Chapter 3
Opiates (Heroin)
Opiates are a class of narcotic drugs that include natural opiates derived from the opium poppy, such as morphine and heroin, and chemically similar drugs that are made to produce opiate-like effects, such as methadone. Like other depressants, opioids slow down the activity of the central nervous system. Opioids have legitimate medical uses, especially relief from pain. However, they are also widely abused as street drugs. Morphine was introduced in the late 19th century in the US during the Civil War and in Europe during the Franco-Prussian War. It was freely used to deaden pain from war wounds. Physical dependence on the morphine became known as the soldier's disease. Heroin was so named because it made people feel heroic. It was also hailed as the hero that would cure the physical dependence on morphine we just mentioned. Yet heroin proved to be just as addictive as morphine. Heroin can provide a strong euphoric rush. Users claim that it is so pleasurable it can eradicate any thought of food or sex.
Regular users develop tolerance for heroine, leading them to take yet higher doses, which can cause potentially life-threatening overdoses. Heroin is usually taken by injection. Heroin is illegal. Because the penalties for possession or sale are high, it is also expensive. For this reason, many physiologically dependent people support their habit through dealing (selling heroin), prostitution, theft, or selling stolen goods. Opiate addicts such as heroin users face extremely unpleasant withdrawal syndromes, which may begin with flu-like symptoms and progress through tremors, cramps, chills alternating with sweating, rapid pulse, high blood pressure, insomnia, vomiting, and diarrhoea. However, these syndromes are variable from one person to another and can be managed medically. For many individuals, the effect of taking an opioid such as heroin for the first time is actually dysphoric rather than euphoric, and nausea and vomiting may result. Individuals with an opioid dependence are at risk for the development of mild to severe depression. Periods of depression are especially common during chronic intoxication or in association with other physical, psychological or social stresses. Insomnia is common, especially during withdrawal. Antisocial Personality Disorder is much more common in individuals with opioid dependence than in the general population - as is Post-Traumatic Stress Disorder. A history of conduct disorder in childhood or adolescence has been identified as a significant risk factor for substance-related disorders, especially opioid dependence. Heroin is also sold as brown. Brown is still heroin, although some people mistakenly think it is not as addictive. As mentioned above, heroin is usually taken by injection. The risks of sharing needles and other contraptions to inject heroin are well-known, veins are often severely damaged and this has been known to lead to gangrene. There is also the very possible danger of infections like hepatitis B or C, tuberculosis and of course HIV/AIDS. Females commonly have disturbances of reproduction and irregular periods. The risk of death from overdose increases after a period when not taking the drug because the body's tolerance for the drug decreases. Excessive doses can lead to a coma and respiratory failure, as well, as inhaling vomit (heroin stops the body's cough reflex working properly) can lead to death. Accidents and injuries due to violence that is associated with buying or selling drugs is common. In some countries, violence accounts for more opioid-related deaths than overdose or HIV infection. Opioid dependence can begin at any age, but problems associated with opioid use are most commonly observed in the late teenage years or early 20s. Once dependence develops, it usually continues over a period of many years, even though brief periods of abstinence are frequent. Relapse following abstinence is common. Unfortunately, it is not just opioid users themselves that suffer; it is also their families that suffer with them. Studies show that family members of individuals with an opioid dependence such as heroin are likely to have higher levels of psychopathology.
In closing, this chapter we shall state something that is not known to many: The brain has its own natural opioids. For example, the brain secretes endorphins to blunt the feeling of pain (like the brain's own morphine). Another effect can be hyperactivity and a temporary feeling of well being. The brain's opioids are powerful numbing agents that can enable people to have a heightened tolerance for pain. This effect has been noted by battlefield surgeons who found severely wounded soldiers needed lower doses of narcotics to handle their pain than did civilians with far less serious injuries. We mentioned the origin of heroin used in wars in the beginning of this chapter.
