OPIOIDS AS DRUGS OF ABUSE

1. OPIOIDS AS DRUGS OF ABUSE

2. Historical Perspectives • 1806-1914 Opiates widely abused • Typical addict was a 30-50-year-old white woman who functioned well as wife & mother • Many wounded soldiers in Crimean War and U.S. Civil War became addicted to morphine • Physicians routinely used opiates as drugs in treatment for many medical conditions • 1848 - hypodermic needle invented

3. Historical Perspectives • 1874 - Bayer Laboratories gives the brand name Heroin for their derivative of opium • 1898 - Heroin is marketed as a non-addictive substitute for codeine • 1914 -Casual non-medical use of opiates declared illegal • 1920’s - Heroin illegal for medical use • Becomes major source of revenue for criminal & militia organizations worldwide

4. Historical Perspectives • Between the wars, Heroin was primarily used by “people in the life” • Post WW II inexpensive Heroin leads to increased use in slum areas of large cities • 1961 - due to critical shortage prices tripled and adulteration of Heroin began • Vietnam brought Heroin abuse onto doorstep of most American communities • 1971 - Pentagon initiates “Golden Flow”

5. Opoid Effects • Medicinal: deaden pain, control coughing, stop diarrhea • Tissue tolerance occurs rapidly • Users often need 10 times their initial dose within a month of beginning regular use • Acute toxicity results in coma, respiratory failure, and pinpoint pupils • Elevated blood alcohol levels often present in Heroin overdose

7. Opoid Effects • Heroin users produce less testosterone and are often not interested in sex “Lots of times I don’t want to be bothered by anybody or anyone touching me, like my girlfriend. Like if she wants to hug me, kiss me, I just say, ‘Don’t touch me.’ 28-year-old heroin user • Men often suffer primary impotence as a direct result of presence of Heroin

8. Opoid Effects • Nausea and vomiting are a common reaction to Heroin injection “It hit me from the feet going up to the head. I was yelling at him to take the needle out and I was on the toilet seat. I mean, I hugged that toilet bowl for hours, vomiting.” 21-year-old Heroin user • Heroin addicts know a batch of their Heroin is good if it makes them vomit. “You don’t mind vomiting behind smack.”

9. Chronic Heroin Abuse • Heroin can be injected, snorted,smoked, or heated on foil and the fumes inhaled • There is no scientific evidence of long-term damage to any tissues or organ system solely from Heroin • Withdrawal signs begin about 4 hours after last use, putting addicts on a schedule of 3-4 injections a day, 7 days a week, 365 days a year - no vacations off

10. Chronic Heroin Abuse • Variability in purity of Heroin is a problem because of the possibility of overdose • Sharing needles spreads blood-borne diseases, e.g., serum hepatitis & HIV virus • A convenient site for injection is the left forearm (for right handed users) • Because of lack of sterility or even cleanliness, tetanus and abscesses at the site of injection are common

12. Chronic Heroin Abuse • The addict’s lack of money for, or interest in, food frequently results in malnutrition • Becoming addicted takes time, perhaps a week or more of persistent use, although it is possible within a weekend. • Clinical studies & street reports indicate the initial euphoria lessens over time in some people who soon only experience nausea & discomfort

13. Chronic Heroin Abuse • Cell death in the lungs, liver, kidneys, or brain results from additives which do not dissolve easily and clog the blood vessels as well as fragments of cotton used to strain the Heroin prior to injection • Chronic constipation • Spontaneous abortion • Collapsed veins

14. INTOXICATION • Signs of Heroin intoxication include • all muscles relaxed • walking gate is slowed • eyelids droop • head nods • voice muscles relax, speech slowed & slurred • pupils of eyes are pinpoint and non-reactive to light • Skin dries out and itching increases

15. Heroin Use in Manhattan Arrestees by Birthdate

16. Opoid Withdrawal • Withdrawal symptoms are rarely life-threatening • 6 hrs - craving for drugs, anxiety • 14 hrs - yawning, perspiration, running, nose, teary eyes • 16 hrs - above signs increased plus pupil dilation, goose bumps (‘cold turkey’), tremors, hot and cold flashes, aching bones and muscles, appetite loss

17. Opoid Withdrawal • 24 to 36 hrs - Increased intensity of the preceding plus insomnia; raised blood pressure; increased temperature, pulse rate, respiratory rate and depth; nausea; restlessness • 36 to 48 hrs - Increased intensity of all the preceding plus curling up in fetal position, kicking movements (‘kicking the habit’) vomiting, diarrhea, spontaneous orgasm or ejaculation, weight loss

18. Conclusion In 1972 Turkey, the major source of Heroin, banned all opium cultivation & production in return for $35 million from the U.S. By 1975, 80% or more of Heroin was from Mexico until we financed opium eradication there as well. Now, 50% is coming from Southwest Asia (Iran, Pakistan), with the rest coming from Southeast Asia & Mexico. Heroin trade is largely financing the very terrorist groups targeting U.S. citizens worldwide.