How many times does something need to happen before we as a culture do what is necessary to stop it from happening again? With heroin, it seems that we never do what needs to be done, and never seem to learn our lesson. An estimated 13.5 million people in the world take opioids (opium-like substances), including 9.2 million who use heroin. In 2007, 93% of the world’s opium supply came from Afghanistan. (Opium is the raw material for heroin supply.) Its total export value was about $4 billion, of which almost three quarters went to traffickers. About a quarter went to Afghan opium farmers. The 2007 National Survey on Drug Use and Health reported 153,000 current heroin users in the US. Other estimates give figures as high as 900,000.
In 2014, just 7 years later, an estimated 9.2 million people reportedly use heroin. It is also estimated that over 13.5 million people take opioids or opium-like products too. Opiates, mainly heroin, were involved in four of every five drug-related deaths in Europe, according to a 2008 report from the European Monitoring Centre on Drugs and Drug Addiction. Opiates, mainly heroin, account for 20% of the admissions for drug and alcohol treatment in the US.
So how did we get here? Opiates were popular in the United States throughout the 19th century, particularly among women. Tonics and elixirs containing opium were readily available in drugstores, and doctors commonly prescribed opiates for upper and middle class women suffering from neurasthenia and other “female problems.” Chinese laborers who came to work on US railroads in the 1850s and 1860s brought with them the practice of opium smoking. While a San Francisco city ordinance passed in 1875 banned smoking opium within city limits, by the turn of the century opium dens were commonplace throughout the nation. In the 1890s, tabloids owned by William Randolph Hearst published stories of white women being seduced by Chinese men and their opium to invoke fear of the “Yellow Peril.”
Additionally, the synthesis of morphine by Friedrich Sertuerner of Germany in 1803 led physicians to label the drug as “God’s own medicine” for its reliability, long-lasting effects, and safety. The mid-nineteenth century invention of the hypodermic syringe and the use of injectable morphine as a pain reliever during the American Civil War led to the first wave of morphine addiction. In 1895, Heinrich Dreser, working for the Bayer Company in Germany, synthesized heroin. Bayer began to market the drug in 1898. In the early 1900s heroin provided a potential solution to the increasing problem of morphine addiction. Also, the philanthropic St. James Society mounted a campaign to mail free samples of heroin to morphine addicts. However, heroin addiction grew, particularly in northern industrial slums.
In the second major wave of American opiate addiction, heroin was integrated into the new cultural identity of the “hipster” first through the Harlem jazz scene in the 1930s and 1940s. Then, the Beatnik subculture of the 1950s continued to integrate opiates into the hipster movement. During this period, the major supply of heroin entering the US came through the “French Connection” – a collaboration between Corsican gangsters in Marseille and the Sicilian Mafia. In April 1971, Congressman Robert Steele (R-CT) investigated reports of rampant heroin abuse among US servicemen in Vietnam. His fact-finding mission estimated an addiction rate of 10 to 15%. This alarming statistic, combined with emerging evidence linking heroin addiction to crime, pushed the heroin problem to the front of Nixon’s drug policy agenda.
Improvements in purity of street heroin in the 1980s and 1990s led to the potential of the drug being effectively smoked and snorted. Usage of heroin increased significantly in the 1990s. Historically the majority of the drug entered the US through the French Connection or the Golden Triangle of South-east Asia (Burma, Thailand, Laos). However since 1993 South American drug organizations have been expanding from the cocaine market into the heroin market.
And now here we are. It’s 2017, and heroin use remains more rampant than ever. It’s not a “urban” drug, it’s in middle class suburban homes around the globe. But now, the drug dealer is the pharmacist. It starts in your medicine cabinet, and once you’re hooked, it grows into a full blown addiction that wills you into losing everything you have to quell the craving for it. So, in a world where we are more connected than ever, how do we learn the lesson and stop this from happening to someone we love, or unfortunately for some, someone else we love?
Let’s start by educating ourselves about heroin. Smack, horse, mud, brown sugar, junk, black tar, big H, dope, skag, dreck, mojo, white lady, brown. Users report feeling a rush of pleasure, accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. They then sink into a dreamy, pleasant, drowsy state in which they have little sensitivity to pain. Other effects included slowed and slurred speech, slow gait, dilated pupils, droopy eyelids, vomiting, as well as constipation. Heroin is a white to dark brown powder or tar-like substance. It is a highly addictive drug obtained by chemically altering morphine, a major constituent of the poppy seed pod.
Heroin is a “downer” that affects the brain’s pleasure systems and interferes with the brain’s ability to perceive pain. Heroin can be used in a variety of ways, depending on user preference and the purity of the drug. Heroin can be:
Heroin causes a pleasant, drowsy state, in which all cares are forgotten and there is a decreased sense of pain (analgesia). Immediately after injection, the feelings are most in- tense and described like a sexual orgasm. After that, the sexual feelings diminish and there is a decreased sexual desire and performance. Breathing slows, pupils are constricted and many users experience nausea and perhaps even vomit. Opiates also create tension in certain muscles in the gastrointestinal tract so much that the normal propulsive movements that move food along cannot operate effectively, hence their ability to cause constipation. Through a similar action, they can also cause difficulties in urination.
Heroin is derived from poppy seeds. Importantly, the poppy plant evolved to match the biology of their predator/pollinators by developing opium alkaloid. These alkaloids are a compound that acts on a class of neurotransmitter receptors in the brain of mammals. Opiates act by binding to specific receptor molecules for the endorphin/enkephalin class of neurotransmittors in the brain. These are among the neurotransmittors that control movement, moods, and physiology. Heroin enters the brain more rapidly than other opiates but is then converted back to morphine once inside. Taking heroin is like all the endogenous opioid neurons firing at once.
Long-term effects of heroin appear after repeated use for some period of time. Typically, chronic users potentially develop collapsed veins, infection of the heart lining and valves, abscesses, cellulites, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heron’s depressing effects on respiration. In addition to the effects of the drug itself, street heroin may have additives that do not really dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.
With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped. Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces certain symptoms, such as:
Major withdrawal symptoms peak between 48 and 72 hours after the last use and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.
Project Courage is committed to educating our clients, their families, and our communities so they have the ability to make informed decisions regarding their health and care. If you or someone you know has any questions and/or needs help, please know we are always available at Project Courage and by phone at 860.744.9878. Call us, we can help.