Heroin: Uses, Side Effects, Medico Legal Aspects & Post-Mortem Appearences

Different forms of Heroin

Heroin is a potent analgesic drug with a strong euphoric effect. It is the phenanthrene derivative of the somniferous plant Papaver somniferum (poppy plant). 

Heroin is a semisynthetic opioid derived from the acetylation of morphine and called diacetylmorphine or diamorphine. It is 2-3 times more potent than morphine. Among all the addictive drugs it is the most dangerous. It is sold illegally under the names- ‘smack’, ‘brown sugar’, ‘junk’ and ‘dope’. The place where heroin activities are conducted is generally known as a ‘shooting gallery’.

The IUPAC name for heroin is (5𝛂,6𝛂)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol acetate. Its molecular formula is C₂₁H₂₃NO₅ and molecular weight is 369.4g/mol.

Heroin is metabolised to acetylmorphine, which is then hydrolysed to morphine within 30 to 60 minutes. Therefore during chemical analysis heroin is not detected.

 It is available in the form of white to dark brown powder. The white heroin is soluble in water but insoluble in organic solvents and found in south-east Asia. Whereas, dark brown heroin is insoluble in water but soluble in organic solvents and found in south-west Asia.

Route of Administration of Heroin

Heroin can be administered through smoking, inhaled as a snuff or injected.

It is smoked by placing a black tar heroin on an aluminium foil and applying heat underneath. This produces vapours that can be inhaled through straws or tubes.

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For injections, the heroin is mixed with water, heated in a spoon and injected using a syringe. The heroin is placed in lines on a smooth surface and snorted through a surface.

Uses and Effects of Heroin 

Previously it was used as a sedative but for its narcotic and addiction forming effects its production has been banned and favoured in illicit drug trafficking.

Heroin is more lipid soluble, therefore enters the brain more rapidly as compared to morphine. It behaves as an agonist at a complex group of receptors (usually 𝜇, 𝜅 and 𝛿 subtypes) that are normally acted upon by endogenous peptides known as endorphins, which produces analgesic effects.

It produces drowsiness, euphoria and a sense of detachment. The user feels the ‘rush’ (surge of euphoria) accompanied by a warm flushing of the skin, dry mouth and heavy extremities. Mental functioning becomes clouded due to the depression of the central nervous system.

Since it is more potent than morphine it causes dependence rapidly and finally addiction which leads to following effects:

Short-Term Effects

  • Euphoria
  • Dry mouth
  • Warm, flushed skin,
  • Arms and legs that feel heavy
  • Upset stomach
  • Itching
  • A fuzzy brain

Long-Term Effects

  • Collapsed veins
  • Insomnia
  • Infections of heart lining and valves
  • Skin infections (abscesses and cellulitis)
  • Liver and kidney diseases
  • Mental disorders
  • Lung diseases (Pneumonia, Tuberculosis)
  • Menstrual problems and miscarriage
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Tolerance occurs very rapidly and can be increased to more than hundred times the initial dose.

Heroin causes mast cells to release histamine, and can result in intense pruritus. It causes excitation by lifting cortical inhibitions similar to alcohol. It can cause sudden death in a person who has been using heroin for sometime, with the needle still in the vein.

The addiction is quite severe, difficult to treat and carries considerable mortality. The withdrawal symptoms are also severe which include:

  • Jitters
  • Chills
  • Convulsions
  • Twitching
  • Vomiting and diarrhoea
  • Bone and muscle pain
  • Trouble sleeping 
  • Cold flashes
  • Uncontrollable leg movement

Medicolegal Aspects

Since heroin is the most dangerous addictive drug and causes a lot of deaths worldwide, therefore a lot of initiatives are taken by different governments and the United Nations to control its production, supply and use.

In India following are the statutes of importance in relation to drugs and poison:

  • The Indian Penal Code (IPC)
  • The Criminal Procedure Court (CrPC)
  • The Indian Evidence Act (IEA)
  • The Narcotics and Psychotropic Substance Act, 1985
  • The Drug and Magic Remedies Act, 1954
  • The Drug Control Act, 1950
  • The Pharmacy Act,1948
  • The Drugs and Cosmetics Act,1940
  • The Drugs and Cosmetics Rules, 1945
  • The Drugs Act, 1940
  • The Poison Act, 1919
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The most important is the Narcotics and Psychotropic Substance Act, 1985, which prohibits cultivation, manufacture, possession, sale, purchase, transport, import, export, etc. of these drugs and substances except for medical and scientific purposes. Opium and its derivatives are included in this act.

Fatal Dose of Heroin :– 50mg – 200mg

Fatal Period of Heroin :- 12 hours to 2-3 days

Heroin usually causes accidental deaths due to overdose. But suicidal or homicidal deaths are rare.

Post-Mortem Appearances

External

  • Body emits smell of opium
  • Injection marks may be seen on the forearm, back of hands, neck, groin, and ankle
  • Face/body appears bluish or deeply cyanosed or blackish
  • Postmortem lividity may appear purple or blackish
  • Froth at the nostrils
  • Constricted/dilated pupil

 Internal

  • All organs are congested, trachea contains frothy secretions and the blood is dark in colour.
  • Lungs present with gross oedema and froth coming out from the mouth and nostrils
  • Presence of small, soft brownish lumps of opium in the stomach
  • Smell of opium is perceived which disappears with onset of putrefaction
  • Microscopic examination of lungs shows granulomas
  • Liver shows chronic triaditis with mononuclear cell infiltrates

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