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24
JUL / AUG 2014
I
Healthcare Journal of new orleans
heroin
The drug has spread through the population, and overdoses
have soared in recent years. With a number of serious
associated health risks and alarming proliferation of users,
heroin has become a major public health concern. At the
same time, funding for behavioral health and substance
abuse treatment has been cut amid budget concerns. Prisons
are much more expensive than drug treatment centers, but
the idea is that dealers will hear about the new legislation
and this will stop them from selling the drug. In other words,
the goal is deterrence to squelch the supply of the drug. To
get an idea about whether this approach is likely to be
effective, it is instructive to take a look at the history of heroin
.
Heroin (the brand name for diacetylmor-
phine) is a synthetic drug that was created
by Bayer in the late 1800s by adding acetyl
groups tomorphine. (Morphine, like codeine,
While the majority of heroin users did not
become addicted, by the early 1900s, reports
were being published that heroinwas at least
as dangerous asmorphine, and it was banned
from home use and eventually, in the U.S.,
from physician-supervised use as well. By
the 1920s, doctors were no longer allowed
to prescribe heroin. Unfortunately, though,
this did not have the intended effect of stop-
ping its distribution. Dealers were happy to
step in and fill the void, and organized crime
found in heroin an ideal money-making com-
modity. By the mid-1920s, heroin was more
plentiful than ever, and the illicit heroin trade
continues to thrive to this day.
While diacetylmorphine is currently
banned from all medical use in the United
States, in the U.K. and other countries it is
widely used in hospitals and palliative care
settings. As with morphine, codeine, and
other synthetic opiates, it is not the case that
everyone who gets a dose of heroin becomes
addicted to it. It is indisputable that opiates
are highly addictive, but plenty of people use
them without ever becoming addicted. So,
why do some people become addicted while
is a natural component of opium.) Marketed
alongside Bayer’s other big commercial
product, aspirin, it was largely touted as a
replacement for morphine in treating serious
respiratory illnesses. It was alsomarketed for
a number of home health needs, including
cold and cough treatment for children and a
sleep aid. (One particularly disturbing 19th
Century Spanish ad shows a child reaching
for the heroin bottle as hismother holds
it back—”No, no! Just one spoonful!”she
seems to be saying.)While it was well-
known that morphine was addictive,
heroinwas thought to be a non-addic-
tive alternative, and was even touted
as a treatment for morphine addiction.
Unlike aspirin, though, whichwas syn-
thesized a year after heroin fromwhite wil-
lowbark using a similar acetylation process,
the “heroic”morphine derivative—so effective
for pain treatment, sleep induction, and treat-
ing respiratory disease—had a very dark side.