Showing posts with label Heroin. Show all posts
Showing posts with label Heroin. Show all posts

31 May 2014

NOT JUST Heroin

Powder death among users called the mix is actually a type of heroin but not pure. It is created by illegal factories which usually takes place in the garden of opium or opium in the Golden Triangle area or West Asia. What and why it is so dangerous to the health of the wearer?

Drug abuse in recent years widespread hit the younger generation. Drugs of abuse ranging from marijuana or hashish, koplo pills, cocaine, up to ecstasy. Even recently emerged shabu-shabu (a type of amphetamine) and mix (a type of heroin). Marijuana or hashish, cocaine, and mix including narcotics. While koplo pills, ecstasy, and shabu-shabu belonging psychotropic.

Mix is a type of heroin is not pure and very dangerous for the health of the wearer. The victims of addiction, illness, and deaths from heroin has been quite a lot. There are no official data how many victims in Indonesia, because their families are reluctant to report. There is a sense of shame and family trying to cover-up.

The manufacture of heroin is the opiate of fruit juice (opium) from Papaver somniferum, Papaveraceae family, who are old but not yet ripe. From the dried sap is opium obtained. The content of opium is a narcotic alkaloids, such as morphine, codeine, thebaine, narsein, and non-narcotic alkaloids, such as papaverine, narkotin, apomorfin.

While morphine is the standard content and dosage of another opiate, such as extracts, tinctures, powders, etc.. Year 1805, a German pharmacist named Sertuerner managed to isolate morphine (derived from the Greek Morpheus, which is a god Dreams). The content of morphine from opium to 10%. 1874, Bayer factory managed to synthesize heroin (diasetilmorfin or diamorphine) of raw materials morphine using anhydrous acetic acid or vinegar. The name heroin was taken from German, the heroic, which means hero. Heroin was first built, is tested for drugs cough suppressant (antitussive) and pain relievers (analgesics).

Nevertheless, only in 1898 examined the benefits and dangers in animals and humans. It turns out the dangers of heroin is much greater than the benefits. Therefore, in 1924 in the United States banned production and use.

Formerly made by the manufacturer heroin legal. But since the ban on the production of heroin is made by a dark industry (Clandestine). This dark industrial locations in the garden often take opium, for example in the Golden Triangle (Myanmar, Thailand, and Laos), West Asia (Turkey, Iran, Iraq, Afghanistan, Pakistan). This can be seen, from any police or military operations is found large amounts of acetic acid. Heroin is more expensive than morphine; addictive effects (addiction) and hallucinations more powerful than morphine.

It is said that the use of morphine increased among teenagers. In the past our adolescent drug abuse generally permitted legally circulating in Indonesia such as powder or extract of opium, morphine injection. But along with the ease of transportation, communications, and networks are more orderly narcotics syndicate, then heroin eventually can also go to Indonesia.

Some smuggling a reckless manner by members of the syndicate for example via condoms or capsules which are swallowed and detected in the stomach. Cases like this ever uncovered by customs officials in Jakarta some time ago.

Not classified as drugs

Heroin and the like, including mix, do not qualify as a drug, because:

a) Heroin or mix of chemicals that harm is far greater than the benefits. These chemicals are prohibited from being produced, circulated, and used and created by the illegal factory. This is different from the official drugs produced by legitimate manufacturers and distributed by a distributor who is also legal.

Violation of production, distribution, and its use can be sanctioned according to the Narcotics Law no.9/1976. Heroin use is only permitted when used for research. Quite severe legal sanctions for offenders.

b) Heroin or mix circulating on the black market are not pure heroin. If the factory can be 80% dark levels, but after arriving to the issuer (through 50-10 channels), levels of heroin dropped to 1-15%. This is reasonable because they were involved in falsifying or high grade heroin mix with additional ingredients such as quinine, mannitol (laxative), caffeine, lactose, etc.. As such they will benefit far greater. Heroin or mix is usually distributed in small packets.

c) Routes misuse is often fatal. Dose of 3 mg strength equivalent to 10 mg of morphine. The use of powder is done by dissolving the powder in a container or a spoon mixed with water that is not sterile, filtered with cotton, and injected into the intravenous (by vein) or subcutaneous (under the skin through). Sometimes also smoked like a cigarette, or aspirated.

Another way to chasing, the powder is placed on aluminum foil and heated underneath. Vapor flows through a hole of paper rolls or pipes, inhaled through the nose to be forwarded to the lungs.

In case of overdose can occur lung abscess. Chasing done by the user because the powder was purchased was not pure heroin. On the use of parenteral (intravenous, subcutaneous or to injure) there will be an abscess, infected some diseases such as HIV / AIDS, hepatitis, rheumatic heart disease, embolism, tetanus, cellulitis / thrombophlebitis.

The danger

Heroin in addition to causing psychological and physical dependence, also can cause euphoria, body ache, nausea and vomiting, miosis, drowsiness, dry mouth, sweating, respiratory depression, hypothermia, decreased blood pressure, constipation, biliary tract spasms, difficulty urinating. Death usually occurs when excessive doses are used. Users who already tend to use a drug addict with excessive doses. This is caused by the body's tolerance limits are more elevated.

In addition, users often use other drugs such as alcohol, cocaine, etc.. and do not know the dosage for sure, so often the case of overdose. Heroin with a dose of 3 mg when given parenterally, especially intravenously, can cause compulsive disorder. Three times the strength of morphine. Because of its more lipofil than morphine, then heroin penetrates the brain faster than morphine. Thus the work faster than morphine heroin. Heroin itself is converted into morphine in the body.

Drugs antidotum (bidder) to treat victims of drug abuse, especially morphine and heroin is readily available in the country, especially in the floating house drug dependence. However, efforts to prevent or avoid the use of illegal drugs will be better than having to go to the hospital first.

06 May 2011

Neurological Effects of Heroin Use

Heroin is derived from the pulp drying opium poppies that have a content of morphine and codeine, which is an effective pain reliever and is widely used in medicine for the treatment of cough and diarrhea drug.

Heroin has been known by humans at least since 6000 years ago, and is known comes from the tree of happiness. In the 7th century or the 8th, suspected Arab traders took it to China and used as a medicine. After that, the English and Portuguese to supply China with opium and put the UK as the world's largest heroin.


New in 1874 people make heroin and opium poppies. At that time, heroin is sold as a safe substitute for morphine and not addictive. But eventually it was realized that heroin addiction also causes a high, then in England in 1920 prohibited by law, the Dangerous Drug Act.

The use of heroin have been increasing since early 1990 and experienced a boom since 1996. According to the National Household Survey on drug abuse in the USA in 1996 as many as 2.4 million people had used heroin. In Indonesia the number of people with narcotics in 1995 was 130,000 people (0.065%). Narcotics Users are mostly young people aged 26 years.

The death rate due to the use of heroin in Indonesia reached 17.6%. Heroin (diasetilmorfin) including the group of opioid agonists and is a derivative of morphine which is made from morphine which had acetylation of the hydroxyl group at C3 and C6 bond.

Other names of heroin: smack, junk, china ehirte, chiva, black tar, speed balling, dope, brown, dog, Negra, Nod, white hores, stuff.

Pharmacokinetic

Absorption

Heroin is absorbed well in the subcutaneous, intramuscular and mucosal surface of the nose or mouth.



Distribution

Heroin with a quick entry into the blood and into the network. High concentration of heroin in the lungs, liver, kidney and spleen, whereas in low concentrations in skeletal muscle. Concentration in the brain is relatively low compared to other organs due to blood brain barrier. Heroin penetrate the blood brain barrier more easily and rapidly than with morphine or other opioids class.



Metabolism

Heroin hydrolysis in the brain rapidly became monoasetilmorfin and eventually became the morphine, then experience an advanced glukuronik acid conjugation with morphine 6-glukoronid a stronger analgesic effect than morphine alone. Drug accumulation occurs in patients with renal failure.



Excretion

Heroin / morphine diekstresi mainly through the urine (kidney). 90% is excreted within the first 24 hours, although it can still be found in urine 48 hours in the body is converted into heroin and morphine is excreted as morphine.



Pharmacodynamic

Working Mechanism.

Opioid agonists cause analgesia due to binding to specific receptors located in the brain and spinal cord, thus affecting the transmission and modulation of pain. There are 3 types of specific receptors, namely μ receptor (mu), δ (delta) and κ (kappa). In the brain there are three kinds of peptides whose activities endogeneus like opiates, yitu enkephalin binding to δ receptors, β endorphin to μ receptors dandynorpin with resptor κ. Μ receptor is the receptor for morphine (heroin). The three types of receptors is associated with G proteins and is paired with adenilsiklase cause a decrease in the formation of cyclic AMP thus inhibited the activity of neurotransmitter release.



Inhibitory effects of opiates in the release of neurotransmitters.

The release of noradrenaline.

Opiates inhibit noradrenaline release by activating μ receptors located in the area noradrenaline. Morphine effect is not limited in the cortex, but also in the hippocampus, amygdala, cerebellum, and locus cereleus periaquaductal area.



Disposal asetikolin

Asetikolin release inhibition occurs by receptor deltha striatum region, the amygdala and hippocampus region by μ receptors.

Release of dopamine release by dopamine diinhibisi kappa receptor activity.



Workplace

There are two places that the main opiate drugs work, namely the central nervous system and visceral. In the central nervous system opiate effect in several regions including cortex, hippocampus, thalamus, hypothalamus, nigrostriatal, mesolimbik system, locus coreleus, periaquaductal region, medulla oblongata and spinal cord. In the visceral nervous system, opiates work on myenterikus plexus and plexus submukous that cause constipation effect.



Effects to other organ systems

Central nervous system

1. Analgesia

Analgesic efficacy is based on 3 factors:



  • Increase the pain threshold excitatory

  • Affect emotions, in the sense that morphine can alter the resulting reaction accompanies the pain at the time the patient felt pain. After the administration of drugs the patient still feel (realize) there is pain, but fear no longer worried reactions arise. Effects of this drug is relatively larger influence effective component (emotional) than sensory

  • Facilitate sleep onset

2. Euphoria
Administration of morphine in patients experiencing pain, will cause feelings of euphoria in which patients will experience a comfortable feeling free from anxiety. Instead of an equal dose when given to normal people who do not experience pain, often leading to feelings of worry disforia be accompanied by nausea, vomiting, apathy, decreased physical activity and heavy extremities.

3. Sedation

Administration of morphine can cause drowsiness and lethargi effect. The combination of morphine with a drug that affects the central depression as sedative hypnotics will cause very deep sleep.

4. Breathing

Administration of morphine can cause respiratory depression, caused by direct inhibition on the respiratory center in the brain stem. Respiratory depression usually occurs within 7 minutes after intravenous injection or 30 minutes after subcutaneous or intramuscular injection. Respiration returned to normal within 2-3 hours.

5. Pupil

Systemic administration of morphine can cause miosis. Miosis occurs due to stimulation of the Edinger Westphal nucleus N. III

6. Nausea and vomiting

Caused by direct stimulation in the emetic chemoreceptor trigger zone in the brain stem.



Peripheral Effects

1. Gastrointestinal tract.



  • In the hull will inhibit gastric acid secretion, gastric mortilitas reduced, but the tone of the antrum rising.

  • In the intestine beasr will reduce peristalsis, which can cause constipation.

2. Cardiovascular System

Does not have significant effects on blood pressure, cardiac frequency and rhythm. Changes that seem only to be secondary to decreased activity and sleep state agencies, hypotension due to peripheral arterial and venous dilatation due to the mechanism of central depression by the stabilization mechanism of vasomotor and release of histamine.

3. Skin

Cause dilation of blood vessels of skin, so skin looks red and feels hot. Often the formation of sweat, probably caused by increased blood circulation in the skin due to central effects and release of histamine.

4. Urinary tract

Ureter and urinary vesika tonus increase, sphinkter increased muscle tone, which can cause urinary retention.



Types of Heroin

This type of heroin that is often traded are:

1. White powder

Traded in the bags that have been specially packaged with a size of 3x1, 5 cm, contains 100 mg of powder with high levels of heroin ranged from 1-10%. At present levels of heroin in powder tends rose, averaging around 35%. Usually the powder is mixed with sugar, milk powder or starch. Many bought and sold in the Asian region.

2. Cocoa powder

The shape, packaging and levels similar to white powder heroin, only the brown color. Many found in the area of ​​Mexico.

3. Black Tar

Many bought and sold in Usa. The black color is caused by the processing method. Shape into small pieces like nuts and sticky. Levels of heroin in it ranges from 20-80%. Usage is usually diluted with water and then warmed over the fire. After reconstitution can be inserted into the syringe.



How to Use

1. Injection

Injection intravenously, subcutaneously or intra muscular injection is more practical and efficient for low grade heroin. Intravenous injection can cause euphoria effects within 7-8 seconds, while the intra-muscular effect is 5-8 minutes slower.

Losses injection:



  • Can cause other daninf septikemi

  • Can cause hepatitis or HIV

  • Injection nerulang can damage the veins, causing thrombosis and abscess.

2. Inhaled.

Heroin powder is placed in aluminum foil and heated over the fire, then the smoke inhaled through the nose. Peak effect with the use of inhaled / smoked usually felt within 10-15 minutes.

3. Inhaled through a pipe or a rolled cigarette.

The use of heroin with high levels usually by inhaled or smoked. The use of heroin is smoked or inhaled (chasing the dragon) is now increased to avoid the effects caused by injection. Use of inhaled safer than inhaled, and therefore enters the body is gradually making it easier to control.



Effects arising from the use of heroin

According to the National Institute of Drug Abuse (NIDA), divided into short-term effects and long-term effects.

Short Term Effects:



  • Fidget

  • Respiratory Depression

  • Function mentally foggy

  • Nausea and vomiting

  • Pressing pain

  • Spontaneous Abortion

Long-term effects:



  • Addiction

  • HIV, hepatitis

  • Collapse vein

  • Bacterial infections

  • lung disease (pneumonia, tuberculosis)

  • Infection of the heart and valve

The influence of heroin to pregnant women:



  • Potential serious complications, spontaneous abortion, premature delivery.

  • Infants born to narcotic addicted mothers are at high risk for the occurrence of SIDS (Sudden Infant Death Syndrome).

  • Infants born to narcotic addicted mothers can suffer with drawl symptoms within 24-36 hours after birth. Symptoms baby added anxiety, agitation, frequent yawning, sneezing and crying, shaking, vomiting, diarrhea and seizures in some cases occur commonly.

Neurological complications that can occur due to use of heroin:



  • Cerebral edema

  • Myelitis

  • Postanoxia encephalopathy

  • Crush injury

  • Impaired coordination, difficulty speaking



TOXICITY AND OTHER EFFECTS OF NON-INTEREST HEROIN USERS

Acute intoxication (overdose)

Toxic dose, 500 mg for non-addicts and 1800 mg for narcotic addicts. Symptoms of overdose usually occur shortly after drug administration.

Symptoms of acute intoxication (overdose):



  • - Awareness of decline, sopor - coma

  • - respiratory depression, lower respiratory frequency 2-4 times a minute, and breathing may be Cheyene Stokes

  • Pupil small (pin poiny pupil), symmetric and reactive

  • Looks sianotik, skin redness face unevenly

  • Blood pressure at first either, but can be if respiratory worsening hypotension and shock

  • Low body temperature (hypothermia) and the skin feels cold

  • Bradycardia

  • Pulmonary Edema

  • Seizures

  • Death is usually caused by respiratory depression. Mortality increases when combined with drug addicts drugs that cause cross-reactions such as alcohol, tranquilizer.

  • The death rate of heroin + alcohol → 40%

  • The death rate of heroin + tranquilizer → 30%



Chronic Infection

Show various aspects of heroin addiction:



  1. Habituation, ie psycho-emotional changes that patients addicted to the drug.

  2. Physical dependence, namely the need for these drugs because of physiology and biochemistry body can not function anymore without the drug.

  3. Tolerance, namely the increasing need for the drug to get the same effect. Although tolerance arises when the first use of opioids, but the manifest after 2-3 weeks of therapeutic doses of opioid use. Tolerance will happen more quickly when given in high doses and shorter intervals of administration. Opioid cross-tolerance is an important characteristic, whereby if the patient has been tolerant with morphine, he will also be tolerant to other opioid agonists, such as methadone, meperidine and so forth.

The mechanism of drug tolerance and dependence.

The exact mechanism is unknown, possibly by cellular adaptations that lead to changes in enzyme activity, the release of certain biogenic amines or some immune response.

Nucleus locus ceruleus allegedly responsible for inflicting on withdrawal symptoms. The nucleus is rich in opioid receptors places, alpha-adrenergic and other receptors. Stimulation of opioid receptors and alpha-adrenergic give the same response on intracellular. Receptor stimulation by opioid agonists (morphine) will suppress the activity of cyclic AMP adenilsiklase.

When the stimulation was given continuously, will occur in the physiological adaptation of neurons that make normal levels of adeniliklase although binding to opiates. If the bond is terminated with a sudden opiates or replaced with opioid antagonist drug that is, there will be an increase in cyclic AMP adenilsilase effect sudden and is associated with the patient's symptoms of hyperactivity symptoms.

Drug withdrawal symptoms (symptoms of abstinence or withdrawal syndrome) occurs when a drug addict to stop using the drug abruptly. Symptoms usually occur within 6-10 hours after the last drug administration and peak in 36-48 hours.

Withdrawal can occur spontaneously due to the sudden cessation of drug or can be in precipitation with opioid antagonist administration as naloxono, naltrexone. Within 3 minutes after injection of opioid antagonists, withdrawal symptoms develop, reaching a peak within 10-20 minutes, then disappeared after 1 hour.

Withdrawal symptoms:



  • 6 - 12 hours, lakrimasi, rhinorrhea, multilevel, frequent yawning, restless o 12-24 hours, restless sleep, iritabel, tremors, pupillary dilatation (midriasi), anorexia

  • 24-72 hours, all symptoms increase in intensity accompanied by weakness, depression, nausea, vornitus, diarrhea, abdominal cramps, pain in muscles and bones, alternating cold and heat, increasing blood pressure and heart rate, involuntary movements of arms and leg, dehydration and electrolyte disturbances

  • Furthermore, autonomic hyperactivity symptoms begin gradually reduced within 7-10 days, but people still depend strongly on the drug. Some mild symptoms can still be detected within 6 months. In infants with maternal drug addicts will be a delay in the development and growth that can be detected after age 1 year.



DIAGNOSIS

Diagnosis is based on:

1. Diagnose



  • Auto diagnose (honest recognition of patients)

  • Alo diagnose (from families who can be trusted)

2. Physical examination

Intoxikasi acute:



  • Impairment of consciousness

  • Autonomic disturbances, bradycardia, hypothermia, hypotension, cyanosis, pin point pupils

  • Respiratory Depression

  • Pulmonary edema

  • Seizures (rare)

  • Eye, sclera jaundice due to complications in the use of IV opiates

  • Talk to be rigid, dismetri.

Symptoms abstinensia



  • Nervousness, insomnia, sweating, frequent yawning, pupillary dilatation, tachycardia, abdominal cramps. Both the intoxication and abstinensia, found on the skin injection site (hyperpigmentation) along the arm veins.

3. The discovery of objects associated with the use of drugs such as syringes, pipes, aluminum foil, powdered heroin and others around the patient

4. Laboratory tests



  • Urine (drug screening)

To find a substance that is used by the patient. Urine should be obtained not more than 24 hours after last use of substances. Inspection methods such as by way of paper chromatography,

Thin Layer Chromatography, enzyme immunoassay



  • Hair

Liquid chromatography method using ultraviolet dspat determined the existence of opiates in hair pexcandu heroin (opiates). someone said to heroin addicts, when the hair of heroin found in the content of 10 ng / mg hair.



MANAGEMENT

Acute intoxication (overdose)



  • Improve and maintain airway as possible.

  • Oxygenation of adekua.

  • Naloxone injection, an initial dose of 0.4 to 2.0 mg IV (children 0.01 mg / kg) naloxane effect seen in 1-3 min and reached its peak in 5-10 minutes. If no response naloxane 2 mg can be repeated every 5 minutes up to a maximum of 10 mg. Naloxone effectively to improve the degrees of consciousness, respiratory depression, pupil size. Patients still must be observed to the effects of naloxone in 2-3 hours. Because of the short duration of action. To prevent rekulensi opiates effects can be given intravenous naloxone 0.4 to 0.8 mg / hour up to minimal symptoms (disappear).



Chronic intoxication

Hospitalization

Performed for patient hospitalization patient substance addiction, primarily intended for:



  1. Therapy withdrawal conditions

  2. Detoxification therapy

  3. Maintenance therapy (maintenance)

  4. Therapeutic complications

  5. Aftercare therapy

With the entry of patients into hospital addiction, physical medical evaluations should be given priority. Besides the examination of urine drug screen (to see if patients use other substances that do not admit), routine laboratory tests (including the function of liver function, kidney, danjantung), also performed thoracic images. Detoxification therapy aims for patients to decide the use of his substance and restore cognitive abilities. No other form of therapy that must be done before the second goal was achieved.

Other hospitalitation goal is to help patients to identify the consequences obtained as a result of substance use and understand the risks in case of relapse. In terms of mental hospitalization to control the atmosphere felt like a stony depression, paranoia, feeling quilty because regrets his actions in the past, and acts of self destruction violence.

Short-term hospitalization is recommended for substance addiction which they will be getting treatment for his condition. During the short-term treatment, patients are prepared to follow the maintenance therapy. For adiksinya condition, the patient is never recommended for long-term care.



Fermakoterapi

Opioid withdrawal therapy



  • Opioid withdrawal is not life-threatening, but associated with fisikologis disorders and physical distress is quite heavy.

  • Most patients with mild withdrawal symptoms which only requires a supportive environment without requiring them drug.

  • Klonidin can be used to reduce withdrawal symptoms with suppress feelings of anxiety, lakrimasi, rhinorrhea and excessive sweating. The initial dose given 0.1 to 0.2 mg every 8 hours. Then can be increased if necessary to 0.8 -1.2 mg / day, next to ditappering off after 10-14 days.

Non-specific therapy (symptomatic).



  • Sleep disturbance (insomnia) may be given sedative hypnotics

  • Pain can be given analgesic

  • Nausea and vomiting can be given class metoklopamide

  • Colic can be given antispasmolitika

  • Anxiety can be given antiansietas

  • Rhinorrhea can be given class fenilpropanolamin



Opioid addiction detoxification therapy



  • Methadone is the drug of choice in addiction detoxification therapy opioids. But when the methadone dose is lowered, the possibility of relapses are common. Another obstacle is to take a long time in detoxification therapy, and when using opioid antagonists will have to wait abstinensia symptoms for 5-7 days. The recommended dose of methadone detoxification treatment for heroin (morphine) is 2-3 x 5-10 mg per day orally. After a stable dose of 2-3 days starting ditappering off within 1-3 weeks.

  • Low dose buprenorphine (1.5 to 5 mg sublingual every 2-3 x per week) reported more effective and lighter than the withdrawal effects metadone.

  • Another alternative therapy that is suggested that rapid detoxification shorten the time of detoxification therapy and allows patients to be included in the opiate antagonist therapy. Types of rapid techniques detoxification among others klinidin naltrexon.

Maintenance therapy (maintenance) of opioid addiction.



  • Methadone and left-handed alpha-acetyl; methadol (Lam) is a standard maintenance therapy opioid addiction. Methadone given every day, while Lam only 3 times a week. Providing methadone maintenance therapy and Lam on a very helpful suppress criminal behavior. For maintenance therapy, methadone dose may be increased (usually 40-100 mg / day). To keep the patient still fun and lowered slowly.

  • Buprenorphine can also be used as a traditional therapy with a dose of 2 mg-20 mg / day.

  • Naltrexone is used for opioid addiction who have high motivation to quit. Naltrexone given orally 50-100 mg daily for 2 - 3 times a week.

After-care therapy

Covers the stabilization efforts in the field of physical, mental, religious, communication, social interaction, educational, aiming to achieve better conditions of behavior and function better than a former substance abusers. The role of the family at this time is necessary.



CLOSING

Heroin is a powerful narcotic in the cause of tolerance, physical dependence and fsikis. Discontinued drug suddenly may cause symptoms abstinesia (medication discontinuation). The use of heroin can also cause symptoms of acute intoxication (overdose), short-term complications and long term.

To control drug addict patient required an integrated management between doctors, patients and patients' families because it takes a long time to restore the patient's body.



REFERENCES­­

Cohan SL. Central nervous system disturbances Narcotics and brain death in clinical management of poisoning and drug overdose, ed. By Haddad LM. 2nd ed. Philadelphia: WB Saunders, 1990 (11): 223-7

Hubbell KC. Opiats and Narcotics in clinical management of poisoning and drug overdose, ed. By Haddad LM. 2nd ed. Philadelphia: WB Saunders, 1990 (38): 706-16

Kriegstein. Chasing the dragon heroin use cans brain damage. New York: Reuteut Health, 1999.

Olson KR. Management of Poisoned patient in Basic and Clinical Pharmacology. Katzung BG (ed). 7th ed. Stamfort: Appleton, 1998 (59): 970-77

Ruttenberg AJ. Etiology of heroin, related death. Journal of Forensic Science, 35 (4) July 1990: 890-900

Way EL. Drugs of abuse in Basic and Clinical Pharmacology. Katzung BG (ed). 7th ed. Stamfort: Appleton, 1998 (32): 518-9

Way WL. Analgosics opioids and antagonists in Basic and Clinical Pharmacology. Katzung BG (ed). 7th ed. Stamfort: Appleton, 1998 (31): 496-514

08 March 2011

Just mix Open Heroin

Powder death among users called the mix is actually a type of heroin but not pure. It is created by illegal factories which usually takes place in the garden of opium or opium in the Golden Triangle area or West Asia. What and why it is so dangerous to the health of the wearer?

Drug abuse in the world these days increasingly extends hit the younger generation. Drugs of abuse ranging from marijuana or hashish, koplo pills, cocaine, up to ecstasy. Even recently emerged shabu-shabu (a type of amphetamine) and mix (a type of heroin). Marijuana or hashish, cocaine, and mix including narcotics. While koplo pills, ecstasy, and shabu-shabu belonging psychotropic.

Mix is a type of heroin is not pure and very dangerous for the health of the wearer. The victims of addiction, illness, and deaths from heroin has been quite a lot. There are no official data how many victims around the world, because the families of the victims are reluctant to report. There is a sense of shame and family trying to cover-up.

The manufacture of heroin is the opiate of fruit juice (opium) from Papaver somniferum, Papaveraceae family, who are old but not yet ripe. From the dried sap is opium obtained. The content of opium is a narcotic alkaloids, such as morphine, codeine, thebaine, narsein, and non-narcotic alkaloids, such as papaverine, narkotin, apomorfin.

While morphine is the standard content and dosage of another opiate, such as extracts, tinctures, powders, and so forth. Year 1805, a German pharmacist named Sertuerner managed to isolate morphine (derived from the Greek Morpheus, who is none other than god Dreams). The content of morphine from opium to 10%.

1874, Bayer factory managed to synthesize heroin (diasetilmorfin or diamorphine) of raw materials morphine using anhydrous acetic acid or vinegar. The name heroin was taken from German, the heroic, which means hero. Heroin was first built, is tested for drugs cough suppressant (antitussive) and pain relievers (analgesics).

Nevertheless, only in 1898 examined the benefits and dangers in animals and humans. It turns out the dangers of heroin is much greater than the benefits. Therefore, in 1924 in the United States banned production and use.

Formerly made by the manufacturer heroin legal. But since the ban on the production of heroin is made by a dark industry (Clandestine). This dark industrial locations in the garden often take opium, for example in the Golden Triangle (Myanmar, Thailand, and Laos), West Asia (Turkey, Iran, Iraq, Afghanistan, Pakistan). This can be seen, from any police or military operations is found large amounts of acetic acid.
Heroin is more expensive than morphine; addictive effects (addiction) and hallucinations more powerful than morphine. It is said that the use of morphine increased among teenagers.

In the past our adolescent drug abuse generally permitted legally circulating in Indonesia such as powder or extract of opium, morphine injection. But along with the ease of transportation, communications, and networks are more orderly narcotics syndicate, then heroin eventually can also go to Indonesia.

Some smuggling a reckless manner by members of the syndicate for example via condoms or capsules which are swallowed and detected in the stomach. Cases like this ever uncovered by customs officials in Jakarta some time ago.

Not classified as drugs
Heroin and the like, including mix, do not qualify as a drug, because:
a) Heroin or mix of chemicals that harm is far greater than the benefits. These chemicals are prohibited from being produced, circulated, and used and created by the illegal factory. This is different from the official drugs produced by legitimate manufacturers and distributed by a distributor who is also legal.

b) Heroin or mix circulating on the black market are not pure heroin. If the factory can be 80% dark levels, but after arriving to the issuer (through 50-10 channels), heroinnya levels dropped to 1-15%. This is reasonable because they were involved in falsifying or high grade heroin mix with additional ingredients such as quinine, mannitol (laxative), caffeine, lactose, etc.. As such they will benefit far greater. Heroin or mix is usually distributed in small packets.

c) Routes misuse is often fatal. Dose of 3 mg strength equivalent to 10 mg of morphine. The use of powder is done by dissolving the powder in a container or a spoon mixed with water that is not sterile, filtered with cotton, and injected into the intravenous (by vein) or subcutaneous (under the skin through). Sometimes also smoked like a cigarette, or aspirated.

Another way to chasing, the powder is placed on aluminum foil and heated underneath. Vapor flows through a hole of paper rolls or pipes, inhaled through the nose to be forwarded to the lungs.

In case of overdose can occur lung abscess. Chasing done by the user because the powder was purchased was not pure heroin. On the use of parenteral (intravenous, subcutaneous or to injure) there will be an abscess, infected some diseases such as HIV / AIDS, hepatitis, rheumatic heart disease, embolism, tetanus, cellulitis / thrombophlebitis.
The danger

Heroin in addition to causing psychological and physical dependence, also can cause euphoria, body ache, nausea and vomiting, miosis, drowsiness, dry mouth, sweating, respiratory depression, hypothermia, decreased blood pressure, constipation, biliary tract spasms, difficulty urinating. Death usually occurs when excessive doses are used.
Users who already tend to use a drug addict with excessive doses. This is caused by the body's tolerance limits are more meninggi.Di addition users often use other drugs such as alcohol, cocaine, etc.. and do not know the dosage for sure, so often the case of overdose. Heroin with a dose of 3 mg when given parenterally, especially intravenously, can cause compulsive disorder.

Three times the strength of morphine. Because of its more lipofil than morphine, then heroin penetrates the brain faster than morphine. Thus the work faster than morphine heroin. Heroin itself is converted into morphine in the body.

Drugs antidotum (bidder) to treat victims of drug abuse, especially morphine and heroin is readily available, especially in hospitals drug addiction. However, efforts to prevent or avoid the use of illegal drugs will be better than having to go to the hospital first.

29 May 2010

Heroin pharmacology

INTRODUCTION
Approximately 30-60 seconds after the heroin was injected into a vein, the individual will feel a warm wave spread from the waist down as a sensation of "busy" (rush sensation) that slides into the central nervous system. A sense of calm that envelops himself in a rapidly individuals.
What exactly all this stimuli? From where chemicals asetilmorfin (heroin) is derived, and how these substances work when entered into the blood circulation?

Opium is an extract of the plant of Papaver somniferum (poppy), known for many centuries.  There is much on the slopes of the mountains of Colombia, Myanmar, Mexico, Thailand, Laos, Afghanistan and Pakistan. Opium or opiate narcotic properties which means numb, reduces pain, drowsiness and general depressants. Contains more than 20 types of alkaloids active ingredient, one of which is the morphine, which was discovered in the 19th century, taken from the name of the Greek God of dreams (Morpheus). Given the long process of synthesis of opium morphine have been initiated by Paracelsus in the 16th century. Opium is working on your receiver has a similar chemical structure of compounds formed by the body (endorphins).

Make heroin in chemistry
To reduce the petals of poppy is the perfect time for harvest, usually two large bags of harvest annually. Harvesters also a few slices poppies outside with a knife in the form of a Crescent,  and waited until the Milky SAP. Lymph is continuously shedder of the blade of the incision.  The molten resin is left to dry in the Sun until browned, scraping, and they were stored in the bag as the raw opium to be processed or transformed into pure morphine under the supervision of an experienced chemist.

Raw opium is heated for the first time in a large barrel with water, stirring with a wooden stick until dissolved. Later added lime can force manure to the remains of other organic materials solution than opium that float on the surface of the liquid. Liquid containing opium pelanel filters with a cloth to another barrel. While the fluid is heated and is shaken, the concentrated ammonia solution gave morphine that makes that clotted and sediment at the bottom of the barrel. Once the liquid is filtered to leave a morphine precipitate White dry. In general, the relationship / comparison of opium crude morphine 10% purity. Thus, 50 kilograms of raw opium produced five kilograms of pure morphine.

Once dry, ready to be processed into morphine or heroin diasetilmorfin. Required four levels of the chemical process for extracting morphine into heroin No. 4, which is the purest form of heroin (heroin illegally high levels). Heroin although derived from morphine but has properties that are soluble in fat, so the heroin is very fast through the blood-brain barrier (100 times morphine).

Heroin in the market.
So far the public don't get heroin No. 4 in the market or level to the retail. This level of heroin (distributors) distributors are given Adder substance for more, as well as the benefits.  Adder material or mixer can be quinine, sugar, milk, flour, milk powder and powders to the face. This subwoofer substances may cause danger if they are used, such as powders for the face that can not be dissolved when injected into the blood circulation but to form small particles that can block blood flow. There have been cases of heroin overdose gross on the first night in New York City for heroin to be confused with fentanyl is synthetic opioid.

Because the heroin trade on the black market so difficult for offenders to determine the quality of the products they buy. In a competitive market for commercialization, retail traders seek profit by introducing a trade name as a legal product. For example in New York City police found the heroin that caused a fatal road-named Tango & Cash. It turned out that heroin originating from retailers in the suburbs of Manhattan. Other names such as DOA (Dead On Arrival), Body Bag or Red Rum. Baby Dust, Brown Sugar. POM in the United States declared that the level of heroin in street heroin is less than 4%.

Use Heroin.
Used intra-venous, inhaled through the nose or through the smoke. Heroin spreads throughout the body via blood circulation. If inhaled through the nose both in the form of powder or smoke heroin into the blood circulation through the pulmonary circulation. Heroin can also be injected with a syringe into a muscle, under the skin or directly into a vein.  Strong influence is through intra-venous injection. In this way, the effects of heroin appear quickly, if the effects of heroin by inhaling the smoke usually appears a few minutes later and rather mild. But some still hoose smoke inhalation abuse of heroin, for fear of HIV infection transmitted through sharing needles or universal stigma attached to the needle user.

Wearing dirty needles or infected with HIV, in addition to the needles may also cause sepsis (poisoning the body of the bacteria that cause infection, hepatitis, endocarditis, skin abscesses.

Physiological Effects Heroin.
All effects that appear after the heroin was injected into the blood circulation will be very quick about 30-60 seconds. Heroin affects the central nervous system, heart and blood vessels, respiratory, digestive tract, urinary tract, the hormone system and skin.

Some effects of heroin on body functions:

  • Sensation "busy" which feels warm on the body (warm rush of sensation) immediately after the heroin into the blood circulation is a reaction on the central nervous system.

  • It comes with sedation so that the euphoria seen nodding off (Nod) or asleep.

  • Expenses of the mind (stress) and reduced anxiety is felt immediately.

  • Bead eyes (pupils) decreases to such a sharp pencil tip (pin point pupils). Diminution of pupil is a measure of the purity of heroin is used. Or the smaller the pupil arising means that the more pure grade heroin is used.

  • In a less immediate and rapid breathing.

  • Not too much influence on the heart and vascular system can be followed despite the decrease in blood pressure and pulse of light in a standing position (orthostatic hypotension).  This happens because the blood in the lower body into the heart of late.

  • There was a decrease in bowel movements pushing (peristaltic) coupled with increased muscle tension resulting in difficulty anal defecation (constipation or constipation). Often nausea and vomiting also occurred.

  • Difficult urination and sometimes pain caused by increased muscle tension below the mouth of the urinary tract. So that urine does not exit smoothly (dripping).

  • There was an increase with the release of the hormone system ACTH (Adreno Cortico Tropic hormones) that affect the child's renal glands. Furthermore, production of the hormone prolactin increased with decrease in luteinizing hormone (LH). Prolactin is a hormone associated with formation of breast milk (lactation) while the LH effect on the function of eggs in women and sperm production in men. Therefore, sperm formation is reduced while in the female menstrual cycle disruptions.

  • On going itchy skin, sweating, redness and warmth. Many trespasser assumes the appearance of the purity of heroin with sweat and itching. Yet mixing substances such as quinine can also cause itching.


    All the above effects occur quickly that give pleasure and satisfaction. In addicts, the effects are unpleasant, such as constipation, low blood pressure, and inability to urinate is not a problem as long as they can feel the pleasures of heroin. Even the warmth and calm that are identified with such warmth back into the womb (uterus in women). There is no doubt that the euphoria that occurs, the Chief motivating factor for someone to continue to use heroin.

    Heroin and the Brain
    Psychoactive element in heroin is morphine, which is a substance that causes euforik effect, analgesia and sedation. Morphine was formed through the metabolism of heroin on the body. While the effect is due to the binding of morphine to its receptor are scattered in the central nervous system (brain). One of the newbies that strengthen and deepen ties theory morphine through receptors in the brain is Avram Goldstein, Solomon Snyder and Candace Pert in the United States. Furthermore, John Hughes and Hans Kosterlitz in Europe to isolate specific substances from pig brain which has some similarities activities such as morphine. They call these substances as a means enkefalin in my head (in the head). Enkefalin is a short chain of amino acids are formed naturally by the body to respond to stimuli inside and outside, such as eliminating harmful stress and prevent shock. Enkefalin has similarities with the molecular form of morphine derived from heroin. Although the molecules are not peptides and morphine have different chemically. The key is that the similarity form of morphine can occupy the receptor and the body responds enkefalin pleasure, euphoria and analgesia.

    Further research proved that the body produces endogenous morphine or morphine natural, known as endorphins. Endorphins play an important role in long-distance runners as a biological chemical that produces the power runner. After running about 30-40 minutes or longer runners feel the joy, the state eforik. Body to release endorphins that time to eliminate the stress and pain. But not only had a role to endorphins a runner but also released during childbirth. This is the way the body naturally in order to survive the threat of stress and pain. Stress causes the release of endorphins from the pituitary gland located at the base of the brain.

    As heroin is highly addictive, as well as with endogenous morphine. It seems that every substance that can bind to opioid receptors influence addiction as a brain that influence the perception of a substance required for survival. Once a state of dependence on heroin, the brain will send signals and govern the body get more and morphine tolerance process occurs until the dosage the greater the desire to achieve euphoria. For example, every 4-6 hours just to survive the threat of broken substance syndrome (withdrawall).

    Heroin Addiction can occur within a relatively short time depending on the level of purity is used, the amount of usage and individual metabolic rate. As an example of someone who injected heroin every day for 50-10 days then the next morning will feel the drop syndrome substances.

    Signs and heroin withdrawal symptoms include:

    • Insomnia (difficulty sleeping)

    • Watery eyes (lakrimasi)

    • Yawning

    • Pain and muscle tension

    • Chills (piloereksi)

    • Abdominal cramps

    • Fast breathing (hyperventilation)

    • Chills

    • Pupil's eyes widened (midriasis) and blurred vision.

    • Painful joints

    • Vomiting

    • Diarrhea

    • Redness (flushing)

    • Anxiety

    • Hostile attitude

    Withdrawal symptoms can appear within 12 hours after injecting the last dose and can be ended as long as 72-96 hours, while the peak of symptoms occurs in 36-48 hours. Light weight of heroin withdrawal symptoms depends on the level of dependency of light weight and the amount normally used. For example someone who only occasionally use heroin (recreational) can overcome the perceived heroin withdrawal symptoms like the flu with rest and feel quite able to return to work within 1-2 days.

    Heroin withdrawal symptoms affect not only physical but also mental and emotional on the hopelessness that can lead to terrible conditions. Arises a sense of desperation, remorse and guilt, including a sense of confusion. Combined physical and emotional symptoms of abuse vulnerable delivers extreme acts.

    After the last for the next five days are known as symptoms of prolonged withdrawal symptoms (protracted withdrawal) that can last for several months. Symptoms include low blood pressure, and widened pupils who are not excited. Trespasser feel strong suggestion repeated unless they obtain medical assistance and appropriate pharmacological therapy, psychosocial counseling and support each other.

    Over Dose
    Overwhelmed circumstances drinks or heroin overdose causes severe impairment of consciousness (stupor / coma) or even death. Occurs emphasis respiratory center so the breath becomes very low frequency (2-4 times / minute). As the weakening of breathing, blood pressure also started to decline. Body temperature decreased and the skin becomes cold and wet, sometimes grayish blue. Can occur seizures and respiratory failure due to the entire brain stem is filled with heroin.

    To overcome this situation needs quick medical intervention that is given an injection of a narcotic like-Naltrekson neutralizing or naloxone to counteract the influence of heroin. This drug will bind with opioid receptors with morphine replace it with a triggering receptor on heroin withdrawal symptoms. If the state does not obtaining medical treatment overdose then within 20-30 minutes the patient will die.