Opiates

What are opiates?

Opiates (morphine, heroin, opium) are painkillers. As medicines they are prescribed by doctors for severe (chronic) pain. These painkillers often come as tablets. Some opiates (such as heroin) mainly come from outside the medical market. Heroin looks like a granular (white, gray, or brown) powder. A street name for heroin is “brown” referring to that brown powder.

There is a difference between opiates and opioids. Opiates are substances that can be extracted from the poppy. Examples include codeine, morphine, heroin and opium. Opioids are substances that have a similar effect in the brain as opiates, but are not found in the poppy. For the sake of convenience, we call both opiates here.


Effects

Opiates are pain relievers with a sedating effect.

The effect of a substance is determined by the properties of the substance itself, but also by the set and setting of the user. Here we describe the effects of opiates in general.

Morphine and heroin have about the same effect, only heroin is stronger. The effect heroin has depends on the dose, purity and method of use. The experience and physical condition of the user also play a role.

Positive effects (negative) Side effects

Relaxation

Reduction of stress, uneasiness, sadness, panic, and feelings of depression.

Head ache

Head ache

Euphoria, feelings of love

This substance can make you feel euphoric, like you are in love. You feel comfortable in your own skin and can experience things as pleasant more quickly.

Nausea/vomiting

An uneasy and tense feeling in the abdomen, which may cause discomfort. Nausea often precedes vomiting.

Mood swings

Using this drug may cause mood swings in users. These mood changes may be either positive or negative, and often alternate between extremes.

Constricting of the pupils

Some drugs constrict the pupils.

Reduction of worries

You can experience (strong) feelings of satisfaction and safety. Stress and/or worries that keep you busy on a daily basis are placed in the background a bit more, which can be pleasant.

Itch

Some drugs can cause ichting.

More intense music experiences

Music can be experienced louder or more intense. For example, it can feel as if you are completely ‘absorbed’ in the music or that you feel the low tones from the music go through your body more intensely.

Decreased appetite

Stimulation of the fight-or-flight response in the body can suppress appetite.

Pain reduction

You feel pain stimuli less. People sometimes use drugs to ease certain complaints they are experiencing. This can provide some relief.

But because of the inhibitory effect of the drug, you will, for example, feel less of a collision or fall or of too much movement. This can cause extra physical damage, for example, because you continue to dance when you should have rested. For example, you may not realize that a bruised ankle hurts.

Difficulty urinating

Your body releases a lot of antidiuretic hormone (ADH) causing you to retain more fluids. There is also more tension in the muscles in your urinary tract, which makes relaxing (and therefore urinating) more difficult.

More intense dreaming

You may start dreaming more actively and/or more intensely than usual. The dreams can then be a lot more vivid, more intense or weirder. This can be an interesting and fun, but also scary and unpleasant at times. The effect can therefore work both positively and negatively for you. You may also wake up less refreshed in the morning as a result.

Sedation

Decreased energy level

Reduction of cough stimulus

You are less bothered by the feeling that you have to cough.

Decrease in libido

Reduced sexual lust

Slowed breathing

Slowed breathing

Decreased body temperature

Some drugs cause a decrease in body temperature.

Double vision

Not being able to focus your eyes properly.

Craving

Feeling a (strong) need to take more when the effect wears off.

Lowered blood pressure

Some drugs can lower the blood pressure in your body.

Constipation

Some drugs can cause a constipation of the intestines.

Dry mouth

Stimulation of sympathetic pathways decrease saliva production, this causes the mouth to feel dry.

Increased sweating

In response to the increased stimulation and changes in body temperature, the skin will start to secrete sweat to cool the body temperature back to normal levels.

Dulling of emotions

Dulling of your emotions, apathy.


Dose and route of administration

Heroin can be inhaled (chinesed) or injected. When inhaling (“chasing the dragon”), the heroin is placed on a piece of aluminum foil and heated. The vapors are inhaled through a tube. When injecting, the heroin is placed on a spoon and mixed with water and lemon juice or ascorbin. Then the mixture is heated and the dissolved heroin is drawn into a syringe and injected directly into a vein. Heroin quickly reaches the brain via the blood.

In the Netherlands, heroin is mostly inhaled. In the past, it was also often injected, but partly due to the fear of AIDS, that group of users in the Netherlands has become smaller: the injecting community consists mainly of older (long-using) users and users from countries where injecting is still happening.

You can also snort or smoke heroin mixed with tobacco, but few users do this. Oral use is also possible (eating or dissolving in a drink), but that gives a much less intense ‘flash’ and is therefore not very popular.

The strength of the heroin can vary greatly. To find out how strong your heroin is, you can have it tested at the drug checking service. The dose to achieve the desired effect also varies widely and is very dependent on the user and in particular the degree of tolerance (habituation)!

Heroïn dose when injecting
Medium dose (no tolerance) 5 – 10 mg
Medium dose (large tolerance) 20 mg
Very high dose (large tolerance) 60+ mg
Heroïn dose when inhaling 15 – 25 mg

Duration

When injecting, the effects start after about 10 to 20 seconds and last for about four hours. When inhaling, the effects start after 5 to 10 seconds and also last about 4 hours.


Risks

Heroin itself is hardly harmful to the body. The way of life that often accompanies use is harmful to the body. Many heroin users live on the streets, eat poorly and some use contaminated needles. Mortality among heroin users is increasing faster than among the general population. In addition to overdose and AIDS, causes of death are liver cirrhosis, cancer, lung problems, cardiovascular disease, suicide, accidents and violence.

Short term risks

HIV and hepatitis infection (only with injecting)

When injecting drugs you run an increased risk of HIV, hepatitis and other blood-borne infections. Injecting is strongly discouraged for this reason. If you do decide to inject, make sure you don’t share equipment such as needles with others and that you use a clean needle every time.

Overdose heroin

The narcotic effect of heroin can cause breathing to stop completely. Overdose users appear pale and limp, breathe shallow or not at all, sometimes foam at the mouth and may vomit or have seizures.

Overdose – too high a dose and possibly fatal, can happen to a user if he:

  • Is a new user that is not used to the strength.
  • Stops for a while and takes this ‘regular’ dose again.
  • Uses aldulterated heroin.
  • Uses heroin that’s stronger than he thought.
  • Combines several drugs.
  • Uses in case of fatigue or low resistance.

Long term risks

Mental problems

Mental complaints can arise or already existing psychological complaints can worsen. Feeling gloomy or anxious, not feeling well and poor concentration.

Unnoticed pregnancy

Female heroin users often have irregular menstrual cycles or absence of their period. This does not prevent them from becoming pregnant, however. The inconsistency of menstrual cycles often causes these pregnancies to only be discovered in advanced stages of pregnancy.

Physical dependence in babies

A newborn baby of someone with heroin addiction is physically dependent on opioids and will develop withdrawal symptoms. After birth, the baby cries a lot, is easily startled, and has trouble sleeping. There is also a risk of developmental disorders. Medical supervision is necessary.

Diseases go unnoticed

Heroin suppresses pain which could lead to certain complaints to go unnoticed or that they are felt too late and therefore worsen.

Triggering a drug-induced psychosis

Frequent and high-dosage ketamine use can increase susceptibility to developing psychosis. During a psychosis, you may suffer from delusions, hallucinations, losing your grip on reality, and you could become very anxious. It becomes difficult to differentiate between reality and your thoughts. Your behaviour and thought patterns are often erratic and chaotic.

It is still unclear whether this can only be triggered in people who are already predisposed to psychosis, or whether regular drug use and an unhealthy lifestyle (e.g. little sleep) by itself can induce psychosis.

Using ketamine consecutively for days without sleeping, resting and eating exhausts your body, and therefore increases the risks of psychosis. Does someone in your environment react erratic and anxious? You can help that person by removing distractions (music, TV off for a while) and finding another environment where that person can get some rest. Speak calmly, be understanding and, if necessary, go outside together. Do not deny or confirm any delusions and if it does not get better, call a general practice centre. Medical staff are there to help you and can, if necessary, arrange a consult, write a prescription or provide care in another way.

Read more about psychosis in this article.

Physical addiction

Regular use of this drug can lead to physical addiction. This means that in addition to the psychological urge to take more, withdrawal symptoms arise when using is interrupted or stopped. Withdrawal symptoms include but are not limited to: poor sleep, sweating and becoming restless.

Withdrawal symptoms are often a reason to start drinking or using again. In actuality, those phenomena are only temporarily  suppressed.

Tolerance or habituation also occurs. That means if you use it regularly, you need more to feel the same effect.

Tolerance and stimulants

With stimulant use, tolerance will build-up for both the mental changes and appetite-suppressing effect, but not for cardiovascular effects. The higher your dose, the higher your blood pressure.

Psychological dependency

When someone has a psychological dependency, they are convinced that they cannot function without using the substance.

However, there is no physical change in body chemistry that would produce bodily side effects from quitting the substance.

Social isolation

Chronic and habitual use may cause users to spend less time maintaining friendships, relationships, and family bonds. Over time, they may start to reject any forms of social interaction, isolating them from their social circles.


Interactions

Combining different types of drugs can be risky and unpredictable. Combining medications can put you at a higher risk of health problems. In the following sections, you’ll read about the effects and risks of some common combinations, as well as some that can be extra dangerous. See also the theme of combining drugs.

Opiates and alcohol

Opiates and alcohol are both downers. They slow down activity in your nervous system. This has several risks. First, they both cause your breathing to slow down and become shallower. This can cause you to pass out faster than if you only take 1 drug.

Especially if you first drank alcohol and then take opiates, this increases the chance of passing out. If you first take opiates and then drink (some) alcohol, you are less likely to drink a lot. But of course it is better not to combine. This combination can cause serious physical risks.


Unity tips

It is very difficult to consume heroin on a recreational basis. We therefore advise against the consumption of heroin. If you do use heroin, you can limit the risks by:

  • Never use alone to avoid being alone in the case of overdose.
  • Be extremely self-disciplined and use it in moderation.
  • Inhale heroin and don’t inject it.
  • Be aware of the danger of overdose.
  • When you inject, always take a clean syringe.

Unity tips for using drugs

  • When using a drug for the first time, take only a small dose to see how your body reacts to the substance
  • Only use drugs when you are feeling well
  • Use drugs recreationally, not to combat psychological issues like fatigue
  • Avoid using drugs if you have (had) psychological afflictions or if you have a family history of psychological diseases (such as depression) in your family
  • Test your drugs before use at a drugs-testing service
  • Make sure to prepare a good set and setting for drug use
  • Only use drugs sparingly. Keep track of your use over time.
  • Decide in advance how much you are planning to use over the evening, and stick to that. 
  • Do not combine drugs with other substances or medicines
  • Do not participate in traffic after drug use
  • Prevent infectious diseases; Use your own snorter/sniffer and do not share paraphernalia with others
  • After insufflating, rinse your nose well with lukewarm saline water (for example, by using a nasal spray or nasal douche)
  • Are you, or one of your friends not feeling well? Keep an eye out for one another, take care of each other and visit the first aid (if one is available)
  • Call 112 in a life-threatening situation
  • Eat healthy before and after drug use. In particular, foods with lots of antioxidants and vitamins (blueberries, raspberries, blackberries, grapes, raisins, oranges, kiwi, broccoli). This is perhaps the most important tip! It can be difficult to eat during and after drug use, but make sure to try to eat something anyway. Eating well is a great way to reduce the hangover! If you can’t hold in solid foods, try juices, breakfast drinks, and smoothies.

Unity tips for using sedatives

  • Do not use sedatives (downers) in combination with other sedatives (alcohol, GHB, sleeping pills, opiates) or ketamine. This is dangerous because you can fall unconscious and suffocate on your vomit.
  • Write down the time of intake and your dose, text the dose and time to each other or put it in your phone to keep track of it yourself.
  • If you feel that you are getting falling asleep, you can try to keep moving to avoid falling asleep. But beware; if moving takes a lot of effort, there is a chance that you may fall or trip, so be careful.
  • An overdose is more likely on an empty stomach, a full stomach increases the chance of vomiting.
  • Less is more; taking a small, extra dose later because you did not feel anything after your first dose is better than taking too much and having an overdose.
  • Ensure that the people around you are aware of what you are going to use and have been using.

FAQ

How addictive is heroin actually?

Heroin is highly addictive. Few people manage to control the use of the drug. The body quickly gets used to heroin. You then need more and more to still feel the desired effect of euphoria. It is striking that the withdrawal symptoms also occur very quickly; after only two or three weeks of use. A user feels sick, clammy and cold, perspires, has goosebumps, a runny nose, diarrhoea, abdominal cramps and muscle pain in arms and legs. These symptoms disappear when heroin is taken again. But the withdrawal symptoms only get worse every time. In addition, due to the euphoric and analgesic effect, a user continues to long for the drug. He/she puts everything aside and does everything (including stealing) just to be able to use. The mental dependence is especially great.

How did the use of opiates begin?

The history of opiates goes back a long way, about 4000 to 6000 years. Even then, people wrote about the poppy plant. Egyptians and many other peoples of the early Middle East used it. In the 7th century, opium arrived in China via Arab traders, where it was initially used to cure diarrhea. Later, under the influence of the Dutch settlers, opium became a remedy for malaria and it was used as a drug. China became obsessed with opium. The result was that many users became addicted and the then rulers announced a ban. This ban gave rise to two opium wars in which the English ensured that the opium from their colony of India could be sold in China. They wanted to keep selling this because they made a lot of money with it.

How did opium come to Europe?

In Europe, opium was not introduced as a medicinal drink until 1525. The drink was called ‘laudanum’ and was made from alcohol and opium. It was used by both adults and children as a sleep and pain reliever. The drink was quite popular. There was almost no disease in which opium was not seen as some sort of panacea. During the 19th century, opium was freely available in drugstores in both the US and England.

The use of opium as a drug in Europe dates back to the end of the eighteenth century. It was used by all walks of life, but at that time it didn’t cause too many problems: it was cheap and not yet illegal. There was hardly any knowledge about the negative effects and the risks.

How did the use of morphine start and how does it relate to heroin?

In 1803, a German pharmacist discovered how to make morphine from opium. Morphine, like opium, was used as a remedy for chronic pain and insomnia, but it was also taken by people who were addicted to laudanum (tincture of opium) and wanted to get rid of it. This didn’t work as morphine is even more potent and addictive than opium. Just how addictive morphine was was revealed when 45,000 soldiers returned addicted from the American Civil War.

Heroin was discovered in 1898 by a German company. It is made from morphine. The effect of this discovered new drug heroin turned out to be much stronger than that of morphine. For that reason, the drug was also called “heroin,” which means heroic or powerful in German. Where people used morphine to get rid of an opium addiction, they started using heroin to get rid of that morphine addiction. A vicious circle was the result. It was only too late to realize how addictive heroin was.

Heroin entered the drug market in 1972. The price was very low at first and before long all opium users switched to heroin and the same happened to the people who used other drugs. For years, the opiate problem has been the main drug problem in our country. This has now been reversed and there are relatively few heroin addicts.

How about the law and opiates?

In 1919 the Dutch Opium Act was passed. This determined that heroin was a hard drug from then on: possession, production, import, export and trade are punishable by law. Morphine, codeine and heroin may be used for medical purposes. People who own user amounts are not actively prosecuted. However, the heroin and the syringe attributes can be confiscated. Opiates such as morphine and codeine are mainly used in medicine. Morphine as a heavy painkiller and codeine as a cough suppressant. In that context, they are legal.
Check the theme Drugs and the law  for more info.

I am planning to combine opiates with other drugs. What are the consequences?

Combining different drugs can be risky and unpredictable. If you combine, you are more likely to have problems with your health. For more information, check the theme Drugs and combination use.

Heroin is regularly used in combination with other substances, for example with alcohol or cocaine. The combination with other downers is extra risky. For example, the respiratory inhibiting effect of opiates is enhanced by the use of alcohol. A combination with MAO inhibitors can lead to high blood pressure.

The combination with uppers such as cocaine gives your body different signals. Your body needs extra oxygen because of the cocaine, but gets it less because the heroin makes you breathe less.

How long are opiats detectable in the body?

How long a drug is detectable in your blood or urine depends on a number of factors. How often and how much you use and your personal metabolism (the speed at which the breakdown substances of a substance are broken down by your liver, in particular) influence how long it is detectable. Drugs are longer detectable in your urine than in your blood.

Heroin itself is usually detectable up to 8 hours after use. Tests usually look at the metabolite of heroin and these are detectable 3 to 5 days after use.

How are opiates made?

Opiates

Opiates are produced from the poppy plant. These plants grow in Central Asia and Southeast Asia (eg Iran, Iraq, Afghanistan, Burma and Thailand), but also in South America. Opium is obtained by making an incision in the seed bulb of the poppy plant. The seed bulb excretes a milky substance. When this dries up, a dark brown substance is formed, the raw opium. This raw substance can be smoked. Morphine can be made from the raw opium, and codeine can be made from morphine. Compared to morphine, codeine is a weak analgesic and a powerful anti-cough suppressant. By chemically processing the morphine, the heroin can eventually be created.

Opioids

Substances that have a similar effect in the brain as opiates, but do not occur in the original poppy bulb, are called opioids.

What if I have medical complaints after the use of partydrugs?

Some complaints after using drugs can last longer, A medical explanation or even treatment may then be necessary. The Brijder has set up a national consultancy for party drugs related medical complaints. If you have medical complaints after the use of party drugs, you can call the consultancy: 088 – 358 29 40. This service is only available in the Netherlands.

 


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