Uses Drugs of Abuse—Origins and Effects - Semisynthetic Narcotics

Semisynthetic narcotics are derived by altering chemicals contained in opium. The two most commonly produced are heroin and hydromorphone.

Heroin

Heroin was first synthesized from morphine in 1874 but was not used extensively until the Bayer Company of Germany first began commercial production in 1898. It was widely accepted as a painkiller for years, with the medical profession largely unaware of its potential for addiction. The Harrison Narcotic Act of 1914 established control of heroin in the United States.

Pure heroin, a bitter white powder, is usually dissolved and injected. Heroin found "on the street" may vary in color from white to dark brown depending on the amount of impurities left from the manufacturing process or the presence of additives, such as food coloring, cocoa, or brown sugar.

For many years, the typical "bag" (single dose) of street heroin weighed about 100 milligrams and frequently contained less than 10% actual heroin, with the remainder made up of sugar, starch, powdered milk, or quinine. By the 1990s, however, the national average of heroin purity ranged between 35 and 40%, according to the DEA. In 1997 the highest-purity heroin was reported in cities in the Northeast, such as Philadelphia (79.5%) and New York City (62.5%).

"Black tar" heroin is popular in the western United States. A crudely processed form of heroin, black tar is manufactured illegally in Mexico and derives its name from its sticky, dark brown or black appearance. According to USNoDrugs.com, black tar is often sold on the street in its tar-like state and can have purities ranging from 20 to 80%. It can be diluted with substances such as burnt cornstarch or converted into a powder. It is most commonly injected.

Until recently, heroin was usually injected—intravenously (the preferred method), subcutaneously ("skin popping"), or intramuscularly. The increased availability of high-purity heroin, however, meant that users could snort or smoke the drug, which contributed to an increase in heroin use. Snorting or smoking is more appealing to those users who fear contracting diseases like human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) and hepatitis through shared syringes; users who smoke or snort heroin also avoid the historical stigma attached to heroin use—the marks of the needle left on one's skin. Once hooked, however, many abusers who started by snorting or smoking the drug shift to intravenous use.

Because of the increased availability of heroin, the price of the drug dropped—in the 1990s street-level prices were generally $10 to $20 a bag, or even less, according to the National Institute on Drug Abuse (NIDA). The National Drug Intelligence Center, in its National Drug Threat Assessment 2005: Threat Matrix, put the 2005 street price of heroin at $10 per dose. Heroin use has increased in recent years, and officials believe the increase is primarily due to lower prices, greater availability, and higher purity.

SYMPTOMS AND RELATED PROBLEMS.

Symptoms and signs of heroin use include euphoria, drowsiness, respiratory depression, constricted pupils, and nausea. Withdrawal symptoms include watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills, sweating, nausea, diarrhea, muscle cramps, and insomnia. Elevations in blood pressure, pulse, respiratory rate, and temperature occur as withdrawal progresses. Because heroin abusers are often unaware of the actual strength of the drug and its true contents, they are at risk of overdose. Symptoms of overdose, which may result in death, include shallow breathing, clammy skin, convulsions, and coma. According to the Substance Abuse and Mental Health Services Administration, which is part of the U.S. Department of Health and Human Services, heroin is one of the most frequently reported drugs in drug-abuse deaths, either singly or in combination with cocaine and/or alcohol.

Sharing unsterilized needles with other addicts increases the risk of exposure to HIV, the virus that causes AIDS. The use of heroin, as well as the self-abusing lifestyle that often accompanies its use, may compromise the body's ability to withstand infection, compounding the devastating effects of HIV. As a result, drug abusers have become one of the fastest-growing groups of HIV sufferers in the United States.

Pregnant women addicted to heroin often give birth to addicted babies. These babies must go through painful withdrawal and may not develop normally. Some women give birth to children carrying HIV, some of whom will eventually develop AIDS. In addition, children born to addicted mothers are at greater risk of sudden infant death syndrome (SIDS), a disorder in which infants suddenly and inexplicably stop breathing and die.

Hydromorphone

Commonly called by the trade name Dilaudid, hydromorphone is the second-oldest semisynthetic narcotic painkiller. It is shorter-acting, more sedating, and two to eight times more intense than morphine. Easily abused, it is sought after by addicts—usually through theft or fraudulent prescriptions. Hydromorphone tablets, which are stronger than liquid forms of the drug, may be dissolved and injected.