!!!HeroiN??? July 11, 2009
Posted by Visakh Vijay in General.add a comment
Heroin is a highly addictive drug, and Heroin Addiction is a serious problem in America. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction.
Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for 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 heroin?
Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. 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.
What is the scope of heroin use in the United States?
According to the 1998 National Household Survey on Drug Abuse, which may actually underestimate illicit opiate (heroin) use, an estimated 2.4 million people had used heroin at some time in their lives, and nearly 130,000 of them reported using it within the month preceding the survey. The survey report estimates that there were 81,000 new heroin users in 1997. A large proportion of these recent new users were smoking, snorting, or sniffing heroin, and most (87 percent) were under age 26. In 1992, only 61 percent were younger than 26.
The 1998 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 1991 and 1996, heroin-related ED episodes more than doubled (from 35,898 to 73,846). Among youths aged 12 to 17, heroin-related episodes nearly quadrupled.
NIDA’s Community Epidemiology Work Group (CEWG), which provides information about the nature and patterns of drug use in 21 cities, reported in its December 1999 publication that heroin was mentioned most often as the primary drug of abuse in drug abuse treatment admissions in Baltimore, Boston, Los Angeles, Newark, New York, and San Francisco.
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.
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Route of Administration Among |
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Source: Community Epidemiology Work Group, NIDA,
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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 the most widely reported means of taking heroin among users admitted for drug treatment in Newark, Chicago, and New York.
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, the increase continues 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.
What are the immediate (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.” 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.
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 function slows. 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. 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, diarrhea, vomiting, cold flashes 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 fetus 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.
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Short- and Long-Term Effects of Heroin Use |
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What are the medical complications of chronic heroin use?
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 rheumatologic 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?
Heroin addicts are at risk for contracting HIV, hepatitis C, and other infectious diseases. Drug abusers may become infected with HIV, hepatitis C, and other blood-borne pathogens through sharing and reuse of syringes and injection paraphernalia that have been used by infected individuals. They may also become infected with HIV and, although less often, to hepatitis C through unprotected sexual contact with an infected person. Injection drug use has been a factor in an estimated one-third of all HIV and more than half of all hepatitis C cases in the Nation.
NIDA-funded research has found that drug abusers can change the behaviors 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 behaviors 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.
What are the treatments for heroin addiction?
A variety of effective treatments are available for heroin addiction. Treatment tends to be more effective when heroin abuse is identified early. The treatments that follow vary depending on the individual, but methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has a proven record of success for people addicted to heroin. Other pharmaceutical approaches, like LAAM (levo-alpha-acetyl-methadol) and buprenorphine, and many behavioral therapies also are used for treating heroin addiction. If you are seeking addiction treatment make sure the facility understands and specializes in heroin addiction.
Detoxification
The primary objective of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free state. Not in itself a treatment for addiction, detoxification is a useful step only when it leads into long-term treatment that is either drug-free (residential or outpatient) or uses medications as part of the treatment. The best documented drug-free treatments are the therapeutic community residential programs lasting at least 3 to 6 months.
Methadone programs
Methadone treatment has been used effectively and safely to treat opioid addiction for more than 30 years. Properly prescribed methadone is not intoxicating or sedating, and its effects do not interfere with ordinary activities such as driving a car. The medication is taken orally and it suppresses narcotic withdrawal for 24 to 36 hours. Patients are able to perceive pain and have emotional reactions. Most important, methadone relieves the craving associated with heroin addiction; craving is a major reason for relapse. Among methadone patients, it has been found that normal street doses of heroin are ineffective at producing euphoria, thus making the use of heroin more easily extinguishable.
Methadone’s effects last for about 24 hours – four to six times as long as those of heroin – so people in treatment need to take it only once a day. Also, methadone is medically safe even when used continuously for 10 years or more. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives.
Methadone dosages must be carefully monitored in patients who are receiving antiviral therapy for HIV infection, to avoid potential medication interactions.
LAAM and other medications
LAAM, like methadone, is a synthetic opiate that can be used to treat heroin addiction. LAAM can block the effects of heroin for up to 72 hours with minimal side effects when taken orally. In 1993 the Food and Drug Administration approved the use of LAAM for treating patients addicted to heroin. Its long duration of action permits dosing just three times per week, thereby eliminating the need for daily dosing and take-home doses for weekends. LAAM will be increasingly available in clinics that already dispense methadone. Naloxone and naltrexone are medications that also block the effects of morphine, heroin, and other opiates. As antagonists, they are especially useful as antidotes. Naltrexone has long-lasting effects, ranging from 1 to 3 days, depending on the dose. Naltrexone blocks the pleasurable effects of heroin and is useful in treating some highly motivated individuals. Naltrexone has also been found to be successful in preventing relapse by former opiate addicts released from prison on probation.
Another medication to treat heroin addiction, buprenorphine, may already be available by the time this Research Report appears. Buprenorphine is a particularly attractive treatment because, compared to other medications, such as methadone, it causes weaker opiate effects and is less likely to cause overdose problems. Buprenorphine also produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than do those who stop taking methadone. Because of these advantages, buprenorphine may be appropriate for use in a wider variety of treatment settings than the currently available medications. Several other medications with potential for treating heroin overdose or addiction are currently under investigation by NIDA.
Behavioral therapies
Although behavioral and pharmacologic treatments can be extremely useful when employed alone, science has taught us that integrating both types of treatments will ultimately be the most effective approach. There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. An important task is to match the best treatment approach to meet the particular needs of the patient. Moreover, several new behavioral therapies, such as contingency management therapy and cognitive-behavioral interventions, show particular promise as treatments for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn ÒpointsÓ based on negative drug tests, which they can exchange for items that encourage healthy living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Both behavioral and pharmacological treatments help to restore a degree of normalcy to brain function and behavior, with increased employment rates and lower risk of HIV and other diseases and criminal behavior.
What is CocainE July 11, 2009
Posted by Visakh Vijay in General.add a comment
Slang
Coke, C, Charlie, Snow, Crack, Rock, Freebase, Nose candy, Dust, Toot, White lady
How it is taken
Snorted
Injected
Smoked
Swallowed
Common effects
- initial physiological arousal and feelings of well being
- increased body temperature, heart rate
- dilated pupils
- sexual arousal
- poor concentration and judgement
- feelings of great physical strength and confidence
- unpredictable and violent behaviour
What it is
Cocaine is a highly addictive stimulant of the central nervous system and an appetite suppressant. It provides increased energy and a euphoric sense of wellbeing.
Cocaine commonly comes in the form of a white odourless powder called cocaine hydrochloride (HCI). This is the pure form of cocaine that has a pearl-colouredappearance and a bitter numbing taste. The powder is extracted from the leaves of the coca bush found. Various chemicals are used to develop the different types of cocaine.
Historically, cocaine was used as a painkiller in dentistry and for surgical operations on eyes and throats.
There are several forms of cocaine, each with differing modes of administration:
- Freebase – Freebase is the base form of cocaine as opposed to the salt. It is derived from cocaine hydrochloride which has been chemically treated with ammonia or baking soda. It then forms shards of rock like crystals that are not dissolvable in water, so freebase cannot be injected or sniffed. It is smoked from pipes, or mixed with tobacco or cannabis and the rush is almost instant. The initial high lasts no longer than 5-10 minutes and a craving for a second hit occurs soon after.
- Crack cocaine – Crack is a less pure variety of freebase. The cocaine hydrochloride is mixed with baking soda and water, and then heated to form crystals like rocks. Crack cocaine is smoked. Crack cocaine was initially developed for a poorer market and some people still refer to it today as ‘poor man’s cocaine’. Crack cocaine’s impurity is indicated by its colour which will generally range from a yellowish crème to light brown. Pure cocaine (HCI) will be a pearly white colour.
- Cocaine hydrochloride – Cocaine hydrochloride is a salt and a more pure form of cocaine, though it can sometimes be mixed with other substances, some of which are poisonous. It comes in a powdered form which is snorted. The powder that is not absorbed through the nasal membranes collect in mucus and drips down the back of the throat. For many this is an unpleasant sensation. Regular and heavy snorting use can damage the tissue on the inside of the nose.
Cocaine can be swallowed (eaten) or injected, although these methods are more rarely used.
Short term effects
Cocaine’s effects can last from 20 minutes to several hours depending on the dosage, method of administration and purity. Common initial signs are an intense sense of euphoria, hyperactivity, restlessness and increased blood pressure and heart rate.
The initial rush commonly wears off fast and is usually followed by feelings of discomfort, depression and a craving to experience the drug again. Side effects from these feelings include twitching, paranoia and impotence which usually increases with frequent use.
The immediate craving to use more cocaine is strong, because euphoric effects often subside within an hour of the last dosage. When administration stops after binge use, it is usually followed by a ‘crash’, or the onset of a state of restlessness and anxiety, with escalating exhaustion until sleep is achieved.
Cocaine causes heat loss and cocaine induced hyperthermia has been known to occur. This may cause muscle cell destruction and can ultimately result in renal failure.
Cocaine is generally detectable in urine for two to three days after use, although long time habitual users may have traces of cocaine in their system for longer.
Long-term effects
Long-term use has multiple physical and psychological health consequences. It is associated with a lifetime risk of heart attack that is seven times that of non-users.
With excessive use and dosage the drug can produce:
- hallucinations and paranoid delusions,
- erratic heartbeat, itching, and psychosis.
- paranoia, nausea and vomiting
- loss of concentration and coordination
- loss of interest in sex,
- loss of ambition and motivation
Tolerance develops after excessive use over long periods leading the user to require larger doses to achieve desired effects and heightening the risk of developing negative health consequences.
Smoking cocaine long-term can result in chest pains, lung trauma, shortness of breath, sore throat, and aching flu like symptoms.
Snorting as a mode of administration degrades the cartilage separating the nostrils which can cause it eventually to disappear.
Long-term injection use can result in blood vessels becoming blocked by substances mixed with cocaine, collapsed veins, tetanus, abscesses, and damage to the lungs, heart, liver and brain. Nose bleeds can also occur with excessive use.
Dependence, addiction, and overdose risk
The high from cocaine can be intensely rewarding but the experience is very short lived. The euphoria initially experienced produces an intense craving which can develop quickly into an addiction. Addiction rates are high for smoking and much higher for injecting.
Many dependent users develop a transient manic like condition similar to amphetamine psychosis and schizophrenia. Symptoms of this include aggression, severe paranoia, tactile hallucinations as well as feelings of insects crawling under the skin.
Because cocaine is a highly addictive substance with shorted lived effects, users sometimes go on binge sessions resulting in overdose. Overdoses can lead to rapid heartbeat, raised blood pressure, heart attack, seizures, kidney failure, stroke and repeated convulsions. Death may result. There is no specific antidote for cocaine overdose.
Withdrawal symptoms occur when a dependent user decides to stop use or significantly cuts down the amount they are using. Cocaine withdrawal commonly occurs in three phases:
1. ‘Crash’: occurs immediately after the person stops using cocaine and especially after a cocaine binge session. Symptoms include:
- agitation
- depression
- intense craving for the drug
- fatigue.
2. Withdrawal: depending on individual history of use, this can last up to ten weeks. Symptoms include:
- depression
- lack of motivation
- anxiety, shaking
- intense craving foe the drug
- angry outbursts
- nausea and vomiting
- muscle pain.
- sleep disturbances
3. Extinction: Even after withdrawal symptoms have ceased, sporadic cravings for cocaine may surface months or years after the user has ceased using cocaine.
The New Zealand context
The cocaine market in New Zealand is not big and has rarely been the focus of media attention or the cause of a significant number of hospital admissions in recent years. The cocaine market has remained stable with high prices and low availability. There is little evidence to suggest that this trend will change.
Statistics
Recent surveys indicate that:
- the median cost of cocaine in 2005 was $300 per gram
- 75 percent of participants said that cocaine’s street price has been stable in the past six months
- 36 percent of participants indicated that availability of cocaine had become ‘more difficult’ in the past six months.
- between 1996 and1998 there were 23 cases of cocaine admissions to publicly funded hospitals
- in 1998 only 4.4 percent of survey participants had ever tried cocaine and 1.1 percent had tried cocaine in the past year.
- in 1998 0.8 percent of survey participants had tried crack cocaine and 0.2 percent had tried crack cocaine in the past year.
- in 2001 3.2 percent of participants had tried cocaine and 0.6 percent had tried cocaine in the past year. Only 0.3 percent were current users.
The law and penalties
Cocaine is illegal in New Zealand and is classified as a Class A drug scheduled under the Misuse of Drugs Act. This means it attracts the highest penalties possible for manufacture, sale and use.
Manufacturing, importing, supply or dealing cocaine can attract a maximum sentence of life in jail. Conspiracy to commit an offence or to manufacture, import or supply can attract up to 14 years imprisonment. Possession of cocaine can attract up to 6 months imprisonment and/or a $1000 fine.
Safe use
Because cocaine is a highly addictive drug, and the initial effects of euphoria wear off quickly, it is important that users do not feed their cravings by repeating cocaine use (bingeing) to achieve the desired effect. It is very common for cocaine bingeing to lead to addiction. Possessing excessive amounts of cocaine at one time can help feed bingeing behaviour.
Injecting users should always use clean needles and return used needles to a needle exchange service. This will help prevent blood-borne diseases such as HIV/AIDS and Hepatitis.
Studies show that shared straws (used for sniffing) can cause the spread of blood borne diseases such as HIV, Hepatitis as a result of residual of blood and mucus left on the straw.
How to get help
There are a number of treatment organisations that can help. If you feel that you or anyone you know needs help, then you can call these services in strict confidence.
If you are faced with an emergency, call 111 immediately.
To talk to someone about your or someone else’s drug use, call the Alcohol Drug Helpline – 0800 787 797
You can also get contact details for your local alcohol and other drug counsellor or treatment provider by calling the helpline or by visiting www.addictionshelp.org.nz
