Heroin

Heroin
Heroin - Heroine.svg
Heroin-from-xtal-horizontal-3D-balls.png
Clinical data
PronunciationHeroin: /ˈhɛrɪn/
Other namesDiacetylmorphine, acetomorphine, (dual) acetylated morphine, morphine diacetate, Diamorphine[1] (BAN UK)
AHFS/Drugs.comheroin
Dependence
liability
High[2]
Addiction
liability
High[3]
Routes of
administration
Intravenous, inhalation, transmucosal, by mouth, intranasal, rectal, intramuscular, subcutaneous, intrathecal
Drug classOpioid
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability<35% (by mouth), 44–61% (inhaled)[4]
Protein binding0% (morphine metabolite 35%)
Metabolismliver
Onset of actionWithin minutes[5]
Elimination half-life2–3 minutes[6]
Duration of action4 to 5 hours[7]
Excretion90% kidney as glucuronides, rest biliary
Identifiers
  • (5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol diacetate
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.008.380 Edit this at Wikidata
Chemical and physical data
FormulaC21H23NO5
Molar mass369.417 g·mol−1
3D model (JSmol)
  • InChI=1S/C21H23NO5/c1-11(23)25-16-6-4-13-10-15-14-5-7-17(26-12(2)24)20-21(14,8-9-22(15)3)18(13)19(16)27-20/h4-7,14-15,17,20H,8-10H2,1-3H3/t14-,15+,17-,20-,21-/m0/s1 checkY
  • Key:GVGLGOZIDCSQPN-PVHGPHFFSA-N checkY
  (verify)

Heroin, also known as diacetylmorphine and diamorphine among other names,[1] is an opioid used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt which is distinguished from black tar heroin, 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] Diamorphine 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]

It is typically injected, usually into a vein, but it can also be smoked, snorted, 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] Side effects of use by injection can include 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, with 950,000 using it in the last year.[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]

  1. ^ a b Sweetman, Sean C., ed. (2009). Martindale: the complete drug reference (36th ed.). London: Pharmaceutical Press. p. 42. ISBN 978-0-85369-840-1.
  2. ^ Bonewit-West, Kathy; Hunt, Sue A.; Applegate, Edith (2012). Today's Medical Assistant: Clinical and Administrative Procedures. Elsevier Health Sciences. p. 571. ISBN 9781455701506.
  3. ^ a b c d e f "Heroin". Drugs.com. 18 May 2014. Archived from the original on 19 October 2016. Retrieved 19 October 2016.
  4. ^ Rook EJ, van Ree JM, van den Brink W, Hillebrand MJ, Huitema AD, Hendriks VM, Beijnen JH (2006). "Pharmacokinetics and pharmacodynamics of high doses of pharmaceutically prepared heroin, by intravenous or by inhalation route in opioid-dependent patients". Basic Clin. Pharmacol. Toxicol. 98 (1): 86–96. doi:10.1111/j.1742-7843.2006.pto_233.x. PMID 16433897.
  5. ^ Riviello, Ralph J. (2010). Manual of forensic emergency medicine : a guide for clinicians. Sudbury, Mass.: Jones and Bartlett Publishers. p. 41. ISBN 978-0-7637-4462-5. Archived from the original on 18 March 2017. Retrieved 29 August 2017.
  6. ^ "Diamorphine Hydrochloride Injection 30 mg – Summary of Product Characteristics". electronic Medicines Compendium. ViroPharma Limited. 24 September 2013. Archived from the original on 30 March 2014. Retrieved 30 March 2014.
  7. ^ Field, John (2012). The Textbook of Emergency Cardiovascular Care and CPR. Lippincott Williams & Wilkins. p. 447. ISBN 978-1-4698-0162-9. Archived from the original on 10 September 2017.
  8. ^ Friedrichsdorf, SJ; Postier, A (2014). "Management of breakthrough pain in children with cancer". Journal of Pain Research. 7: 117–23. doi:10.2147/JPR.S58862. PMC 3953108. PMID 24639603.
  9. ^ National Collaborating Centre for Cancer, (UK) (May 2012). "Opioids in Palliative Care: Safe and Effective Prescribing of Strong Opioids for Pain in Palliative Care of Adults". PMID 23285502. Cite journal requires |journal= (help)
  10. ^ Uchtenhagen AA (March 2011). "Heroin maintenance treatment: from idea to research to practice" (PDF). Drug and Alcohol Review. 30 (2): 130–7. doi:10.1111/j.1465-3362.2010.00266.x. PMID 21375613.
  11. ^ "Diamorphine". SPS - Specialist Pharmacy Service.
  12. ^ a b c d e f g h i "DrugFacts—Heroin". National Institute on Drug Abuse. October 2014. Archived from the original on 19 October 2016. Retrieved 19 October 2016.
  13. ^ National Institutes on Drug Abuse (2014). Research Report Series: Heroin (PDF). National Institutes on Drug Abuse. p. 1. Archived (PDF) from the original on 30 December 2016. Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use…. Impure heroin is usually dissolved, diluted, and injected into veins, muscles, or under the skin.
  14. ^ a b c Crime, United Nations Office on Drugs and (May 2016). "Statistical tables" (PDF). World Drug Report 2016. Vienna, Austria. p. xii, 18, 32. ISBN 978-92-1-057862-2. Archived (PDF) from the original on 9 August 2016. Retrieved 1 August 2016.
  15. ^ "Information sheet on opioid overdose". WHO. August 2018. Archived from the original on 21 April 2019. Retrieved 10 December 2018.
  16. ^ GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  17. ^ a b World Drug Report 2017 Part 3 (PDF). United Nations. May 2017. pp. 14, 24. ISBN 978-92-1-148294-2. Archived (PDF) from the original on 27 July 2018. Retrieved 10 December 2018.
  18. ^ "What is the scope of heroin use in the United States?". National Institute on Drug Abuse. Archived from the original on 10 December 2018. Retrieved 10 December 2018.
  19. ^ Valencia, Marie (23 June 2016). "Record 29 million people drug-dependent worldwide; heroin use up sharply – UN report". United Nations Sustainable Development. Archived from the original on 14 April 2019. Retrieved 10 December 2018.
  20. ^ A Century of International Drug Control. United Nations Publications. 2010. p. 49. ISBN 9789211482454. Archived from the original on 10 September 2017.
  21. ^ "Yellow List: List of Narcotic Drugs Under International Control" (PDF). International Narcotics Control Board. December 2004. Archived from the original (PDF) on 10 May 2012. Retrieved 5 May 2006. Referring URL = "Archived copy". Archived from the original on 21 June 2006. Retrieved 21 June 2006.CS1 maint: archived copy as title (link)
  22. ^ Lyman, Michael D. (2013). Drugs in Society: Causes, Concepts, and Control. Routledge. p. 45. ISBN 9780124071674. Archived from the original on 10 September 2017.
  23. ^ CUT : a guide to adulterants, bulking agents and other contaminants found in illicit drugs. Cole, Claire., Liverpool John Moores University. Centre for Public Health. Liverpool: Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University. 2010. ISBN 978-1-907441-47-9. OCLC 650080999.CS1 maint: others (link)