Heroin 3, 151 smoking

In the second study there were 174 patients in two similar experimental groups in whom injectable rather than inhaled heroin was used (5). A response to treatment was defined as at least a 40% improvement in physical, mental, or social domains of quality of life, if not accompanied by a substantial (over 20%) increase in the use of another illicit drug, such as cocaine or amphetamines. After 12 months those who took methadone and heroin (smoked or injected) had significantly better outcomes. The incidences of adverse effects (constipation and drowsiness) were similar in all the groups. However, owing to the limitations of the study and the complex nature of drug dependence, the therapeutic outcomes could not be justifiably and solely attributed to the specific drug(s). 

Symmetrical deep cerebellar lesions have been associated with heroin smoking (32). 

Gervin M, Hughes R, Bamford L, Smyth BP, Keenan E. Heroin smoking by chasing the dragon in young opiate users in Ireland stability and associations with use to come down off Ecstasy . J Subst Abuse Treat 2001 20(4) 297-300. 

Some countries report anecdotal evidence of increased heroin smoking among young people, and some school surveys reveal greater experimentation. 

Huizer, H. Analytical studies on illicit heroin V. Efficacy of volatilization during heroin smoking. Pharmaceutish Weekhlad Scientific Edition 9 203-211, 1987. 

Shang J, Griffiths P and Gossop M (1997). Heroin smoking by Chasing the Dragon origin and history. Addiction 92, 673-683. 

If she does use heroin, smoking is safer than injecting... 

Opioids are easily absorbed subcutaneously and intramuscularly, as well as from the gastrointestinal tract, nasal mucosa (e.g., when heroin is used as snuff), and lung (e.g., when opium is smoked). About 90% of the excretion of morphine occurs during the first 24 hours, but traces are detectable in urine for more than 48 hours. Heroin (diacetyhnorphine) is hydrolyzed to monoacetylmorphine, which is then hydrolyzed to morphine. Morphine and monoacetylmorphine are responsible for the pharmacologic effects of heroin. Heroin produces effects more rapidly than morphine because it is more lipid soluble and therefore crosses the blood-brain barrier faster. In the urine, heroin is detected as free morphine and morphine glucuronide (Gutstein and Akil 2001 Jaffe et al. 2004). 

Heroin can be smoked ( chasing the dragon ), sniffed or prepared for injection. Opioids prescribed for medical use may be used for non-medical reasons, especially by heroin users who cannot otherwise get hold of heroin. 

Heroin can be snorted, smoked, and given intravenously. Complications of heroin use include overdoses, anaphylactic reactions to impurities, nephrotic syndrome, septicemia, endocarditis, and acquired immunodeficiency. 

Epidemiological research suggests that probably 10 to 20% of the population of the United States may have problems related to substance use, with approximately 5 % of the population having problems with drugs other than alcohol (Substance Abuse and Mental Health Services Administration [SAMHSA], 2003). The most widely abused substances in the United States are alcohol, tobacco, and marijuana, but the typical pattern is for a person to abuse more than one substance at a time. An example might be that a person may smoke both cigarettes and marijuana, or may use both cocaine and heroin. 

Opioids are administered in several ways. Opium was most commonly taken recreationally by smoking, but intravenous administration has become most common since the isolation of opium alkaloids and invention of the hypodermic needle. The development of heroin from morphine at the turn of the twentieth century led to more intense euphoric effects and greater risk for addiction. Heroin may also be snorted, or it can be smoked when added to a medium such as tobacco. Medically, opioids are commonly given through oral, subcutaneous, intravenous, transdermal, or rectal routes. 

Talhout R, Opperhuizen A, van Amsterdam JG (2007) Role of acetaldehyde in tobacco smoke addiction, Eur Neuropsychopharmacol 17 627-636 Tanda G, Pontieii FE, Di Chiara G (1997) Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common mul opioid receptor mechanism. Science 276 2048-2050 Taylor JR, Robbins TW (1984) Enhanced behavioural control by conditioned reinforcers following microinjections of d-amphetamine into the nucleus accumbens. Psychopharmacology 84 405 12... 

Another problem for the makers of naltrexone was recently uncovered by researchers testing the drug on marijuana smokers. To the researchers surprise, people who were given naltrexone and then smoked marijuana reported that they felt greater psychotropic effects from the marijuana than if they had simply smoked the marijuana alone. In other words, while naltrexone blocks the psychotropic effects of alcohol, heroin and opium, it appears to increase the effects of marijuana. 

In opiate abuse, smack ( junk, jazz, stuff, China white mostly heroin) is self administered by injection ( mainUning ) so as to avoid first-pass metabolism and to achieve a faster rise in brain concentration. Evidently, psychic effects ( kick, buzz, rush ) are especially intense with this route of administration. The user may also resort to other more unusual routes opium can be smoked, and heroin can be taken as snuff (B). 

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