Narcotics
(See:Drugs in American Society, 5th, 6th, 7th, 8th, and 9th editions, Erich Goode, McGraw-Hill, 1999/2005/2008/2012/2014. Chapter 11/10/12 and Drugs, Society, and Human Behavior, Ray and Ksir, Mosby, 1993 (and 2004). Chapter 14; Statistics are gathered from the various surveys discussed, especially: Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.)

Opiates

"Can anybody lend me a dime?"

The HARD Drugs!

(Erowid, From the Indiana University Prevention)

• Street level competition: Heroin versus Cocaine
• The "stuff" of social images about drugs and drug users
• Heroin on the streets
  
• Opiates are considered to be some of the most important pharmaceuticals worldwide, and their use is considered to constitute the most serious problem, too.

  Opium (photo from erowid)

1. Traders, Fighters, and Explorers: spread use of opium.
2. Used opium as a trade product- sold seeds to Chinese (by 900 A.D. mentioned in Chinese Medical writing).
3. Arabic physicians make substantial contributions to medicine and develop insights about opium: first description of addiction circa 1000 A.D.

• Early 1500, European medicine- Paracelsus: Laudanum; called opium the "stone of immortality"
• Dr. Thomas Sydenham (English "Hippocrates", circa 1700's): reinvented laudanum: 2 oz. Opium, 1 oz. saffron, a dram of cinnamon and cloves- all dissolved in 1 pint of Canary wine.

Opium Wars

• 1644 Chinese Emperor outlawed tobacco use: partly responsible for spread of opium use. Prior use of tobacco with opium led to development of opium smoking- this spread rapidly (quicker onset)
• 1729: non-medicinal use of opium outlawed: Smuggled in from India. Highly profitable enterprise (especially for the British)
• Britain and the Dutch had been attempting to get trade set up with China since before 1500. (Opium in China)
• By 1700: limited trade began through the port of Canton: English took tea, and began smuggling in opium (Chinese apparently weren't interested in any of the legitimate goods the English had.
• In India, opium was legal- the government was the British East India Company- held monopoly on opium. Auctioned chests of opium to private merchants, given to selected British firms, who sold to Chinese merchants in Canton.
• Each chest=> 120 pounds of opium. 1729- 200 smuggled in, 1838- 25,000
• First Opium War, 1839: Emperor sent honest man to end the practice. He was successful, and destroyed 20,000 chests ($6 million).
• After incident involving alcohol and the death of a Chinese civilian, war was declared
• 2 years of fighting- Britain won. Got Hong Kong and $6/$20 million. "Trade" in opium continued, but declined. 1893: moral protest and by 1906 bill passed- ending the process in 1913. Hong Kong reverts to Chinese rule: July 1, 1997.

19th Century Use and Patterns

• 1803: Frederick Sertürner (Hannover, Germany) conducts experiments and isolates the primary active ingredient in opium, names it- Morphium after Morpheus, the god of dreams.
• Use grows slowly, but by 1831, Sertuener is given the French version of the Nobel Prize.
• Further work reveals over 30 alkaloids, with codeine isolated in 1832 (Greek word for poppy head
• These drugs were viewed as major medical breakthroughs, effective in treating a variety of human ailments.
• 1853 marks another breakthrough, in technology- the perfection of the hypodermic syringe, making the administration of morphine more efficient and effective. It was thought that IV injection would not be as addicting as oral use!!
• Wars: Civil War (1861-1865), Prussian-Austrian (1866), and Franco-Prussian (1870) led to the widespread use of morphine in injectable form- "Soldier's Disease" (this terminology is suspect. Although still cited in Ray and Ksir, 2004, and repeated in Mosher and Akins, Drugs and Drug Policy, Sage, 2007, page 95, it appears that the reference to "soldier's disease" or "army disease" may have originated in the 20th century as part of campaign to prohibit narcotics. See, "The Mythical Roots of US Drug Policy: Soldier's Disease and Addiction in the Civil War," by Jerry Mandel (local copy). Mandel's argument makes sense since the idea of addiction, especially as a "disease," did not become commonly accepted until the 20th century.
• Throughout the 19th Century the use of opiates spread quite rapidly. Most use was instrumental. The drugs could be bought openly, Sears carried syringe kits in their catalogs, by the end of the century the number of addicts is estimated at being well over 100,000-- some suggest, millions (probably an overestimate).
• The typical addict was characterized as being: respectable, older (middle-aged), female, middle class, rural/suburban and white.
• Opium and its various extracts and preparations were widely used by creative individuals: writers, artists, etc. Thomas De Quincy, perhaps most importantly known for his attempts to explore the effects of the drug laudanum on consciousness: "The confessions of an Opium Eater."
• Opium in San Francisco
• Samuel Taylor Coleridge: "Kubla Khan" and Elizabeth Barrett Browning were also well known users.
• Heroin was synthesized in 1874 (2 acetyl groups were added to the morphine molecule- increasing the lipid solubility- leading to more rapid transferal to the brain. Heroin is 3-6x as potent as morphine, although the pharmacology of the drugs is identical.
• Heroin was originally marketed in 1898 as a Non-addicting substitute for codeine- a cough suppressant. It was viewed as a "perfect" drug, and was thought to hold potential as a cure for "Morphinism" It's addictive potential did not become understood until well into the 20th Century.

Opiates, Opioids, and Narcotics

Schaffer Library on Opiates (see especially the online chapters from "licit and Illicit Drugs)

Morphine(10% by weight of opium)
Codeine
Laudanum (10% opium and alcohol) (erowid image)
Paregoric (4% opium and alcohol) (wikipedia)

Heroin (diacetylmorphine)
Dilaudid (Hydromophone) (semi-synthetic) (erowid)
Oxycodone (Percodan) (semi-synthetic, from Thebaine) (wikipedia) (erowid)
Hydrocodone (Vicodin) (erowid)

Buphrenorphine

Meperidine (Demerol)
Propoxyphene (Darvon)
Dolophine (Methadone) (wikipedia)
Pentazocine (Talwin)
Fentanyl (Sublimaze) (80x as potent as morphine) (wikipedia)(Fentanyl overdoses)

• Outlaws sale and distribution: Heavy tax penalty.
• Leads to creation of the Bureau of Narcotics (tax collection agency) and a variety of federally run heroin clinics (all closed during the 1920 due to negative publicity and shifting attitudes concerning heroin and medicine.
• Other rulings effectively eliminate the medical use and prescription of heroin.

"The provision protecting physicians, however, contained a joker hidden in the phrase, "in the course of his professional practice only. "After passage of the law, this clause was interpreted by law-enforcement officers to mean that a doctor could not prescribe opiates to an addict to maintain his addiction. Since addiction was not a disease, the argument went, an addict was not a patient, and opiates dispensed to or prescribed for him by a physician were therefore not being supplied "in the course of his professional practice." Thus a law apparently intended to ensure the orderly marketing of narcotics was converted into a law prohibiting the supplying of narcotics to addicts, even on a physician's prescription." (The Consumers Union Report on Licit and Illicit Drugs by Edward M. Brecher and the Editors of Consumer Reports Magazine, 1972.   Chapter 8. The Harrison Narcotic Act (1914))

Norman Zinberg: Euphoria seekers (compulsive) and Maintainers

Goal is not getting a fix so much as it is succeeding in getting the money, and maintaining the "structure of the group."

"Chippying" or the "chipper"-- Controlled use patterns

All in study used heroin, IV, used for extended period of time, some with periods of compulsive use.

Controlled users different in that:

1. Rarely used more than once a day
2. Were able to keep a "stash"
3. Avoided associating with "hard-core" addicts
4. Used the drug recreationally rather than to treat depression
5. Knew their dealer
6. Did not use to "escape" reality
7. Rituals and sanctions control use patterns.

1. Define moderate use, condemn compulsive
2. Limit use to physical, psychological, and social settings conducive to positive or 'safe' experiences
3. Develop means of identifying untoward drug effects: test drugs to avoid OD
4. Compartmentalize drug use and support non-drug related obligations and relationships.

"If, as I contend, the use of opiates and other illicit drugs is indeed an evolving social process, the recognition that the social setting strongly influences the capacity for control offers an alternative to prohibition. Elements of potential control are active in all groups of opiate users, even among addicts. Many opiate users representing many different styles of use have precepts, however punitive, that dictate how they can use their drug without becoming addicted or suffering physical and psychological damage, or, at least, how they can use the drug in order to get what they desire from it. Is it not possible that using groups will gradually develop these ideas into social sanctions and rituals similar to those that govern acceptable alcohol use (Zinberg et al. 1975)? Although the sample studied in my NIDA project is small, the fact that many of those who fulfilled the project's stringent criteria for controlled use had formerly been addicted suggests the need to consider approaches other than abstinence. For example, assisting the maintenance of controlled use could be a practical means of preventing drug abuse with the least social cost; and experimenting with this alternative in a careful and gradual way would not obstruct the effort to discourage the use of the opiates generally." (Norman E. Zinberg, "Nonaddictive Opiate Use in Robert 1. DuPont, Avram Goldstein, and John O'Donnel (eds.), Handbook on Drug Abuse (Rockville, MD: National Institute on Drug Abuse, 1979), pp. 303-313.)

• Use by "respectable" people-- especially doctors and other medical professionals
  • 3-4,000 heavy users (usually narcotics)
  • Pure and standardized substance
  • Good, clean needles
  • Awareness of nutritional needs
  • Not a money problem
  • Recorded instance of individuals in this type of setting using morphine for 30-40 years with no debilitating effects
• Other Effects: Alcohol worse than heroin and cocaine?

• The world of heroin use is different from that of other drugs: Pot smoker- "straight" means no drug effect. Heroin: "getting straight"-- injected and back to "normal"
• The drug is viewed with magical powers, a certain religious quality to the behavior pattern
• Abstention==> Stupid. The world is filled with pain and misery. Why face that?
• Relevance of other things and people: Insofar as they relate to getting and using dope.
• Heroin valued more than money, better than money: "It's a commodity"
• Love/hate relationship with the dealer (vs. Pusher)
• Quitting=> giving up far more than the drug. Lifestyle and networks. Turning on and kicking are both group phenomenon
• Being addicted is perhaps of little consequence: Viet Nam veterans, most had signs of physical dependence. 50% just stopped. 14% maintained. Rest: used sporadically.
• Treatment: Variety. Multiple enrollments.
• Drug Policy Alliance

1. Quantity and quality increasing: 14-80% pure depending on type (Columbian/Mexican) and location (DEA Pluse Check: Mid Year 2000)
2. Current MTF Data
3. Current NSDUH Data: 2013 1.8% report lifetime use, .3% report past year use, and .1% report past month use (US population 12 and older). Rates for OxyContin use are about twice that for heroin.
4. Due to social image: unlikely to become as popular as cocaine.
5. But, new forms of use: "Chasing the Dragon" and a new smokable "speedball"--heroin and crack.
6. Alternating between heroin and crack or cocaine, some areas: MDMA and Ketamine are popular. (DEA Pluse Check: Mid Year 2000)
7. Combination with methamphetamine/ice.
8. Alcohol use remains popular