Essay Code D17
Heroin - Needles, Pain, and Addiction
"[Users] just feel good, chill happy, but they feel like this spooky drug 'heroin' hasn't
delivered...People tend to think oh, what a nice drug...Everything in the world is
beautiful...Heroin is a wonder drug. Heroin is better than everything else. Heroin builds up a
tolerance fast...Now I'm sick. I can't afford the heroin that I need...I NEED TO QUIT." This is
an anecdote of a former opiate addict describing his use of heroin. Heroin is synthesized from
morphine, a naturally occurring chemical found in the opium poppy, Papaver somniferum. As of
1992, 1.5% of the population of the United States has tried heroin; however, 23.1% of users are
also addicts, making it the second most addictive drug. The first is tobacco. According to UN
estimates in 2005, over 50 million people across the globe are regular users of heroin.
Figure 1. In Breaking Bad, Jesse Pinkman literally floats in the sky in bliss after using heroin
Heroin is a semi-synthetic derivative of morphine, as it is not present in opium flowers.
Several derivatives of opium are used both medically and recreationally for their analgesic
properties, including morphine, codeine, Vicodin, and fentanyl. Opioids are defined as any
psychoactive substance, both natural and synthetic, that has effects similar to opium. Medically,
opioids, are useful for their pain numbing properties, and are used for a variety of health related
conditions such as chronic pain, C-section surgeries, and cough suppressants. Certain opioids
have also antidiuretic properties, and are used to treat dysentery and severe diarrhea, such as
Imodium. Humans also have endogenous opioid peptides known such as endorphins, which also
has analgesic properties. In nature, opioids are quite useful for pain management; however,
more potent synthetic derivatives such as heroin have potential for high abuse.
Morphine is one of three naturally occurring opioids extracted from the opium poppy,
including codeine and thebaine. Heroin is synthesized using morphine in order to form diacetyl
morphine and has a chemical structure of (5α,6α)-7,8-didehydro-4,5-epoxy-17methylmorphinan-3,6-diol diacetate [Figure 2]. Heroin was first produced by a pharmaceutical
company, Bayer, most famous for aspirin. Currently there are three known methods of
synthesizing heroin. The purest is in the form of a hydrochloride salt. However, the most
common illicit form is in its freebase form. [Figure 3]. A third form has recently been developed
because of its cost effectiveness and simplicity, known as black tar heroin. Currently,
Afghanistan and Mexico account for over 90% of the global illicit heroin production.
Figure 2. Chemical structure of heroin
Figure 3. Synthesis of Freebase Heroin
Heroin is almost exclusively used recreationally within the United States, as it is a
Schedule I drug, meaning that it has "a high potential for abuse", "no currently accepted medical
use in treatment", and "lack of accepted safety for use of the drug." However, in the United
Kingdom, heroin is still used medically as a controlled substance. Typically, addicts and
medical users utilize an intravenous route of administration. This method is typically only used
for purer, higher quality heroin. In turn intravenous administration has the highest dose in the
bloodstream, leading to more intense euphoric effects that users seek. Other lower quality heroin
can be administered by smoking, suppository (anal or vaginal insertion), snorting, and ingestion,
and are typically preferred in that order. However, in pop culture and in the media, the
intravenous administration is almost always depicted [Figure 4].
Figure 4. Intravenous use of heroin using needles
Opioids are commonly depicted in media as the drug of addicts, because of its
stereotypical highs and lows. The highs created from drugs such as heroin make one
exceptionally euphoric, while withdrawal symptoms can be fatal as many users die from fatal
respiratory depression. Recently, heroin has been in the media with many celebrity deaths,
including Phillip Seymour Hoffman, Academy Award winning actor who died in early February
due to heroin overdose, and Cory Monteith, star of hit TV show Glee who died in 2013.
Furthermore, intravenous heroin use has been depicted throughout various movies and TV shows
such as Breaking Bad, Pulp Fiction, and Trainspotting, which are all award winning movies or
shows that depicted heroin users who died as a result of their addiction. Yet despite the media
coverage that it gets, heroin is continued to be used for its psychoactive effects, which helps one
numb the effects of stress.
Opioids, including heroin, share many psychoactive symptoms that vary in degree
between each specific substance. Most importantly, opioids are analgesics, which raises pain
thresholds, making users feel more comfortable when inflicted with continuous dull pain,
common in cancer patients. However, unlike anesthetics, users are conscious and awake when
the drugs' are effective. In addition, opioids have sedative effects (sleep-inducing). Certain ones
also cause constipation, making it suitable for the treatment of chronic diarrhea. However, in
recreational users it is common to use amounts several times the recommended dose in order to
elicit its more desired effects.
In high doses, the opioids can produce euphoric effects and general feeling of numbness,
which is illustrated by the anecdote. These can give users what is described as a general feeling
of mellowness and happiness. This "high" should not be confused with the
euphoria produced by psychostimulants such as cocaine and methamphetamine; drugs such as
those give one heightened energy, confidence, and a much more potent feeling of happiness,
which has an equally negative withdrawal effect. Negative side effects include nausea, vomiting,
itching, and respiratory depression. However, continual use quickly builds tolerance, which
makes heroin an addictive substance.
Addiction (substance dependence disorder, as defined by the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition) is characterized by several criteria, most notably the
development of tolerance, inability to quit (physiological addiction), cravings, withdrawal
symptoms, and the causation of problems in normal functioning, such as work, social
relationships, and the law. Heroin fits all of these criteria, as addiction from heroin quickly
results in increased tolerance as regular users require over five times the original dose in order to
produce an equivalent "high." In addition, the withdrawal is very potent and has very
uncomfortable symptoms, including vomiting, depression, weakness, diarrhea, and tremors
[Figure 5]. As one builds tolerance these symptoms become worse, leading to continued use in
order to mitigate the negative symptoms. This cycle quickly leads one to addiction in
intravenous users, and almost a quarter of all users eventually become addicted.
Figure 5. Timeline of withdrawal symptoms as a result of IV heroin use
Almost five thousand individuals die of heroin overdose annually in the US, and over
fourteen percent of drug related hospital visits are a direct result of heroin use. Heroin is a
deadly substance and can be deadly at a dose as little as 75mg. However, most deaths are not
caused by heroin alone. Other psychological depressants, such as barbiturates, alcohol, and
tranquilizers, potentiate the effects of one another, and combining several depressants can make
the lethal dose much lower than 75mg. However, another reason why heroin related hospital
visits are so common is because of the variability in purity. Because it is an unregulated street
drug, a gram of heroin needed to get high might be significantly more potent than the heroin
bought the next week. As a result, an individual who suddenly buys purer heroin than they are
used to will unknowingly administer a higher dose, increasing their chance of overdose. Its
deadly effects are caused by respiratory depression, or when the lungs start to fail and the
individual stops breathing at high doses. This effect can be quickly reversed with the
administration of opioid antagoinists, drugs that bind to opioid receptors in the body, preventing
the uptake of heroin in the bloodstream. The most common of these drugs is Naloxone, a shot
that immediately stops the negative effects of heroin and prevents death due to overdose. In
addition, it is a cheap drug that costs less than ten dollars a dose. However, many users dislike
Naloxone because it immediately elicits withdrawal symptoms that cause them to seek more
heroin not long after their lives are saved by the treatment.
In summary, heroin is a drug that causes significant harm to society and the economy in
the US. Its deadly effects have permeated through the media and its use as an illicit drug have
taken the lives of many, including prominent figures in society. However, like many other
drugs, it was developed for its medical uses in the treatment of pain, while other opioids are used
daily in medicine in a variety of contexts. Today, people actively fight the continued use of
heroin by promoting safe usage and education in order to prevent deaths and overdoses in users
that try to seek the blissful high that heroin elicits.
Works Cited
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Web. 28 Feb. 2014.
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