What Are Opiates

       Strictly speaking, opiates are drugs derived from the poppy plant that have been used over the centuries primarily for pain relief. Also known as narcotics, opiates can be natural or synthetic.  The natural opiates include opium, morphine, and codeine.  Other substances, called opioids, are man-made.  These substances behave like opiates in that they produce the same effects and are most often used to treat chronic or severe pain.  All opiate or opioids are also highly addictive.  Examples of opioids include Dilaudid, Demerol, Oxycodone, Vicodin, Fentanyl, Methadone, and Darvon.  Heroin is an opioid manufactured from morphine.  Heroin is rarely, if ever, used medicinally. Rather, it is used for its ability (initially) to give the user a feeling of euphoria.
      The use of opiates in medical practice has a long history. Reports of opium cultivation and use date back as early as 3400 B.C. by the peoples of Assyria, Babylon, Egypt, and Sumeria.
A number of developments in the use of opiates took place in the nineteenth century. Morphine, named after Morpheus, the Greek god of dreams, was discovered in 1803 by German pharmacist Friedrich Wilhelm Adam Sertürner, and it was first administered by an injection using a syringe in 1843 by Scottish physician Alexander Wood. In 1874, the English scientist C. R. Wright became the first person to synthesize heroin, which began to be sold by The Bayer Company in 1898.
      A user’s reactions and experiences with the opiate are dependent upon several factors including length of time, quantity of use, method of use, and the source of the opiate.  If procured on the street versus the pharmacy, it is usually mixed (“cut”) with numerous other substances, some of which are potentially deadly.   Under a doctor's supervision and used as prescribed for short periods of time (1-2 weeks), opiates are very effective painkillers; however, even appropriate use over the long term can lead to dependence.  When a person becomes dependent, finding and using the drug often becomes the main focus in life. Even if the patient has never had a problem with alcohol or drug abuse, they can technically become and addict.           
      Caught in the vise of dependence, people often "doctor shop,” going to several different physicians complaining of pain and asking for opiates. There are unscrupulous physicians, also known as “dirty doctors” who will supply users with prescriptions at inflated prices of up to $500 per visit. Often, people seek suppliers from the Internet or the streets; these activities are highly dangerous and very illegal.
Signs of opiate use are:

• Lethargy and/or drowsiness
• Constricted pupils and reduced vision
• Shallow breathing
• Needle or track marks on inner arms or other parts of the body from injecting needles
• Redness and raw nostrils from sniffing heroin or pulverized narcotic painkillers
• Use or possession of paraphernalia including syringes, bent spoons, bottle caps, eye droppers, rubber tubing, cotton and needles.

Methods of delivery

      Opiate powders can be swallowed or dissolved in water and injected, particularly into a vein which maximizes the effect. Heroin is sometimes sniffed, or the fumes from the heated powder is inhaled, or “smoked.” Subcutaneous injection ("skin popping") is when a heroin solution is injected into the layers of skin, usually in the arms or thighs. Intravenous injection ("mainlining") is when the heroin is injected into a vein. The effects of injecting heroin are felt within minutes and last three to four hours, depending on the dosage.

      The large majority of heroin is illegally manufactured and imported, which originates largely from the Indian sub-continent. When sold at street level it is likely to have been diluted or cut with a variety of similar powders. The main dilutant is glucose. However, the practice of using other substances such as caffeine, flour and talcum powder is a constant danger to users.

Most man-made opiates are taken orally or are pulverized and then sniffed.

Psychological effects

      Like other depressants, opiates produce a tranquil and euphoric effect. Users who inject an opiate such as heroin may also experience a "rush" as the drug circulates through the body. Some users combine opiates with a stimulant such as cocaine. This is called "speed balling." The stimulant keeps the user from falling asleep; the opiate reduces the hyperactive effects often caused by stimulants.

      Psychological dependence is assured with continued use of opiates. When a user becomes dependent, finding and using the drug becomes the main focus of life. Opiates induce tolerance: the need for more of the drug in order to produce the same effects.

Physical effects

      The physical effects of opiates depend on the opiate used, its source, the dose and the method used. Opiates slow breathing, heart rate and brain activity. Opiates depress appetite, thirst and sexual desire. The body's tolerance to pain is increased.

Regular opiate users who abruptly stop using the drug experience withdrawal symptoms four to six hours following the last dose. Symptoms include uneasiness, diarrhea, abdominal cramps, chills, sweating, nausea, runny nose and eyes, irritability, weakness, tremors and insomnia. The intensity of these symptoms depends on how much of the drug was taken, how often and for how long. These symptoms are usually strongest 24 to 72 hours after onset and can persist for seven to 10 days.

Withdrawal

      Individuals using opiate drugs may become both psychologically and physically addicted to the drugs in as little as two weeks. Individuals withdrawing from an opiate often feel like they have a severe case of the flu. In addition, psychological withdrawal may include mood swings, depression and increased sensitivity to pain.  These withdrawal symptoms are always uncomfortable, sometimes excruciating, but they are not life-threatening.
Treatment
      Like with any addiction, there are many treatment options. Prescription painkiller dependence can be resolved by weaning (or “titrating”) a patient gradually off the drug, usually for a period of two weeks. Prolonged use of heroin, morphine, opium, methadone and suboxone can result in longer periods of withdrawal, accompanied by psychological treatment, group sessions and drug counseling. The best advice, obviously, is not to get started. However, if one must take painkillers for medical reasons, it’s always best to use them for short periods of time and always under the direction of a responsible physician.