add: Tramdol, sufentanil, alfentanil, apo-morphine [other preperations], carfentanil, alpha-methyl fentanyl, apo-morphine [and other preperations], 3-methyl fentanyl, oxymorphone, re-do bupe subutex/suboxone
Drug: HEROIN (Diacetylmorphine)
Description: A semi-synthetic opiate, diacetylmorphine is produced by boiling morphine base in acetic anhydride and purifying the resulting heroin base with hydrochloric acid. (Mexican “black tar” derives from a shortcut process, with lots of vegetable matter remaining in the final product.) First synthesized by a British chemist in 1874, and first marketed by Bayer Co. in 1898 as a cough remedy, the name derives from “heroisch,” German for “powerful.” Prohibited by the U.S. government in 1924, this is the ultimate Bad Boy drug. Roughly three times more potent than morphine, heroin is favored by drug users because it readily by-passes the blood-brain barrier–making for a warm rush upon injection–though it promptly reconverts to morphine in the body.
Drug: OPIUM (Papaver Somniferum)
Description: The source of God’s Own Medicine, opium has been in use since prehistoric times. Can be grown almost everywhere on the planet, though Southeast Asia,Southwest Asia, Colombia and Mexico are the source for most of the world’s illicit opiate production. The poppy’s latex gum contains from 3-25% morphine content, plus smaller amounts of codeine and a wealth of other alkaloids. Pantopon is a pharmaceutical preparation of injectable opium. Otherwise, the gum can be eaten, or once boiled and strained into a tarry paste called “chandu” can be smoked. Gum opium is only rarely encountered in the U.S. street market.
Drug: MORPHINE (Duramorph, Oramorph, MS-Contin, Roxanol)
Description: First isolated by Friedrich Serturner in early 1800s, and still a staple analgesic in hospitals, morphine is the Mother Molecule. Once the staple of injecting addicts, morphine was driven off of the street market after passage of the 1914 Harrison Narcotic Act by heroin, which was more potent and more readily adulterated. Morphine sulfate is currently available in a wide variety of trademarked prescription preparations: Duramorph, Oramorph, MS-Contin, Roxanol, etc. Most of these preparations are best taken orally, as directed. When injected into a vein, morphine produces a decidedly unpleasant pins-and-needles rush.
Drug: CODEINE (Methylmorphine)
Description: First isolated in 1832, codeine occurs naturally in opium gum, though in smaller amounts than morphine. Most of the codeine on the market is thus produced by chemically converting morphine. The body, ironically, then converts the codeine back into morphine–though inefficiently. Codeine is thus only one-tenth as potent as morphine. Available in a wide number of pharmaceutical preparations for coughs and mild pain–most notably as Tylenol 3, containing 30 mgs. of codeine–this is the most easily acquired of pharmaceutical opiates. It is only moderately euphoric, however, and is thus considered to have a low potential for creating addiction and tolerance.
Drug: DILAUDID (Hydromorphone)
Description: Patented in 1953, hydromorphone is a semisynthetic variant of morphine that is roughly as powerful as heroin. In fact, it is often referred to as “drugstore heroin.” Available as Dilaudid in 2, 4 and 8 mg. tablets, this powerful opiate is widely available on the streets; favored by many addict users because it is chemically pure. A super-concentrated injectable solution, Dilaudid-HP, is rarely found outside of hospitals. Typically the tablets are prepared in a “cold shake”: place a tablet in the barrel of the syringe, replace the plunger, pull in some water and shake until dissolved. Other users simply crush and cook the tablets, like any other dope. This stuff is very addictive and very expensive because tolerance typically builds up very rapidly.
Drug: HYDROCODONE (Vicodin, Lortab, Lorcet, Hycodan)
Description: Patented by Merck in 1925, hydrocodone is a semisynthetic codeine derivative that is four times more potent than its parent alkaloid but only a third as powerful as morphine. Typically prescribed for relief of coughs or mild-to-moderate pain, hydrocodone produces much more euphoria than does an equivalent dose of codeine, and has thus generated a considerable black market and legions of devotees/addicts. The pains of withdrawal also fall somewhere between those of codeine and morphine in severity, but–as always–the real hook is psychological and there is a considerable “Vicodin Underground” out there amongst middle-class druggies with friendly doctors.
Drug: OXYCODONE (Percocet, Percodan, Roxicet, Oxycontin, Tylox, Oxyfast)
Description: First isolated in 1916, oxycodone is derived from the opium alkaloid thebaine, which is itself not a pleasure drug. Though typically available only in oral preparations, oxycodone is as potent as morphine and extremely euphoric. This is the drug that Beat writer William Burroughs was slamming during his Tangier years (in a German-made injectable formulation called Eukodal). Though Burroughs described this as the “best junk kick ever,” he also found that the onset of tolerance was swift and that withdrawal from oxycodone was as harsh as that from morphine. If you have a high-tolerance heroin habit, oral oxycodone is not likely to do much for you. Taking large numbers of Percocets can also prove dangerous because the high dose of acetaminophen (325 mgs. per pill, compared to only 5 mgs. of oxydone) is very hard on the liver. On the other hand, Oxycontin, has no NSAID filler, and can be crushed and cooked and injected, if you are of a mind to do so.
Drug: MEPERIDINE (Demerol, Pethidine)
Description: Patented in 1930, Demerol was the first purely synthetic opioid drug ever to be marketed. Early hopes that it would prove to be non-addictive were quickly dashed. Though only one-tenth as potent as morphine, meperidine is highly euphoric and is favored by users who have access to it (i.e., doctors and nurses) because it does not cause those tell-tale pinpoint pupils. In high doses–which can reached quite quickly because tolerance sets in promptly–meperidine can cause seizures and a variety of temporary neurological disorders. On the other hand, withdrawal is more short-lived and less severe than from heroin or morphine.
Drug: METHADONE(Dolophine tablets, Methadone Hcl diskettes and solution)
Description: Developed by German pharmacologists in 1943, when access to opium was cut off during World War II, Dolophine was not named after Adolf Hitler. (That name derives from “dolor” for pain, and the Nazis called the stuff Amidone, anyway.) Roughly equipotent with morphine, methadone boasts better than four times the staying power and is highly active in an oral dose. Thus its use in official treatments of opiate addiction; addicts can be dosed but once a day with a liquid solution that cannot be easily diverted. This is also one of the most highly regulated drugs in America, which often makes methadone maintenance in clinics a bureaucratic nightmare for addicts seeking a change from the street scene. By federal law, any methadone detox lasting longer than 21 days is considered methadone maintenance. Many states mandate dosage ceilings, resulting in the under-medication of clients. Bear in mind that methadone “blockades” the effects of heroin simply by establishing and maintaining a tolerance to opiates. If so inclined, low-dose patients can readily “shoot through” the blockade, though this can be expensive and dangerous. Warning: Though slow and easy at the beginning, cold-turkey methadone withdrawal is extremely protracted and very unpleasant.
Drug: BUPERNORPHINE (Bupernex, Subutex, Suboxone)
Description: Derived from the opium alkaloid thebaine, bupernorphine is roughly thirty times more powerful than morphine and longer lasting, to boot. It is, however, a mixed agonist-antagonist, meaning that it bonds with some of the body’s opiate receptors, but unseats opiate molecules from other receptors. And that means that this drug can cause withdrawal symptoms if administered to a high-tolerance addict. On the other hand, bupernorphine is reputed to be quite euphoric and withdrawal from the drug is comparatively easy. (This is the chief drug of abuse by street addicts in India.) The FDA approved a bupernorphine formulation for maintenance treatment of opiate addiction (Suboxone): A sublingual tablet will contain a dose of the pure-antagonist drug, naloxone. If a patient goes against orders and cooks the bupernorphine pill down for injection, the Naloxone, inactive sublingually, would throw him or her into violent withdrawal upon being shot up. Very effective for detoxing off stronger opiate habits.
Drug: LAAM (Levomethadyl acetate hydrocholide)
Description: This is the “super-methadone” increasingly showing up as an option at clinics since being approved by the FDA in 1993 for the maintinance treatment of opiate addiction. LAAM’s supposed advantage over methadone is that it last three times as long and thus can be administered only three times a week. (This is because LAAM breaks down slowly in the body into extremely long-acting metabolites.) On the other hand, federal regulations currently prohibit take-home dosing of LAAM, so clients using this drug cannot hope for fewer than three clinic visits weekly. Withdrawal is reputed to be an endless nightmare, so LAAM patients are thus rehabituated to methadone and withdrawn from that drug. Many patients reporting feeling that LAAM “holds” them less well than methadone, though LAAM advocates contend that sufficiently high doses of the drug must be maintained for effective treatment.
Drug: PROPOXYPHENE (Darvon, Darvocet, Dolene)
Description: Patented by Lilly in 1955, propoxyphene is a cogener of methadone, though far less potent. Found in many medicine cabinets in the form of those red-and-grey Darvon capsules, Darvon is actually less potent (and euphoric in action) than codeine. It is, however, a very potent respiratory depressant, meaning that high dose abuse quite often leads to overdose. Intravenous injection is quite rough on the veins, and thus this practice is generally self-limiting. Mild withdrawal symptoms have occured after protracted use (800 mgs. or so over the course of two months). Has been used to moderate heroin withdrawal symptoms, but is not generally considered particularly effective in this role.
Drug: PENTAZOCINE (Talwin, Fortalgesic)
Description: Patented in 1962, pentazocine belongs to the benzomorphan group of mixed agonist-antagonist opiate drugs. That means that it bonds to some opiate receptors but can unseat some already-consumed opiates binding to other receptors. Roughly one-third as powerful as morphine, pentazocine, is also of shorter duration. On the other hand, withdrawal symptoms are comparatively mild. At one time, Talwin was widely used on the street, particularly in combination with an antihystamine (an injected formulation nicknamed “Ts and Blues”). Talwin tablets have a high talc content, however, which causes talc deposits and lesions in the lungs when injected. Moreover, Winthrop has taken to formulating Talwin with naloxone, a pure opiate antagonist, which causes abrupt withdrawal symptoms when injected. Consequently, Talwin has pretty much fallen off the street drug map.
Drug: BUTORPHANOL (Stadol)
Description: A cogener of the opiate alkaloid morphinan, butorphanol came into clinical use in the U.S. about 20 years ago. A mixed agonist-antagonist, this drug will not cause withdrawal symptoms in addicts with relatively low-tolerance habits, but caution is urged as use of agonist-antagonist drugs can precipitate dope sickness. Traditionally available solely in injectable solution, Stadol is also marketed (prescription only) in a nasal inhaler for relief of migraine pain. As such, it has reportedly led to no few cases of habituation and addiction. Withdrawal symptoms are comparatively mild and the drug’s action, generally, is very similar to that of pentazocine (Talwin).
Drug: DEXTROMETHORPHAN (Romilar, Robitussin)
Description: An isomer of the codeine analog of levorphanol, a semisynthetic mixed agonist-antagonist opiate, dextromethorphan (DXM) is neither analgesic nor addictive. For that reason, it is widely available in over-the-counter cough remedies. Although it is not a pleasure drug in the same way as its fellow opiates, DXM is often used by drug experimenters to achieve a bizarre dissociative state not unlike that caused by PCP. Like many others, I personally found its effects to be extremely unpleasant, though DXM does have its fans.
Drug: NALOXONE (Narcan)
Description: Patented in 1966, naloxone is a pure opiate antagonist, meaning that it rapidly unseats opiate molecules binding to the body’s opiate receptors. Injection of naloxone (and it is ineffective by any other route) will rapidly reverse a potentially fatal heroin overdose. This is a very potent drug: 1 mg. of naloxone delivered intramuscularly will completely block the effects of 24 mg. of heroin. This effect will only last for 1-4 hours, however, and so the antagonist must be periodically readministered if the patient is overdosing on a longer last opiate (such as heroin or methadone). Besides restoring respiration, unfortunately, naloxone will also precipitate abrupt withdrawal symptoms in the habituated addict. This is a very unpleasant experience, but it beats dying. Although a prescription drug, naloxone is not scheduled. There is a movement afoot to make Narcan available to using addicts in case of overdose emergencies. I have seen it available at Chicago outreach centers (needle exchange), but I still say call 911 for naloxone when a friend is ODing.
Drug: NALTREXONE (Trexan, ReVia)
Description: A much longer lasting pure opiate antagonist than naloxone, naltrexone also has the clinical advantage of being active orally. It is thus commonly prescribed to post-withdrawal opiate addicts in early recovery: though not remotely euphoric, this drug will block the effects of opiate agonists, such as heroin. Though not completely: It is possible to “shoot through” the naltrexone blockade, though at the danger of causing respiratory arrest if high doses of both drugs are present concurrently. Naltrexone is also now being administered in “depot” doses, placed under the skin (implants), to achieve a long-lasting opiate blockade that does not depend upon the addict taking his naltrexone pill every day. Remarketed as ReVia, naltrexone is also being used in the treatment of alcoholism, on grounds that it diminishes the euphoria alcoholics experience from drinking.
Drug: FENTANYL (Sublimaze)
Description: Developed in the early 1960s, this synthetic opioid is related to meperidine, though more powerful by orders of magnitude. Eighty times more potent than morphine, fentanyl is effective in microgram doses, though its effect is generally quite short-lived by comparison with other opiates. Available medically in injection form, transcutaneous patches, fentanyl lollypops, and lozenge form (Fentanyl Oralet) is used as anesthetic premedication in the OR or to induce conscious sedation prior to a diagnostic or therapeutic procedure in monitored hospital settings. This powerful opioid is the drug most commonly abused by medical addicts (doctors and nurses). Fentanyl cogeners manufactured by street chemists (most typically alpha-methyl-fentanyl) occasionally turn up on the corner marketed as “China White.” (Not to be confused with the original China White #4 heroin) because it so potent, errors in cutting street fentanyl can lead to local epidemics of overdose.
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