and the United States]
*[http://www.saferinjecting.net/ Harm reduction strategies in relation to heroin and other illicit drugs]
*[http://historyofalcoholanddrugs.typepad.com/alcohol_and_drugs_history/heroin/index.html Heroin news page] - [[Alcohol and Drugs History Society]]
{{Opioids}}
{{Analgesics}}
[[Category:Opioids]]
[[Category:Heroin| ]]
[[Category:Prodrugs]]
[[Category:Genericized trademarks]]
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