OPIATES
POPPY FLOWERS IN BLOOM
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The poppy Papaver somniferum is the source for nonsynthetic
(natural) narcotics. It was grown in the Mediterranean region as early
as 5000 B.C., and has since been cultivated in a number of countries throughout
the world. The milky fluid that seeps from incisions in the unripe seed
pod of this poppy has, since ancient times, been scraped by hand and air
dried to produce what is known as opium. |
BEE'S EYE VIEW OF POPPY
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The pretty little ("cousin") flower, the European Poppy, was worn for
years by millions of americans as a symbol of patriotism on many holidays...
especially on Veterans day. This custom has apparently disappeared... perhaps
as the poppy's role in America's drug problem is now well known. |
PURE HEROIN POWDER
READY FOR SALE
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The term narcotic, derived from the Greek word for stupor, originally
referred to a variety of substances that induced sleep. In a legal context,
narcotic refers to opium, opium derivatives, and their semisynthetic or
totally synthetic substitutes. Cocaine and coca leaves, which are classified
as "narcotics" in the Controlled Substances Act (CSA), are technically
not narcotics and are discussed in the section on Cocain. Narcotics can
be administered in a variety of ways. Some are taken orally, transdermally
(skin patches) or injected. They are also available in suppositories. As
drugs of abuse, they are often smoked, sniffed or self- administered by
the more direct routes of subcutaneous ("skin popping") and intravenous
("mainlining") injection.
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Drug effects depend heavily on the dose, route of administration, previous
exposure to the drug, and the expectation of the user. Aside from their
clinical use in the treatment of pain, cough suppression and acute diarrhea,
narcotics produce a general sense of well-being by reducing tension, anxiety,
and aggression. These effects are helpful in a therapeutic setting but
contribute to their abuse.
Narcotic use is associated with a variety of unwanted effects including
drowsiness, inability to concentrate, apathy, lessened physical activity,
constriction of the pupils, dilation of the subcutaneous blood vessels
causing flushing of the face and neck, constipation, nausea and vomiting
and, most significantly, respiratory depression. As the dose is increased,
the subjective, analgesic, and toxic effects become more pronounced. Except
in cases of acute intoxication, there is no loss of motor coordination
or slurred speech as occurs with many depressants.
Among the hazards of illicit drug use is the ever-increasing risk of
infection, disease and overdose. Medical complications common among narcotic
abusers arise primarily from adulterants found in street drugs and in the
non-sterile practices of injecting. Skin, lung and brain abscesses, endocarditis,
hepatitis and AIDS are commonly found among narcotic abusers. Since there
is no simple way to determine the purity of a drug that is sold on the
street, the effects of illicit narcotic use are unpredictable and can be
fatal.
With repeated use of narcotics, tolerance and dependence develop. The
development of tolerance is characterized by a shortened duration and a
decreased intensity of analgesia, euphoria and sedation, which creates
the need to administer progressively larger doses to attain the desired
effect. Tolerance does not develop uniformly for all actions of these drugs,
giving rise to a number of toxic effects. Although the lethal dose is increased
significantly in tolerant users, there is always a dose at which death
can occur from respiratory depression.
Physical dependence refers to an alteration of normal body functions
that necessitates the continued presence of a drug in order to prevent
the withdrawal or abstinence syndrome. The intensity and character of the
physical symptoms experienced during withdrawal are directly related to
the particular drug of abuse, the total daily dose, the interval between
doses, the duration of use and the health and personality of the addict.
In general, narcotics with shorter durations of action tend to produce
shorter, more intense withdrawal symptoms, while drugs that produce longer
narcotic effects have prolonged symptoms that tend to be less severe.
The withdrawal symptoms experienced from heroin/morphine-like addiction
are usually experienced shortly before the time of the next scheduled dose.
Early symptoms include watery eyes, runny nose, yawning and sweating. Restlessness,
irritability, loss of appetite, tremors and severe sneezing appear as the
syndrome progresses. Severe depression and vomiting are not uncommon. The
heart rate and blood pressure are elevated. Chills alternating with flushing
and excessive sweating are also characteristic symptoms. Pains in the bones
and muscles of the back and extremitites occur as do muscle spasms and
kicking movements, which may be the source of the expression "kicking the
habit." At any point during this process, a suitable narcotic can be administered
that will dramatically reverse the withdrawal symptoms. Without intervention,
the syndrome will run its course and most of the overt physical symptoms
will disappear within 7 to 10 days.
The psychological dependence that is associated with narcotic addiction
is complex and protracted. Long after the physical need for the drug has
passed, the addict may continue to think and talk about the use of drugs.
There is a high probability that relapse will occur after narcotic withdrawal
when neither the physical environment nor the behavioral motivators that
contributed to the abuse have been altered.
There are two major patterns of narcotic abuse or dependence seen in
the United States. One involves individuals whose drug use was initiated
within the context of medical treatment who escalate their dose through
"doctor shopping" or branch out to illicit drugs. A very small percentage
of addicts are in this group.
The other more common pattern of abuse is initiated outside the therapeutic
setting with experimental or recreational use of narcotics. The majority
of individuals in this category may abuse narcotics sporadically for months
or even years. These occasional users are called "chippers." Although
they are neither tolerant of nor dependent on narcotics, the social, medical
and legal consequences of their behavior is very serious. Some experierimental
users will escalate their narcotic use and will eventually become dependent,
both physically and psychologically. The earlier drug that use begins,
the more likely it is to progress to abuse and dependence. Heroin use among
males in inner cities is generally initiated in adolescence, and dependence
develops in about 1 or 2 years.
Narcotics (opiates) of Natural Origin are harvested from the poppy seed.
and ARE CURRENTLY INCLUDED IN ALMOST ALL TESTING SYSTEMS!
TOOLS AND PRODUCTS
OF OF THE POPPY HARVEST
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A more modern method of harvesting is by the industrial
poppy straw process of extracting alkaloids from the mature dried plant.
The extract may be in liquid, solid or powder form, although most poppy
straw concentrate available commercially is a fine brownish powder. More
than 500 tons of opium or its equivalent in poppy straw concentrate are
legally imported into the United States annually for legitimate medical
use. |
VARIOUS GRADES OF HEROIN
WITHBALLOONS FOR TRANSPORTATION
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There were no legal restrictions on the importation or use of opium
until the early 1900s. In the United States, the unrestricted availability
of opium, the influx of opium smoking immigrants from the Orient, and the
invention of the hypodermic needle contributed to the more severe variety
of compulsive drug abuse seen at the turn of this century. In those days,
medicines often contained opium without any warning label. Today, there
are state, federal, and international laws governing the production and
distribution of narcotic substances. |
MEDICAL GRADE CODEIN
READY FOR SALE OR DIVERSION
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Although opium is used in the form of paragoric to treat diarrhea,
most opium imported into the United States is broken down into its alkaloid
constituents. These alkaloids are divided into two distinct chemical classes,
phenanthrenes and isoquinolines. The principal phenanthrenes are morphine,
codeine and thebaine, while the isoquinolines have no significant central
nervous system effects and are not regulated under the CSA. |
MORPHINE
Morphine, the principal constituent of opium, can range in concentration
from 4 to 21 percent (note: commercial opium is standardized to contain
10% morphine). It is one of the most effective drugs known for the relief
of pain, and remains the standard against which new analgesics are measured.
Morphine is marketed in a variety of forms including oral solutions
(Roxanol), sustained-release tablets (MSIR and MS-Contin), suppositories
and injectable preparations. It may be administered orally, subcutaneously,
intramuscularly, and intravenously, the latter method being the one most
frequently used by addicts. Tolerance and physical dependence develop rapidly
in the user. Only a small part of the morphine obtained from opium is used
directly; most of it is converted to codeine and other derivatives.
CODEINE
This alkaloid is found in opium in concentrations ranging from 0.7
to 2.5 percent. Most codeine used in the United States is produced from
morphine. Compared to morphine, codeine produces less analgesia, sedation
and respiratory depression, and is frequently taken orally.
Codeine is medically prescribed for the relief of moderate pain. It
is made into tablets either alone or in combination with aspirin or acetaminophen
(Tylenol). Codeine is an effective cough suppressant and is found in a
number of liquid preparations. Codeine products are also used to a lesser
extent as an injectable solution for the treatment of pain. It is by far
the most widely used naturally occurring narcotic in medical treatment
in the world. Codeine products are encountered on the illicit market, frequently
in combination with glutethimide (Doriden) or carisoprodol (Soma).
THEBAINE
A minor constituent of opium, thebaine, is chemically similar to both
morphine and codeine, but produces stimulatory rather than depressant effects.
Thebaine is not used therapeutically, but is converted into a variety of
compounds including codeine, hydrocodone, oxycodone, oxymorphone, nalbuphine,
naloxone, naltrexone and buprenorphine. It is controlled in Schedule II
of the CSA as well as under international law.
SYNTHETIC NARCOTICS
Semi-synthetic narcotics include Heroin, Hydromorphone, Oxycodone,
and Hydrocodone.Ê Synthetic narcotics inculde Meperidine, Methadone,
Fentanyl, Pentazocine, and many other less potent drugs.
Synthesized from morphine in 1874, heroin was not extensively used in
medicine until the beginning of this century. Commercial production of
the new pain remedy was first started in 1898. While it received widespread
acceptance from the medical profession, physicians remained unaware of
its potential for addiction for years. The first comprehensive control
of heroin in the United States was established with the Harrison Narcotic
Act of 1914.
Pure heroin is a white powder with a bitter taste. Most illicit heroin
is a powder which may vary in color from white to dark brown because of
impurities left from the manufacturing process or the presence of additives.
Pure heroin is rarely sold on the street. A "bag"--slang for a single dosage
unit of heroin--may contain 100 mg of powder, only a portion of which is
heroin; the remainder could be sugars, starch, powdered milk, or quinine.
Traditionally, the purity of heroin in a bag has ranged from 1 to 10 percent;
more recently heroin purity has ranged from 1 to 98 percent, with a national
average of 35 percent.
Another form of heroin known as "black tar" has also become increasingly
available in the western United States. The color and consistency of black
tar heroin result from the crude processing methods used to illicitly manufacture
heroin in Mexico. Black tar heroin may be sticky like roofing tar or hard
like coal, and its color may vary from dark brown to black. Black tar heroin
is often sold on the street in its tar-like state at purities ranging from
20 to 80 percent. Black tar heroin is most frequently dissolved, diluted
and injected.
The typical heroin user today consumes more heroin than a typical use
did just a decade ago, which is not surprising given the higher purity
currently available at the street level. Until recently, heroin in the
United States almost exclusively was injected either intravenously, subcutaneously,
(skin-popping), or intracuscularly. Injection is the most practical and
efficient way to administer low-purity heroin. The availability of higher
purity heroin has meant that users now can snort or smoke the narcotic.
Evidence suggests that heroin snorting is widespread or increasing in those
areas of the country where high purity heroin is available, generally in
the northeastern United States. This method of administration may be more
appealing to new users because it eliminates both the fear of acquiring
syringe-borne diseases such as HIV/AIDS and hepatitis, and the historical
stigma attached to intravenous heroin use.
[Abstracted from D.E.A. website]
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OPIATES
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| Effects |
| Heroin is usually injected directly into the blood stream
by the abuser. (Mainlining!) The newer "pure" heroin is potent enough to
be "snorted" (which is seen by the abuser as a "real convenience!") It
can also be injected under the skin, which is called skin-popping. Today
it is popular to smoke heroin just like "crack" cocaine. The effects of
heroin (and all the opiates) are sedation, euphoria, reduced anxiety, relief
from unpleasant feelings or thoughts, and a feeling of "depersonalization"
... like being in "another world." The euphoric effects are very short
in duration. The side effects last much longer and include pinpoint pupils,
reduced vision, drowsiness, apathy, decreased physical activity, constipation,
sleep, nausea, vomiting and respiratory depression! The symptoms of withdrawl
last from 7 to 10 days and include severe anxiety/panic, runny nose, watery
eyes, perspiration, yawning, restlessness, irritability, loss of appetite,
diarrhea, stomach cramps, chills, pain, and muscle cramps |
| Incidence of Abuse |
Heroin is becoming "THE DRUG OF THE NINETIES."
E.R. Visits involving Heroin increased from 40,000 in 1992 to 62,000
in 1993 in U.S. alone! [See also "Drugs of Abuse: An Update" in July 1995
issue of "Emergency Medicine."] |
| Chemical Name |
| Codein (Phosphate), Morphine, Heroin (Diacetylmorphine), etc. (see
below). |
| Forms and Street Names |
Heroin: Horse, Big H, Harry, Dope, Boy, WhiteJunk,
Smack, TNT, "H" "China White" and "China Cat" is extremely (90%) pure &
dangerous Heroin!
Morphine: M, Miss Emma, Mister Blue, Morph
Codeine = Schoolboy
Dilaudid = Lords
Methadone = Fizzies, Dollies |
| Preferred routes of administration |
| See above |
| Length of time detectable
after use |
Heroin: > 6-MAM > Morphine cascade is very rapid ! Therefore: 6-MAM
only found in urine collected within 8-10 hours of Heroin use!
Codeine & Morphine: detectable for maximum of 2-3 days |
| Metabolite
Actually sought in urine |
| Morphine, Codeine, 6-MAM [6-mono-acetyl-morphine. |
| Confounding
drugs (or factors): |
| Current regs. provide for testing of Codeine, Morphine,
and 6-M.A.M. in verification process! The most difficult part of
the MRO review is the requirement for "clinical proof" (see below!) |
| Screening
Cut-off: |
Older cut-offs were in effect till August, '02. Thereafter:
Screening cut-off is 2,000 ng/ml |
| Confirmation
GC/MS Cut-off: |
Older cut-offs were in effect till August, '02. Thereafter:
Standard cut-off is 2,000 ng/ml
6-MAM is "automatic" in DOT testing.
"Burden of Proof" Cut-off is 15,000 ng/ml |
| Facts for
Verifying M.R.O |
| Remember that 6 MAM is now automatically run
by lab whenever a specimen tests above 2,000 ng/ml for Morpine or codeine.
POSITIVE 6-MAM is SPECIFIC FOR HEROIN,
6-MAM is always gc/ms and cut-off is 10 ng/ml
When 6-MAM is positive, usually, Morphine level above 6,000.
UNIQUE REQUIREMENT IN VERIFICATION OF OPIATE ABUSE:
CLINICAL EVIDENCE
is required to report a POSITIVE opiate test.
EXCEPT FOR:
1.6-MAM POSITIVE
DONOR WHO IS HEROIN-POSITIVE WITHOUT EXAM! ...OR
2. DONOR ABOVE
15,000 ng/ml who bears burden of proof of legitimate use.
WHAT ABOUT POPPY SEEDS?? YES!
Ingestion
of poppy seeds (legal) can and does cause a TRUE positive test! END
OF ITEM! (Save yourself hours of reading!)
NOTE: This would be an INNOCENT
POSITIVE test.. NOT A FALSE POSITIVE.
Morphine levels can be several hundred following poppy seed ingestion...
but There is only ONE REPORTED CASE of a level above 5,000 from poppy seeds!
A POPPY SEED CLAIM REQUIRES MRO ACTION! Poppy seeds are almost pure
morphine... and contain almost no codein! Therefore, QUANTS SHOULD BE REQUESTED
.... A morphine/codeine ratio less than 2 is proof of codein use from
a source other than poppy seeds. [M/C<2] ... with apologies to Einstein.
Because of the strict requirement for clinical evidence and the handy
appeal to "poppy seed use" ... 95% OF LAB-POSITIVE OPIATE RESULTS ARE REPORTED
AS "M.R.O. NEGATIVE" FOLLOWING THE VERIFICATION PROCESS!
IN CASES OF CODEIN USE OR ABUSE:
The PROPORTION OF CODEINE / MORPHINE gives clue as to TIME of Codeine
use:
EARLY: (shortly after abuse) Codeine is high & Morphine is low!
LATER: Codeine is low (degradation) and Morphine is high!
CLAIM OF O.T.C. CODEINE USE: can be legitimate (both U.S. and
Canada) but if this claim is made, donor must provide all info for MRO
to verify and MRO must verify!
FINAL REMINDER: POSITIVE 6-MAM =POSITIVE FOR HEROIN ... DOES
NOT REQUIRE "CLINICAL" EVIDENCE! (EXAM) |
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