Morphine & Heroin Opium, Morphine and Heroin Opium - the first Painkiller Opium is obtained from the opium poppy (papaver somniferum) by scraping the unripe seed capsule, and then collecting and drying the rubbery exudate. The name opium comes from the Greek opion, or poppy juice. It is important as a painkilling drug in its own right, but it is also the source of other analgesic drugs such as morphine and heroin . The opium poppy, papaver somniferum The seed pod, showing the exudate Mankind had discovered the use of opium by the time of the earliest written records. In fact, the first recorded use of opium as a painkiller was around 6000 years ago by the Sumerians, and Babylonian and Egyptian writings contain many references to the value of opium preparations for the relief of pain. Later on, in Eurasia there emerged a legend that Buddha cut off his eyelids in order to prevent sleep overtaking him, and where they fell there grew a herb which bore a nodding violet flower which was to give sleep and tortured dreams to all mankind.

Thomas Sydenham, the 17th-century pioneer of English medicine wrote: "Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium". Nowadays, although opium is no longer regarded as a universal analgesic, it is still very important as the source of morphine, the drug that is still the most commonly prescribed by physicians for the relief of severe pain. Morphine - the first alkaloid Raw opium contains some 20 alkaloid substances, one of which is morphine , in a typical yield of 10%. Morphine was first isolated in 1805 by Friedrich Sertürner, an apothecary's assistant in Paderborn, Germany, however its basic structure was not correctly determined until 120 years later. In the 1800s morphine (known then as laudanum) was a popular panacea and was available from grocers and markets. Later on its addictive qualities led to its use and availability being severely restricted.

Morphine is isolated from opium in large quantities (over 1000 tons per year), although most commercial opium is converted into codeine by methylation. Morphine acts as an anesthetic without decreasing consciousness, and it is one of the most powerful analgesics known. However it also suppresses the respiratory system, and high doses can cause death by respiratory failure. Its analgesic properties are related to the ability of the molecule to fit into and block a specific receptor site on a nerve cell. This eliminates the action of the pain receptor, preventing the pain signals reaching the brain. This is similar to the way in which the body's natural painkillers (endorphins and enkaphalins) work. The shape of the morphine molecule is crucial to its ability to exactly fit into the active site on the receptor - the 'lock-and-key' mechanism. The benzene group of the morphine molecule fits snugly against a flat section of the receptor protein, whilst the bent neighbouring group of carbon atoms fits into a nearby groove. This allows the positively charged nitrogen atom to attach to a negatively-charged group on the receptor, so locking the two molecules together.

Morphine blocks deep aching pain, but has no effect on the fast pain that results from injury. One side effect of the analgesic action is that the patient often gets a feeling of detachment from the world, along with euphoria and sometimes pleasure. It is this which makes morphine, and the other drugs related to it (such as heroin), attractive to those who want to use drugs for 'recreational' reasons. However all of these drugs are highly addictive, and the body rapidly gets acclimatised to their use, such that increasingly large dosages are required for the same effect. Morphine - replacing the -OH group shown in red with -OCH3 produces codeine . Replacing the both the red and blue -OH groups with OCOCH3 produces heroin. Codeine - the methoxy addition is shown in red. Pethidine - the parts of the molecule resembling the morphine structure are shown in red. The isolation of morphine was the beginning of alkaloid chemistry, which has yielded many important medicinal substances. Although a satisfactory theory of analgesic structure or action still eludes us, experimenters have developed a number of synthetic analgesics related to morphine.

The oldest is pethidine (also known as meperidine, Demerol and about 40 other names). It was synthesised in 1939 by the German chemist Otto Eisleb. It is less potent than morphine, but is still widely used for the relief of post-operative pain. By replacing one of the -OH groups with a methoxy group, morphine is converted into codeine , another powerful painkiller. When mixed with paracetamol it goes by the trade name Tylenol. When ingested, the -OCH3 group is converted back to -OH, regenerating morphine. Heroin The most notorious derivative of morphine is heroin . It is synthesised by acetylation of the two hydroxyl groups of morphine with acetyl chloride, hence its other names, diacetylmorphine or diamorphine. Heroin was first isolated from morphine in 1874 and was originally used as a 'safe' (i.e. non addictive) cure from morphine addiction. This was later found to be incorrect and in the 1900s heroin abuse and addiction became common.

Heroin was first restricted in the UK in 1868 due to 'unprofitable diversion of workers' and an international ban followed after the first world war. It is now classified as a Class A drug and possession or trading in it results in heavy penalties in most countries. Heroin The -OCOCH3 groups that replaced the -OH groups in morphine are shown in red. Replacing the hydrogen-bonding -OH groups with -OCOCH3 makes heroin much less soluble in water than morphine, but more soluble in non-polar solvents, like oils and fats. Therefore heroin has to be injected directly into the bloodstream, but once there it can pass rapidly through the blood-brain barrier which normally prevents the passage of water-soluble and large molecules. As a result it is much more potent than morphine, but its effect does not last as long. Again, once the heroin molecule is absorbed into the body, the acetyl groups are removed, reforming morphine.

Methadone Methadone hydrochloride is an opioid (a completely synthetic molecule), as opposed to an opiate, which is the name given to drugs which derive directly or indirectly from the opium poppy, such as morphine and heroin. It was originally synthesised by the German pharmaceutical company Axis during the second world war. It was first marketed as 'Dolophine' (to honour Adolph Hitler) and was used as an analgesic for the treatment of severe pain. It is still occasionally used for pain relief, although it is more widely used now as a substitute drug for people addicted to opiates (primarily heroin). Methadone - the parts of the molecule resembling the morphine structure are shown in red. Levorphan and Dextrorphan The fact that painkilling activity depends greatly upon the exact geometry of the molecule is strikingly illustrated by the drugs levorphan and dextrorphan. They are very similar in structure to morphine, except that they are both mirror images of one another. The left-handed molecule, levorphan, is several times more potent than morphine and is strongly addicting.

But the right-handed molecule, dextrorphan, has no analgesic ability and is non-addicting. This is also true for morphine, which is naturally left-handed. There is no naturally occurring right-handed form of morphine, but the Japanese chemist Kakuji Goto has synthesised it and found that it possesses none of morphine's biological properties. Heroin | Psychology Wiki | Fandom powered by Wikia Routes of administration Inhalation, Transmucosal, Intravenous, Oral, Intranasal, Rectal, Intramuscular Heroin ( INN : diacetylmorphine, BAN : diamorphine) is a semi-synthetic opioid synthesized from morphine , a derivative of the opium poppy . It is the 3,6- diacetyl ester of morphine (hence diacetylmorphine). The white crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride, however heroin freebase may also appear as a white powder. As with other opioids , heroin is used as both a pain-killer and a recreational drug . Frequent and regular administration can cause tolerance and a moderate physical dependence to develop.

A severe psychological dependence often develops in heroin abusers and as such, heroin has a very high potential for addiction See heroine addiction . Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs . [1] It is illegal to manufacture, possess, or sell heroin in Belgium , Denmark , Germany , Iran , India , the Netherlands , the United States , Australia , Canada , Ireland , Pakistan , the United Kingdom and Swaziland . However, under the name diamorphine, heroin is a legally prescribed Controlled Drug in the United Kingdom. In the Netherlands, heroin is available for prescription as the generic drug diacetylmorphine to long-term heroin addicts. Popular street names for heroin include black tar , skag, horse, smack,Junk, chieva, gear, Evil, "H", "Boy", "Big Boy", "dog food,'baby powder' 'brownstone'" and others. Contents Old advertisement for Bayer Heroin. Bayer Heroin bottle. The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BC.

[2] The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two alkaloids , codeine and morphine . Heroin was first synthesized in 1874 by C. R. Alder Wright, an English chemist working at St. Mary's Hospital Medical School in London, England. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride over a stove for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine. The compound was sent to F. M. Pierce of Owens College in Manchester for analysis, who reported the following to Wright: Doses ... were subcutaneously injected into young dogs and rabbits ... with the following general results ... great prostration, fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis. Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular.

Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4° (rectal failure). [3] Wright's invention, however, did not lead to any further developments, and heroin only became popular after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann . Hoffmann, working at the Bayer pharmaceutical company in Elberfeld, Germany , was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing codeine , a constituent of the opium poppy, similar to morphine pharmacologically but less potent and less addictive. But instead of producing codeine, the experiment produced an acetylated form of morphine that was 1.5-2 times more potent than morphine itself. Bayer would name the substance "heroin", probably from the word heroisch, German for heroic, because in field studies people using the medicine felt "heroic". [4] From 1898 through to 1910, heroin was marketed as a non-addictive morphine substitute and cough suppressant.

Bayer marketed heroin as a cure for morphine addiction before it was discovered that it is rapidly metabolized into morphine, and as such, "heroin" was essentially a quicker acting form of morphine. The company was embarrassed by this new finding and it became a historical blunder for Bayer. [5] As with aspirin , Bayer lost some of its trademark rights to heroin under the 1919 Treaty of Versailles following the German defeat in World War I . [6] In the U.S.A. the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of heroin and other opioids. The law did allow heroin to be prescribed and sold for medical purposes. In 1924, the United States Congress passed additional legislation banning the sale, importation or manufacture of heroin in the United States. It is now a Schedule I substance , and is thus illegal in the United States. Pharmacology Edit When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation , making it a prodrug for the systemic delivery of morphine.

[7] When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood-brain barrier due to the presence of the acetyl groups, which render it much more lipid-soluble than morphine itself. [8] Once in the brain, it then is deacetylated into 6- monoacetylmorphine (6-MAM) and morphine which bind to μ-opioid receptors , resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor. [9] Unlike hydromorphone and oxymorphone, however, administered intravenously, heroin creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective "body high" to some, but also instances of pruritus (itching)when they first start using . [10] Both morphine and 6-MAM are μ-opioid agonists which bind to receptors present throughout the brain , spinal cord and gut of all mammals .

The μ-opioid receptor also binds endogenous opioid peptides such as β-endorphin , Leu-enkephalin , and Met-enkephalin . Repeated use of heroin results in a number of physiological changes, including decreases in the number of μ-opioid receptors. [ How to reference and link to summary or text ] These physiological alterations lead to tolerance and dependence, so that cessation of heroin use results in a set of extremely uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called the opioid withdrawal syndrome. Depending on usage it has an onset 4 to 24 hours after the last dose of heroin. Morphine also binds to δ - and κ -opioid receptors. There is also evidence that 6-MAM binds to a subtype of μ-opioid receptors which are also activated by the morphine metabolite morphine-6β-glucuronide but not morphine itself. [11] The contribution of these receptors to the overall pharmacology of heroin remains unknown. Usage and effects File:Diamorphine ampoules.JPG Heroin is used as a recreational drug for the profound relaxation and intense euphoria it produces, although the latter effect diminishes with increased tolerance .

Its popularity with recreational drug users, compared to morphine , reportedly stems from its perceived different effects. [14] In particular, users report an intense "rush" that occurs while the heroin is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Any intravenous opioid will induce rapid, profound effects, but heroin produces more euphoria than other opioids upon injection. One possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin. While other opioids of abuse, such as codeine, produce only morphine, heroin also leaves 6-MAM, also a psycho- active metabolite . However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other. Equipotent, injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness. [15] Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine.

When compared to the opioids hydromorphone , fentanyl , oxycodone , and pethidine / meperidine , former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to abuse and addiction. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids. [15] One of the most common methods of illicit heroin use is via intravenous injection (colloquially termed "shooting up"). Recreational users may also administer the drug by snorting , or smoking by inhaling its vapors when heated, i.e. " chasing the dragon ." The onset of heroin's effects depends upon the route of administration . Orally, since heroin is completely metabolized in vivo to morphine before crossing the blood-brain barrier the effects are the same as with oral morphine. Snorting results in an onset within 3 to 5 minutes; smoking results in an almost immediate effect that builds in intensity; intravenous injection induces a rush and euphoria usually taking effect within 30 seconds; intramuscular and subcutaneous injection take effect within 3 to 5 minutes.

The heroin dose used for recreational purposes depends strongly on the frequency of use. A first-time user typically ingests between 5 and 20 mg of heroin, but an individual who is heavily dependent on the drug may require several hundred mg per day. [16] Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer Dr Harold Shipman used it on his victims as did Dr John Bodkin Adams ( see his victim, Edith Alice Morrell ). Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin death was an accident, suicide or murder. Examples include the overdose deaths of Sid Vicious , Janis Joplin , Tim Buckley , Layne Staley , Bradley Nowell , Jim Morrison , and Ted Binion . [17] Medical use Edit Diamorphine is used as a strong analgesic in the United Kingdom , where it is given via subcutaneous , intramuscular or intravenous route. Its use includes acute pain, such as in severe trauma , myocardial infarction , and following surgery, and chronic pain, including in cancer .

In other countries it is more common to use morphine or other strong opioids in these situations. In 2005, there was a shortage of diamorphine in the UK, due to a problem at the main UK manufacturers. [18] Due to this, many hospitals changed to using morphine instead of diamorphine. Although there is no longer a problem with its manufacture, many hospitals have continued to use morphine. Diamorphine is continued to be widely used in palliative care in the United Kingdom , where it is commonly given by the subcutaneous route, often via a syringe driver , if patients could not easily swallow oral morphine solution . The advantage of diamorphine over morphine is that diamorphine is more soluble and smaller volumes of diamorphine are needed for the same analgesic effect. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care . The medical use of diamorphine (in common with other strong opioids such as morphine , fentanyl and oxycodone ) is controlled in the United Kingdom by the Misuse of Drugs Act 1971 .

It is a schedule 2 controlled drug , and registers of its use are required to be kept in hospitals, and prescriptions for its use must be written with the form and strength of the preparation, and quantity stated in both words and figures. Regulation Unverifiable material may be challenged and removed . This article has been tagged since August 2008. In the Netherlands , diamorphine (heroin) is a List I drug of the Opium Law . It is available for prescription under tight regulation to long-term heroin addicts for whom methadone maintenance treatment has failed. Heroin is exclusively available for prescription to long-term heroin addicts, and cannot be used to treat severe pain or other illnesses. In the United States, heroin is a schedule I drug according to the Controlled Substances Act of 1970, making it illegal to possess without a DEA license. Possession of more than 100 grams of heroin or a mixture containing heroin is punishable with a minimum mandatory sentence of 5 years of imprisonment in a federal prison. In Canada, heroin is a controlled substance under Schedule I of the Controlled Drugs and Substances Act (CDSA).

Any person who seeks or obtains heroin without disclosing authorization 30 days prior to obtaining another prescription from a practitioner is guilty of an indictable offense and subject to imprisonment for a term not exceeding seven years. Possession of heroin for the purpose of trafficking is guilty of an indictable offense and subject to imprisonment for life. In Hong Kong, heroin is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It is available by prescription. Anyone who supplies heroin without a valid prescription can be fined $10,000 ( HKD ). The penalty for trafficking or manufacturing heroin is a $5,000,000 (HKD) fine and life imprisonment. Possession of heroin without a license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time. In the United Kingdom, heroin is available by prescription, though it is a restricted Class A drug . According to the 50th edition of the British National Formulary (BNF), diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction , acute pulmonary oedema , and chronic pain .

The treatment of chronic non- malignant pain must be supervised by a specialist. The BNF notes that all opioid analgesics cause dependence and tolerance but that this is "no deterrent in the control of pain in terminal illness". When used in the palliative care of cancer patients, heroin is often injected using a syringe driver . Price Edit The European Monitoring Centre for Drugs and Drug Addiction reports that the retail price of brown heroin varies from 14.5€ per gram in Turkey to 110€ per gram in Sweden, with most European countries reporting typical prices of 45-55€ per gram. The price of white heroin is reported only by a few European countries and ranged between 27€ and 110€ per gram. [19] The United Nations Office on Drugs and Crime claims in its 2008 World Drug Report that typical US retail prices are 172 dollars per gram. [20] Production and trafficking: The Golden Triangle Edit Heroin is produced for the black market by refining opium. The first step of this process involves isolation of morphine from opium. This crude morphine is then acetylated by heating with acetic anhydride.

Purification of the obtained crude heroin and conversion to the hydrochloride salt results in a water-soluble form of the drug that is a white or yellowish powder. Crude opium is carefully dissolved in hot water but the resulting hot soup is not boiled. Mechanical impurities - twigs - are scooped together with the foam. The mixture is then made alkaline by gradual addition of lime. Lime causes a number of unwelcome components present in opium to precipitate out of the solution. (The impurities include inactive alkaloids, resins, proteins). The precipitate is removed by filtration through a cloth, washed with additional water and discarded. The filtrates containing the water-soluble calcium salt of morphine (calcium morphinate) are then acidified by careful addition of ammonium chloride . This causes morphine (as a free phenol) to precipitate. The morphine precipitate is collected by filtration and dried before the next step. The crude morphine (which makes only about 10% of the weight of opium) is then heated together with acetic anhydride at 85 °C (185 °F) for six hours.

The reaction mixture is then cooled, diluted with water, made alkaline with sodium carbonate, and the precipitated crude heroin is filtered and washed with water. This crude water-insoluble freebase product (which by itself is usable, for smoking) is further purified and decolorised by dissolution in hot alcohol, filtration with activated charcoal and concentration of the filtrates. The concentrated solution is then acidified with hydrochloric acid, diluted with ether, and the precipitated heroin hydrochloride is the purest form of heroin collected by filtration. This precipitate is the so-called "no. 4 heroin", commonly known as "chyna white". Chyna white is heroin in its purest form. Chyna white is Heroin freebase cut with a small amount of caffeine (to help vaporise it more efficiently), typically brown in appearance, is known as "no. 3 heroin". These two forms of heroin are the standard products exported to the Western market. Heroin no. 3 predominates on the European market, where heroin no. 4 is relatively uncommon. Another form of heroin is " black tar " which is common in the western United States and is produced in Mexico.

The initial stage of opium refining—the isolation of morphine—is relatively easy to perform in rudimentary settings - even by substituting suitable fertilizers for pure chemical reagents. However, the later steps (acetylation, purification, and conversion to the hydrochloride salt) are more involved—they use large quantities of chemicals and solvents and they require both skill and patience. The final step is particularly tricky as the highly flammable ether can easily ignite during positive-pressure filtration (the explosion of vapor-air mixture can obliterate the refinery). If the ether does ignite, the result is a catastrophic explosion. History of heroin traffic This article or section may contain original research or unverified claims. Please help Wikipedia by adding references. See the talk page for details. 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 heroin trade. French Connection route started in the 1930s. Heroin trafficking was virtually eliminated in the U.S. during World War II due to temporary trade disruptions caused by the war.[ How to reference and link to summary or text ] Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium. [ How to reference and link to summary or text ] After World War II, the Mafia took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily.[ How to reference and link to summary or text ] The Mafia took advantage of Sicily's location along the historic route opium took westward into Europe and the United States.

[ How to reference and link to summary or text ] Large scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s.[ How to reference and link to summary or text ] 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 abuse led most western countries to declare heroin a controlled substance by the latter half of the 20th century. In late 1960s and early 70s, the CIA supported anti-Communist Chinese Nationalists settled near 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 1973 American withdrawal from Vietnam. As of 1999, Myanmar (former Burma ), the heartland of the Golden Triangle remained the second largest producer of heroin, after Afghanistan .

[21] Soviet-Afghan war led to increased production in the Pakistani-Afghani 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. [21] 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. Trafficking See also: Opium production Traffic is heavy worldwide, with the biggest producer being Afghanistan. [22] According to U.N. sponsored survey, [23] as of 2004 [update] Template:Dated maintenance category , Afghanistan accounted for production of 87 percent of the world's heroin.

[24] The cultivation of opium in Afghanistan reached its peak in 1999, when 225,000 acres - 350 square miles - 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 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, with Afghanistan supplanting Burma to become the world's largest opium producer once more. [25] Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War once again appeared as a facilitator of the trade. [26] At present, opium poppies are mostly grown in Afghanistan , and in Southeast Asia , especially in the region known as the Golden Triangle straddling Myanmar , Thailand , Vietnam , Laos and Yunnan province in the People's Republic of 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. Conviction for trafficking in heroin carries the death penalty in most South-east Asian , some East Asian and Middle Eastern countries (see Use of death penalty worldwide for details), among which Malaysia , Singapore and Thailand are the most strict. The penalty applies even to citizens of countries where the penalty is not in place, sometimes causing controversy when foreign visitors are arrested for trafficking, for example the arrest of nine Australians in Bali , the death sentence given to Nola Blake in Thailand in 1987, or the hanging of an Australian citizen Van Tuong Nguyen in Singapore, both in 2005.

Risks of use Chronic constipation Addiction and increasing tolerance Physical dependence can result from prolonged use of all opioids, resulting in withdrawal symptoms on cessation of use Decreased kidney function (although it is not currently known if this is due to adulterants or infectious diseases) [27] Many countries and local governments have begun funding programs that supply sterile needles to people who inject illegal drugs in an attempt to reduce these contingent risks and especially the contraction and spread of blood-borne diseases. The Drug Policy Alliance reports that up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of drug use by injection. But despite the immediate public health benefit of needle exchanges , some see [attribution needed] such programs as tacit acceptance of illicit drug use. The United States federal government does not operate needle exchanges, although some state and local governments do support needle exchange programs. A heroin overdose is usually treated with an opioid antagonist , such as naloxone ( Narcan ), or naltrexone , which has high affinity for opioid receptors but does not activate them. This reverses the effects of heroin and other opioid agonists and causes an immediate return of consciousness but may precipitate withdrawal symptoms.

The half-life of naloxone is much shorter than that of most opioid agonists, so that antagonist typically has to be administered multiple times until the opioid has been metabolized by the body. Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours due to anoxia because the breathing reflex is suppressed by µ-opioids. An overdose is immediately reversible with an opioid antagonist injection. Heroin overdoses can occur due to an unexpected increase in the dose or purity or due to diminished opioid tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other depressant drugs like alcohol or benzodiazepines . [28] It should also be noted that since heroin can cause nausea and vomiting, a significant number of deaths attributed to heroin overdose are caused by aspiration of vomit by an unconscious victim. Some sources give a figure of between 75 and 375 mg for a 75 kg being fatal for 50% of opiate naive people. [29] Street heroin is of widely varying and unpredictable purity. This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended.

Also, tolerance typically decreases after a period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in a dangerous overdose. It has been speculated that an unknown portion of heroin related deaths are the result of an overdose or allergic reaction to quinine , which may sometimes be used as a cutting agent. [30] A final factor contributing to overdoses is place conditioning . Heroin use is a highly ritualized behavior. While the mechanism has yet to be clearly elucidated, longtime heroin users display increased tolerance to the drug in locations where they have repeatedly administered heroin. When the user injects in a different location, this environment-conditioned tolerance does not occur, resulting in a greater drug effect. The user's typical dose of the drug, in the face of decreased tolerance, becomes far too high and can be toxic, leading to overdose. [31] A small percentage of heroin smokers and occasionally IV users may develop symptoms of toxic leukoencephalopathy . The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon adulterant that is only active when heated.

[32] [33] [34] Symptoms include slurred speech and difficulty walking. Cocaine sometimes proves to be fatal when used in combination with heroin. Though " speedballs " (when injected) or "moonrocks" (when smoked) are a popular mix of the two drugs among users, combinations of stimulants and depressants can have unpredictable and sometimes fatal results. In the United States in early 2006, a rash of deaths was attributed to either a combination of fentanyl and heroin, or pure fentanyl masquerading as heroin particularly in the Detroit Metro Area; one news report refers to the combination as 'laced heroin', though this is likely a generic rather than a specific term. [35] Harm reduction approaches to heroin Edit Proponents of the harm reduction philosophy seek to minimize the harms that arise from the recreational use of heroin. Safer means of taking the drug, such as smoking or nasal, oral and rectal insertion, are encouraged, due to injection having higher risks of overdose, infections and blood-borne viruses. Where the strength of the drug is unknown, users are encouraged to try a small amount first to gauge the strength, to minimize the risks of overdose.

For the same reason, poly drug use (the use of two or more drugs at the same time) is discouraged. Users are also encouraged to not use heroin on their own, as others can assist in the event of an overdose. Heroin users who choose to inject should always use new needles, syringes, spoons/steri-cups and filters every time they inject and not share these with other users. Governments that support a harm reduction approach often run Needle & Syringe exchange programs , which supply new needles and syringes on a confidential basis, as well as education on proper filtering prior to injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing heroin for injection may also be supplied including citric acid sachets/vitamin C sachets, steri-cups, filters, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop use of shoe laces or belts). Withdrawal Black tar heroin The withdrawal syndrome from heroin may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose.

Symptoms may include: sweating , malaise , anxiety , depression , priapism , extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, excessive yawning or sneezing , tears , rhinorrhea , sleep difficulties ( insomnia ), cold sweats, chills, severe muscle and bone aches; nausea and vomiting , diarrhea , cramps , and fever . [36] Many users also complain of a painful condition, the so-called "itchy blood", which often results in compulsive scratching that causes bruises and sometimes ruptures the skin, leaving scabs. Abrupt termination of heroin use often causes muscle spasms in the legs ( restless leg syndrome , (also known as "kicking the habit")). The intensity of the withdrawal syndrome is variable depending on the dosage of the drug used and the frequency of use. Very severe withdrawal can be precipitated by administering an opioid antagonist to a heroin addict. Three general approaches are available to ease the physical part of opioid withdrawal. The first is to substitute a longer-acting opioid such as methadone or buprenorphine for heroin or occasionally another short-acting opioid and then slowly taper the dose.

In the second approach, benzodiazepines such as diazepam (Valium) may be recommended for opiate withdrawal especially if there is comorbid alcohol withdrawal . Benzodiazepines may temporarily ease the anxiety, muscle spasms, and insomnia associated with opioid withdrawal. The use of benzodiazepines must be carefully monitored because these drugs have a high risk of physical dependence as well as abuse potential and have little or no cross tolerance with opiates and thus are not generally recommended as a first line treatment strategy. Also, although very unpleasant, opioid withdrawal is seldom fatal, whereas complications related to withdrawal from benzodiazepines , barbiturates and alcohol withdrawal (such as psychosis , suicidal depression, epileptic seizures , cardiac arrest , and delirium tremens ) can prove hazardous and are potentially life-threatening. Many symptoms of opioid withdrawal are due to rebound hyperactivity of the sympathetic nervous system , which can be suppressed with clonidine (Catapres), a centrally-acting alpha-2 agonist primarily used to treat hypertension . Another drug sometimes used to relieve the " restless legs " symptom of withdrawal is baclofen , a muscle relaxant .

Diarrhoea can likewise be treated with the peripherally active opioid drug loperamide . Methadone is another μ-opioid agonist most often used to substitute for heroin in treatment for heroin addiction. Compared to heroin, methadone is well (but slowly) absorbed by the gastrointestinal tract and has a much longer duration of action of approximately 24 hours. Thus methadone maintenance avoids the rapid cycling between intoxication and withdrawal associated with heroin addiction. In this way, methadone has shown success as a substitute for heroin; despite bearing about the same addiction potential as heroin, it is recommended for those who have repeatedly failed to complete withdrawal or have recently relapsed. Patients properly stabilized on methadone display few subjective effects to the drug (i.e., it does not make them "high"), and are unable to obtain a "high" from other opioids except with very high doses. Methadone, since it is longer-acting, produces withdrawal symptoms that appear later than with heroin, but usually last considerably longer and can in some cases be more intense. Methadone withdrawal symptoms can potentially persist for over a month, compared to heroin where significant physical symptoms subside within 4 - 7 days.

Buprenorphine is another opioid that was recently licensed for opioid substitution treatment. As a μ-opioid receptor partial agonist , patients develop less tolerance to it than to heroin or methadone due to its partial activation of the opiate receptor. Patients are unable to obtain a "high" from other opioids during buprenorphine treatment except with very high doses. It also has less severe withdrawal symptoms than heroin or other full agonist opiates when discontinued abruptly, although the duration of the withdrawal syndrome is often longer than that seen with heroin. It is usually administered sublingually (dissolved under the tongue) every 24-48 hrs. Buprenorphine is also a κ opioid receptor antagonist, which led to speculation that the drug might have additional antidepressant effects; however, no significant difference was found in symptoms of depression between patients receiving buprenorphine and those receiving methadone. [37] Researchers at Johns Hopkins University have been testing a sustained-release "depot" form of buprenorphine that can relieve cravings and withdrawal symptoms for up to six weeks. [38] A sustained-release formulation would allow for easier administration and adherence to treatment, and reduce the risk of diversion or misuse.

Three opioid antagonists are available: naloxone and the longer-acting naltrexone and nalmefene . These medications block the ability of heroin, as well as the other opioids to bind to the receptor site. There is also a controversial treatment for heroin addiction based on an Iboga -derived African drug, ibogaine . Many people travel abroad for ibogaine treatments that generally interrupt substance use disorders for 3-6 months or more in up to 80% of patients. [39] Heroin prescription Edit The UK Department of Health's Rolleston Committee report in 1926 established the British approach to heroin prescription to users, which was maintained for the next forty years: dealers were prosecuted, but doctors could prescribe heroin to users when withdrawing from it would cause harm or severe distress to the patient. This "policing and prescribing" policy effectively controlled the perceived heroin problem in the UK until 1959 when the number of heroin addicts doubled every sixteenth month during a period of ten years, 1959-1968. [40] The failure changed the attitudes; in 1964 only specialized clinics and selected approved doctors were allowed to prescribe heroin to users.

The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone, until now only a small number of users in the UK are prescribed heroin. [41] In 1994 Switzerland began a trial heroin maintenance program for users that had failed multiple withdrawal programs. The aim of this program is to maintain the health of the user in order to avoid medical problems stemming from the use of illicit street heroin. Reducing drug-related crime and preventing overdoses were two other goals. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000 based on the apparent success of the program. Participants are allowed to inject heroin in specially designed pharmacies for 15 Swiss Francs per dose. [42] A national referendum in November 2008 showed 68% of voters supported the plan, [43] introducing heroin prescription into federal law. The trials before were based on time-limited executive ordinances . The success of the Swiss trials led German, Dutch, [44] and Canadian [45] cities to try out their own heroin prescription programs.

[46] Some Australian cities (such as Sydney) have instituted legal heroin supervised injecting centers , in line with other wider harm minimization programs. Starting in January 2009 Denmark is also going to prescribe heroin to a few addicts that have tried methadone and subutex without success. [47] Controversy Edit It has been claimed that sustained use of heroin for as little as three days can cause withdrawal symptoms to appear if use is stopped, & the myth that "just one shot will hook you for life" has been one of the many sensationalist claims made about the drug, & a belief in its overwhelming ability to addict anyone who tries it one of the main justifications for heroin's continuing prohibition. The truth is that true physical dependence on heroin demonstrated by genuine physical withdrawal symptoms upon discontinuation of consumption, [as opposed to a mental or psychological craving to repeat the heroin experience], is not acquired any faster than with continuous use of any other opiate, normally between three to six weeks in an opiate naive person. Many times patients in UK hospitals are treated with diamorphine daily for many weeks following painful surgery without experiencing any withdrawal upon discontinuation of the drug.

[48] [49] See also Diacetylmorphine Hydrochloride Diacetylmorphine Hydrochloride Tweet Uses Physicians prescribe diacetylmorphine hydrochloride to treat severe pain, such as pain resulting from an acute event such as a heart attack or a chronic, terminal illness such as cancer. Doctors sometimes prescribe diacetylmorphine hydrochloride to relieve labor pains because it works better and has fewer side effects than other drugs. While diacetylmorphine hydrochloride is illegal in the United States, it is still used in some countries to provide pain relief. Learn More About Diacetylmorphine Hydrochloride Uses Other, off label uses for this medicine In 2004, the National Institute for Health and Clinical Excellence provided guidance on administering diacetylmorphine hydrochloride during caesarian section. Drug rehabilitation specialists in the United Kingdom rarely prescribe diacetylmorphine hydrochloride as a maintenance drug to treat a handful of addicts, although this practice is controversial.

More Off-Label Uses for Diacetylmorphine Hydrochloride Administration/Dosage Brand name preparations of this drug include Diamorphine, Diagesil, Diamorf, Diaphin, Diamorphine and Linctus. A nurse may administer diacetylmorphine hydrochloride subcutaneously, intramuscularly, or intravenously. Drug abusers frequently smoke diacetylmorphine hydrochloride. The typical dose is during labor and delivery is between 5 and 10 mg. It is never appropriate to administer diacetylmorphine hydrochloride to a child. Read More About Diacetylmorphine Hydrochloride Administration and Dosage Action Diacetylmorphine hydrochloride is an opioid pain reliever, which means it binds to certain pain receptors in your brain and CNS, or central nervous system. Diacetylmorphine hydrochloride functions as a morphine prodrug, which means your body metabolically converts diacetylmorphine hydrochloride to morphine.

Injectable diacetylmorphine hydrochloride is more fat-soluble than is morphine and therefore more potent; it takes smaller doses of diacetylmorphine hydrochloride to provide relief from pain. Tolerance to opioids builds at equal rates with diacetylmorphine hydrochloride or morphine. Diacetylmorphine hydrochloride induces relaxation and intense euphoria. Following injection, diacetylmorphine hydrochloride crosses the blood-brain barrier within 20 seconds. About 70 percent of the injected diacetylmorphine hydrochloride reaches the brain. More About How Diacetylmorphine Hydrochloride Works Precautions Do not take this drug if you are allergic to other narcotics, such as morphine or oxycodone. Call an ambulance, go to the hospital or contact a doctor at first sign of an allergic reaction. A person's condition can decline swiftly and without warning after exposure to a drug allergen. Common symptoms of a mild allergic reaction include hives, especially over the face and neck, nasal congestion, itching, rashes and watery, red eyes.

Anaphylaxis is a very serious, potentially deadly form of an allergic reaction that usually occurs within minutes of exposure to the drug. Without medical help, a person can die from anaphylaxis within 15 minutes of contact. Symptoms of a moderate or severe reaction include: Abdominal Cramps or Pain. Read More About Diacetylmorphine Hydrochloride Precautions Warnings Do not use this medication to treat hronic obstructive pulmonary disease, commonly known as COPD. Do not use to treat pain relating to a head injury or diseases of the bile ducts. People who have taken monoamine-oxidase inhibitor antidepressants in the last 14 days should not use diacetylmorphine hydrochloride. Do not use diacetylmorphine hydrochloride if you are experiencing respiratory depression, characterized by slow and shallow breathing. During respiratory depression, your lungs do not adequately exchange oxygen for carbon dioxide. Do not use to treat tumor of the adrenal gland. Do not take diacetylmorphine hydrochloride while pregnant or breastfeeding your baby; doing so could have a profound impact on your child.

Your baby may become dependent on diacetylmorphine hydrochloride and suffer withdrawal symptoms after birth. Using diacetylmorphine hydrochloride during pregnancy may cause premature birth, lower your baby's birth weight, breathing problems, low blood sugar, bleeding within the brain and death. More Warnings About Using Diacetylmorphine Hydrochloride Drug Interactions Do not use diacetylmorphine hydrochloride if you have used an MAO inhibitor in the past 14 days. Examples of MAO inhibitors include the antidepressants phenelzine, tranylcypromine and isocarboxazid. Taking diacetylmorphine hydrochloride while an MAO inhibitor is still in your system can cause a dangerous or fatal drug interaction. Alcohol and some antipsychotic drugs such as haloperidol may enhance drowsiness associated with diacetylmorphine hydrochloride use, as can barbiturates such as phenobarbital and amobarbital.

Benzodiazepines such as diazepam will increase drowsiness when taken with diacetylmorphine hydrochloride as can temazepam and other opioids such as codeine and tramadol. Sedating antihistamines such as chlorphenamine and hydroxyzine increase drowsiness associated with diacetylmorphine hydrochloride. Sleeping tablets, especially zopiclone, and tricyclic antidepressants such as amitriptyline increase the drowsy effects of diacetylmorphine hydrochloride. Cimetidine increases the risk for breathing problems associated with diacetylmorphine hydrochloride. Diacetylmorphine hydrochloride may interfere with the way domperidone and metoclopramide work in your body. Rifampin or ritonavir could reduce the amount of diacetylmorphine hydrochloride and make it less effective. More Drug Interactions Side effects People have reported side effects from using diacetylmorphine hydrochloride. Most commonly reported side effects are not serious. Common side effects include drowsiness, disorientation and delirium.

One of the most damaging effects of diacetylmorphine hydrochloride is physical dependence and addiction. Some side effects of diacetylmorphine hydrochloride can be serious, life threatening medical emergencies. If you experience any serious side effect after using diacetylmorphine hydrochloride, seek immediate medical care. Serious side effects include respiratory arrest, coma and death. Learn More About Diacetylmorphine Hydrochloride Side Effects Overdose The estimated lethal dose of diacetylmorphine hydrochloride is 200 mg but a person who has developed tolerance for diacetylmorphine hydrochloride may take up to ten times that amount. If you believe you or someone you know has taken an overdose of diacetylmorphine hydrochloride, contact poison control center at 1-800-222-1222 or go to the emergency room. Overdose symptoms include: Blue Lips and Fingernails. Learn More About Diacetylmorphine Hydrochloride Overdose Abuse Diacetylmorphine hydrochloride is most widely abused after adulteration to its freebase form, known as heroin.

Diacetylmorphine hydrochloride is a schedule I controlled substance, which means it, has a high potential for abuse. Recreational doses for diacetylmorphine hydrochloride can be as high as 100 mg. To abuse a drug means to use it for non-medical purposes, either by using a prescription drug without a prescription to reduce symptoms or to use these drugs to get high. Prescription drug abuse is a growing problem in the United States. Drug abusers no longer prefer illegal drugs like cocaine and diacetylmorphine hydrochloride but now favor using prescription drugs to get high. According to the Centers for Disease Control and Prevention, or CDC, more than 12 million Americans admit to using narcotics for non-medical purposes in 2010. Two million of these people reported using the drugs non-medically for the first time that year. Almost all drug overdose deaths in the United States were from drugs originally legally obtained with a prescription. About 55 percent of people who abuse prescription drugs such as hydrocodone got the drugs free from a friend or relative, as compared to just over 4 percent of people who purchased opioids from a drug dealer.

More than three out of four people who misuse prescription drugs abuse a medicine originally prescribed to another person. A minority of physicians prescribe the majority of opioids: approximately 20 percent of authorized prescribers write 80 percent of the prescriptions for painkillers Read More About Diacetylmorphine Hydrochloride Abuse Withdrawal A 2002 report by the Centers for Disease Control and Prevention, or CDC, states that at least 980,000 Americans are addicted to diacetylmorphine hydrochloride and other opioids. Withdrawal symptoms are a normal, predictable outcome of using diacetylmorphine hydrochloride , opioids and some other substances. When you discontinue medication on which your body has grown physically dependent to, your system struggles to stabilize its chemical balance and, as a result, you feel unpleasant withdrawal symptoms. Withdrawal symptoms are a physical response to a substance. Withdrawal symptoms can be overpowering, preventing you from discontinuing diacetylmorphine hydrochloride without the help of qualified professionals. Consult with your doctor or a rehabilitation specialist if your withdrawal symptoms stop you from quitting this medication.

Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities and joint stiffness. These symptoms peak between 48 and 72 hours after the last dose of diacetylmorphine hydrochloride. Sudden cessation may be fatal to heavily dependent individuals in very poor health. Detox Dependence on diacetylmorphine hydrochloride is a complex medical condition requiring expert rehabilitation. Treatment is especially challenging to those dependent upon diacetylmorphine hydrochloride. About 40 percent of those who use diacetylmorphine hydrochloride for recreational purposes also use cocaine. You may not be able to stop taking diacetylmorphine hydrochloride without the help of qualified professionals. Successful rehabilitation from dependence on drugs involves several components of medical care, including withdrawal management, detoxification and counseling. During standard rehabilitation, doctors prescribe medicines to ease withdrawal symptoms, cleanse the body of drugs and restore the body's chemical balance before the patient attends counseling sessions to address any issues that may have contributed to or were the result of drug abuse. Methadone and buprenorphine are effective tools in rehabilitation from dependence on diacetylmorphine hydrochloride.

One dose of methadone blocks the effects of diacetylmorphine hydrochloride for about 24 hours. The CDC notes that those who discontinue methadone maintenance treatment later relapse and start using drugs again. Rapid detox is a more advance and humane form of detoxification. During rapid detox, specially trained physicians administer the standard detoxification and anti-withdrawal drugs along with anesthesia and sedatives so that the patient sleeps through the demoralizing and overwhelmingly unpleasant withdrawal symptoms. Rapid detox helps the patient retain a sense of dignity and self-worth that often deteriorates with standard slow and painful methods of detoxification. After rapid detox, the patient awakens with no recollection of withdrawal. Learn More About Diacetylmorphine Hydrochloride Detoxification Programs Storage Put diacetylmorphine hydrochloride out of the reach of children and pets. Do not allow adults to use this product willingly or by mistake. Diacetylmorphine hydrochloride is a controlled substance with the highest potential for abuse. To reduce the risk for theft, do not tell anyone other than a trusted caregiver that you have diacetylmorphine hydrochloride in your home.

Read More About Storing Diacetylmorphine Hydrochloride Miscellaneous information In 1895, the Bayer Company marketed diacetylmorphine hydrochloride as an over-the-counter drug under the brand name Heroin. Makers derived the name from the Greek word "heros" because of the heroic effect it imparted to users. Bayer developed diacetylmorphine hydrochloride as an alternative to morphine as a cough suppressant because diacetylmorphine hydrochloride has fewer associated side effects. While Bayer marketed diacetylmorphine hydrochloride as being non-addictive, heroin would soon have the highest dependency rate of all opioids of the time. Diacetylmorphine hydrochloride is derived from opium poppies. Presently, most poppies are grown in Afghanistan and Southeast Asia. Afghanistan is the largest producer. By 1980, 60 percent of the heroin sold in the United States came from Afghanistan. Opium production peaked in 1999. In 2000, the Taliban outlawed opium, a move that reduced production by 94 percent.

Removal of the Taliban in that country has caused a resurgence in poppy production that results in more opium and diacetylmorphine hydrochloride. Miscellaneous Information About Diacetylmorphine Hydrochloride Dangerous Drugs Dangerous Drugs Infestus Venenum Ecstasy Methylenedioxymethamphetamine (MDMA), commonly known as "ecstasy", or by its any other name, refers to the drug having such chemical composition, including any of its isomers or derivatives in any form. Three neurobiological mechanisms for the therapeutic effects of MDMA have been suggested: "1) MDMA increases oxytocin levels, which may strengthen the therapeutic alliance; 2) MDMA increases ventromedial prefrontal activity and decreases amygdala activity, which may improve emotional regulation and decrease avoidance, and 3) MDMA increases norepinephrine (NE) release and circulating cortisol levels, which may facilitate emotional engagement and enhance extinction of learned fear associations." Opium Poppy tears, lachryma papaveris) is the dried latex obtained from the opium poppy ( Papaver somniferum ).

Opium contains up to 12% morphine , an alkaloid , which is frequently processed chemically to produce heroin for the illegal drug trade . The latex also includes codeine and non-narcotic alkaloids such as papaverine , thebaine and noscapine . Is a pharmaceutic necessity for powdered opium. It acts chiefly on the central nervous system; its action first stimulates and then depresses nerve response. It serves as an analgesic, a hypnotic, and a narcotic and checks excessive peristalsis and contracts the pupil of the eye. A dose of 60 mg was formerly listed for opium and powdered opium. Prescription Products: Diabismul®, KBP/O® Nonprescription Products: Parepectolin®, Parelixir®, Donnagel-PG® Heroin Diacetylmorphine is derived from the morphine alkaloid found in opium and is roughly 2-3 times more potent. A highly addictive drug, heroin exhibits euphoric ("rush"), anxiolytic and analgesic central nervous system properties.

Heroin is classified as a Schedule I drug under the Controlled Substances Act of 1970 and as such has no acceptable medical use in the United States. Pure heroin is a white powder with a bitter taste. Most illicit heroin is sold as a white or brownish powder and is usually "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. It can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Another form of heroin known as "black tar" may be sticky, like roofing tar, or hard, like coal. Its color may vary from dark brown to black. Under the chemical name diamorphine, diacetylmorphine is prescribed as a strong analgesic in the United Kingdom, where it is given via subcutaneous, intramascular, intrathecal or intravenous route. Its use includes treatment for acute pain, such as in severe physical trauma, myocardial infarction , post-surgical pain, and chronic pain, including end-stage cancer and other terminal illness.

In other countries it is more common to use morphine or other strong opioid in these situations. In 2004, the National Institute for Health and Clinical Excellence produced guidance on the management of caesarian section, which recommended the use of intrathecal or epidural diacetylmorphine for post-operative pain relief. Shabu Methamphetamine Hydrochloride, commonly known as "Shabu", "Ice", "Meth", or by its any other name, refers to the drug having such chemical composition, including any of its isomers or derivatives in any form.Methamphetamine has a high potential for abuse. It should thus be tried only in weight reduction programs for patients in whom alternative therapy has been ineffective. Administration of Methamphetamine for prolonged periods of time in obesity may lead to drug dependence and must be avoided. Particular attention should be paid to the possibility of subjects obtaining Methamphetamine for non-therapeutic use or distribution to others, and the drug should be prescribe or dispensed sparingly. Misuse of Methamphetamine may cause sudden death and serious Cardiovascular Adverse events.

Example drug for this is DESOXYN® (methamphetamine hydrochloride tablets, USP), chemically known as (S)-N,α-dimethylbenzeneethanamine hydrochloride, is a member of the amphetamine group of sympathomimetic amines. It has the following structural formula: DESOXYN tablets contain 5 mg of methamphetamine hydrochloride for oral administration. Ipinaskil ni

Question: By what name is Diamorphine Hydrochloride more commonly known?
Answer: HEROIN