1. From Opium to Heroin

2. Papaver Somniferum
Seed pot

3. Papaver Somniferum
Opium collection
Seed pot

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

5. Laudanum (alcohol + opium)

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

7. Innovations in the 1800s

8. Innovations in the 1800s
Morphine isolated from opium

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

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

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

12. Detoxification (not enough) Substitution treatment Heroin

13. Detoxification (not enough) Substitution treatment Heroin

14. More potent than morphine

15. More potent than morphine Crosses the BBB more rapidly

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

17. Initially marketed as sedative and cough suppressant

18. Heroin became the de facto opioid of choice

19. 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

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

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

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

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

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

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

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

28. 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)

29. 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)

30. 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)

31. 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)

32. 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)