Treating Heroin Addiction

Heroin

Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”
In 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) had used heroin at least once in their lives. It is estimated that about 23 percent of individuals who use heroin become dependent on it.

Production and trafficking

Production

Diacetylmorphine is produced from acetylation of morphine derived from natural opium sources. Numerous mechanical and chemical means are used to purify the final product. The final products have a different appearance depending on purity and have different names.

Heroin grades

Heroin purity has been classified into four grades. No.4 is the purest form – white powder (salt) to be easily dissolved and injected. No.3 is "brown sugar" for smoking (base). No.1 and No.2 are unprocessed raw heroin (salt or base).

Trafficking

International drug routes

Traffic is heavy worldwide, with the biggest producer being Afghanistan. According to a U.N. sponsored survey, as of 2004^[update], Afghanistan accounted for production of 87 percent of the world's diacetylmorphine. Afghan opium kills around 100,000 people annually.
The cultivation of opium in Afghanistan reached its peak in 1999, when 350 square miles (910 km²) of poppies were sown. The following year the Taliban banned poppy cultivation, a move which cut production by 94 percent. By 2001 only 30 square miles (78 km²) of land were in use for growing opium poppies. A year later, after American and British troops had removed the Taliban and installed the interim government, the land under cultivation leapt back to 285 square miles (740 km²), with Afghanistan supplanting Burma to become the world's largest opium producer once more. Opium production in that country has increased rapidly since, reaching an all-time high in 2006.War in Afghanistan once again appeared as a facilitator of the trade. Some 3.3 million Afghans are involved in producing opium.
At present, opium poppies are mostly grown in Afghanistan, and in Southeast Asia, especially in the region known as the Golden Triangle straddling Burma, Thailand,Vietnam, Laos and Yunnan province in 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.

Trafficking history

Primary worldwide producers of heroin

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 gangs eventually came to play a major role in the illicit heroin trade. The FrenchConnection route started in the 1930s.
Heroin trafficking was virtually eliminated in the U.S. during World war II because of 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 World War II, 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 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 recreational use led most western countries to declare heroin a controlled substance by the latter half of the 20th century.
In late 1960s and early 1970s, the CIA supported anti-Communist Chinese Nationalists settled near the Sino-Burmese border and Hmong tribesmen in Laos. This helped the development of the Golden Triangle opium production region, which supplied about one-third of heroin consumed in US after the 1973 American withdrawal from Vietnam. As of 1999, Burma, the heartland of the Golden Triangle remained the second largest producer of heroin, after Afghanistan.
The Soviet-Afghan war led to increased production in the Pakistani-Afghan border regions, as U.S.-backed mujaheddin militants raised money for arms from selling opium, contributing heavily to the modern Golden Crescent creation. By 1980, 60% of heroin sold in the U.S. originated in Afghanistan.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.
 

From Poppy to Heroin: 

Step 1: Planting Opium Poppy

Opium poppies traditionally are white, but also come in a variety of colors such as red and purple. (Photo: AP)

Papaver somniferum, one of the few species of poppy that produces opium, is an annual plant with a growth cycle of 120 days. Farmers plant seeds, which range in color from white to yellow to brown and gray, in shallow holes. Within six weeks a cabbage-like plant emerges. It takes eight weeks for the poppy plant to grow about one to two feet. Each poppy has one long primary stem with secondary stems called tillers. As the plant continues to grow, a bud develops at the tip. After 90 days, the bud blossoms into a flower with four petals in a variety of colors. The petals fall away to reveal a green pod or ghozah that will continue to grow to the size of an egg. Inside the pod is the ovary that produces opium. Opium, which contains over 50 types of alkaloids including codeine and morphine, is only produced during the ten to 12 day period when the pod is ripening. Once the pod reaches maturity, the alkaloids in the opium are no longer made.
Sources: US Department of Justice, “Opium: A History” by Martin Booth, “Unholy Wars” by John Cooley

Photo: AP

Heroin Fact
In 1803, a German pharmacist, F.W. Sertürner isolated the main alkaloid of opium and named it morphine after Morpheus, the Greek god of dreams. Morphine was soon widely used for medical purposes in Europe and the U.S. But by the end of the century, addiction to the drug had become a problem. In 1898, while searching for a non-addictive substitute for morphine, Heinrick Dresser, working at the Bayer Laboratory in Germany, developed diacetylmorphine. Bayer marketed it under the brand name Heroin. The new drug, however, turned out to be up to ten times more potent than morphine.



Step 2: Harvesting Opium

A farmer scrapes off raw opium that has oozed out of the pod. (Photo: AP)

Since pods ripen at different stages, farmers must carefully examine each one to determine if it is ready for harvesting. Farmers typically begin to harvest opium about two weeks after the petals have fallen. While still on the stem, the farmer makes vertical incisions on two or three sides of the pod. The farmer must carefully cut the pod so that the cut is not too deep. Otherwise, the milky white sap, called sheera, will flow too quickly and drip to the ground. So that the opium will ooze out overnight onto the pod’s surface, incisions are made in the afternoon. The pods will continue to secrete opium for several days.
As the sap oxidizes, it turns brown and forms a resin called apeen or taryak that is collected the following morning. Yields of raw opium vary according to the size of the pod and the efficiency of the farmer. The average weight of raw opium collected per pod is 80 milligrams — about 15 to 20 kilograms per hectare of land. The raw opium, which does not spoil if it is stored in a cool, dry environment, is placed in a plastic bag, ready to be made into morphine base.
Sources: US Department of Justice, “Opium: A History” by Martin Booth, “Unholy Wars” by John Cooley

Photo: Itar-Tass

Heroin Facts
AAlthough heroin can be smoked or snorted, the most effective and common form of consumption is to inject it. Before an addict can inject heroin, it must be made into a solution. To dissolve the heroin, the addict mixes heroin in a large spoon with water. Lemon juice is sometimes added to help dissolve the heroin. The solution or cocktail is heated until it boils and is then drawn into a hypodermic needle. While still warm, the addict will inject it just below the skin, a process known as “skin-popping.” For more of a quick fix, the addict can also inject it into a vein, otherwise known as “mainlining.”

Step 3: Extracting Morphine

An Afghan farmer sells a bag of raw opium in an opium shop in Helmand province in western Afghanistan. (Photo: AP)

Raw opium, which has a strong odor that can be easily detected by customs officials, must be converted into morphine base before it can be transported out of the country. To create morphine base, the opium is added to boiling water. The raw opium dissolves into a clear brown liquid or “liquid opium.” Plant scrapings and other impurities float to the top to be scooped up. Slaked lime is then added to the liquid so that the morphine alkaloid reacts with the lime to form a solution. The solution is poured through a filter to remove any impurities, such as other alkaloids, that have sunk to the bottom. Concentrated ammonia is added to the solution and is then reheated. The morphine solidifies and settles at the bottom of the pot. A cloth is used to filter out the solid white chunks of morphine base. The morphine base, also known as “Heroin No. 1,” which makes up about 10 percent of the original quantity of raw opium, is wrapped into blocks and dried out in the sun. The blocks are now ready to be shipped to heroin laboratories.
Sources: US Department of Justice, “Opium: A History” by Martin Booth, “Unholy Wars” by John Cooley, National Institutes of Health, UNDCP

Photo: Reuters

Heroin Facts
When injected, heroin creates an instantaneous rush that lasts only a few seconds. Drowsiness ensues, followed by a sense of contentment and detachment from the world. Short-term side affects may include nausea, vomiting, and depressed respiration. Since tolerance quickly builds up, the user must increase the dose to create a high, eventually leading to addiction. Heroin addicts may inject up to four times a day and over time will experience weight loss and malnutrition from a decrease in appetite brought on by the drug. Heroin abuse can also lead to collapsed veins, abscesses, lung complications and miscarriages. Iran has the highest number of heroin addicts as a percentage of its population in the world.

 

Step 4: Morhpine to Heroin Base

Police officers in Tehran, Iran inspect a bag of Afghan-origin morphine among 1,114 kilograms of morphine seized from drug traffickers. (Photo: Reuters)

Converting morphine to heroin base, sometimes called “Heroin No. 2,” is more complicated than extracting morphine, but is still a simple process requiring commonly available industrial chemicals and no special tools. The process starts when a mixture of heroin base and acetic acid is heated at 85°C for two hours. During this time, the morphine dissolves. When cooking is completed, the mixture cools and the morphine and the acid chemically bond to form heroin. Next, water is added to the mixture to dissolve the heroin. Sodium carbonate — a common ingredient in soaps — is added to the heroin solution from which finally heroin base results. Depending on the quality of morphine, slightly more than one kilogram of heroin base is made for each kilogram of morphine. Heroin base is further processed into smoking heroin called “Heroin No. 3″ or “injectible heroin” called “Heroin No. 4.”
Sources: US Department of Justice, “Opium: A History” by Martin Booth, National Institutes of Health, UNDCP

Photo: AP

Heroin Facts

Since many heroin addicts inject the drug, they are at special risk for contracting HIV and other infectious diseases such as hepatitis B and C. Injection drug users can contract HIV by reusing contaminated syringes and needles or other drug paraphernalia by more than one person. Drug abuse by injection is the largest factor for the spread of HIV in many countries.In USA a study by the National Institutes of Health found that 27 percent of all injecting drug users are HIV-infected.

Step 5: Heroin Purification

Heroin No. 4 is suitable for injection. (Photo: CIA)

T To make smoking heroin or “Heroin No. 3,” the heroin base is mixed with hydrochloric acid and additives such as caffeine. The paste is stirred until it dries; often in lumps that must be crushed before packaged for sale. Gray or brown, “Heroin No. 3″ is also known as “brown sugar” thanks to its resemblance to unrefined sugar. Only 20 to 30 percent pure, “Heroin No. 3″ is unsuitable for injection. Heroin of purer quality is called “Heroin No. 4″ and is made by adding ether and hydrochloric acid to heroin base. A white powder heroin is the result. The heroin is filtered and dried and compressed into bricks with a heroin press. Heroin of this quality has a purity of 80 to 90 percent.
Sources: US Department of Justice, “Opium: A History” by Martin Booth, National Institutes of Health, Office of National Drug Control Policy

Photo: AP

Heroin Facts
Methadone, discovered by German scientists during World War II, has been used for more than 30 years to treat opiate addiction. Methadone is a synthetic painkiller that mimics the effects of heroin and is usually taken orally in the form of pills and liquid syrup. To reduce heroin withdrawal symptoms such as diarrhea, tremors, and goose bumps methadone is taken once a day under a doctor’s supervision. Unlike the quick rush of heroin, its effects are more gradually felt and can — and last up to 36 hours. Twenty percent of the estimated 810,000 heroin addicts in the U.S. receive methadone. Methadone treatment continues to be controversial since patients can develop an addiction to the methadone itself.

How Is Heroin Used?

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three routes of administration deliver the drug to the brain very rapidly, which contributes to its health risks and to its high risk for addiction, which is a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.

How Does Heroin Affect the Brain?

When it enters the brain, heroin is converted back into morphine, which binds to molecules on cells known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem, which controls automatic processes critical for life, such as blood pressure, arousal, and respiration. Heroin overdoses frequently involve a suppression of breathing, which can be fatal.
After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same.
Regular heroin use changes the functioning of the brain. One result is tolerance, in which more of the drug is needed to achieve the same intensity of effect. Another result is dependence, character-ized by the need to continue use of the drug to avoid withdrawal symptoms.

What Are the Other Health Effects of Heroin?

Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the user as well as from heroin’s effects on breathing.
In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.

Treating Heroin Addiction

A range of treatments including behavioral therapies and medications are effective at helping patients stop using heroin and return to stable and productive lives.
Medications include buprenorphine and methadone, both of which work by binding to the same cell receptors as heroin but more weakly, helping a person wean off the drug and reduce craving; and naltrexone, which blocks opioid receptors and prevents the drug from having an effect (patients sometimes have trouble complying with naltrexone treatment, but a new long-acting version given by injection in a doctor’s office may increase this treatment’s efficacy). Another drug called naloxone is sometimes used as an emergency treatment to counteract the effects of heroin overdose.

Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—can include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), and kicking movements (“kicking the habit”). Users also experience severe craving for the drug during withdrawal, which can precipitate continued abuse and/or relapse.
Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization. According to a recent study, treating opioid-addicted pregnant mothers with buprenorphine (a medication for opioid dependence) can reduce NAS symptoms in babies and shorten their hospital stays.


Reference:
http://www.pbs.org/wnet/wideangle/episodes/bitter-harvest/from-poppy-to-heroin/step-5-heroin-purification/3172/

http://www.drugabuse.gov/drugs-abuse/heroin.

http://www.influence.com-Office of National Drug Control Policy.

http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-drugs-chart.

Stephens, Richard (1991). The Street Addict Role: A Theory of Heroin Addiction. SUNY Press. p. 7.  
ISBN 9780791406199.

Brown, Peter. The Love You Make: An Insider's Story of The Beatles. McGraw-Hill, 1983. New American Library, 2002. 331.