From Opium to Heroin Papaver Somniferum Seed pot

From Opium to Heroin

Papaver Somniferum Seed pot

Papaver Somniferum Opium collection Seed pot

Papaver Somniferum Opium collection Opium contains: Seed pot • Morphine • Codeine

Laudanum (alcohol + opium)

Laudanum (alcohol + opium) Widely used Even used in infants

Innovations in the 1800 s

Innovations in the 1800 s Morphine isolated from opium

Innovations in the 1800 s Morphine isolated from opium Hypodermic needle invented

Soldiers received IV morphine during civil war Many became addicted

Soldiers received IV morphine during civil war Many became addicted Civilians using Laudanum

Detoxification (not enough) Substitution treatment Heroin

Detoxification (not enough) Substitution treatment Heroin

More potent than morphine

More potent than morphine Crosses the BBB more rapidly

More potent than morphine Crosses the BBB more rapidly Converted to morphine

Initially marketed as sedative and cough suppressant

Heroin became the de facto opioid of choice

70’s and 80’s • Criminal convictions • HIV, HCV • Comorbid psychiatric disorders Heroin became the de facto opioid of choice

Black tar heroin National Institute on Drug Abuse. Epidemiologic Trends in Drug Abuse, in Proceedings of the Community Epidemiology Work Group, January 2014. Bethesda, MD: National Institute on Drug Abuse, 66.

Black tar heroin National Institute on Drug Abuse. Epidemiologic Trends in Drug Abuse, in Proceedings of the Community Epidemiology Work Group, January 2014. Bethesda, MD: National Institute on Drug Abuse, 66. Powder heroin

Heroin: routes of administration Intravenous Injection Intramuscular Intranasal Subcutaneous (“skin popping”) Smoked

Heroin: routes of administration Intravenous Inhaled vapors • “Chasing the dragon” Injection Intramuscular Intranasal Subcutaneous (“skin popping”) Smoked

Commonly abused opioids 1970 s and 1980 s: • Heroin Today: • Prescription opioids

Opioid addiction develops very quickly Treatment required Initial use Alcohol Years, decades

Opioid addiction develops very quickly Treatment required Initial use Alcohol Years, decades Opioids Months Initial use Treatment required

Summary: Key Points • Heroin: first tried as substitution treatment • 1970 s and 1980 s: heroin was the most commonly misused opioid • Early 1990 s-today: prescription opioids became the drugs of choice • Heroin administration: IV, IM, SC, intranasal or smoked • Opioid addiction can develop very fast (sometimes in months)

Summary: Key Points • Heroin: first tried as substitution treatment • 1970 s and 1980 s: heroin was the most commonly misused opioid • Early 1990 s-today: prescription opioids became the drugs of choice • Heroin administration: IV, IM, SC, intranasal or smoked • Opioid addiction can develop very fast (sometimes in months)

Summary: Key Points • Heroin: first tried as substitution treatment • 1970 s and 1980 s: heroin was the most commonly misused opioid • Early 1990 s-today: prescription opioids became the drugs of choice • Heroin administration: IV, IM, SC, intranasal or smoked • Opioid addiction can develop very fast (sometimes in months)

Summary: Key Points • Heroin: first tried as substitution treatment • 1970 s and 1980 s: heroin was the most commonly misused opioid • Early 1990 s-today: prescription opioids became the drugs of choice • Heroin administration: IV, IM, SC, intranasal or smoked • Opioid addiction can develop very fast (sometimes in months)

Summary: Key Points • Heroin: first tried as substitution treatment • 1970 s and 1980 s: heroin was the most commonly misused opioid • Early 1990 s-today: prescription opioids became the drugs of choice • Heroin administration: IV, IM, SC, intranasal or smoked • Opioid addiction can develop very quickly (sometimes in months)