Deadly Short Cuts "It's so good. Don't even try it once."

intravenous heroin user

Heroin is named after the German word for powerful, heroic, heroisch. According to popular legend, its substitute, methadone, was initially christened Dolophine in honour of Adolf Hitler. In reality, the name comes from the Latin dolor, meaning "pain", and fin, meaning "end": hence "end of pain".

The consumption of heroin is marked by a euphoric rush, a warm feeling of relaxation, a sense of security and protection, and a dissipation of pain, fear, hunger, tension and anxiety. When heroin is snorted or smoked, the rush is intense and orgasmic. Subjectively, time may slow down. Any sense of anger, frustration or aggression disappears. Users enjoy the feeling of "being wrapped in God's warmest blanket".

Heroin is the most fast-acting of all the opiates. When injected, it reaches the brain in 15-30 seconds; smoked heroin reaches the brain in around 7 seconds. The peak experience via this route lasts at most a few minutes. The surge of pleasure seems to start in the abdomen; a delicious warmth then spreads throughout the body, or at least the somatosensory cortex. After the intense euphoria, a period of tranquillity ("on the nod") follows, lasting up to an hour. Experienced users will inject between 2-4 times per day. After taking heroin, some people feel cocooned and emotionally self-contained. Others feel stimulated and sociable. Either way, there is a profound sense of control and well-being. The euphoria gradually subsides into a dreamy and relaxed state of contentment. Higher doses of heroin normally make a person feel sleepy. At higher doses still, the user will nod off into a semi-conscious state. The effects usually wear off in 3-5 hours, depending on the dose. Heroin is not inherently toxic to the organ systems of the body. Whereas a 200-400mg dose of heroin could kill a novice, a chronic user may take 1800mg without ill-effects. But in prohibitionist society the mortality of street users is high.

Diacetylmorphine, or heroin, was first synthesized from morphine in 1874. It is formed simply by adding two acetyl groups. Heroin is around three times more potent than morphine. Its increased lipid solubility allows heroin to cross the blood-brain barrier more quickly. The drug is reconverted back to morphine before it binds to brain-tissue receptors. Pure heroin is a white, odourless powder with a bitter taste. Most illicit heroin, however, varies in color from white, pink/beige to dark brown. This is because of impurities left from the manufacturing process or the presence of additives.

In the late nineteenth century, it was fondly believed that if only one could filter out the "addictive" properties of opium, then one would capture its therapeutic essence. Heinrich Dreser, in charge of drug development at Bayer, tested the new semi-synthetic drug on animals, humans, and most notably himself. Dreser was impressed. He pronounced heroin an effective treatment for a variety of respiratory ailments, especially bronchitis, asthma and tuberculosis.

Commercial production of heroin began in 1898. Heroin was advertised under its well-known trademark by German manufacturers Bayer as "the sedative for coughs". The new wonderdrug enjoyed widespread acceptance in the medical profession. This was because heroin induces a serene, un-manic euphoria with minimal interference with sensation, motor skills or intellect - though chronic opioid use typically diminishes the inclination to abstract thought.

Bayer was soon enthusiastically selling heroin to dozens of countries. Free samples were handed out to physicians. The medical profession remained largely unaware of the potential risk of addiction for years. Eventually news filtered out. Doctors noticed that some of their patients were consuming inordinate quantities of heroin-based cough remedies. It transpired that heroin was not the miracle-cure for morphinism that some of its early boosters had supposed. In 1913, Bayer halted production. They wrote the drug out of their official company history, and focused instead on marketing their second blockbuster drug, aspirin.

Comprehensive control of opiates in the United States was first established in 1914 with the Harrison Narcotic Act. In 1924, federal law made any use of heroin illegal. Within a decade, the Bureau of Narcotics had arrested some 50,000 users and 25,000 physicians. Most of the problems suffered by contemporary users derive, directly or indirectly, from the criminalisation of heroin use and the draconian penalties inflicted on those who take it. Likewise, most of the needless pain suffered by the physically ill today derives, directly or indirectly, from the demonisation of opioid drugs and from the reluctance of physicians to prescribe stigmatised remedies for pain that really work.

During World War One, newspaper editors, police forces, politicians and "patriots" whipped up a climate of hysteria against seditious "dope fiends" enslaved by "the German invention". Heroin use was associated with anarchy, violence, foreigners and Bolshevism. Prohibition led inexorably to control of the heroin business by organised crime. Jewish gangsters such as Meyer Lansky dominated distribution in the 1920s. In the 1930s, they were superseded by the Mafia: this was the era of "Lucky" Luciano, the celebrated Sicilian mobster.

Drug law was widely flouted. In explaining the failure of decades of prohibitionist legislation, former chief of police of the USA, Joseph D McNamara, wrote in National Review...

"It's the money, stupid. After 33 years as a police officer in three of the country's largest cities, that is my message to the righteous politicians who obstinately proclaim that a war on drugs will lead to a drug-free America. About $500 of heroin or cocaine in a source country will bring in as much as $100,000 on the streets of an American city. All the cops, armies, prisons and executions in the world cannot impede a market with that kind of tax-free profit-margin. It is the illegality that permits the obscene mark-up, enriching drug-traffickers, distributors, dealers, crooked cops, lawyers, judges, politicians, bankers, businessmen..."

"...The basic fact that eluded these great geniuses was that it takes only ten square miles of poppy to feed the entire American heroin market, and they grow everywhere...."

When injected, heroin provides an extremely powerful rush. After 4 to 8 hours, the effects start to wear off. Tolerance develops to the respiratory depressant, sedative, analgesic, emetic and euphorigenic effect. So users tend to increase their daily dose - sometimes as much as a hundredfold or more - if financial resources permit. Financial resources frequently don't: the term "junkie" derives from addicts who stole junk metal to support their habit.

Injecting drugs can be a risky business in prohibitionist society. This is because hygiene is difficult, education is minimal, and fluctuations in quality can lead to accidental overdose. US opposition to needle-exchange programs at home and abroad has massively promoted the spread of HIV and hepatitis in users - and non-users - alike. Noxious tobacco-smoking aside, the Supreme Court of the United States has never been sympathetic to a drug-based lifestyle....

"To be a confirmed drug addict is to be one of the walking dead....The teeth have rotted out, the appetite is lost, and the stomach and intestines don't function properly. The gall bladder becomes inflamed; eyes and skin turn a bilious yellow; in some cases membranes of the nose turn a flaming red; the partition separating the nostrils is eaten away-breathing is difficult. Oxygen in the blood decreases; bronchitis and tuberculosis develop. Good traits of character disappear and bad ones emerge. Sex organs become affected. Veins collapse and livid purplish scars remain. Boils and abscesses plague the skin; gnawing pain racks the body. Nerves snap; vicious twitching develops. Imaginary and fantastic fears blight the mind and sometimes complete insanity results. Often times, too, death comes-much too early in life....Such is the torment of being a drug addict; such is the plague of being one of the walking dead..." (1962)

Heroin is sometimes smoked with crack cocaine. This combination delivers an even more intensely rewarding experience than taking either drug alone. "Speedballs" are hugely addictive and ruinously expensive. Yet in a clinical setting and among the terminally ill, the simultaneous use of cocaine, methylphenidate or amphetamines with heroin or morphine can augment the opioid's analgesic and anxiolytic effect while allowing its dosage to be lowered. The risks of respiratory depression are thus diminished.

Why do we like opium and its derivatives so much?

Heroin mimics the action of natural chemicals, endorphins, produced by the body in response to pain. Endorphins are small-chain peptides that activate our endogenous opioid receptors. Opioid receptors are proteins embedded in the cell membrane; opioid agonists bind to the receptors to initiate their effects. The highest density of opioid receptors is found in the limbic system. Their activation produces feelings of happiness, relaxation, fearlessness and tolerance to pain. Endorphins are hundreds or even thousands of times more potent than morphine on a molar basis. Their potency means their concentrations in vivo are low. Endorphins are also involved in respiration, nausea, vomiting, pain modulation, hormonal regulation and itching.

Opioid drugs also act in these limbic brain regions. Yet except at very high doses, the opioids don't block the pain messages themselves. Rather, they change the subjective experience of the pain. This is why people receiving morphine for pain-relief may say that they still feel the pain - but that it doesn't bother them any more. Many users self-medicate: opioids are powerful antidepressants and antianxiety agents. Response and remission rates are high; but so are tolerance, dependence and addiction.