Archive for category Diamorphine (Heroin)'

Criminality During the Life Course of Heroin Addiction

Statement of the research problem It has been established that opiate addiction in the contemporary United States is associated with exceedingly high crime rates (). Indeed, recent studies have reported () that heroin addicts are frequently involved in criminal behavior on a daily basis and that, consequently, they comnithundreds and thousands of offenses per individual during their addiction careers. Furthermore, it is becoming apparent that the scope and magnitude of the crime problem associated with opiate addiction is not only due to the frequency with which addicts commit “victimless” and lesser offenses, but that many of their offenses are serious and destructive (). But further questions about the association of crime and addiction remain to be answered. One of the most crucial of these involves the continuity of crime among heroin addicts. What are the long-term consequences of this crime-drug relationship? Do active addicts become more, or less, enmeshed in criminal behavior over their adult years? Do the types of crimes they commit change? Or do they reach a high crime plateau which remains stable? What is the effect of successive abstinence periods upon criminality? In order to investigate the life Read more […]

Consequences of Use: Heroin and Other Narcotics

Irving F. Lukoff, Ph.D Our charge is to say something about the consequences of narcotic use. Our remarks are restricted to the post-World-War-II American experience. Out of the host of issues, we selected those that may have some possible relevance for policy. We first venture a brief, schematic review of current epidemiological findings, because we feel this must serve as a backdrop for anything about the sequel to heroin use. We then highlight the inappropriate tendency to minimize the impact that heroin use has on some communities as knowledge of the self-limiting nature of narcotic use for many persons is noted. The view that alcohol and tobacco undoubtedly inflict more aggregate damage is, in our opinion, a myopic one because it fails to locate the problems with sufficient specificity. Therefore, we will look at one community in order to elaborate our view that overall heroin use rates may be a bit deceiving, and that the problem of heroin use cannot be compared to other forms of abuse by the simple criterion of quantity. Since we were charged to look at the sequel to heroin use, we review, perhaps too critically, the efforts to identify life cycles and various role typological schemes we all find so attractive. Read more […]

The lnstitutional Matrix: Methadone Treatment, Science, and Research

An appraisal of the consequences of heroin use, we suggested earlier, cannot be limited to the examination of the actors in the heroin scene. We reviewed several of the efforts to identify types of adaptations of heroin addicts; however, the conclusion we drew was that this was only a prolegomenon to what has to be done in the future. Our examination of a high risk community suggested that where rates of narcotic involvement are high, the problem can no longer be viewed as confined to a collection of individuals who happen to choose a particular mode of adaptation. Instead, it becomes an issue that reverberates throughout the community and influences the community’s ability to solve its problems of survival. There is still another aspect to the consequence of heroin use, the organizational and institutional one, with its concomitant establishment of a complex public and private system to deal with narcotics. Expenditures for supply reduction alone represent over 350 million dollars annually. There are 276,000 treatment slots provided by federal and local governments and under private auspices (White Paper, 1975). A major industry has been spawned to cope with a problem that may involve between one-quarter to one-half Read more […]

The Sequel to Heroin Use: Life Cycles, Stages, and Role Typologies

The brief summary of the various patterns of heroin and other narcotic consumption abstracted from the epidemiological literature suggests the complexity involved in attempts to understand stages of drug use. One conclusion from the epidemiological findings just reviewed is that narcotic use does not present a unitary pattern; instead, many diverse and complex patterns are apparent. Yet, we restricted ourselves to the relationship of users to the frequency of narcotic use. We ignored the various sequences through time, the attendant life-styles, and the institutional and organizational dimensions of narcotic use. A proliferation of schemes has been advanced that attempts to identify various stages of involvement with narcotics, mainly with heroin. There are also typological schemes and social role concepts that attempt to summarize complex patterns that identify significant dimensions of behavior. A legitimate scientific activity is to search behind the complex and shifting “realities” for an underlying structure to serve as a foundation for understanding and control. Despite their long history in drug research, none of these schemes has fulfilled its promissory note. They have, in failing to account for the Read more […]

Epidemiology and the Course of Narcotics Use

What happens to those who finally succumb to the lure of narcotics? Most such individuals have had at least some prior experience not only with tobacco and alcohol, but also with marihuana and a veritable pharmacopoeia of other substances, ranging from glue and other toxic substances to various opiate-laced drugs, barbiturates, amphetamines, and other somewhat less common depressants, psychedelics, and stimulants (). Only a small subset ever move on to heroin, currently the most common opiate and the one about which there is most societal and policy concern. More individuals are reported to have used nonheroin opiates. Yet, in most communities they abort nonheroin opiate use, or they transform their allegiance to heroin. Although the lure of opium and morphine has been long acknowledged -strengthened by the difficulty that identified compulsive users have had in abandoning their dependence – the myths about heroin are at least as firmly established as those developed in the early struggle concerning opium (). Myths not only exist in the public mind, but are also promoted by addicts and the professionals who work with them. For example, the title of one popular book written by one of the more progressive and enlightened Read more […]

Critique of Consequences of Use: Heroin and Other Narcotics

William H. McGlothlin, Ph.D. In the main paper of this section of this report, Dr. Lukoff has provided us with some interesting observations, although some of them fall outside what is normally considered under the topic Consequences of Heroin Use. This paper presents brief comments on his paper and some observations from our own research. One aspect that is useful to keep in mind is that when we speak of consequences of narcotics use we mean the consequences that result from use in the highly coercive environment in which the addict exists in this country. The consequences would likely be quite different under conditions of social acceptance or toleration. For instance, Dr. Lukoff correctly concludes that recent findings clearly demonstrate that the use of heroin often does not lead to addiction, and than, once established, addiction is not nearly so permanent a phenomenon as was once believed. The role of the environment is an important factor here. Military personnel who became addicted in Vietnam tended to discontinue the behavior once they return to the very different conditions in the United States. Older addicts in the United States tend to get tired of going to jail and stop using. There is no evidence of Read more […]

Some Comments on Consequences of Chronic Opiate Use

Charles Winick, Ph.D. Dr. Lukoff’s paper, which has appeared earlier in this report, has presented a very useful analysis of the need to study the details of the subarea prevalence of opiate use as well as the larger national samples of the population. It also contains some trenchant observations on typologies and a number of vigorous assessments of our use of data on methadone maintenance. Prevalence Policymakers and social scientists are especially concerned about that form of opiate use that we can call a chronic relapsing condition. It is more a condition than a disease, because it is so heavily mediated by social and ecospace factors that the disease model, as explicated by researchers like De Alarcon (1969) and Hunt (1973), appears to have limited utility without consideration of social factors. Consider some of the differences in dimensions of opiate use in different communities at the present time (): 1. Street methadone is the primary drug of abuse of 500% more users in New York than in Los Angeles. 2. Texas users are almost 300% more likely to be arrested than New Jersey users. 3. New York users are 200% more likely than Philadelphia users to have a legitimate source of income. 4. Detroit Read more […]

Drug-Drug Interactions of Heroin

Alcohol Many heroin users use heroin and alcohol together. There has been an evaluation of the pharmacokinetic interaction between heroin and alcohol and the role of that interaction in the cause of 39 heroin-related deaths that were attributed to either heroin or heroin + ethanol. The cases were arbitrarily divided into two groups according to blood ethanol concentration (low-ethanol group, under 1000 ng/ml, and high ethanol group, over 1000 μg/ml. The high-ethanol group was associated with reduced hydrolysis of 6-acetylmorphine to morphine, and there was an inverse correlation between blood ethanol concentration and hydrolysis of 6-acetylmorphine to morphine. The concentration of total morphine was lower in the high-ethanol group. High blood ethanol concentrations were also associated with an increased ratio of unbound to total morphine and with reduced excretion of unbound and total morphine. The relative concentrations of conjugated heroin metabolites were reduced in the presence of a high blood ethanol concentration. The authors hypothesized that alcohol inhibits the glucuronidation of morphine, resulting in less conjugated morphine in the blood. Thus, in patients with high blood ethanol concentrations the additional Read more […]