Heroin maintenance in Britain and heroin for the relief of pain in the United States of America

SUMMARY

The British themselves have recognized that heroin may not be the safest and most appropriate form of treatment for heroin addicts. The percentage of narcotic addicts in Britain being treated with methadone alone has risen steadily from 58% (of 1,549 addicts) in 1971 to 67% (of 2,588 addicts) in 1981. Also, the percentage of narcotic addicts receiving heroin alone has dropped from 7.1% (of 1,549 addicts) in 1971 to 2.6% (of 3,844 addicts) in 1981. The amount of heroin prescribed to addicts also fell from 22,778 grams in 1969 to 8,501 grams in 1978.

Further increases in the use of oral methadone and sterile injectable methadone, and resulting decreases in unsterile injections of heroin, would no doubt greatly diminish the incidence of death and severe disability in the treatment of British addicts.

On the issue of heroin's use for intractable pain, there is no evidence that heroin has unique advantages over other drugs. When given in equivalent doses, morphine has been proven to be as effective as heroin, orally or subcutaneously, for the relief of pain. In fact, heroin is rapidly converted into morphine in the body. Given the fact that heroin is the drug most narcotic addicts prefer, legally stocking the drugs in pharmacies, hospitals, and hospices would pose serious security and personal safety risks at these facilities. It is possible, in fact, that most pharmacies would refuse to stock the drug.     

Acute myoglobinuria as a fatal complication of heroin addiction

A fatal case of myoglobinuria complicating heroin addiction is described. Clinically the patient had no overt symptoms of rhabdomyolysis. Pathologists should be alerted to this rare complication in heroin addicts who die of no apparent cause. The antimyoglobin immunoperoxidase technique is useful in confirming the diagnosis.     

吸毒者头发中海洛因、6-单乙酰吗啡、吗啡、可待因和乙酰可待因的分析及评价

目的确定海洛因吸毒者头发中海洛因、6-单乙酰吗啡（6-MAM）、吗啡（MOR）、可待因（COD）和乙酰可待因（AC）的浓度并考察其与国际毛发分析协会（Society of Hair Testing,SOHT）建议标准的适用性。方法 50个头发样品经冷冻研磨处理后采用液相色谱-串联质谱方法分析。结果所有样品中均检出6-MAM,并且浓度高于SOHT所建议的0.2 ng/mg,其中海洛因、6-MAM、MOR、COD和AC的浓度与其它研究报道无明显差异。头发中6-MAM：MOR的比率在0.15~36.27范围。结论由于各实验室间毛发样品前处理方法不同,而且存在吸食毒品中成分、剂量、吸食方式、代谢、头发颜色等诸多个体差异,本研究认为采用头发中6-MAM：MOR的比率大于1.3标准难以应用于鉴定海洛因吸毒。     

Morphine in lymph nodes of heroin users

During the autopsy of heroin users, the most consistent morphologic finding is the enlargement of hepatic lymph nodes. Nodes from seven heroin addicts were analyzed for morphine and a concentration range of 0.02 to 0.87 mg/100 g was found. Morphine was detected in all of the nodes examined and the concentration was generally higher than that in the blood.     

Forensic medicine experiences with methadone substitution in the Geneva canton

Methadone treatment for heroin addiction has followed three distinct periods in Geneva, Switzerland. The first period (1970-1979) corresponds to the beginning of the heroin addiction epidemic. Treatment was restricted to detoxification and did not succeed in reducing fatal overdoses. During the second period (1980-1989), methadone maintenance program was favoured but access to this program was limited. This period has brought a decrease of illegal heroin consumption and criminality but not of fatal overdoses. Finally, during the third period (since 1990), legislation was changed to allow easier access to methadone maintenance program. As a consequence there was a significant drop in lethal heroin overdoses and in deaths attributed to HIV.     

Histologic findings of the sinus node and the perinodal area in street heroin addicts, victims of sudden unexpected death

Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16-40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.     

Fatal intoxication as a consequence of intranasal administration (snorting) or pulmonary inhalation (smoking) of heroin

In recent years we have noticed an increasing proportion of mortalities resulting from an overdose of heroin that involve routes of administration other than injection. Of 239 cases of fatal heroin intoxication examined at our department during the period 1997-2000, 18 deaths were associated with non-parental administration. Seven of these fatalities were experienced heroin users who had begun to use more sporadically, seven were recreational "party-users", while the remaining four persons had relapsed into heroin use following long periods of abstinence. The median blood morphine concentration of these non-injectors was 0.095 microg/g (range: 0.02-0.67 microg/g), significantly lower than that of the injectors. Concurrent use of alcohol, other illicit drugs and/or pharmaceutical preparations was observed in 17 of the 18 cases. However, there were no statistically significant differences between the victims of heroin intoxication by injection or by other routes with respect to the proportion who had simultaneously consumed alcohol or benzodiazepines. Pathological alterations like lung fibrosis, liver cirrhosis, endocarditis, etc. were not found to play a significant role in any of the 18 mortalities. We conclude that snorting or smoking heroin probably involves a reduced risk of obtaining high blood concentrations of morphine but still constitutes a considerable risk of lethal outcome due to high variability in blood concentrations. Furthermore, decreased tolerance resulting from periods of reduced or sporadic use appears to be an important risk factor in connection with heroin overdosing by snorting or smoking, which indicate that some heroin addicts may inaccurately assume that these routes of administration are safe when resuming their use of heroin after a period of abstinence.     

SELF-ESTEEM AND DEVIANCE: THE EFFECTS OF RACE AND GENDER*

Provision of occupational and educational opportunities has been the accepted means of reintegrating offenders into society because, with assumption of conventional roles, they are believed to experience improved economic conditions and renewed feelings of respectability. However, given the limited legal options available to them, offender self-esteem may continue to depend on immersion in deviant subcultures. To examine the effects of subcultural and conventional life-styles on offender self-esteem, a sample of 372 heroin addicts in treatment was surveyed. Employment had a positive effect on the self-esteem of white male addicts only; the self-evaluations of black male, black female, and white female addicts were unaffected by employment because these users were subjected to less stable working conditions. Subcultural integration had no impact or negative impact on the self-esteem of black male, black female, and white female addicts while subcultural involvement was associated with higher self-esteem in white males. The fact that white male addicts experienced favorable self-evaluations with involvement in both conventional and deviant life-styles is inconsistent with research which suggests an antagonism between crime and work: rather, these data seem to indicate that the join pursuit of legal and illegal professions may be more common.     

Evaluation of the role of abstinence in heroin overdose deaths using segmental hair analysis

In the body heroin is rapidly metabolized to 6-acetylmorphine and morphine. Victims of lethal heroin overdose often present with fairly low blood concentrations of morphine. Reduced tolerance due to abstinence has been proposed to account for this finding. The aim of the present study was to examine the role of abstinence in drug-related deaths by comparing recent and past exposure to opioids using segmental hair analysis with the postmortem blood morphine concentrations in deceased heroin users. The study included 60 deceased drug addicts in the Stockholm area, Sweden. In 32 cases, death was not related to heroin intake. In 18 of the 28 heroin fatalities, opioids were absent in the most recent hair segment, suggesting a reduced tolerance to opioids. However, the blood morphine levels were similar to those found in the 10 subjects that showed continuous opioid use. Hair and blood analysis disclosed an extensive use of additional drugs that directly or indirectly may influence the opioid system. The results suggest that abstinence is not a critical factor for heroin overdose death. Obviously tolerant subjects die after intake of similar doses. Other factors, particularly polydrug use, seem to be more causally important for these deaths.     

Analysis of morphine by RIA and HPLC in fingernail clippings obtained from heroin users

Heroin is abused around the world and is frequently reported as the cause of death in overdose cases. Analysis of morphine in hair has been used in the past in forensic toxicology to study the addiction history of heroin addicts. The purpose of the present study was to evaluate the usefulness of the nail as an analytical specimen in the identification and quantification of morphine in fingernail clippings of known heroin users. Fingernail clippings were obtained from 26 consenting patients of the Glasgow Drug Problem Service. At the time of sampling, the participants provided answers to a questionnaire regarding their drug use patterns. Samples were decontaminated by sonication in SDS, deionized water and methanol, and the methanolic washes were screened for analyte presence. The washed nail clippings were then hydrolyzed and extracted. RIA was used for the screening and HPLC for the confirmation of morphine. Positive RIA results were obtained with nail clippings from 25 of the 26 heroin users. The levels ranged from 0.06 to 4.69 ng/mg with a mean morphine concentration of 1.67 ng/mg. HPLC results were positive for 22 of the 26 nail samples. The mean morphine level by HPLC was 2.11 ng/mg with a range from 0.14 to 6.90 ng/mg. Based on these results, we suggest that nails have the potential of becoming a powerful alternative to hair for the detection of past heroin use in forensic cases.     

Hypoxic/ischaemic brain damage, especially pallidal lesions, in heroin addicts.

The occurrence of pallidal lesions with or without other hypoxic/ischaemic brain injuries was evaluated in 100 intravenous (i.v.) heroin addicts. The brains were collected consecutively from forensic autopsies during the period from January 1995 to June 1996. The autopsies were required by the police and performed at The Institute of Forensic Medicine, The National Hospital, Oslo. There were 21 women and 79 men, median age 32 (range 21-47) and 34 (19-60) years, respectively. Of 38 brains with abnormalities, twenty-five cases showed isolated or combined lesions of hypoxic/ischaemic origin. Pallidal lesions were found in nine brains; six lesions were old, one was subacute (a couple of weeks), and two were part of recent, generalized hypoxia/ischaemia. Six persons had old infarcts in the hippocampal formation, and one of them in combination with old pallidal infarcts. In seven brains small and old infarcts were found in watershed areas in the cerebellum. Between five and ten percent of i.v. heroin addicts might have pallidal infarcts, either as the sole lesion, or combined with other manifestations of hypoxic/ischaemic brain injury. This might give severe mental disturbances in the affected persons.     

The regulation of heroin: Drug policy and social change in early twentieth-century Britain

Heroin, a derivative of opium, was first created in 1874 and was marketed in 1898 as a cough medicine by a German pharmaceutical company. In Britain, the dispensing of heroin was initially restricted to pharmacists under the general pharmacy and poisons legislation. Just 22 years later, the Dangerous Drugs Act 1920 made it a criminal offence to manufacture, sell, distribute or possess heroin for non-medical purposes. This article attempts to explain this major shift in the regulation of heroin by drawing on David Garland's influential book Punishment and Welfare. Garland traces the fundamental transformation in social regulation that occurred at the turn of the twentieth century, arguing that a new penal-welfarism emerged which was to underpin the welfarist politics that held sway until the 1970s. It is argued that by locating the shift in heroin regulation in this wider context of social change, some new insights are revealed. In conclusion, some implications of this argument for contemporary approaches to heroin are discussed.     

血液和尿液样品中海洛因代谢物稳定性研究

目的对尿液和血液中海洛因代谢物3-β-D-葡萄糖醛酸吗啡（M3G）,吗啡,O6-单乙酰吗啡（O6）在180d内的稳定性进行研究。方法准备空白添加血液、尿液、染毒动物（大白兔）血液、尿液和吸食海洛因者血液、尿液样本,分别置于20℃、4℃、-20℃下,分别于0、1、2、4、7、14、28、56、112、156、180d时间点测定样品中M3G、吗啡,O6相对含量。结果在3种不同温度下,随保存时间的延长,血液、尿液中的O6含量均逐渐下降至零;血液中吗啡含量升高（空白血液添加组）或下降（染毒动物组）,在尿液则均升高;血液样中M3G含量均升高,尿样中则略有下降。下降和升高的幅度均随保存温度的下降而缩小。结论海洛因代谢物在-20℃时保存稳定性最佳。     

Isotopic fractionation of carbon and nitrogen during the illicit processing of cocaine and heroin in South America

The forensic application of stable isotope analysis to cocaine and heroin for geolocation of exhibits must take into account the possible enrichment and/or depletion of 13C and 15N during the illicit manufacturing process. Continuous-flow elemental analysis-isotope ratio mass spectrometry was utilized to measure changes in the stable isotope ratios of carbon and nitrogen for both cocaine (N = 92) and heroin/morphine (N = 81) exhibits derived from illicit manufacturing processes utilized by South American clandestine chemists. In controlled settings in South America, there was no siginficiant carbon isotope fractionation during the conversion of cocaine base to cocaine HCI using current illict methodologies. In contrast, nitrogen isotope fractionation for this conversion was 1 per thousand. There was a kinetic carbon isotope ratio fractionation during the acetylation of Colombian morphine to heroin and as a result heroin exhibits will almost always have more negative delta13C values than the original morphine. There was an isotopic fractionation against 15N during the acetylation of morphine base to heroin base, but this effect was not expressed since all of the heroin base was precipitated during the manufacturing process. However, the clandestine process of converting a single batch of heroin base usually involved two consecutive crops of heroin HCl and the latter crop was isotopically depleted as expected from a Rayleigh distillation process. When heroin was deacetylated to morphine, the morphine produced resulted in delta13C values that were indistinguishable from the original morphine. The kinetic carbon isotope fractionation factor for the South American process of morphine acetylation was -1.8 per thousand, allowing calculation of the delta13C values of the acetic anhydride from deacetylated heroin delta13C values.     

海洛因戒断大鼠位置偏爱及海马神经元膜电性质的变化

目的 研究海洛因戒断期大鼠的位置偏爱性和海马CA1区神经元电生理特性,并探讨行为变化与神经元膜电性质变化之间的关系。方法 制作海洛因慢性给药戒断大鼠模型,对大鼠Y型迷宫位置偏爱行为及其海马CA1区神经元膜电特性,以及电镜下海马皮质突触结构的变化进行观察,并与对照组比较。结果 海洛因慢性给药戒断期,大鼠Y型迷宫位置偏爱显著增强(P<0.01),其海马CA1区神经元静息膜电性质,与对照组相比无显著差异(P>0.05),但动作电位(AP)半幅时程和10％-90％衰减时间缩短(P<0.01);兴奋性突触后电位(EPSP)幅值和曲线下面积增大(P<0.01)。电镜下见戒断组动物海马皮质神经突触间隙较对照组变窄,前膜和后膜内电子致密物聚集,密度增高。结论 海洛因慢性给药戒断模型,可引起大鼠明显的位置偏爱,且在不改变静息膜电特性的前提下,海马CA1区神经元AP和EPSP特性及突触结构产生了相应的改变。     

汽油中的毒品还原分析

目的建立汽油中海洛因的检验方法及还原方法。方法利用无水乙醇挥发汽油混合物中的汽油,通过TLC、IR、GC、GC/MS对汽油混合物中溶剂和毒品成份进行了定性定量分析。结果利用该方法对涉案检材成功进行了毒品还原及检验分析。结论该方法适合于此类案件检验。     

Health care policy issues in the drug abuser treatment field

As we enter the 1990s drug abuse has once again become a major health concern, and for the first time the drug treatment field has had to address many of the policy, regulation, and planning issues resulting from cost inflation that have become commonplace in other parts of the health care field. To avoid serious errors and confusion, drug abuse health policies must recognize the very different needs of the public and private sectors. The public sector, where poor addicts receive drug treatment provided or purchased by the government, has long suffered from chronically inadequate funding. Although responses to several epidemics (heroin, crack, and AIDS) have produced periods of increased allocations for drug abuse treatment, more often than not long waiting lists at programs have rationed treatment to lower-income addicts seeking care. Low salary levels have limited the quality of public treatment services, and the absence of resources has hindered the development of programs that respond to new technical developments and drug abuse problems, such as the crack epidemic. Despite severe resource shortages, the public drug treatment system has sometimes used resources inefficiently, with little attention to appropriateness of admissions, lengths of stay, ambulatory treatment modalities, or varying levels of care. Public sector goals for the 1990s should include filling current shortages in drug treatment services, developing adequate long-term funding for treating addicts who lack third-party coverage, modernizing the treatment system, developing new patterns of practice that use existing resources more efficiently, and developing a plan for treating intravenous drug users infected with the AIDS virus. In the private sector, the advent of working- and middle-class demand for drug treatment in the 1970s and 1980s has produced a new drug treatment system that suffers from many of the policy problems common to the rest of health care. Drug abuse in the workplace has resulted in much wider coverage of substance abuse services by insurance companies and HMOs. The availability of third-party funds has spawned a for-profit chemical dependency treatment industry. The high cost of private residential treatment services has caused significant cost inflation. Cost-containment measures, which are a new phenomenon for this field and are inappropriate for the public sector, have led to the same confusion and debates that they have produced in other areas of health care.(ABSTRACT TRUNCATED AT 400 WORDS)     

Pyrolysis products of heroin

Heating of heroin hydrochloride or of heroin at 250 degrees C led to extensive degradation. Major components of the pyrolysate were identified as heroin, 6-acetylmorphine, N,6-diacetylnormorphine, and N-acetylnorheroin by comparison of mass spectra and 13C- and 1H-nuclear magnetic resonance (NMR) spectra with those of authentic compounds. There was evidence for degradation of the piperidino moiety and the structure 3,4-diacetoxyphenanthrene was proposed for a minor product.     

Isolation and purification of heroin from heroin street samples by preparative high performance liquid chromatography

The present study established a novel method using preparative high performance liquid chromatography to isolate and purify heroin·HCl from heroin street samples to be used as a reference standard. Different kinds of mobile phases and columns were used, ultimately the mobile phase consisting of hexane-isopropanol-methanol (65:28:7, v/v) and the SIL preparative column prepared in laboratory were selected as the final condition. Heroin was further purified by the drowning-out crystallization method using isopropanol-methanol (50:1, v/v) and hexane as drowning-out anti-solvents and salting-out agents, respectively. The purity was assessed by analytical high performance liquid chromatography and the confirmation of the chemical structure was performed by IR and NMR. About 110.7mg of heroin·HCl at a purity of over 99.52% was obtained from 180mg of heroin street samples which contained 156.15mg of heroin·HCl component by preparative high performance liquid chromatography. This method is suitable for preparing heroin standards in forensic science area.