Heroin

Heroin (medical name diamorphine) is one of a group of drugs called ’opiates’ which are derived from the opium poppy. Opium is the dried milk of the opium poppy. It contains morphine and codeine, both effective painkillers. Heroin is made from morphine and in its pure form is a white powder.

The main source of street heroin in the UK is the Golden Crescent countries of South West Asia, mainly Afghanistan, Iran and Pakistan. Today street heroin usually comes as an off white or brown powder.

For medical use heroin usually comes as a tablets or an injectable liquid. A number of synthetic opiates (called opioids) are also manufactured for medical use and have similar effects to heroin. These include dihydrocodeine (DF 118s), pethidine (often used in childbirth), Diconal, Palfium, Temgesic and methadone, a drug, which is often prescribed as a substitute drug in the treatment of heroin addiction.

Heroin can be smoked, snorted or prepared for injection. Opioids made for medical use usually come in tablet or injectable form and may be used for non-medical reasons, especially by heroin users who cannot get hold of heroin. Methadone is usually prescribed as syrup, which is drunk.

The UK Situation

The street price of heroin was £50 per gram at June 2005 (source: Druglink survey, Sept 2005), and 75 per cent of Europe’s heroin comes from Afghanistan, with UK-based Turkish groups behind 70 per cent of heroin in the UK. Heroin / morphine remain the top-ranking substance implicated in death in the UK.

Treatment and Prevention There are several schools of thought on treatment for heroin dependency ranging from abstinence to maintenance. The National Treatment Agency (NTA) formulates policy for treatment in England. As part of the national drug strategy their target is to double the numbers in treatment by 2008.

Methadone is the leading drug for substitute prescribing and can be used to maintain or detox. It has a reputation among users as being more difficult to detox from compared to heroin. From April 2001 Buprenorphine can also be prescribed by GPs. This is marketed under the trade names Subutex and may be useful when methadone is not the best choice, for example when a person is in the early stages of dependency.

Naltrexone implants can be used to block the effects of heroin as part of a treatment programme they are not yet licensed in the UK but are available from private practitioners.

Needle Exchange Needle exchanges are a pragmatic response to the rise in blood borne diseases such as HIV and hepatitis B/C. The first needle exchange opened around 1987. There is now 100% coverage across England with every PCT having at least one[5]. Injecting drug user’s hand in used needles and syringes in return for sterile injecting equipment.

Dihydrocodeine While methadone is the most frequently prescribed substitute for the management of heroin misuse, GPs seem to be increasing their prescribing of dihydrocodeine. Although not licensed for the management of drug dependence, dihydrocodeine is used by some practitioners to reduce the severity of withdrawal symptoms, usually at the end of a methadone reduction programme. However, the drug is also used in cases where the dispensing of oral methadone is inappropriate, for example when an user is going on holiday for a period longer than methadone storage will allow. The drug is usually dispensed in tablet form.

The Law

Heroin and other opiates are controlled under the Misuse of Drugs Act making it illegal to possess them or to supply them to other people without a prescription. Heroin is treated as a Class A drug where the maximum penalties are 7 years imprisonment and a fine for possession and life imprisonment and a fine for supply.

Morphine, opium, methadone, pethidine and Diconal are also Class A drugs under the Act. Codeine and dihydrocodeine (DF118) are Class B drugs and Temgesic and Distalgesic are Class C drugs.

Effects / Risks

Heroin and other opiates are sedative drugs that depress the nervous system. They slow down body functioning and are able to combat both physical and emotional pain. The effect is usually to give a feeling of warmth, relaxation and detachment with a lessening of anxiety. Effects start quickly and can last several hours but this varies with how much is taken and how the drug is taken.

Initial use can result in nausea and vomiting but these unpleasant reactions fade with regular use. With high doses sedation takes over and people become drowsy. Excessive doses can produce stupor and coma and even death from espiratory failure.

With regular use tolerance develops so that more is needed to get the same effect. Physical dependence can also result from regular use. Withdrawal after regular use can produce unpleasant flu like symptoms and may include aches, tremor, sweating and chills and muscular spasms. These fade after 7- 10 days but feelings of weakness and feeling ill may last longer. Whilst many people do successfully give up long-term heroin use, coming off and staying off heroin can be very difficult.

Fatal overdoses can happen, especially when users take their initial dose after a break during which tolerance has faded, or when opiate use is combined with use of other depressant drugs such as an alcohol, tranquillizers or other opiates. Many regular heroin users will use other opiates or depressant drugs when they cannot get hold of heroin.

It is often difficult to know exactly what is being taken because the purity of street heroin varies and it is often mixed with adulterants. Injecting increases these risks and also puts users at risk of a range of infections including hepatitis and HIV if injecting equipment is shared. The physical effects of long-term heroin use are rarely serious in themselves but may include chronic constipation, irregular periods for women and possibly pneumonia and decreased resistance to infection. This can be made worse by poor nutrition, self neglect and bad housing. Regular injectors may suffer more health problems including damaged veins, heart and lung disorders. Opiate use during pregnancy tends to result in smaller babies who may suffer withdrawal symptoms after birth. These can usually be managed with good medical care. Updated June 2006

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The source of above information is with the permission of DrugScope. For the direct link to this source click on: http://www.drugscope.org.uk/resources/drugsearch/drugsearchpages/heroin.htm