HEROINHEROIN

Nick AtencioNick Atencio

&&

Gabrielle SanchezGabrielle Sanchez

““It’s not hypnotic and theirs no It’s not hypnotic and theirs no danger in acquiring a habit!” danger in acquiring a habit!” –Boston Medical and Surgical –Boston Medical and Surgical Journal 1900Journal 1900

IntroductionIntroductionHeroin is a narcotic analgesic derived from Heroin is a narcotic analgesic derived from

morphine. It is believed to be one of the most morphine. It is believed to be one of the most addictive drugs in the world today. For our addictive drugs in the world today. For our group this topic was selected due to interest group this topic was selected due to interest sparked by friends and family who have used sparked by friends and family who have used and died from heroin as well as coming from and died from heroin as well as coming from a city and state that leads the nation in a city and state that leads the nation in heroin related deaths per capita.heroin related deaths per capita.

This presentation will cover topics such as the This presentation will cover topics such as the history, routes of administration, mechanism history, routes of administration, mechanism of action, treatments, effects on babies and of action, treatments, effects on babies and laws attributed to heroin. laws attributed to heroin.

““Need Something Need Something New”New”

In the late 1800’s morphine and codeine In the late 1800’s morphine and codeine were the most popular prescribed and were the most popular prescribed and addictive drugs. The Bayer company in addictive drugs. The Bayer company in Germany was looking for alternate Germany was looking for alternate medications that were capable of treating medications that were capable of treating the same diseases as codeine and the same diseases as codeine and morphine (which is derived from the morphine (which is derived from the opium poppy) but yet less potent and less opium poppy) but yet less potent and less addictive (Hodgson).addictive (Hodgson).

DiacetlymorphineDiacetlymorphineIn 1874, English chemist C.R. Wright ventured In 1874, English chemist C.R. Wright ventured

out into making a non-addictive form of out into making a non-addictive form of codeine and morphine. In doing so he codeine and morphine. In doing so he combined anhydrous morphine alkoid and combined anhydrous morphine alkoid and acetic andhydride (Hodgson). This produced acetic andhydride (Hodgson). This produced what is known as diacetylmorhpine what is known as diacetylmorhpine (Hodgson). In short diacetylmorphine is an (Hodgson). In short diacetylmorphine is an acetylated version of morphine.acetylated version of morphine.

Acetylation

Morphine

Diacetlymorphine

““Heroic”Heroic”In 1898, Heinrich Dreser of Germany saw In 1898, Heinrich Dreser of Germany saw

the commercial value in Wright’s invention the commercial value in Wright’s invention and began testing on rabbits, himself and and began testing on rabbits, himself and fellow co-workers at the drug company he fellow co-workers at the drug company he worked at in Germany, Bayer (Hodgson). worked at in Germany, Bayer (Hodgson). Dreser later then termed Wright’s Dreser later then termed Wright’s invention as “Heroin.” This was due to the invention as “Heroin.” This was due to the results from testing his co-workers which results from testing his co-workers which said they had a “heroic” like feeling while said they had a “heroic” like feeling while using the drug (Hodgson).using the drug (Hodgson).

““It’s not hypnotic and theirs It’s not hypnotic and theirs no danger in acquiring a no danger in acquiring a habit!” habit!” –Boston Medical and Surgical Journal –Boston Medical and Surgical Journal 19001900

In 1898, Dreser advertised Heroin to the In 1898, Dreser advertised Heroin to the Congress of German Naturalists and Congress of German Naturalists and Physicians (Hodgson). Claiming it was 10x Physicians (Hodgson). Claiming it was 10x more effective then codeine as a cough more effective then codeine as a cough medicine with only 1/10 of it’s effects medicine with only 1/10 of it’s effects (Hodgson). Also that it was more effective (Hodgson). Also that it was more effective then morphine as a pain killer (Hodgson). then morphine as a pain killer (Hodgson). In 1899, the Bayer company began In 1899, the Bayer company began advertising heroin to doctors and advertising heroin to doctors and practitioners in Europe and the U.S. practitioners in Europe and the U.S. (Hodgson). (Hodgson).

Routes of Routes of AdministrationAdministrationIntravenously a.k.a. Shooting up!Intravenously a.k.a. Shooting up!

The most common route of administration. Requires The most common route of administration. Requires user to dissolve the heroin powder in an acid such as user to dissolve the heroin powder in an acid such as citric acid or lemon juice in order to break down the citric acid or lemon juice in order to break down the heroin (Hart). Sometimes water. Then heated into fine heroin (Hart). Sometimes water. Then heated into fine liquid and injected intravenously. This route requires liquid and injected intravenously. This route requires smaller doses yet achieves faster effects then other smaller doses yet achieves faster effects then other routes of administration. Most injections occur on routes of administration. Most injections occur on majors veins (aka mainling) such as those in the arm majors veins (aka mainling) such as those in the arm (Hart). If veins collapse then injections typically will (Hart). If veins collapse then injections typically will occur in groin, neck and legs (Hart). Intravenous occur in groin, neck and legs (Hart). Intravenous avoids first pass metabolism and therefore readily avoids first pass metabolism and therefore readily able to cross the blood brain barrier and effects felt able to cross the blood brain barrier and effects felt immediately after injection (Meyer). immediately after injection (Meyer).

Routes of Routes of AdministrationAdministration

The second most common route is smoking. The second most common route is smoking. Smoking heroin requires the user to heat the Smoking heroin requires the user to heat the drug in order to inhale the vapors. Typically drug in order to inhale the vapors. Typically heated on tin foil or lacing the drug with heated on tin foil or lacing the drug with marijuana or tobacco and smoking it in a pipe or marijuana or tobacco and smoking it in a pipe or cigarette (Meyer). When heated it turns into a cigarette (Meyer). When heated it turns into a thick liquid. Smoking heroin is also termed as thick liquid. Smoking heroin is also termed as “chasing the dragon,” since the user chases the “chasing the dragon,” since the user chases the globs of heroin that are in the tube with the globs of heroin that are in the tube with the intention of inhaling as much smoke as possible intention of inhaling as much smoke as possible (Meyer).(Meyer).

Routes of Routes of AdministrationAdministrationSnorting heroin is one of the least Snorting heroin is one of the least

common routes. When snorted, users common routes. When snorted, users will use a glass tube or tin foil to make will use a glass tube or tin foil to make a tube Meyer. Any residue left in the a tube Meyer. Any residue left in the tin foil tube allows for further usage. tin foil tube allows for further usage. By snorting users bypasses first pass By snorting users bypasses first pass metabolism in the liver (Meyer). metabolism in the liver (Meyer).

Routes of Routes of AdministrationAdministration

The less common route of administration The less common route of administration is oral intake. When taken orally, is oral intake. When taken orally, heroin merely serves as a pro-drug for heroin merely serves as a pro-drug for morphine (Hart). Heroin must first pass morphine (Hart). Heroin must first pass metabolism in the liver when taken metabolism in the liver when taken orally. It is in the liver that heroin is orally. It is in the liver that heroin is converted into morphine (Meyer).converted into morphine (Meyer).

DistributionDistribution- The acetyl groups in heroin make it more lipid The acetyl groups in heroin make it more lipid

soluble and able to penetrate the BBB (Meyer). It soluble and able to penetrate the BBB (Meyer). It is in the brain where heroin is able to have its is in the brain where heroin is able to have its overall effects. overall effects.

- Heroin primarily modifies the action of dopamine Heroin primarily modifies the action of dopamine in the nucleus accumbens and ventral in the nucleus accumbens and ventral tegemental area (VTA) of the brain (Meyer).tegemental area (VTA) of the brain (Meyer).

Metabolism of HeroinMetabolism of Heroin-Once crossing the BBB heroin is Once crossing the BBB heroin is deacetlyated into 6-deacetlyated into 6-monoacetlylatedmorphine (6-MAM) and monoacetlylatedmorphine (6-MAM) and morphine (Hart).morphine (Hart).

Heroin

Morphine

6-MAM

Mechanism of ActionMechanism of Action- 6-MAM and Morphine then act as agonists and 6-MAM and Morphine then act as agonists and

bind to mu, kappa (both play a role in pain bind to mu, kappa (both play a role in pain reception) and delta opioid receptors in the brain reception) and delta opioid receptors in the brain (Hart). (Hart).

- It is important to note that the mu receptor has It is important to note that the mu receptor has the highest affinity of the three for morphine and the highest affinity of the three for morphine and opiate related drugs (Meyer).opiate related drugs (Meyer).

- This binding then prevents the release of GABA, This binding then prevents the release of GABA, therefore reducing the inhibitory effects of GABA therefore reducing the inhibitory effects of GABA on dopamine neurons (Meyer). on dopamine neurons (Meyer).

- The increase in activation of the dopamine The increase in activation of the dopamine neurons further results in activation of the post-neurons further results in activation of the post-synaptic membrane (Meyer). Which then results synaptic membrane (Meyer). Which then results in the activation of the dopaminergic reward in the activation of the dopaminergic reward pathway. Leading to heroin’s desired effects pathway. Leading to heroin’s desired effects (Meyer).(Meyer).

(Image from CNSForum)

This is all made possible due to the three opioid This is all made possible due to the three opioid receptors being linked to G proteins. First G receptors being linked to G proteins. First G protein activation opens K+ channels which protein activation opens K+ channels which increase K+ exiting the cell (Meyer). This leads increase K+ exiting the cell (Meyer). This leads to hyperpolarization of the cell. When the to hyperpolarization of the cell. When the receptors are on the cell, the hyperpolarization receptors are on the cell, the hyperpolarization decreases the cell’s firing rate of GABA decreases the cell’s firing rate of GABA (Meyer). (Meyer).

Second opiates such as heroin can have Second opiates such as heroin can have inhibitory effects by closing Ca2+ channels, inhibitory effects by closing Ca2+ channels, when G protein receptors are on the when G protein receptors are on the presynaptic terminal (Meyer). Reducing Ca2+ presynaptic terminal (Meyer). Reducing Ca2+ intake during an action potential intake during an action potential proportionately decreases the amount of proportionately decreases the amount of inhibitory neurotransmitter released (i.e. GABA) inhibitory neurotransmitter released (i.e. GABA) (Meyer). Therefore increasing the amount of (Meyer). Therefore increasing the amount of dopamine production and pleasure felt (Meyer).dopamine production and pleasure felt (Meyer).

Mechanism of Action Mechanism of Action for Pain Inhibitionfor Pain InhibitionOnce heroin crosses the BBB and becomes morphine, Once heroin crosses the BBB and becomes morphine,

morphine is then able to bind to the opiate receptors morphine is then able to bind to the opiate receptors that trigger inhibitory spinal neurons to release that trigger inhibitory spinal neurons to release endorphins (Meyer). It is these endorphins that then endorphins (Meyer). It is these endorphins that then inhibit the spinal projection neurons from being inhibit the spinal projection neurons from being activated. There are three ways of inhibiting spinal activated. There are three ways of inhibiting spinal cord pain transmission (Meyer):cord pain transmission (Meyer):

1)1) Directly inhibiting the projection neuron.Directly inhibiting the projection neuron.

2) Inhibiting the excitatory neuron2) Inhibiting the excitatory neuron

3) Exciting the inhibitory opioid neuron, which sends out 3) Exciting the inhibitory opioid neuron, which sends out a neuron of its own when activated to inhibit the a neuron of its own when activated to inhibit the activation of the projection neuron. activation of the projection neuron.

Projection NeuronEndorphin Projection Neuron

Projection Neuron

Endorphin

Endorphin

Excitatory Interneuron

Opiod Neuron

Projection Neuron

1) Direct Inhibition of Projection Neuron

2) Inhibition of excitatory neuron

3) Excitation of inhibitory opioid interneuron

It’s just not worth it!It’s just not worth it!

Desired EffectsDesired Effects- Euphoria rushEuphoria rush- Decrease in anxietyDecrease in anxiety- Reduction in painReduction in pain

Undesired/Long term effectsUndesired/Long term effects- HypothermiaHypothermia- Nausea/vomitingNausea/vomiting- Bone and muscle painBone and muscle pain- Veins collapsingVeins collapsing- Lung infectionsLung infections- Increase chances for strokeIncrease chances for stroke- Liver/kidney diseaseLiver/kidney disease- Pulmonary complicationsPulmonary complications- HIV/AIDSHIV/AIDS- HepatitisHepatitis

(Hart)

ExcretionExcretion The excretion of heroin occurs a The excretion of heroin occurs a

majority of the time through the majority of the time through the kidneys and out as urine (Hart).kidneys and out as urine (Hart).

Depending on the amount Depending on the amount administered/frequency heroin administered/frequency heroin levels in the body vary, therefore levels in the body vary, therefore complete excretion from the body complete excretion from the body varies from days, to weeks to varies from days, to weeks to months.months.

OverdosingOverdosingIn the events of a heroin overdose, medical In the events of a heroin overdose, medical

professionals and in some cases law professionals and in some cases law enforcement administer naloxone, commonly enforcement administer naloxone, commonly reffered to as Narcan.reffered to as Narcan.

Narcan acts as an antagonist and reverses the Narcan acts as an antagonist and reverses the traumatic effects of a heroin overdose by traumatic effects of a heroin overdose by competing with morphine for the opiate competing with morphine for the opiate receptors (mostly the mu receptors) and receptors (mostly the mu receptors) and binding to them therefore reversing the binding to them therefore reversing the effects of heroin overdosing such as effects of heroin overdosing such as respiratory depression and sedation (Meyer). respiratory depression and sedation (Meyer).

It is administered via I.V., I.M. or S.C. (sub It is administered via I.V., I.M. or S.C. (sub cutaneously) and is excreted through the cutaneously) and is excreted through the urine within 72 hours (A.P.A) . urine within 72 hours (A.P.A) .

One down fall to the usage of Narcan is the One down fall to the usage of Narcan is the onset of withdrawal symptoms for the heroin onset of withdrawal symptoms for the heroin user.user.

WithdrawalWithdrawal

The onset of withdrawal symptoms vary The onset of withdrawal symptoms vary among users. Typically those who use among users. Typically those who use heroin once a day experience peak heroin once a day experience peak withdrawal effects within 36-48 hours withdrawal effects within 36-48 hours of there last administered dose (A.P.A). of there last administered dose (A.P.A). Symptoms such as pain, restlessness Symptoms such as pain, restlessness and vomiting go away within in 7-10 and vomiting go away within in 7-10 days (Meyer). days (Meyer).

There are several treatments for There are several treatments for withdrawal, methadone is one of them. withdrawal, methadone is one of them.

MethadoneMethadone

Methadone helps alleviate withdrawal Methadone helps alleviate withdrawal symptoms. When taken orally it occupies symptoms. When taken orally it occupies opiate receptors (like heroin) (Meyer). In a opiate receptors (like heroin) (Meyer). In a sense it acts like heroin by reducing the sense it acts like heroin by reducing the need for more heroin, therefore causing a need for more heroin, therefore causing a reduction in withdrawal side effects reduction in withdrawal side effects (Meyer).(Meyer).

It is important to note that Methadone does It is important to note that Methadone does not provide any of the euphoric effects not provide any of the euphoric effects that heroin does when administered. that heroin does when administered.

Narcan vs MethadoneNarcan vs Methadone

When coming off of heroin it is best to When coming off of heroin it is best to quit “cold turkey” and seek prescribed quit “cold turkey” and seek prescribed methadone treatment. When Narcan is methadone treatment. When Narcan is used opiate receptors are more rapidly used opiate receptors are more rapidly deprived of opiate compared to deprived of opiate compared to quitting “cold turkey” (Hart).quitting “cold turkey” (Hart).

However, one complication with However, one complication with methadone is that some individuals methadone is that some individuals will begin to become addicted to will begin to become addicted to methadone if it is not prescribed in methadone if it is not prescribed in adequate amounts (Meyer). adequate amounts (Meyer).

Heroin Use During Heroin Use During PregnancyPregnancy Heroin is easily made available to the unborn Heroin is easily made available to the unborn

baby because it can cross the placenta and baby because it can cross the placenta and enter the blood stream of the baby. Most of enter the blood stream of the baby. Most of the blood supplied to babies does not the blood supplied to babies does not experience the first pass effect, it does not experience the first pass effect, it does not pass through the mother’s liver, and thus is pass through the mother’s liver, and thus is more potent (Blackburn).more potent (Blackburn).

Heroin once broken into its metabolites Heroin once broken into its metabolites becomes less lipid soluble and stays trapped becomes less lipid soluble and stays trapped on the fetal side of the placenta (Blackburn). on the fetal side of the placenta (Blackburn). There it begins to accumulate in the fetus There it begins to accumulate in the fetus and the amniotic fluid. (Blackburn)and the amniotic fluid. (Blackburn)

(Merck)

The affects of Heroin The affects of Heroin on Babieson Babies Heroin can cause Heroin can cause

serious complications serious complications during pregnancy during pregnancy including miscarriage, including miscarriage, premature birth, premature birth, decreased weight, decreased weight, birth defects, birth defects, withdrawal symptoms withdrawal symptoms (or Neonatal (or Neonatal Abstinence Abstinence Syndrome), Syndrome), behavioral or learning behavioral or learning disabilities, and are at disabilities, and are at a larger risk for a larger risk for sudden infant death sudden infant death syndrome (SIDS). syndrome (SIDS). (March of Dimes)(March of Dimes)

•Babies that experience withdrawals show symptoms including fever, sneezing, trembling, irritability, vomiting, diarrhea, and sometimes seizures. (Edwards)

Treatment for MothersTreatment for Mothers

Mothers who are using are encouraged Mothers who are using are encouraged to seek treatment from professional to seek treatment from professional medical staff. Treatments such as medical staff. Treatments such as methadone or minimal amounts of methadone or minimal amounts of opiates for the baby in order to prevent opiates for the baby in order to prevent withdrawal symptoms at birth (Edwards). withdrawal symptoms at birth (Edwards). Where as completely quitting heroin, A Where as completely quitting heroin, A sudden decrease of heroin may have sudden decrease of heroin may have serious negative affects on the baby serious negative affects on the baby ranging from breathing complications to ranging from breathing complications to seizures (Edwards).seizures (Edwards).

Heroin by the NumbersHeroin by the Numbers

The average heroin addict will spend $150 The average heroin addict will spend $150 to $200 dollars a day to support their habit to $200 dollars a day to support their habit (G.D.C.A.D.A).(G.D.C.A.D.A).

It is estimated that there were 149,000 new It is estimated that there were 149,000 new heroin users in 1998 with nearly 80% under heroin users in 1998 with nearly 80% under the age of 26. (G.D.C.A.D.A).the age of 26. (G.D.C.A.D.A).

Current estimates suggest that nearly Current estimates suggest that nearly 600,000 people in America need treatment 600,000 people in America need treatment for heroin addiction. (Heroin Addiction)for heroin addiction. (Heroin Addiction)

In the 25 to 49 age group, illicit drug In the 25 to 49 age group, illicit drug overdose is the fourth leading cause of overdose is the fourth leading cause of death, about the same number as motor death, about the same number as motor vehicle crashes. (Heroin Addiction)vehicle crashes. (Heroin Addiction)

Heroin Studies and Heroin Studies and Classification Classification One study recently conducted found that One study recently conducted found that

addicts will find themselves overdosing on addicts will find themselves overdosing on there normal dose of heroin if administered there normal dose of heroin if administered in a new environment. For more information in a new environment. For more information on this study visit: on this study visit: http://www.pubmedcentral.nih.gov/articlerenhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1196296der.fcgi?artid=1196296

Heroin is a Schedule I drug, labeling it as one Heroin is a Schedule I drug, labeling it as one of the most easily addictive drugs (A.P.A.).of the most easily addictive drugs (A.P.A.).

Animals can also become just as addicted as Animals can also become just as addicted as humans, 3 elephants were rescued from humans, 3 elephants were rescued from smugglers who were lacing their bananas smugglers who were lacing their bananas with the drug heroin. The elephants are with the drug heroin. The elephants are easily irritated and cannot return to the wild. easily irritated and cannot return to the wild. (Telegraph.co)(Telegraph.co)

Heroin LawsHeroin Laws Due to the increase in heroin use in the early 1900’s, Due to the increase in heroin use in the early 1900’s,

congress passed the Harrison Act of 1924. Which congress passed the Harrison Act of 1924. Which made it illegal to produce, import or distribute opiates made it illegal to produce, import or distribute opiates of any kind. Doctors however were allowed to of any kind. Doctors however were allowed to prescribe them for medical issues and not addictive prescribe them for medical issues and not addictive issues (Hodgson).issues (Hodgson).

In New Mexico if heroin is in your possession it is In New Mexico if heroin is in your possession it is considered a 4considered a 4thth degree felony. If found selling the degree felony. If found selling the drug it is considered a 2drug it is considered a 2ndnd degree felony. However, if degree felony. However, if the selling of the drug is near a drug free school zone the selling of the drug is near a drug free school zone or is a subsequent offense it is then a 1or is a subsequent offense it is then a 1stst degree felony degree felony (JRank)(JRank)

Most national laws include a felony offense with some Most national laws include a felony offense with some jail time included. Punishments depend on the jail time included. Punishments depend on the severity of heroin as a problem in the state.severity of heroin as a problem in the state.

Monetary values are placed as high as 1 million dollars Monetary values are placed as high as 1 million dollars and jail time up to life in prison with no parole (JRank). and jail time up to life in prison with no parole (JRank).

Not All Exposure is Not All Exposure is GreatGreatIn 1999, Rio Arriba County in New Mexico led the In 1999, Rio Arriba County in New Mexico led the

nation in heroin related deaths per capita nation in heroin related deaths per capita (NDIC).(NDIC).

To combat the amount of overdoses/deaths, the To combat the amount of overdoses/deaths, the Espanola Police Department required its officers Espanola Police Department required its officers to start caring Narcan with them at all times to start caring Narcan with them at all times (NDIC). (NDIC).

In addition the New Mexico Health Department In addition the New Mexico Health Department began the free needle exchange and Narcan began the free needle exchange and Narcan distribution for heroin users (NDIC).distribution for heroin users (NDIC).

Recently in April 2008, the New York Times Recently in April 2008, the New York Times featured an article/documentry regarding Rio featured an article/documentry regarding Rio Arriba County and its small towns struggling Arriba County and its small towns struggling with heroin abuse. To read the article and view with heroin abuse. To read the article and view the video documentary visit:the video documentary visit:

http://www.nytimes.com/2008/04/02/us/http://www.nytimes.com/2008/04/02/us/02overdose.html?ref=us&pagewanted=all02overdose.html?ref=us&pagewanted=all

SummarySummary

The take home message from this presentation for the The take home message from this presentation for the audience is three things.audience is three things.

1)1) Heroin is highly addictive which can lead to serious health Heroin is highly addictive which can lead to serious health issues that may even result in death.issues that may even result in death.

2)2) The overdosing and withdrawal side effects/issues The overdosing and withdrawal side effects/issues presented are the hardest part for heroin addicts and that presented are the hardest part for heroin addicts and that treatment for addiction is a slow and long process that treatment for addiction is a slow and long process that must be monitored by professionals in the medical field.must be monitored by professionals in the medical field.

3)3) Although laws are continually made and enforced, Heroin Although laws are continually made and enforced, Heroin continues to be one of the major pandemics of crime and continues to be one of the major pandemics of crime and drug abuse not only across the world and in America but drug abuse not only across the world and in America but right here in New Mexico, which is unfortunate for a state right here in New Mexico, which is unfortunate for a state that is known as “The Land of Enchantment.”that is known as “The Land of Enchantment.”

If you know someone that is struggling with heroin addiction or If you know someone that is struggling with heroin addiction or would like more information visit Heroin Help at would like more information visit Heroin Help at http://heroinhelp.com/http://heroinhelp.com/ or call at 1.866.925.4033. or call at 1.866.925.4033.

ReferencesReferencesAmerican Pharmacists Association. American Pharmacists Association. The Pharmacy TechnicianThe Pharmacy Technician. p.40-43 Englewood. 2007.. p.40-43 Englewood. 2007.

Blackburn, Susan. Blackburn, Susan. Maternal, Fetal, and Neonatal Physiology: A Clinical PerspectiveMaternal, Fetal, and Neonatal Physiology: A Clinical Perspective. p.204-206. p.204-206 Philadelphia, 2007.Philadelphia, 2007.

"Drug Addiction and Your Baby." "Drug Addiction and Your Baby." Suite101.com: Online Magazine and Writers' Suite101.com: Online Magazine and Writers' NetworkNetwork. 2007. 22 Apr. 2009 <http://www.suite101.com/article.cfm/maternal_fetal/104588>.. 2007. 22 Apr. 2009 <http://www.suite101.com/article.cfm/maternal_fetal/104588>.

Foley, Michael. “Drug Use During Pregnancy.” Merck. May 2007. 14 Apr. 2009.Foley, Michael. “Drug Use During Pregnancy.” Merck. May 2007. 14 Apr. 2009.http://www.merck.com/mmhe/sec22/ch259/ch259a.html http://www.merck.com/mmhe/sec22/ch259/ch259a.html

Hart, Carl. “Drugs, Society and Human Behavior 12th Edition” p.309-328Hart, Carl. “Drugs, Society and Human Behavior 12th Edition” p.309-328Boston, MA. McGraw Hill 2008. Boston, MA. McGraw Hill 2008.

““Heroin Elephant Can Never be Freed.” Heroin Elephant Can Never be Freed.” Telegraph.coTelegraph.co. 2006. 26 Apr. 2009. 2006. 26 Apr. 2009 <<www.telegraph.co.uk/news/worldnews/asia/chinawww.telegraph.co.uk/news/worldnews/asia/china>>

““Heroin-Facts and Statistics.” Heroin-Facts and Statistics.” Greater Dallas Council on Alcohol and Drug AbuseGreater Dallas Council on Alcohol and Drug Abuse.2004. 22 .2004. 22 Apr. 2009 <www.gdcada.org/statistics/heroin.htm>Apr. 2009 <www.gdcada.org/statistics/heroin.htm>

““Heroin Laws- Information on the law about Heroin.” Heroin Laws- Information on the law about Heroin.” JRankJRank. 2007. 26 Apr. 2009. 2007. 26 Apr. 2009 <http:/law.jrank.org/pages/11810/Heroin.html><http:/law.jrank.org/pages/11810/Heroin.html>

““Heroin Statistics.” Heroin Statistics.” Heroin Addiction 2Heroin Addiction 2. 2005. 22 Apr. 2009. 2005. 22 Apr. 2009 www.heroinaddiction2.com.heroin-statistics.htmwww.heroinaddiction2.com.heroin-statistics.htm

Hodgson, Barbar. “How Aspirin Turned Hero.” 1999Hodgson, Barbar. “How Aspirin Turned Hero.” 1999http://www.heroin-addiction.info/history.htmhttp://www.heroin-addiction.info/history.htm

““Illicit Drug Use During Pregnancy.” Illicit Drug Use During Pregnancy.” March of Dimes FoundationMarch of Dimes Foundation. 22 Apr. 2009. 22 Apr. 2009 http://www.marchofdimes.com/professionals/14332-1169.asp.http://www.marchofdimes.com/professionals/14332-1169.asp.

Meyer, Jarold. “Psychopharmacology: Drugs, The Brain and Behavior.” p.247-269Meyer, Jarold. “Psychopharmacology: Drugs, The Brain and Behavior.” p.247-269Sunderland, MA. Sinauer Assoc. Inc. 2005. Sunderland, MA. Sinauer Assoc. Inc. 2005.

““New Mexico Drug Threat Assessment.” NDIC. April 2002. 27 Mar. 2009.New Mexico Drug Threat Assessment.” NDIC. April 2002. 27 Mar. 2009.http://www.usdoj.gov/ndic/pubs07/803/heroin.htm http://www.usdoj.gov/ndic/pubs07/803/heroin.htm

““The mechanism of action of heroin at the mu (m) opiate receptors.” CNSForum. 2005. 14 Apr. 2009The mechanism of action of heroin at the mu (m) opiate receptors.” CNSForum. 2005. 14 Apr. 2009http://www.cnsforum.com/imagebank/item/moa_heroin_mu/default.aspx http://www.cnsforum.com/imagebank/item/moa_heroin_mu/default.aspx