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From Opium to Heroin

Papaver Somniferum Seed pot

Papaver Somniferum Opium collection Seed pot

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

Laudanum (alcohol + opium)

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

Innovations in the 1800s

Innovations in the 1800s Morphine isolated from opium

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

Soldiers received IV morphine during civil war Many became addicted Soldiers received IV morphine during civil war

Civilians using Laudanum Many became addicted Soldiers received IV morphine during civil war 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 Heroin became the de facto opioid of choice 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.

Powder heroin 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.

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

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

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

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

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

Summary: Key Points Heroin: first tried as substitution treatment 1970s and 1980s: heroin was the most commonly misused opioid Early 1990s-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 1970s and 1980s: heroin was the most commonly misused opioid Early 1990s-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 1970s and 1980s: heroin was the most commonly misused opioid Early 1990s-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 1970s and 1980s: heroin was the most commonly misused opioid Early 1990s-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 1970s and 1980s: heroin was the most commonly misused opioid Early 1990s-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)