Heroin

Heroin addiction
Symptoms of withdrawal
Other associated problems
What is heroin?
How is heroin used?
Effects of heroin use/abuse
Medical complications
Methadone
Dangers of methadone
History of heroin

"The use of morphine in the place of alcohol is but a choice of evils, and by far the lesser"
Cincinnati Lancet-Clinic. 1889

"Heroin will take the place of morphine without its disagreeable qualities."
New York Medical Journal. 1901

"Some (heroin) addicts readily admit that they prefer methadone as their drug of abuse"
International Journal of Pharmacology. 1975

"Clonidine has recently gained prominence as chemotherapeutic agent for the detoxification of individuals dependent upon…methadone"
NIDA Treatment Research Monograph. Research on the Treatment of Narcotic Addiction. 1983

Heroin Addiction

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped. Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhoea and vomiting, cold sweats with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.

Symptoms of withdrawal

Regardless of dosage, these reactions may appear

Convulsions
Increased heart rate
Abnormal heartbeat
Heart attack
Sudden, sharp blood pressure increase
Stroke
Extreme depression
Suicidal behaviour

As withdrawal progresses, elevations in blood pressure, pulse, respiratory rate and temperature occur. Symptoms of overdose -- which may result in death -- include shallow breathing, clammy skin, convulsions and coma.

Are there any other problems that can occur from heroin addiction?

Heroin can cause feelings of depression, which may last for weeks. Attempts to stop using heroin can fail simply because the withdrawal can be overwhelming, causing the addict to use more heroin in an attempt to overcome these symptoms. This overpowering addiction can cause the addict to do anything to get heroin. It could happen to you.

What is heroin?

Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as "black tar heroin." Although purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment. The poppy plant Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names associated with heroin include "smack," "H," "skag," and "junk." Other names may refer to types of heroin produced in a specific geographical area, such as "Mexican black tar."

What is the scope of heroin use in the United States?

According to the 1996 National Household Survey on Drug Abuse, which may actually underestimate illicit opiate (heroin) use, an estimated 2.4 million people use heroin at some time in their lives, and nearly 216,000 of them reported using it within the month preceding the survey. The survey report estimates that there were 141,000 new heroin users in 1995, and that there has been an increasing trend in new heroin use since 1992. A large proportion of these recent new users were smoking, snorting, or sniffing heroin, and most were under age 26. Estimates of use for other age groups also increased, particularly among youths age 12 to 17: the incidence of first-time heroin use among this age group increased fourfold from the 1980s to 1995.

The 1996 Drug Abuse Warning Network (DAWN), which collects data on drug- related hospital emergency department (ED) episodes from 21 metropolitan areas, estimates that 14 percent of all drug-related ED episodes involved heroin. Even more alarming is the fact that between 1988 and 1994, heroin-related ED episodes increased by 64 percent (from 39,063 to 64,013).

NIDA's Community Epidemiology Work Group (CEWG), which provides information about the nature and patterns of drug use in 20 cities, reported in its December 1996 publication that heroin was the primary drug of abuse related to drug abuse treatment admissions in Newark, San Francisco, Los Angeles, and Boston, and it ranked a close second to cocaine in New York and Seattle.

Monitoring the Future Study (MTF)

According to the 1997 MTF, an annual survey of drug use among 8th-, 10th-, and 12th- graders, rates of heroin use remained relatively stable and low since the late 1970s. After 1991, however, use began to rise among 10th- and 12th- graders, and after 1993, among 8th- graders. In 1997, prevalence of heroin use was comparable for all three grade levels. Although the annual prevalence rates for heroin use remained relatively low in 1997, these rates are approximately two to three times higher than those reported in 1991

Heroin Use by Students, 1997:

	8th - Graders	10th - Graders	12th - Graders
Ever Used	2.1%	2.1%	2.1%
Used in the Past	1.3%	1.4%	1.2%
Used in the Past Month	0.6%	0.6%	0.5%

Community Epidemiology Work Group (CEWG)

In December 1996, CEWG reported that the availability of low-priced, high-quality heroin continues to increase, especially in the East and some areas of the Midwest. This increase has also been reported in some cities that previously had escaped the influx of high-quality heroin.

Quantitative indicators and field reports continue to suggest an increasing incidence of new users (snorters) in the younger age groups, often among women. One concern is that young heroin snorters may shift to needle injecting, because of increased tolerance, nasal soreness, or declining or unreliable purity. Injection use would place them at increased risk of contracting HIV/AIDS.

In some areas, such as Boston and San Francisco, the recent initiates increasingly include members of the middle class. In Newark, heroin users are usually found in suburban populations.

National Household Survey on Drug Abuse (NHSDA)

The 1996 NHSDA shows a significant increase from 1993 in the estimated number of current (once in the past month) heroin users. The estimates have risen from 68,000 in 1993 to 216,000 in 1996.

Among individuals who had ever used heroin in their lives, the proportion who had ever smoked, sniffed, or snorted heroin increased from 55 percent in 1994 to 82 percent in 1996. During the same period, the proportion of users who injected heroin remained about the same, at about 50 percent.

How is heroin used?

Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

Route of Administration among Heroin Treatment Admissions in Selected Areas
Source: Community Epidemiology Work Group, NIDA, June 1996

Injection continues to be the predominant method of heroin use among addicted users seeking treatment; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now a widely reported means of taking heroin among users admitted for drug treatment in Newark, Chicago, New York, and Detroit.

With the shift in heroin abuse patterns comes an even more diverse group of users. Older users (over 30) continue to be one of the largest user groups in most national data. However, several sources indicate an increase in new, young users across the country who are being lured by inexpensive, high-purity heroin that can be sniffed or smoked instead of injected. Heroin has also been appearing in more affluent communities.

Effects of heroin use/abuse

What are the short-term effects of heroin use?

Soon after injection (or inhalation), heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation, a "rush."

Short-term effects of heroin abuse:

"Rush"
Depressed respiration
Clouded mental functioning
Nausea and vomiting
Suppression of pain
Spontaneous abortion

The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching.

Opiates act on many places in the brain and nervous system. After the initial effects, abusers usually will be drowsy for several hours. Mental function is clouded by heroin's effect on the central nervous system. Cardiac functions slow. Breathing is also severely slowed, sometimes to the point of death. Heroin overdose is a particular risk on the street, where the amount and purity of the drug cannot be accurately known.

What are the long-term effects of heroin use?

One of the most detrimental long-term effects of heroin is addiction itself. Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse.

Long-term effects of heroin abuse:

Addiction
Infectious diseases, for example, HIV/AIDS and hepatitis B and C
Collapsed veins
Bacterial infections
Abscesses
Infection of heart lining and valves
Arthritis and other rheumatologic problems

As with abusers of any addictive drug, heroin abusers gradually spend more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers' primary purpose in life becomes seeking and using drugs. The drugs literally change their brains.

Physical dependence develops with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhoea, vomiting, cold swaps with goose bumps ("cold turkey"), and leg movements. Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the foetus of a pregnant addict.

At some point during continuous heroin use, a person can become addicted to the drug. Sometimes addicted individuals will endure many of the withdrawal symptoms to reduce their tolerance for the drug so that they can again experience the rush.

Physical dependence and the emergence of withdrawal symptoms were once believed to be the key features of heroin addiction. We now know this may not be the case entirely, since craving and relapse can occur weeks and months after withdrawal symptoms are long gone. We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict.

What are the medical complications of chronic heroin abuse?

Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin's depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other hematological problems.

Of course, sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse - infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.

How does heroin abuse affect pregnant women?

Heroin abuse can cause serious complications during pregnancy, including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome), as well. Pregnant women should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery; rather, treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely in the nursery. Research has demonstrated also that the effects of in-utero exposure to methadone are relatively benign.

Why are heroin users at special risk for contracting HIV/AIDS and hepatitis B and C?

Because many heroin addicts often share needles and other injection equipment, they are at special risk of contracting HIV and other infectious diseases. Shared needles can be deadly. Infection of injection drug users with HIV is spread primarily through reuse of contaminated syringes and needles or other paraphernalia by more than one person, as well as through unprotected sexual intercourse with HIV-infected individuals. For nearly one-third of Americans infected with HIV, injection drug use is a risk factor. In fact, drug abuse is the fastest growing vector for the spread of HIV in the nation.

NIDA-funded research has found that drug abusers can change the behaviours that put them at risk for contracting HIV, through drug abuse treatment, prevention, and community-based outreach programs. They can eliminate drug use, drug-related risk behaviours such as needle sharing, unsafe sexual practices, and, in turn, the risk of exposure to HIV/AIDS and other infectious diseases. Drug abuse prevention and treatment are highly effective in preventing the spread of HIV.

Methadone

Where did methadone come from?

Methadone Hydrochloride is an opioid (a synthetic opiate) that was originally synthesised by German pharmaceutical companies during the Second World War. It was first marketed as 'Dolophine' (possibly to honour Adolph Hitler) and was used as an analgesic (a painkiller) for the treatment of severe pain. It is still occasionally used for pain relief.

Methadone is now primarily used today for the treatment of narcotic addiction. The effects of methadone are longer-lasting than those of morphine-based drugs. Methadone's effects can last up to 24 hours, thereby permitting administration only once a day in heroin detoxification and maintenance programs.

How is methadone taken?

Methadone is usually available as a liquid - linctus or methadone mixture - which should be swallowed. Tablets and injectable ampoules are sometimes prescribed, and like many other medicines some of these prescribed drugs are diverted and become available illegally.

What are methadone's adverse reactions?

Deaths occur more frequently at the beginning of treatment in methadone programs; they are usually a cause of excessive doses (i.e. erroneously estimated tolerance) and they are affected by concomitant diseases (hepatitis, pneumonia). Methadone generally entails the entire spectrum of opioid side effects, including the development of tolerance and physical and psychological dependence. Respiratory depressions are dangerous. The released histamines can cause hypotension or bronchospasms. Other symptoms are: constipation, nausea or vomiting, sedation, vertigo, edema.

What are the symptoms of methadone overdose?

muscle spasticity
difficulty breathing
slow, shallow and laboured breathing
stopped breathing (sometimes fatal within 2-4 hours)
pinpoint pupils
bluish skin
bluish fingernails and lips
spasms of the stomach and/or intestinal tract
constipation
weak pulse
low blood pressure
drowsiness
disorientation
coma

What is methadone dependency?

As an opiate, regular use of methadone causes physical dependency - if you've been using it regularly (prescribed or not) once you stop you will experience a withdrawal. The physical changes due to the drug are similar to other opiates (like heroin); suppressed cough reflex, contracted pupils, drowsiness and constipation. Some methadone users feel sick when they first use the drug. If you are a woman using methadone you may not have regular periods - but you are still able to conceive. Methadone is a long-acting opioid; it has an effect for up to 36 hours (if you are using methadone you will not withdraw for this period) and can remain in your body for several days.

Personal Stories of Methadone Withdrawal

"I've been on both ends of withdrawals, heroin and methadone, every patient of methadone will always tell you the same, as I do; I can kick heroin anytime, but methadone that is something else. In 15 yrs of heroin addiction, I've kicked 3 times, 'cold-turkey'. In 10 years on methadone I've never kicked methadone.

"Once I landed in jail, I had to do 72 hours of jail time before I got to see the judge. I was literally on the floor screaming my guts out. About 12 hours before I was to see the judge, I demanded to be taken to the hospital, I just couldn't take it. I was cuffed, and looking like a 'chair' was glued to my back, I limped to the ambulance, since I couldn't lift my leg to climb into the back, the police grabbed me on both sides and shoved me in like a sack of potatoes, I fell flat on my face. The doctor realizing my condition and that it was severe, gave me a shot of methadone. The relief was immediate.

I was returned to the precinct and 2 days later I was in the same condition! Never did I go through such hell in all my days.

The intensity of methadone withdrawal is just too much! I could never do it. By the way, about 5 years ago one inmate went into convulsions and upon falling, he hit the metal bars and died."

On Sunday morning, March 30, I took my last dose of methadone. I had been on 80 mgs of methadone for the past 6 months.

My doctor, an anesthesiologist, writes prescriptions for 125 tablets. This lasts 15 days. I signed a contract with him that basically says I will use the same pharmacy, I will not get meds from other physicians, and if I run out before the 15 days is up I just have to go without. I didn't mind signing the contract at all, and I have abided by all the stipulations. I called him for a refill on Friday. No response. I called again on Saturday. No response. I called his home on Sunday. No response. On Sunday I took my last dose. I hate anything having this much control over me. I find it very demeaning to be so dependent on a bottle of pills.

On Monday I called his office. They informed me that he was on vacation this week. Panic descended . . . and so did withdrawal symptoms. At first I just got kind of nervous, jittery. My doctor has told me that methadone is not addicting. That is contrary to everything and anything I've ever heard or read about the drug. I never questioned him why he thought methadone wasn't addicting. I was hoping I'd never have to find out. What my body went through for the next 48 hours was one severe blow after another. I kept trying to tell myself I just had the flu. Just crawl in bed for 3 days and sweat it out. Of course I knew this wasn't true but I was going to play whatever mind game it took to get me through this. After the jitters, the muscle contractures started. It felt like the muscles in my legs and then in my arms were like rubber bands, being stretched and pulled to their max and then constricting to a shape that wasn't natural. Then came the sweats, diarrhoea, hallucinations.

I remember trying to dial the phone. It was a number I've called a thousand times before, only now I couldn't remember it. For that matter, I couldn't even hold the phone . . . I kept dropping it. My muscles were out of control. The pain that led me to methadone returned with a vengeance. In a strange way it was like an old friend. I knew it well and understood it completely. The combination of withdrawal and pain was too much. The all too familiar thoughts of suicide were returning.

It was now Tuesday morning. I called the pharmacist and explained the situation. By 1:10 PM I had 8 methadone tablets. I took the entire dose at once all 8 tablets. Within 2 hours my muscles had stopped screaming, my head was beginning to clear, and the pain was lessening.

It's now Thursday morning. I'm still not back to myself . . . but much better. The assault on my body was indeed very traumatic . . . I lost 7 pounds and am still very shaky. Addiction is indeed a dangerous thing and should be avoided. I must admit when I was in the throes of withdrawal there's not much I wouldn't have done to relieve the symptoms.

What are the dangers of methadone?

Is methadone more likely to kill you than heroin?
Dr Marcel Buster, MD & Dr Giel van Brussel, MD - Municipal Health Service, Amsterdam

Based on literature and analysis of mortality figures, Dr Russell Newcombe concluded that methadone programmes as a form of harm-reduction possibly cause more victims than they prevent. We have doubts whether the conclusion about methadone is fully justified. Looking at the mentioned literature gives a one-sided view at the problem. Moreover, the conclusions drawn are beyond those justified by the results of the analyses. Several points of debate come to mind:

Methadone is not an innocent substance; 'one's methadone maintenance dose is another's poison' (2). A regular user of opiates develops a certain tolerance. Therefore, it is possible that a tolerant person can function normally with dosages which can be fatal to a non-tolerant person. Also, methadone dosage in the case of first entry to the programme has to be evaluated carefully. It is wise to begin with a low dosage that has to be increased slowly in the course of weeks or even months. At entry to the programme it has to be carefully evaluated whether a patient has a clear and unambiguous heroin dependence. In methadone maintenance programmes, methadone is dispensed to tolerant persons: moreover, this tolerance remains high because of daily use of methadone. Therefore, it is not surprising that deaths at the King's College Hospital caused by methadone were not those of participants of a methadone maintenance programme but were those of 'recreational' users of illicit methadone.

In cases where more than one drug is used, the drug responsible for death due to overdose is difficult to establish. Moreover, the same drug prescribed by physicians can also be bought on the street. In seventy percent of the deaths due to overdose studied in Glasgow and Edinburgh a combination of different drugs was found (3).

Prescribed drugs such as temazepam were often encountered in deaths in Glasgow. However, among only 14 of the 34 persons who died in 1992 and where temazepam was found, this was prescribed by their physician. Because of the presence of other drugs it is not clear whether temazepam really caused the death of these people. Probably the combination of these different drugs was fatal to them. This was also the case with the methadone deaths in Edinburgh. However, in Edinburgh, the authors could not determine whether methadone was prescribed or not. Both Hammersley and Obafunwa report that heroin/morphine deaths seldom occur in Edinburgh (4). 'The fall of the deaths due to overdose in the Lothian and Borders Region of Scotland (LBRS) after 1984 reflects in part the strict policing that took place, in particular in the Edinburgh area'.

'The increase of methadone deaths is probably due to the introduction of a street trend to use this agent as a substitute to heroin'. The author suggests that methadone deaths are mainly caused by the use of illicit methadone.

Therefore, these figures suggest that participants of methadone programmes are at lower risk of death due to overdose. However, this does not mean that methadone is an innocent substance. The high and increasing number of methadone deaths in Britain is alarming and certainly needs more attention. The first priority should be to establish whether the methadone causing death has been prescribed within a methadone programme or bought on the street. It also should be evaluated at what point during the course of the methadone programme death takes place. Further instruction doctors prescribing methadone could be necessary. The use of non-prescribed methadone without medical supervision can lead to high risks, especially when it is used as a substitute for heroin in order to get a 'high' instead of to prevent withdrawal symptoms. Physicians have to be aware of this danger and they should make sure that the prescribed methadone (as well as other psycho-active drugs) does not end up in the 'grey market'.

History of heroin

Heroin, which is a very popular drug of choice in the American drug culture today, is not a new drug that just showed up in the late 1960's nor are its negative effects unique to modern times. Heroin is an opium derivative and, as with any of the opium derivatives, there is a severe physical/mental dependency that develops when it's abused.

In the mid to late 1800's, opium was a fairly popular drug. Opium dens were scattered throughout what we know today as the Wild West. The opium influx during this period was due in large part to the drug being brought into the country via Chinese immigrants who came here to work on the railroads.

Accurate American history tells us that famous names of the period like Wild Bill Hickok and Kit Carson actually frequented opium dens more often than saloons. The stereo-typed picture we have of the cowhand belly up to the bar drinking whiskey straight after a long hard ride on the dusty trail is only part of the story of the old west. Oftentimes times the cowhand was not belly up to a bar at all. He was in a prone position in a dim candle-lit room smoking opium in the company of an oriental prostitute. It was not uncommon for some of these cowhands to spend several days and nights at a time in these dens in a constant dream-state, eventually becoming physically addicted to the drug.

Nonetheless, it was true that alcoholism was a bigger problem. Alcoholism was one of the major sources of violence and death during this period. Eventually, however, opium was promoted as a cure for alcoholism by the late 1800's.

It was from opium that, morphine, a derivative, was developed as a pain killer in approximately 1810. It was considered a wonder drug because it eliminated severe pain associated with medical operations or traumatic injuries. It left the user in a completely numb euphoric dream-state. Because of the intense euphoric side effects, the drug in 1811 was named after the Greek god of dreams, Morpheus, by Dr. F.W.A. Serturner, a German pharmacist. By the mid 1850's morphine was available in the United States and became more and more popular with the medical profession. The benifets of using the drug to treat severe pain were considered nothing short of remarkable to doctors of the time. Unfortunately, the addictive properties of the drug, on the flip side, went virtually unnoticed until after the civil war.

Civil War-era morphine injection kit during the civil war the numbers of people exposed to morphine in the course of being treated for their war related injuries sky rocketed. Tens of thousands of northern and confederate soldiers became morphine addicts.

In just over 10 years time from its arrival into this country the United States was plagued with a major morphine epidemic. Even though no actual statistics were kept on addiction at this time, the problem had grown to large enough proportions to raise serious concerns from the medical profession. Doctors became perplexed and were completely in the dark as to how to treat this new epidemic.

By 1874 the answer to this increasing problem was thought to be found in the invention of a new drug in Germany. This new wonder drug was called Heroin, after its German trademarked name. Heroin was imported into the United States shortly after it was invented. The sales pitch that created an instant market to American doctors and their morphine addicted patients was that Heroin was a "safe, non addictive" substitute for morphine.

Early Bayer advertisement for heroin.

Hence, the heroin addict was born and has been present in American culture ever since.

From the late 1800's to the early 1900's the reputable drug companies of the day began manufacturing over the counter drug kits. These kits contained a glass barrelled hypodermic needle and vials of opiates (morphine or heroin) and/or cocaine packaged neatly in attractive engraved tin cases. Laudanum (opium in an alcohol base) was also a very popular elixir that was used to treat a variety of ills. Laudanum was administered to kids and adults alike - as freely as aspirin is used today.

There were of course marketing and advertising campaigns launched by the drug companies producing this product that touted these narcotics as the cure for all types of physical and mental ailments ranging from alcohol withdrawal to cancer, depression, sluggishness, coughs, colds, tuberculosis and even old age. Most of the elixirs pitched by the old "snake oil salesmen" in their medicine shows contained one or more of these narcotics in their mix.

Heroin, morphine and other opiate derivatives were unregulated and sold legally in the United States until 1920 when Congress recognized the danger of these drugs and enacted the Dangerous Drug Act. This new law made over-the-counter purchase of these drugs illegal and deemed that their distribution be federally regulated. By the time this law was passed, however, it was already too late. A market for heroin in the U.S. had been created. By 1925 there were an estimated 200,000 heroin addicts in the country. It was a market which would persist until this day.

References

History of Heroin & Opium Use & Abuse

3400 B.C.
The opium poppy is cultivated in lower Mesopotamia. The Sumerians refer to it as Hul Gil, the 'joy plant.' The Sumerians would soon pass along the plant and its euphoric effects to the Assyrians. The art of poppy-culling would continue from the Assyrians to the Babylonians who in turn would pass their knowledge onto the Egyptians.
1300 B.C.
In the capital city of Thebes, Egyptians begin cultivation of opium thebaicum,grown in their famous poppy fields.The opium trade flourishes during the reign of Thutmose IV, Akhenaton and King Tutankhamen. The trade route included the Phoenicians and Minoans who move the profitable item across the Mediterranean Sea into Greece, Carthage, and Europe.
1100 B.C.
On the island of Cyprus, the "Peoples of the Sea" craft surgical-quality culling knives to harvest opium, which they would cultivate, trade and smoke before the fall of Troy.
460 B.C.
Hippocrates, "the father of medicine", dismisses the magical attributes of opium but acknowledges its usefulness as a narcotic and styptic in treating internal diseases, diseases of women and epidemics.
330 B.C.
Alexander the Great introduces opium to the people of Persia and India.
300 B.C.
Opium used by Arabs, Greeks, and Romans as a sedative and soporific.
400 A.D.
Opium thebaicum, from the Egyptian fields at Thebes, is first introduced to China by Arab traders.
1300
Opium disappears for two hundred years from European historical record. Opium had become a taboo subject for those in circles of learning during the Holy Inquisition. In the eyes of the Inquisition, anything from the East was linked to the Devil.
1500
The Portuguese, while trading along the East China Sea, initiate the smoking of opium. The effects were instantaneous as they discovered but it was a practice the Chinese considered barbaric and subversive.
1527
During the height of the Reformation, opium is reintroduced into European medical literature by Paracelsus as laudanum. These black pills or "Stones of Immortality" were made of opium thebaicum, citrus juice and quintessence of gold and prescribed as painkillers.
1600
Residents of Persia and India begin eating and drinking opium mixtures for recreational use.
1606
Ships chartered by Elizabeth I are instructed to purchase the finest Indian opium and transport it back to England.
1680
English apothecary, Thomas Sydenham, introduces Sydenham's Laudanum, a compound of opium, sherry wine and herbs. His pills along with others of the time become popular remedies for numerous ailments.
1689
Use of tobacco-opium mixtures (madak) begins in the East Indies (probably Java) spreads to Formosa, Fukien and the South China coast.
1700
The Dutch export shipments of Indian opium to China and the islands of Southeast Asia; the Dutch introduce the practice of smoking opium in a tobacco pipe to the Chinese.
1729
Chinese emperor, Yung Cheng, issues an edict prohibiting the smoking of opium and its domestic sale, except under license for use as medicine.
1750
The British East India Company assumes control of Bengal and Bihar, opium-growing districts of India. British shipping dominates the opium trade out of Calcutta to China.
1753
Linnaeus, the father of botany, first classifies the poppy, Papaver somniferum- 'sleep-inducing', in his book Genera Plantarum.
1767
Opium from Bengal continues to enter China despite the edict of 1729 prohibiting smoking. The British East India Company's import of opium to China increases in frequency from 200 chests annually in 1729 to a staggering two thousand chests of opium per year. However, much is for medicinal use. Tariffs are collected on the opium.
1772
The East India company establishes a limited monopoly over Bengal opium; the company has general control but the operation is in the hands of contractors, who advance company funds to the farmers, purchases the opium produced, and sell it to the company which then auctions it off to merchants in Calcutta. British companies are the principal shippers.
1773 - 1786
Warren Hastings, the first governor general of India, recognizes that opium is harmful and at first opposes increasing production; later he encourages the control of opium by the company hoping that by monopolizing and limiting the supply he will discourage its consumption. This limited monopoly lasts throughout his administration and beyond, but when the Chinese market is discovered, the monopoly shifts from controlling to expanding cultivation.
1780
First mention of actual trading in opium at Canton.
1787
Trade in opium is still less important than trade in commodities; directors of the East India Company, recognizing China's objections to the importation of opium, make offers to prohibit the export of Indian opium to China. However, company representatives in Canton declare that the Chinese are never sincere in their declared intentions of suppressing illicit traffic, as long as the officials issue prohibitory edicts with one hand and extend the other to receive bribes from the illegal trade.
1793
The British East India Company establishes a total monopoly on the opium trade. All poppy growers in India were forbidden to sell opium to competitor trading companies.
1796
Alarmed by increasing use, the emperor of China issues an edict forbidding importation of opium, as well as export of Chinese silver that is being used as a medium of exchange. Now even legitimate trade is limited to barter. Nonetheless, illegal purchase of opium with silver continues.
1799
The 1799 edict increases traffic through Macao and other areas beyond government control enabling unprecedented growth. The British declare only their legitimate cargo, leave opium on board to be picked up by Chinese merchants who smuggle it ashore in small, fast boats.
1800
Patent medicines and opium preparations such as Dover's Powder were readily available without restrictions. Indeed, Laudanum (opium mixed with alcohol) was cheaper than beer or wine and readily within the means of the lowest-paid worker. As a result, throughout the first half of the 19th century, the incidence of opium dependence appears to have increased steadily in England, Europe and the United States. Working-class medicinal use of opium-bearing nostrums as sedatives for children was especially prominent in England. However, despite some well known cases among 19th century English literary and creative personalities (Thomas de Quincey, Byron, Shelley, Coleridge, and Dickens) recreational use was limited, and there is no evidence that use was so excessive as to be a medical or social concern.
1800
Opium becomes identified with official corruption, criminals and antigovernment secret societies. An edict prohibits domestic cultivation and repeats the prohibition against importing opium. China develops an anti-opium policy, at least on paper. Edicts continue to be issued reiterating prohibitions against importation, sale, and consumption of opium.
1800 - 1820
Domestic opium cultivation is encouraged by increased opium use, along with rising prices and problems with adulteration. It declines after the 1820s, but there does not appear to have been any call for controls.
1803
Friedrich Sertuerner of Paderborn, Germany discovers the active ingredient of opium by dissolving it in acid then neutralizing it with ammonia. The result: alkaloids- Principium somniferum or morphine. This may have been the first plant alkaloid ever isolated and set off a firestorm of research into plant alkaloids. Within half a century, dozens of alkaloids, such as atropine, caffeine, cocaine, and quinine, had been isolated from other plants and were being used in precisely measured dosages for the first time.
1804
Opium trading resumes at the port of Canton. Though the 1799 edict is still in force, it has little effect and no immediate practical change in policy ensues.
1805
A smuggler from Boston, Massachusetts, Charles Cabot, attempts to purchase opium from the British, then smuggle it into China under the auspices of British smugglers.
1812
American John Cushing, under the employ of his uncles' business, James and Thomas H. Perkins Company of Boston, acquires his wealth from smuggling Turkish opium to Canton.
1816
John Jacob Astor of New York City joins the opium smuggling trade. His American Fur Company purchases ten tons of Turkish opium then ships the contraband item to Canton on the Macedonian. Astor would later leave the China opium trade and sell solely to England.
1819
Writer John Keats and other English literary personalities experiment with opium intended for strict recreational use- simply for the high and taken at extended, non-addictive intervals
1821
Thomas De Quincey publishes his autobiographical account of opium addiction, 'Confessions of an English Opium-eater.'
1827
E. Merck & Company of Darmstadt, Germany, begins commercial manufacturing of morphine.
1830
The British dependence on opium for medicinal and recreational use reaches an all time high as 22,000 pounds of opium is imported from Turkey and India.
1832
Codeine is extracted from opium.
1837
Elizabeth Barrett Browning falls under the spell of morphine. This, however, does not impede her ability to write "poetical paragraphs."
1839
Opium and its preparations are responsible for more premature deaths than any other chemical agent. Opiates account for 186 of 543 poisonings, including no fewer than 72 among children.
1839
Lin Tse-Hsu, imperial Chinese commissioner in charge of suppressing the opium traffic, orders all foreign traders to surrender their opium. In response, the British send expeditionary warships to the coast of China, beginning The First Opium War.
1840
New Englanders bring 24,000 pounds of opium into the United States. This catches the attention of U.S. Customs which promptly puts a duty fee on the import.
1841
The Chinese are defeated by the British in the First Opium War. Along with paying a large indemnity, Hong Kong is ceded to the British.
1843
Dr. Alexander Wood of Edinburgh discovers a new technique of administering morphine, injection with a syringe. He finds the effects of morphine on his patients instantaneous and three times more potent.
1852
The British arrive in lower Burma, importing large quantities of opium from India and selling it through a government-controlled opium monopoly.
1853
The hypodermic needle was invented.
1856
The British and French renew their hostilities against China in the Second Opium War. In the aftermath of the struggle, China is forced to pay another indemnity. The importation of opium is legalized.
1874
English researcher, C.R. Wright first synthesizes heroin, or diacetylmorphine, by boiling morphine over a stove.
1878
Britain passes the Opium Act with hopes of reducing opium consumption. Under the new regulation, the selling of opium is restricted to registered Chinese opium smokers and Indian opium eaters while the Burmese are strictly prohibited from smoking opium.
1886
The British acquire Burma's northeast region, the Shan state. Production and smuggling of opium along the lower region of Burma thrives despite British efforts to maintain a strict monopoly on the opium trade.
1890
U.S. Congress, in its earliest law-enforcement legislation on narcotics, imposes a tax on opium and morphine.
1895
Heinrich Dreser working for The Bayer Company of Elberfeld, Germany, finds that diluting morphine with acetyls produces a drug without the common morphine side effects. Bayer begins production of diacetylmorphine and coins the name "heroin."
1898
The Bayer Company introduces heroin as a substitute for morphine.
Early 1900's
The philanthropic Saint James Society in the U.S. mounts a campaign to supply free samples of heroin through the mail to morphine addicts who are trying give up their habits.
1902
The philanthropic Saint James Society in the U.S. mounts a campaign to supply free samples of heroin through the mail to morphine addicts who are trying give up their habits.
1903
Heroin addiction rises to alarming rates.
1905
First mention of actual trading in opium at Canton.
1906
China and England finally enact a treaty restricting the Sino-Indian opium trade.
1909
The first federal drug prohibition passes in the U.S. outlawing the importation of opium. It was passed in preparation for the Shanghai Conference, at which the US presses for legislation aimed at suppressing the sale of opium to China.
1909
The International Opium Commission convenes in Shanghai. Heading the U.S. delegation are Dr. Hamilton Wright and Episcopal Bishop Henry Brent. Both would try to convince the international delegation of the immoral and evil effects of opium.
1910
After 150 years of failed attempts to rid the country of opium, the Chinese are finally successful in convincing the British to dismantle the India-China opium trade.
1914
The passage of Harrison Narcotics Act which aims to curb drug (especially cocaine but also heroin) abuse and addiction. It requires doctors, pharmacists and others who prescribed narcotics to register and pay a tax.
1922
Narcotic Import and Export Act - restricted the importation of crude opium except for medical use.
1923
The U.S. Treasury Department's Narcotics Division (the first federal drug agency) bans all legal narcotics sales. With the prohibition of legal venues to purchase heroin, addicts are forced to buy from illegal street dealers.
1924
Heroin Act - made manufacture and possession of heroin illegal.
1924
In the wake of the first federal ban on opium, a thriving black market opens up in New York's Chinatown.
1925
The majority of illegal heroin smuggled into the U.S. comes from China and is refined in Shanghai and Tientsin.
1940
During World War II, opium trade routes are blocked and the flow of opium from India and Persia is cut off. Fearful of losing their opium monopoly, the French encourage Hmong farmers to expand their opium production.
1945 - 1947
Burma gains its independence from Britain at the end of World War II. Opium cultivation and trade flourishes in the Shan states.
1948 - 1972
Corsican gangsters dominate the U.S. heroin market through their connection with Mafia drug distributors. After refining the raw Turkish opium in Marseille laboratories, the heroin is made easily available for purchase by junkies on New York City streets.
1950
U.S. efforts to contain the spread of Communism in Asia involves forging alliances with tribes and warlords inhabiting the areas of the Golden Triangle, (an expanse covering Laos, Thailand and Burma), thus providing accessibility and protection along the southeast border of China. In order to maintain their relationship with the warlords while continuing to fund the struggle against communism, the U.S. and France supply the drug warlords and their armies with ammunition, arms and air transport for the production and sale of opium. The result: an explosion in the availability and illegal flow of heroin into the United States and into the hands of drug dealers and addicts.
1962
Burma outlaws opium.
1965 - 1970
U.S. involvement in Vietnam is blamed for the surge in illegal heroin being smuggled into the States. To aid U.S. allies, the Central Intelligence Agency (CIA) sets up a charter airline, Air America, to transport raw opium from Burma and Laos. As well, some of the opium would be transported to Marseille by Corsican gangsters to be refined into heroin and shipped to the U.S via the French connection. The number of heroin addicts in the U.S. reaches an estimated 750,000.
1970
Controlled Substances Act was passed - divided drugs into categories, set regulations and penalties for narcotics.
1972
Heroin exportation from Southeast Asia's Golden Triangle, controlled by Shan warlord, Khun Sa,becomes a major source for raw opium in the profitable drug trade.
1973
President Nixon creates the DEA (Drug Enforcement Administration) under the Justice Dept. to consolidate virtually all federal powers of drug enforcement in a single agency.
1970
Saigon falls. The heroin epidemic subsides. The search for a new source of raw opium yields Mexico's Sierra Madre. "Mexican Mud" would temporarily replace "China White" heroin until 1978.
1978
The U.S. and Mexican governments find a means to eliminate the source of raw opium - by spraying poppy fields with Agent Orange. The eradication plan is termed a success as the amount of "Mexican Mud" in the U.S. drug market declines. In response to the decrease in availability of "Mexican Mud", another source of heroin is found in the Golden Crescent area - Iran, Afghanistan and Pakistan, creating a dramatic upsurge in the production and trade of illegal heroin.
1982
Comedian John Belushi of Animal House fame, dies of a heroin - cocaine "speedball" overdose.
1984
U.S. State Department officials conclude, after more than a decade of crop substitution programmes for Third World growers of marijuana, coca or opium poppies, that the tactic cannot work without eradication of the plants and criminal enforcement. Poor results are reported from eradication programmes in Burma, Pakistan, Mexico and Peru.
1990
Opium production in Burma increases under the rule of the State Law and Order Restoration Council (SLORC), the Burmese junta regime.
1992
A U.S. Court indicts Khun Sa, leader of the Shan United Army and reputed drug warlord, on heroin trafficking charges. The U.S. Attorney General's office charges Khun Sa with importing 3,500 pounds of heroin into New York City over the course of eighteen months, as well as holding him responsible for the source of the heroin seized in Bangkok.
1993
The Thai army with support from the U.S. Drug Enforcement Agency (DEA) launches its operation to destroy thousands of acres of opium poppies from the fields of the Golden Triangle region.
1993
Heroin takes another well-known victim. Twenty-three-year-old actor River Phoenix dies of a heroin-cocaine overdose, the same "speedball" combination that killed comedian John Belushi.
1994
Efforts to eradicate opium at its source remains unsuccessful. The Clinton Administration orders a shift in policy away from the anti- drug campaigns of previous administrations. Instead the focus includes "institution building" with the hope that by "strengthening democratic governments abroad, [it] will foster law-abiding behaviour and promote legitimate economic opportunity."
1994
Kurt Cobain, lead singer of the Seattle-based alternative rock band, Nirvana, dies of heroin-related suicide.
1995
The Golden Triangle region of Southeast Asia is now the leader in opium production, yielding 2,500 tons annually. According to U.S. drug experts, there are new drug trafficking routes from Burma through Laos, to southern China, Cambodia and Vietnam.
1996
Khun Sa, one of Shan state's most powerful drug warlords, "surrenders" to SLORC. The U.S. is suspicious and fears that this agreement between the ruling junta regime and Khun Sa includes a deal allowing "the opium king" to retain control of his opium trade but in exchange end his 30-year-old revolutionary war against the government.
1996
International drug trafficking organizations, including China, Nigeria, Colombia and Mexico are said to be "aggressively marketing heroin in the United States and Europe."