Drugs and Our Drugs and Our SocietySociety

CJUS/HPE 151CJUS/HPE 151

Chapter 5: The Major Chapter 5: The Major Narcotics: Opium, Morphine, Narcotics: Opium, Morphine,

and Heroinand Heroin

1.1. Opium / opium derivatives / semi-Opium / opium derivatives / semi-syntheticsynthetic-- opium poppy / syntheticsopium poppy / synthetics-- Greek word: “Greek word: “stuporstupor””-- dull senses / relieve paindull senses / relieve pain

a. a. Opiate receptors of brainOpiate receptors of brain - endorphins- endorphins

- receptors activated - receptors activated - heroin / morphine- heroin / morphine

(1) (1) DiscussionDiscussion- morphine-like effect- morphine-like effect

(2) (2) Cocaine / coca leavesCocaine / coca leaves- classified narcotics- classified narcotics- Uniformed Controlled - Uniformed Controlled

Substances ActSubstances Act

(a) Neither bind to receptors (a) Neither bind to receptors - nor morphine-like effects- nor morphine-like effects- stimulants as discussed- stimulants as discussed

(b) Narcotics (b) Narcotics - produce morphine-like - produce morphine-like

effecteffect

(3) (3) Most important characteristicsMost important characteristics

- powerful analgesic - powerful analgesic

- reduce pain- reduce pain

(a) Cough suppressant(a) Cough suppressant

- alleviate diarrhea - alleviate diarrhea

- induce anesthesia- induce anesthesia

(b) Therapeutically: (b) Therapeutically:

- tension / anxiety / aggression- tension / anxiety / aggression

(4) 1000’s of years (4) 1000’s of years

- sedating / painkilling / sleep-inducing - sedating / painkilling / sleep-inducing

- Greeks / Romans / Egyptians / - Greeks / Romans / Egyptians / AssyriansAssyrians

b. ‘b. ‘Papaver somniferumPapaver somniferum’ ’ - source: non-synthetic narcotics- source: non-synthetic narcotics - Mediterranean: 5000 BC- Mediterranean: 5000 BC - cultivated around the world- cultivated around the world

(1) Milky fluid from incisions (1) Milky fluid from incisions - unripe seedpod - unripe seedpod - air-dry - air-dry - scrapped by hand- scrapped by hand- produces opium- produces opium

(a) Modern method(a) Modern method

- industrial straw process- industrial straw process- alkaloids extracted- alkaloids extracted- mature / dried plant- mature / dried plant- liquid / solid / powder - liquid / solid / powder - fine brownish powder- fine brownish powder

(b) 500 tons legally imported(b) 500 tons legally imported- legitimate medical use- legitimate medical use

(2)(2) Synthetic narcoticsSynthetic narcotics (laboratory) (laboratory)- no synthetic susceptible to - no synthetic susceptible to

abuseabuse- clandestine drugs / medical use - clandestine drugs / medical use

drugdrug

2.2. Foreign sourcesForeign sources- entire supply - entire supply -- unlike cocaine: South Americaunlike cocaine: South America-- opium three source opium three source regions regions - Southeast-Southwest Asia / South - Southeast-Southwest Asia / South AmericaAmerica

a. a. 1996: ‘1996: ‘Golden TriangleGolden Triangle’’ - Myanmar (Burma) / Laos / Thailand- Myanmar (Burma) / Laos / Thailand

(1) (1) Extent of narcotic useExtent of narcotic use- profits: $300 billion yearly- profits: $300 billion yearly- world’s opium - world’s opium

(a) 2,560 metric tons (5,120,000 (a) 2,560 metric tons (5,120,000 lbs) lbs) - Myanmar- Myanmar

(b) 200 metric tons (400,000 lbs) (b) 200 metric tons (400,000 lbs) - Laos- Laos

(c) 30 metric tons (60,000 lbs) (c) 30 metric tons (60,000 lbs) - Thailand- Thailand

(2) (2) AfghanistanAfghanistan- 3,656 metric tons- 3,656 metric tons- Myanmar / Afghanistan majority- Myanmar / Afghanistan majority- Myanmar / Laos- Myanmar / Laos

(3) (3) Latin AmericaLatin America- primary supplier for US- primary supplier for US- Columbia = 60 %- Columbia = 60 %- Mexico = 24 %- Mexico = 24 %

(a) Mexico(a) Mexico- hold - hold - trafficking in western US- trafficking in western US- drug cartels- drug cartels

(b) 2 % illicit opium, (b) 2 % illicit opium, - entire crop for US- entire crop for US

b. b. Opium poppy ‘field’Opium poppy ‘field’ - 60,000 / 120,000 plants- 60,000 / 120,000 plants - 2.46 acres / hectare- 2.46 acres / hectare

(1) (1) Flower 90 daysFlower 90 days - 3 to 8 flowers per plant- 3 to 8 flowers per plant- continues several weeks- continues several weeks- early spring full bloom- early spring full bloom

(a) Petals drop(a) Petals drop- size of chicken egg- size of chicken egg- two weeks- two weeks

(b) Mature(b) Mature- ready to harvest- ready to harvest

(2) (2) 3 - 4 bladed instrument3 - 4 bladed instrument (iron / (iron / glass) glass) -score the pod-score the pod

- one millimeter- one millimeter- 2 or 3 times / afternoon- 2 or 3 times / afternoon- white latex drip on surface- white latex drip on surface

(a) Oxidizes / darkens / thickens (a) Oxidizes / darkens / thickens - over night- over night- morning: flat iron blade- morning: flat iron blade- 80 milligrams- 80 milligrams

(b) Black to brown (b) Black to brown

- after drying- after drying

- quality: brown and sticky- quality: brown and sticky

- 3 to 9 kilos acre- 3 to 9 kilos acre

(3) (3) 40 alkaloids identified40 alkaloids identified

- most = salts- most = salts

- most important: morphine- most important: morphine

- average content: 9 % to 14 %- average content: 9 % to 14 %

- Turkish opium: 21 %- Turkish opium: 21 %

- druggist’s opium- druggist’s opium

(a) Other alkaloids:(a) Other alkaloids:- - codeinecodeine: 0.5 / 2.5%: 0.5 / 2.5%- - noscapinenoscapine: 4 / 8 % (cough: 4 / 8 % (cough suppressant)suppressant)- - papervinepapervine: 0.5 / 2.5 % (muscle: 0.5 / 2.5 % (muscle relaxant)relaxant)- - thebainethebaine: 0.5 / 2.0 %: 0.5 / 2.0 %

(b) Alkaloids: removed in processing(b) Alkaloids: removed in processing- clandestine chemistry not ideal- clandestine chemistry not ideal- 45 % of alkaloids- 45 % of alkaloids- left in raw opium- left in raw opium

3.3. Purification processPurification process

a. a. Raw opium in boiling waterRaw opium in boiling water

- dissolves alkaloids- dissolves alkaloids

- solids remain- solids remain

- impurities: scooped out / filtered- impurities: scooped out / filtered

(1) (1) Liquid reheated / low flameLiquid reheated / low flame

- evaporates the water- evaporates the water

- thick, dark paste / dried in sun- thick, dark paste / dried in sun

(a) Opium left / putty-like consistency(a) Opium left / putty-like consistency

(b) 20 % lighter / 20 % purer(b) 20 % lighter / 20 % purer

b. b. Extraction processExtraction process- stirred in large drum / boiling water- stirred in large drum / boiling water- completely dissolved- completely dissolved- slake lime / fertilizer lime mixed in- slake lime / fertilizer lime mixed in

(1) (1) Convert morphine to soluble saltConvert morphine to soluble salt- becomes insoluble in cold water- becomes insoluble in cold water- other alkaloids do not react- other alkaloids do not react- solution cooled / morphine remains- solution cooled / morphine remains- other chemicals settle / brown - other chemicals settle / brown

sludge sludge

(a) Codeine somewhat soluble (a) Codeine somewhat soluble - some remains in solution- some remains in solution- called ‘- called ‘morphenatemorphenate’’

(b) Morphine solution filtered (b) Morphine solution filtered - rice sacks / burlap bags- rice sacks / burlap bags- reheated / not boiled- reheated / not boiled

(c) Ammonium chloride added(c) Ammonium chloride added- 1/14- 1/14thth mass of opium mass of opium- pH solution: 8 / 9 cooled- pH solution: 8 / 9 cooled

(2) Morphine base settles to bottom(2) Morphine base settles to bottom

- poured off / cloth filters- poured off / cloth filters- chunks morphine base- chunks morphine base- squeezed / set out to dry- squeezed / set out to dry- coffee-colored powder- coffee-colored powder

(3) (3) Hydrochloric acid / activated charcoalHydrochloric acid / activated charcoal - heated = morphine hydrochloride- heated = morphine hydrochloride- filtered: remove charcoal / impurities- filtered: remove charcoal / impurities

(a) Sun dry = morphine hydrochloride (a) Sun dry = morphine hydrochloride - fine white powder- fine white powder- pressed: 1 kilogram (kg) bricks- pressed: 1 kilogram (kg) bricks

c. c. Convert to heroinConvert to heroin

(1) (1) Morphine baseMorphine base - acetic anhydride / 3 times mass- acetic anhydride / 3 times mass - heated: 185 degrees / not - heated: 185 degrees / not

boiledboiled

(2) (2) Stainless steel / enamel potStainless steel / enamel pot - lid clamped down- lid clamped down

- cook 5 hours- cook 5 hours

(3) (3) Filter: soda ash / chloroformFilter: soda ash / chloroform- 700 grams heroin per kilo - 700 grams heroin per kilo

morphinemorphine

Narcotic AbusersNarcotic Abusers1.1. In the United States, there are more than In the United States, there are more than

800,000 people addicted to heroin800,000 people addicted to heroin

-- as well as other narcotics / but primarily as well as other narcotics / but primarily heroinheroin

2.2. National Household SurveyNational Household Survey

-- estimated more than 1.4 million estimated more than 1.4 million Americans Americans have tried heroin at least oncehave tried heroin at least once

-- most are chronic users who are older most are chronic users who are older and and inject the druginject the drug

-- the number of younger users is growing the number of younger users is growing and and are more likely to snort or smoke are more likely to snort or smoke heroinheroin

Narcotic abusers, contNarcotic abusers, cont3.3. Most young people are considered occasional Most young people are considered occasional

or controlled usersor controlled users-- they are called ‘chippers’they are called ‘chippers’-- using only once in awhile or on weekendsusing only once in awhile or on weekends-- and take narcotics in a controlled wayand take narcotics in a controlled way-- this contradicts the commonly held this contradicts the commonly held notion notion that a person is either an abstainer that a person is either an abstainer or addictor addict

4.4. Controlled user patternControlled user pattern-- seldom use the drug more than once a seldom use the drug more than once a dayday-- can keep opiates around without using can keep opiates around without using themthem-- do not use opiates to alleviate depressiondo not use opiates to alleviate depression

Narcotic abusers, contNarcotic abusers, cont-- seldom, if ever, binged on opiatesseldom, if ever, binged on opiates

-- knew the opiate source or dealerknew the opiate source or dealer

-- took opiates for recreation or relaxationtook opiates for recreation or relaxation

-- did not take opiates to escape from did not take opiates to escape from life’s life’s daily hasslesdaily hassles

5.5. Patterns of usePatterns of use

-- patterns of narcotics use do deviate patterns of narcotics use do deviate sharplysharply

-- it is difficult to know the exact extentit is difficult to know the exact extent

6.6. 67 % of heroin addicts are male67 % of heroin addicts are male

-- 33 % female33 % female

Narcotic abusers, contNarcotic abusers, cont-- 69 % are Caucasian69 % are Caucasian-- 31 % of other minority races31 % of other minority races

7.7. 1/31/3rdrd of all addicts live in New York City of all addicts live in New York City-- 40 % are Caucasian40 % are Caucasian-- 40 % are African-American40 % are African-American-- 20 % are other minorities20 % are other minorities-- 25 % (1/425 % (1/4thth) are females) are females

8.8. The majority of new users are middle-The majority of new users are middle-income income -- they inhale heroin rather than injecting they inhale heroin rather than injecting itit-- young blacks in NYC are deliberately young blacks in NYC are deliberately

avoiding itavoiding it

Narcotic abusers, contNarcotic abusers, cont9.9. Viet Nam WarViet Nam War

-- it is estimated that 10 % to 15 % of it is estimated that 10 % to 15 % of US US troops were addicted to herointroops were addicted to heroin

-- it was 95 % pure / inexpensive / it was 95 % pure / inexpensive / sold openlysold openly

-- primarily smoked with tobacco or primarily smoked with tobacco or marijuanamarijuana

Licit and Illicit UsesLicit and Illicit Uses1.1. Two primary pain-killing drugs are Two primary pain-killing drugs are

derived from opiumderived from opium-- morphine and heroinmorphine and heroin

2.2. OpiatesOpiates-- 3 natural components can be 3 natural components can be extracted from extracted from opiumopium-- morphine / codeine / and thebainemorphine / codeine / and thebaine

3.3. Opiate derivativesOpiate derivatives-- from morphine you derive heroin / from morphine you derive heroin / Dilaudid Dilaudid / Numorphan/ Numorphan-- from Thebaine: Percodan / from Thebaine: Percodan / etrophine etrophine

Licit and illicit, contLicit and illicit, cont4.4. Synthetic opiatesSynthetic opiates

-- methadone / Demerol / Darvon / Orlaam methadone / Demerol / Darvon / Orlaam -- they are unrelated to morphinethey are unrelated to morphine-- but produce opiate-like effectsbut produce opiate-like effects

5.5. MethadoneMethadone-- invented by a German scientist during invented by a German scientist during WWIIWWII-- chemically unlike morphine or heroinchemically unlike morphine or heroin-- produces many of the same effectsproduces many of the same effects

6.6. Introduced into the United States in 1947Introduced into the United States in 1947-- used to treat narcotic addictionused to treat narcotic addiction-- used as an oral solution tablet, but also used as an oral solution tablet, but also injectableinjectable

Licit and Illicit, contLicit and Illicit, cont-- it is almost as effective administered it is almost as effective administered orally--orally-- it is a Schedule II drugit is a Schedule II drug

7.7. Methadone is taken every 24 hours Methadone is taken every 24 hours (once per day)(once per day)

-- it blocks the effects of heroinit blocks the effects of heroin

-- while discouraging continued usewhile discouraging continued use

8.8. In chronic administration tolerance In chronic administration tolerance develops develops

-- a person can become dependenta person can become dependent

-- withdrawal develops more slowlywithdrawal develops more slowly

-- symptoms are less severesymptoms are less severe

Characteristics of NarcoticsCharacteristics of Narcotics1.1. Opiates are narcoticsOpiates are narcotics

-- many times you hear all illegal drugs many times you hear all illegal drugs are are narcoticsnarcotics

2.2. OpiumOpium

-- comes from the opium poppycomes from the opium poppy

-- papaver somniferum = the “papaver somniferum = the “plant of plant of joyjoy””

3.3. It was cultivated in the Middle East and AsiaIt was cultivated in the Middle East and Asia

-- grows to a height of 3 to 4 feetgrows to a height of 3 to 4 feet

-- has white / red / or purple flowershas white / red / or purple flowers

4.4. After petals fall, an egg-shaped pod is leftAfter petals fall, an egg-shaped pod is left

Characteristics, contCharacteristics, cont-- slits are made on the sides of the podslits are made on the sides of the pod-- a white, milky sap comes outa white, milky sap comes out

5.5. Once dried, a brown, thick gummy resin Once dried, a brown, thick gummy resin formsforms-- this is opiumthis is opium-- the poppy only as 10 days to the poppy only as 10 days to manufacture manufacture opiumopium

6.6. MorphineMorphine-- Frederich Serturner, a German chemist Frederich Serturner, a German chemist synthesized morphine from opium in 1803synthesized morphine from opium in 1803-- he called it ‘he called it ‘morphiummorphium,’ named for ,’ named for Morpheus, the Morpheus, the Greek god of dreamsGreek god of dreams

Characteristics, contCharacteristics, cont7.7. Effects occur more rapidly than opiumEffects occur more rapidly than opium

-- it is 10 times more potent and the it is 10 times more potent and the most most effective drug for severe paineffective drug for severe pain-- morphine sets the standard, and all morphine sets the standard, and all other other analgesics are measured by itanalgesics are measured by it-- taken orally it is not very effectivetaken orally it is not very effective-- it builds in the spleen / liver / kidney / it builds in the spleen / liver / kidney / lungslungs

8.8. Codeine:Codeine: -- another alkaloid isolated 30 years another alkaloid isolated 30 years laterlater-- a Greek word meaning ‘a Greek word meaning ‘poppy headpoppy head’’-- which can also result in dependencywhich can also result in dependency

CodeineCodeine1.1. Another alkaloid that was isolated 30 years laterAnother alkaloid that was isolated 30 years later

-- it is a Greek word meaning it is a Greek word meaning ‘poppy head‘poppy head’’

-- codeine can also result in dependencycodeine can also result in dependency

2.2. Codeine is the most widely used, naturally Codeine is the most widely used, naturally occurringoccurring

narcotic in medical treatment in the worldnarcotic in medical treatment in the world

-- this alkaloid is also found in opium, but most this alkaloid is also found in opium, but most of itof it used in the US is produced from morphineused in the US is produced from morphine

-- it is usually prescribed for the relief of it is usually prescribed for the relief of moderate moderate pain and cough suppressionpain and cough suppression

-- it can be in liquid form (Tylenol w/ Codeine)it can be in liquid form (Tylenol w/ Codeine)

-- in tablet form (a single drug or a combination)in tablet form (a single drug or a combination)

-- or for severe pain, it can be injectedor for severe pain, it can be injected

ThebaineThebaine1.1. A minor constituent of opiumA minor constituent of opium

-- it is a Schedule II drug (as is it is a Schedule II drug (as is codeine)codeine)

-- chemically similar to morphine and chemically similar to morphine and codeinecodeine

2.2. It produces stimulatory effects rather It produces stimulatory effects rather than depressant effectsthan depressant effects

-- the US uses most of the drugs the US uses most of the drugs derived from derived from ThebaineThebaine

-- such as Naloxone and Oxycodonesuch as Naloxone and Oxycodone

HeroinHeroin1.1. Synthesized from morphine in 1874Synthesized from morphine in 1874

-- derived from the German word derived from the German word meaning meaning ““heroicheroic””-- promoted as a cure for morphine promoted as a cure for morphine addictionaddiction-- later, morphine was touted as a cure later, morphine was touted as a cure for for heroin addictionheroin addiction

2.2. Manufactured by Manufactured by BayerBayer, a , a pharmaceutical company in Germanypharmaceutical company in Germany-- and touted as a cure for coughs / and touted as a cure for coughs / bronchitis bronchitis / and tuberculosis/ and tuberculosis-- newspaper articles: a new type of newspaper articles: a new type of aspirinaspirin

Heroin, contHeroin, cont-- believed to be nonaddictingbelieved to be nonaddicting

-- now we know: it is twice as now we know: it is twice as addicting as addicting as morphinemorphine

3.3. It is administered in several ways: It is administered in several ways: smoked / sniffed / and injectedsmoked / sniffed / and injected

-- injected and smoked: the effects injected and smoked: the effects are rapidare rapid

-- effects not as great when sniffedeffects not as great when sniffed

-- it is ineffective when ingestedit is ineffective when ingested

-- but more people sniff and smoke but more people sniff and smoke rather rather than injectthan inject

Heroin, contHeroin, cont4.4. It is 3 to 10 times more powerful than It is 3 to 10 times more powerful than

morphinemorphine

-- because it is much more lipid-because it is much more lipid-solublesoluble

-- it reaches the brain more quickly it reaches the brain more quickly with higher with higher concentrationsconcentrations

Synthetic OpiatesSynthetic Opiates1.1. They are chemically constructed rather than They are chemically constructed rather than

naturally producednaturally produced-- elicit effects behaviorally similar to elicit effects behaviorally similar to morphinemorphine-- but they bear little chemical resemblance but they bear little chemical resemblance

2.2. The differ in duration / action / potency / The differ in duration / action / potency / intensity / and effectivenessintensity / and effectiveness-- example: Demerol / Dolophine example: Demerol / Dolophine (methadone) (methadone) / Percodan / Talwin / and / Percodan / Talwin / and DarvonDarvon-- drugs that are available only by drugs that are available only by prescriptionprescription

3.3. FentanylFentanyl-- a synthetic opiate stronger than heroina synthetic opiate stronger than heroin

Synthetics, contSynthetics, cont-- it has similar analgesic effectsit has similar analgesic effects

-- is either injected or snorted to be is either injected or snorted to be effectiveeffective

-- called “called “China whiteChina white””

4.4. OxycontinOxycontin

-- from 1996 to 2000, painkiller from 1996 to 2000, painkiller prescriptions prescriptions grew dramaticallygrew dramatically

-- they tripled in sales to $1.8 billionthey tripled in sales to $1.8 billion

5.5. This is when oxycontin gained much This is when oxycontin gained much attentionattention

-- a particularly strong painkillera particularly strong painkiller

-- it blocks pain signals from the nervesit blocks pain signals from the nerves

Synthetics, contSynthetics, cont-- it takes fewer pain pills and lasts 3 it takes fewer pain pills and lasts 3 times times longerlonger

6.6. Oxycontin and PercodanOxycontin and Percodan

-- account for around 6,500 ER visits account for around 6,500 ER visits each yeareach year

-- and possibly hundreds have diedand possibly hundreds have died

7.7. The abuse is acute in the Appalachia The abuse is acute in the Appalachia regionregion

-- this is why it is called “this is why it is called “hillbilly hillbilly heroinheroin” ”

Physical and Psychological Physical and Psychological Effects of NarcoticsEffects of Narcotics

1.1. 95 % of all narcotic abuse in the US is heroin95 % of all narcotic abuse in the US is heroin

-- the impact on each individual can varythe impact on each individual can vary

-- due to quantity / purity / due to quantity / purity / administration / administration / interval / and toleranceinterval / and tolerance

2.2. EndorphinsEndorphins

-- are naturally produced chemical are naturally produced chemical substancessubstances

-- that alter sensory perception and that alter sensory perception and reactionreaction

3.3. Feelings derived from narcotics can be Feelings derived from narcotics can be induced naturally by release of endorphinsinduced naturally by release of endorphins

Effects, contEffects, cont4.4. They regulate a person’s response to stress They regulate a person’s response to stress

and painand pain-- it is the same chemical that produces it is the same chemical that produces the the ““runners highrunners high””

5.5. Many dangers are associated with narcoticsMany dangers are associated with narcotics-- most arise from their illicit statusmost arise from their illicit status-- physical problemsphysical problems: using unclean : using unclean and/or and/or unsafe environments, and from unsafe environments, and from people people associated with drugs (murder / associated with drugs (murder / assaults)assaults)-- unregulated industryunregulated industry: contaminated : contaminated drugs / mixed drugs / what it is ‘cut’ with:drugs / mixed drugs / what it is ‘cut’ with:

sugars / starches / quinine / strychnine sugars / starches / quinine / strychnine

Effects, contEffects, cont-- how administered: sharing needles with how administered: sharing needles with

those who have a medical illness those who have a medical illness (hepatitis / (hepatitis /

AIDS-HIV)AIDS-HIV)-- using dirty needles resulting in abscesses using dirty needles resulting in abscesses / / heart inflammation / blood poisoningheart inflammation / blood poisoning

6.6. Physical effectsPhysical effects-- narcotics cause drowsiness / vomiting / narcotics cause drowsiness / vomiting / nausea / difficulty concentrating / pupils nausea / difficulty concentrating / pupils constrict / lower body temperature / dilated constrict / lower body temperature / dilated blood vessels / lower blood pressure / and blood vessels / lower blood pressure / and abdominal pain (muscle cramps)abdominal pain (muscle cramps)

Effects, contEffects, cont7.7. Psychological effectsPsychological effects

-- the use of narcotics does effect both the use of narcotics does effect both social social and emotional healthand emotional health-- can result in depression / mood changes can result in depression / mood changes / / wanting to sleep /wanting to sleep /anger / suspicion / not anger / suspicion / not

trusting / want to be alone / trusting / want to be alone / embarrassmentembarrassment

8.8. Withdrawal symptomsWithdrawal symptoms-- drugs block the physical effects of drugs block the physical effects of heroinheroin-- they do not eliminate psychological they do not eliminate psychological desiredesire-- majority of those entering treatment majority of those entering treatment relapserelapse