Iraqi PM criticises only timing of Wikileaks,not deny

Nouri Maliki has criticised the timing of the release by Wikileaks of almost 400,000 secret US military documents about the conflict there.

Maliki is trying to keep his job after inconclusive elections in March.

Wiki Leaks "said" the disclosure was target at revealing the truth about the war.

The founder, Julian Assange, said the records showed there had been "a bloodbath on every corner" and provided evidence of war crimes against U.S and allies.

We are hope to correct some of that attack on the truth that occurred before the war, during the war and which has continued on since the war officially concluded," he told a news conference in London.

But from U.S. chairman of the Joint Chiefs of Staff, Admiral Mike Mullen, strongly deny the disclosure of classified information.

Wiki Leaks revelations have attracted relatively little interest among Iraqis, although they triggered an angry response from the office of Prime Minister Nouri Maliki timing of that leaks.

Mr Maliki's office also said the records did not present any proof of these abuses and torture practices with Iraqi citizens, detainees being tortured in Iraqi-run facilities during his premiership

Sunni-backed Iraqiya bloc of the former Prime Minister, Iyad Allawi, said the allegations demonstrated why it was important to have a power-sharing government, and why Mr Maliki should step aside.

"Keep all the security powers in the hands of one person, who is the general commander of the armed forces, have led to these abuses and torture practices in Iraqi illegal prisons," spokeswoman Maysoun al-Damlouji told the Associated Press.

"Maliki wants to have all powers in his hands,"to do white to black and black to white" she added.

Read more:Reports published by Wikileaks

Party and play

Party and play(PNP),

Party and play (PNP or PnP), also known as a chemical session, chem session, or simply as partying, is a phenomenon and subculture of recreational drug users who play together sexually, either one-on-one or in groups.

The term is often but not always used by and associated with gay men and men who have sex with men (MSM). The drug of choice is typically methamphetamine, known as crystal or tina in the gay community. Other "party drugs" such as MDMA are less associated with this term. It has been called both an "epidemic" and "plague" in the gay community.

Participants

Men interested in PNP typically meet through other drug users or through Internet dating sites. On such sites, men often include notations such as "PNP" or the reverse, "No PNP". Some sites, such as Manhunt.net, prohibit members from saying that they want PNP or making other positive references to drug use.

Craigslist.org has the same policy but it is seldom enforced; users often advertise they are willing to provide favors or party favors to prospective partners. Craigslist posts by men seeking PNP experiences often resort to slang, often replacing each occurrence of the letter "t" with a capital "T". This is a reference to a series of bastardizations involving the sale of methamphetamine, which is often sold in sixteenths of an ounce, hence the slang "Teen", "Teena", "Tina", and "T".

As stimulant drugs such as methamphetamine drastically delay the need for sleep and tend to inhibit ejaculation, PNP sexual encounters can continue for many hours or even for several days. These drugs tend to inhibit penile erection, a phenomenon known by the slang term crystal dick. Consequently, many men who engage in PNP use erectile dysfunction drugs such as sildenafil, vardenafil, and tadalafil.

Risks

Besides the inherent risks involved with drug use, health officials have found a strong correlation between drug use and unsafe sex practices. Indeed, some online profiles have notations such as "PNP BB only" (Party and Play, bareback only).

As such, PNP practices are cited as the cause of rising HIV rates in the gay and bisexual male community and other men who have sex with men. San Francisco's STOP Aids Project and the Mayor of San Francisco's Crystal Meth Task Force have reduced methamphetamine use from 18% in 2003 to 10% in 2005 of gay and bisexual San Franciscans PNPing. The STOP AIDS Project has been heavily involved due to the common link between methamphetamine use and sex—PNPing.

The same drug-induced loss of inhibitions makes PNP enthusiasts more vulnerable to more immediate threats, such as robbery, date rape, or assault by someone whom they meet for sex.

Statistics

Men who PNP with methamphetamine, cocaine, MDMA, and ketamine are twice as likely to bareback (have unprotected sex), according to British research. The study also found that up to 20% of gay men from central London gyms have tried methamphetamine, the drug most associated with PNPing.

Club culture

Methamphetamine is popular in the gay party scene.

The term party and play - and pay has emerged as a warning that Partying and Playing leads to bareback sex which increases the chances of contracting HIV and may result in other consequences such as neurological damage and resistance to HIV drugs.

"We're seeing a strong correlation between crystal and HIV infection" -Pride Institute of New York

Methamphetamine can cause sores and abrasions in the mouth which can turn typically low HIV risk sex acts such as oral sex into very high risk sexual activity and transmit HIV.

(source:wikipedia)

Sex and drugs

Sex and drugs,

Many drugs, both legal and illegal, have side effects which impact on the user's sexual functions. For example, the side effect of many legal antidepressants and antipsychotic drugs is the reduction of sexual desire.

Some drugs, such as marijuana and MDMA, increase sensual and erotic sensations, though MDMA may inhibit sexual intercourse itself by causing temporary erectile dysfunctions.

Other drugs, such as alcohol, are notorious for being used to render unknowing victims unconscious or severely sedated and thus easy targets for sexual predators.

Perhaps the most common drug used is alcohol. At low concentrations of blood alcohol, social inhibitions are reduced, though in higher concentrations it can also inhibit performance. Many other drugs also inhibit sexual performance.

Tobacco use (e.g., cigarette smoking), also reduces sexual function, with the incidence of impotence being approximately 85 percent higher in male smokers compared to non-smokers.

Hormone therapies can also change sexual arousal levels, and levels of sexual aggression.

A few drugs can actually increase sexual performance when used to treat erectile dysfunction. These include sildenafil (marketed as Viagra) and tadalafil. Bremelanotide appears to affect sexual desire directly, making it the first scientifically recognized aphrodisiac. This is also true of Melanotan II which bremelanotide is based upon. Additionally, the alkyl nitrites (poppers) have a long history of use as a sexual enhancement aid, going back about fifty years. According to the text "ISOBUTYL NITRITE and Related Compounds", many researchers agree that the alkyl nitrites may be a true aphrodisiac in the sense of promoting and enhancing sexual response.

(source:wikipedia)

Heroin

Diacetylmorphine (INN),

Heroin, or diacetylmorphine (INN), also known as diamorphine (BAN), is a semi-synthetic opioid drug synthesized from morphine, a derivative of the opium poppy. It is the 3,6-diacetyl ester of morphine (di (two)-acetyl-morphine). The white crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride, though often adulterated thus dulling the sheen and consistency from that to a matte white powder, which heroin freebase typically is. 90% of heroin is said to be produced in Afghanistan.

As with other opioids, heroin is used as both an analgesic and a recreational drug. Frequent and regular administration is associated with tolerance and physical dependence, which may develop into addiction.

Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs.It is illegal to manufacture, possess, or sell diacetylmorphine without a license in Belgium, Denmark, Germany, Iran, India, the Netherlands, the United States, Australia, Canada, Ireland, Pakistan, the United Kingdom and Swaziland.

Under the name diamorphine, it is a legally prescribed controlled drug in the United Kingdom. It is available for prescription to long-term users in the Netherlands, United Kingdom, Switzerland, Germany and Denmark alongside psycho-social care, and a similar program is being campaigned for by liberal political parties in Norway.

History

Old advertisement for Bayer Heroin.

Bayer Heroin bottle.

The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BCE. The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two alkaloids, codeine and morphine.

Diacetylmorphine was first synthesized in 1874 by C. R. Alder Wright, an English chemist working at St. Mary's Hospital Medical School in London. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine. The compound was sent to F. M. Pierce of Owens College in Manchester for analysis. Pierce told Wright:

“ Doses ... were subcutaneously injected into young dogs and rabbits ... with the following general results ... great prostration, fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis. Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4°. ”

Wright's invention did not lead to any further developments, and diacetylmorphine only became popular after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann. Hoffmann, working at the Aktiengesellschaft Farbenfabriken (today the Bayer pharmaceutical company) in Elberfeld, Germany, was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing codeine, a constituent of the opium poppy, pharmacologically similar to morphine but less potent and less addictive. Instead the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself.

From 1898 through to 1910 diacetylmorphine was marketed under the trade name Heroin as a non-addictive morphine substitute and cough suppressant. Bayer marketed the drug as a cure for morphine addiction before it was discovered that it rapidly metabolizes into morphine. As such, heroin is essentially a quicker acting form of morphine. The company was embarrassed by the new finding, which became a historic blunder for Bayer.

In the U.S.A. the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of "heroin" and other opioids, which allowed the drug to be prescribed and sold for medical purposes. In 1924 the United States Congress banned its sale, importation or manufacture. It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States.

Later, as with Aspirin, Bayer lost some of its trademark rights to "heroin" under the 1919 Treaty of Versailles following the German defeat in World War I.

Pharmacology

When taken orally, diacetylmorphine undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine. When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood-brain barrier due to the presence of the acetyl groups, which render it much more lipid-soluble than morphine itself. Once in the brain, it then is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), and then to morphine which bind to μ-opioid receptors, resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects; diacetylmorphine itself exhibits relatively low affinity for the μ receptor.Unlike hydromorphone and oxymorphone, however, administered intravenously, diacetylmorphine creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective "body high" to some, but also instances of pruritus (itching) when they first start using.

Both morphine and 6-MAM are μ-opioid agonists which bind to receptors present throughout the brain, spinal cord and gut of all mammals. The μ-opioid receptor also binds endogenous opioid peptides such as β-endorphin, Leu-enkephalin, and Met-enkephalin. Repeated use of diacetylmorphine results in a number of physiological changes, including decreases in the number of μ-opioid receptors. These physiological alterations lead to tolerance and dependence, so that cessation of diacetylmorphine use results in a set of remarkably uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called the opioid withdrawal syndrome. Depending on usage it has an onset four to 24 hours after the last dose of diacetylmorphine. Morphine also binds to δ- and κ-opioid receptors.

There is also evidence that 6-MAM binds to a subtype of μ-opioid receptors which are also activated by the morphine metabolite morphine-6β-glucuronide but not morphine itself. The third substype of third opioid type (mu-3) receptor. Which may be a commonality to other six position monoesters of morphine. The contribution of these receptors to the overall pharmacology of heroin remains unknown.

A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses includes the clinically-used strong analgesics nicomorphine (Vilan), and dipropanoylmorphine; there is also the latter's dihydromorphine analogue, diacetyldihydromorphine (Paralaudin). Two other 3,6 diesters of morphine invented in 1874-5 along with heroin, dibenzoylmorphine and acetylpropionylmorphine, were made as heroin substitutes after heroin was outlawed in 1925 and therefore sold as the first "designer drugs" until they were outlawed by the League of Nations in 1930.

Usage and effects

Worldwide, the UN estimates there are more than 50 million regular users of heroin, cocaine and synthetic drugs. Global users of heroin are estimated at between 15.16 million and 21.13 million people aged 15–64.

Medical use

Under the name diamorphine, heroin is prescribed as a strong analgesic in the United Kingdom, where it is given via subcutaneous, intramuscular, intrathecal or intravenous route. Its use includes treatment for acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain, and chronic pain, including end-stage cancer and other terminal illnesses. In other countries it is more common to use morphine or other strong opioids in these situations.

In 2005, there was a shortage of diamorphine in the UK, due to a problem at the main UK manufacturers. Due to this, many hospitals changed to using morphine instead of diamorphine. Although there is no longer a problem with the manufacturing of heroin in the UK, many hospitals there have continued to use morphine.

Diamorphine continues to be widely used in palliative care in the United Kingdom, where it is commonly given by the subcutaneous route, often via a syringe driver, if patients could not easily swallow oral morphine solution. The advantage of diamorphine over morphine is that diamorphine is more soluble and smaller volumes of diamorphine are needed for the same analgesic effect. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care.

The medical use of diamorphine (in common with other strong opioids such as morphine, fentanyl and oxycodone) is controlled in the United Kingdom by the Misuse of Drugs Act 1971. In the UK, it is a class A controlled drug. Registers of its use are required to be kept in hospitals.

Heroin is also used as a maintenance drug in the treatment of heroin addicts. Though this is somewhat controversial among proponents of a zero tolerance drug policy it has proven superior to methadone in improving the social and health situation of addicts. See: Heroin prescription for addicts

Recreational use

One stamp of heroin

Diacetylmorphine is used as a recreational drug for the transcendent relaxation and intense euphoria it induces. Anthropologist Michael Agar once described heroin as "the perfect whatever drug." Tolerance quickly develops, and users need more of the drug to achieve the same effects. Its popularity with recreational drug users, compared to morphine, reportedly stems from its perceived different effects. In particular, users report an intense rush that occurs while the diacetylmorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Diacetylmorphine produces more euphoria than other opioids upon injection. One possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to diacetylmorphine. While other opioids of recreational use, such as codeine, produce only morphine, heroin also leaves 6-MAM, also a psycho-active metabolite. However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected diacetylmorphine and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other. Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.

Chunky "No.3" heroin

Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both diacetylmorphine and morphine. When compared to the opioids hydromorphone, fentanyl, oxycodone, and pethidine/meperidine, former addicts showed a strong preference for diacetylmorphine and morphine, suggesting that diacetylmorphine and morphine are particularly susceptible to abuse and addiction. Morphine and diacetylmorphine were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids.

Data from The Lancet shows illicit heroin to be the most addictive and most harmful of 20 drugs.

One of the most common methods of illicit heroin use is via intravenous injection (colloquially termed "slamming" or "shooting up"). Heroin base (commonly found in Europe), when prepared for injection will only dissolve in water when mixed with an acid (most commonly citric acid powder or lemon juice) and heated. Heroin in the US is most commonly found in the hydrochloride salt form, requiring just water to dissolve. Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, through damage caused by the acid, the user will often resort to injecting in other veins.

Recreational users may also administer the drug through snorting, or smoking by inhaling its vapors when heated; either with tobacco in a rolled cigarette or by heating the drug on aluminium foil from underneath.When heated the heroin powder changes to a thick liquid, similar in consistency to molten wax, and it will run across the foil giving off smoke which the user inhales through a tube, usually made from foil also so that any heroin that collects on the inside of the tube can be smoked afterward. This method of administration is known as chasing the dragon (whereas smoking methamphetamine is known as "chasing the white dragon").

The diacetylmorphine dose used for recreational purposes is dependant on the frequency and level of use. A first-time user may ingest between 5 and 20 mg of diacetylmorphine, while an addict may require several hundred mg per day.

Effects

The onset of diacetylmorphine's effects depends upon the route of administration. Studies have shown that the subjective pleasure of drug use (the reinforcing component of addiction) is proportional to the rate at which the blood level of the drug increases. Intravenous injection provides the fastest and most intense rush within seven to eight seconds. Intra-muscular injection produces a relatively slow onset of five to eight minutes. Snorting or smoking reaches peak effects within 10 to 15 minutes. If taken orally, the effects take approximately half an hour to set in, with an absence of a rush.

Possible long-term effects of intravenous usage of illicit heroin.

Main short-term effects of heroin usage.

Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer Dr Harold Shipman used it on his victims, as did Dr John Bodkin Adams (see his victim: Edith Alice Morrell).

Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin death was an accident, suicide or murder. Examples include the overdose deaths of Sid Vicious, Janis Joplin, Tim Buckley, Layne Staley, Bradley Nowell, Ted Binion, and River Phoenix.

Chronic opioid use, such as heroin, has potentially been shown to be a cause of hyponatremia, resultant due to excess vasopressin secretion.

Recreational uses:

Euphoria

Relaxation

Medicinal uses:

Powerful analgesic

Cough suppressant

anti-diarrheal

Contraindications:

Alcohol

Barbiturates and Benzodiazepines

Stimulants

Other opioids (depends on tolerance)

Central nervous system:

Drowsiness

Disorientation

Delirium

Neurological:

Analgesia

Tolerance

Addiction (Physical Dependence)

Psychological:

Addiction (Psychological Dependence)

Anxiolysis

Confusion

Euphoria

Somnolence

Cardiovascular & Respiratory:

Bradycardia

Hypotension

Hypoventilation

Shallow breathing

Respiratory depression

Gastrointestinal:

Nausea

Vomiting (protracted)

Constipation

Dyspepsia

Musculoskeletal:

Analgesia

Ataxia

Muscle spasticity

Skin:

Itching

Flushing/Rash

Miscellaneous:

Dry mouth (Xerostomia)

Miosis, or pupil constriction ("pinpoint pupils")

Urinary retention

Diamorphine ampoules for medicinal use

Detection in biological fluids

The major metabolites of heroin, 6-MAM, morphine, morphine-3-glucuronide and morphine-6-glucuronide, may be quantitated in blood, plasma or urine to monitor for abuse, confirm a diagnosis of poisoning or assist in a medicolegal death investigation. Most commercial opiate screening tests cross-react appreciably with these metabolites, as well as with other biotransformation products likely to be present following usage of street-grade heroin such as 6-acetylcodeine and codeine. However, chromatographic techniques can easily distinguish and measure each of these substances. When interpreting the results of a test, it is important to consider the heroin usage history of the individual, since a chronic user can develop tolerance to doses that would incapacitate an opiate-naive individual, and the chronic user often has high baseline values of these metabolites in his system. Furthermore, some testing procedures employ a hydrolysis step prior to quantitation that converts many of the metabolic products to morphine, yielding a result that may be many times larger than with a method that examines each product individually.

Regulation

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In the Netherlands, diamorphine (heroin) is a List I drug of the Opium Law. It is available for prescription under tight regulation to long-term heroin addicts for whom methadone maintenance treatment has failed. Heroin is exclusively available for prescription to long-term heroin addicts, and cannot be used to treat severe pain or other illnesses.

In the United States, heroin is a schedule I drug according to the Controlled Substances Act of 1970, making it illegal to possess without a DEA license. Possession of more than 100 grams of heroin or a mixture containing heroin is punishable with a minimum mandatory sentence of 5 years of imprisonment in a federal prison.

In Canada, heroin is a controlled substance under Schedule I of the Controlled Drugs and Substances Act (CDSA). Any person who seeks or obtains heroin without disclosing authorization 30 days prior to obtaining another prescription from a practitioner is guilty of an indictable offense and subject to imprisonment for a term not exceeding seven years. Possession of heroin for the purpose of trafficking is guilty of an indictable offense and subject to imprisonment for life.

In Hong Kong, heroin is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It is available by prescription. Anyone who supplies heroin without a valid prescription can be fined $10,000 (HKD). The penalty for trafficking or manufacturing heroin is a $5,000,000 (HKD) fine and life imprisonment. Possession of heroin without a license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.

In the United Kingdom, heroin is available by prescription, though it is a restricted Class A drug. According to the 50th edition of the British National Formulary (BNF), diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction, acute pulmonary oedema, and chronic pain. The treatment of chronic non-malignant pain must be supervised by a specialist. The BNF notes that all opioid analgesics cause dependence and tolerance but that this is "no deterrent in the control of pain in terminal illness". When used in the palliative care of cancer patients, heroin is often injected using a syringe driver.

Price

The European Monitoring Centre for Drugs and Drug Addiction reports that the retail price of brown heroin varies from €14.5 per gram in Turkey to €110 per gram in Sweden, with most European countries reporting typical prices of €35-40 per gram. The price of white heroin is reported only by a few European countries and ranged between €27 and €110 per gram.

The United Nations Office on Drugs and Crime claims in its 2008 World Drug Report that typical US retail prices are US$172 per gram.

Production and trafficking: The Golden Triangle

Primary worldwide producers of heroin.

Manufacturing

Heroin, also known as diacetyl morphine is produced from acetylation of morphine derived from natural opium sources. Numerous mechanical and chemical means are used to purify the final product. The final products have different appearance depending on purity and have different names.

History of heroin traffic

This section may contain original research. Please improve it by verifying the claims made and adding references. Statements consisting only of original research may be removed. More details may be available on the talk page. (September 2007)

The origins of the present international illegal heroin trade can be traced back to laws passed in many countries in the early 1900s that closely regulated the production and sale of opium and its derivatives including heroin. At first, heroin flowed from countries where it was still legal into countries where it was no longer legal. By the mid-1920s, heroin production had been made illegal in many parts of the world. An illegal trade developed at that time between heroin labs in China (mostly in Shanghai and Tianjin) and other nations. The weakness of government in China and conditions of civil war enabled heroin production to take root there. Chinese triad gangs eventually came to play a major role in the heroin trade. The French Connection route started in the 1930s.

Heroin trafficking was virtually eliminated in the U.S. during World War II due to temporary trade disruptions caused by the war. Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium.

After World War II, the Mafia took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily. The Mafia took advantage of Sicily's location along the historic route opium took westward into Europe and the United States.

Large scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s. The elimination of Chinese production happened at the same time that Sicily's role in the trade developed.

Although it remained legal in some countries until after World War II, health risks, addiction, and widespread recreational use led most western countries to declare heroin a controlled substance by the latter half of the 20th century.

In late 1960s and early 70s, the CIA supported anti-Communist Chinese Nationalists settled near Sino-Burmese border and Hmong tribesmen in Laos. This helped the development of the Golden Triangle opium production region, which supplied about one-third of heroin consumed in US after 1973 American withdrawal from Vietnam. As of 1999, Myanmar (formerly Burma), the heartland of the Golden Triangle remained the second largest producer of heroin, after Afghanistan.

Soviet-Afghan war led to increased production in the Pakistani-Afghani border regions, as U.S.-backed mujaheddin militants raised money for arms from selling opium, contributing heavily to the modern Golden Crescent creation. By 1980, 60% of heroin sold in the U.S. originated in Afghanistan. It increased international production of heroin at lower prices in the 1980s. The trade shifted away from Sicily in the late 1970s as various criminal organizations violently fought with each other over the trade. The fighting also led to a stepped up government law enforcement presence in Sicily.

Trafficking

International drug routes

Opium#Modern production and usage

Traffic is heavy worldwide, with the biggest producer being Afghanistan.According to U.N. sponsored survey, as of 2004, Afghanistan accounted for production of 87 percent of the world's heroin.Afghan opium kills 100,000 people every year worldwide.

The cultivation of opium in Afghanistan reached its peak in 1999, when 350 square miles (910 km2) of poppies were sown. The following year the Taliban banned poppy cultivation, a move which cut production by 94 percent. By 2001 only 30 square miles (78 km2) of land were in use for growing opium poppies. A year later, after American and British troops had removed the Taliban and installed the interim government, the land under cultivation leapt back to 285 square miles (740 km2), with Afghanistan supplanting Burma to become the world's largest opium producer once more. Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War in Afghanistan once again appeared as a facilitator of the trade. Some 3.3 million Afghans are involved in producing opium.

At present, opium poppies are mostly grown in Afghanistan, and in Southeast Asia, especially in the region known as the Golden Triangle straddling Myanmar, Thailand, Vietnam, Laos and Yunnan province in the People's Republic of China. There is also cultivation of opium poppies in the Sinaloa region of Mexico and in Colombia. The majority of the heroin consumed in the United States comes from Mexico and Colombia. Up until 2004, Pakistan was considered one of the biggest opium-growing countries.

Conviction for trafficking in heroin carries the death penalty in most Southeast Asian, some East Asian and Middle Eastern countries (see Use of death penalty worldwide for details), among which Malaysia, Singapore and Thailand are the most strict. The penalty applies even to citizens of countries where the penalty is not in place, sometimes causing controversy when foreign visitors are arrested for trafficking, for example the arrest of nine Australians in Bali, the death sentence given to Nola Blake in Thailand in 1987, or the hanging of an Australian citizen Van Tuong Nguyen in Singapore.

Risks of use

Prepping Heroin

For intravenous users of heroin (and any other substance), the use of non-sterile needles and syringes and other related equipment leads to several serious risks:

the risk of contracting blood-borne pathogens such as HIV and hepatitis

the risk of contracting bacterial or fungal endocarditis and possibly venous sclerosis

abscesses

Poisoning from contaminants added to "cut" or dilute heroin

Chronic constipation

Addiction and increasing tolerance

Physical dependence can result from prolonged use of all opioids, resulting in withdrawal symptoms on cessation of use

Decreased kidney function (although it is not currently known if this is due to adulterants or infectious diseases)

Many countries and local governments have begun funding programs that supply sterile needles to people who inject illegal drugs in an attempt to reduce these contingent risks and especially the contraction and spread of blood-borne diseases. The Drug Policy Alliance reports that up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of drug use by injection. The United States federal government does not operate needle exchanges, although some state and local governments do support needle exchange programs.

Anthropologists Philippe Bourgois and Jeff Schonberg, who did a decade of field work among homeless heroin and crack addicts in San Francisco, reported that the African-American addicts they observed were more inclined to "direct deposit" heroin into a vein, rather than "skin-popping" their injections. (Skin-popping was a far more widespread practice among the white addicts: "By the midpoint of our fieldwork, most of the whites had given up searching for operable veins and skin-popped. They sank their needles perfunctorily, often through their clothing, into their fatty tissue.") Bourgois and Schonberg describes how the cultural difference between the African-Americans and the whites leads to this contrasting behavior, and also points out that the two different ways to inject heroin comes with different health risks. Skin-popping more often results in abscesses, and direct injection more often leads to fatal overdose and also to hepatitis C and HIV infection.

A heroin overdose is usually treated with an opioid antagonist, such as naloxone (Narcan), or naltrexone, which has high affinity for opioid receptors but does not activate them. This reverses the effects of heroin and other opioid agonists and causes an immediate return of consciousness but may precipitate withdrawal symptoms. The half-life of naloxone is much shorter than that of most opioid agonists, so that antagonist typically has to be administered multiple times until the opioid has been metabolized by the body.

Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours due to anoxia because the breathing reflex is suppressed by µ-opioids. An overdose is immediately reversible with an opioid antagonist injection. Heroin overdoses can occur due to an unexpected increase in the dose or purity or due to diminished opioid tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other depressant drugs like alcohol or benzodiazepines. It should also be noted that since heroin can cause nausea and vomiting, a significant number of deaths attributed to heroin overdose are caused by aspiration of vomit by an unconscious victim. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 375 mg.Street heroin is of widely varying and unpredictable purity. This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended. Also, tolerance typically decreases after a period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in a dangerous overdose.

It has been speculated that an unknown portion of heroin related deaths are the result of an overdose or allergic reaction to quinine, which may sometimes be used as a cutting agent.

A final factor contributing to overdoses is place conditioning. Heroin use is a highly ritualized behavior. While the mechanism has yet to be clearly elucidated, longtime heroin users display increased tolerance to the drug in locations where they have repeatedly administered heroin. When the user injects in a different location, this environment-conditioned tolerance does not occur, resulting in a greater drug effect. The user's typical dose of the drug, in the face of decreased tolerance, becomes far too high and can be toxic, leading to overdose.

A small percentage of heroin smokers and occasionally IV users may develop symptoms of toxic leukoencephalopathy. The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon adulterant that is only active when heated. Symptoms include slurred speech and difficulty walking.

Cocaine is sometimes used in combination with heroin, and is referred to as a speedball when injected or moonrocks when smoked together. Cocaine acts as a stimulant, whereas heroin acts as a depressant. Coadministration provides an intense rush of euphoria with a high that combines both effects of the drugs, while excluding the negative effects, such as anxiety and sedation. The effects of cocaine wear off far more quickly than heroin, thus if an overdose of heroin was used to compensate for cocaine, the end result is fatal respiratory depression.

Harm reduction

Modified Syringe for Rectal Administration

Harm reduction, Safe injection sites, and Needle exchange programs

Harm reduction is a public health philosophy that seeks to reduce the harms associated with the use of heroin. One aspect of harm reduction initiatives focuses on the behaviour of individual users. This includes promoting safer means of taking the drug, such as smoking, nasal use, oral or rectal insertion. This attempts to avoid the higher risks of overdose, infections and blood-borne viruses associated with injecting the drug. Other measures include using a small amount of the drug first to gauge the strength, and minimize the risks of overdose. For the same reason, poly drug use (the use of two or more drugs at the same time) is discouraged. Users are also encouraged to not use heroin on their own, as others can assist in the event of an overdose. Injecting heroin users are encouraged to use new needles, syringes, spoons/steri-cups and filters every time they inject and not share these with other users.

Governments that support a harm reduction approach usually fund Needle & Syringe exchange programs, which supply new needles and syringes on a confidential basis, as well as education on proper filtering prior to injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing heroin for injection may also be supplied including citric acid sachets/vitamin C sachets, steri-cups, filters, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop use of shoe laces or belts).

Another harm reduction measure employed for example in Europe, Canada and Australia are safe injection sites where users can inject heroin and cocaine under the supervision of medically trained staff. Safe injection sites are low threshold and allow social services to approach problem users that would otherwise be hard to reach.

Withdrawal

Heroin withdrawal

Black tar heroin

The withdrawal syndrome from heroin (the so-called cold turkey) may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms may include: sweating, malaise, anxiety, depression, priapism, extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, excessive yawning or sneezing, tears, rhinorrhea, sleep difficulties (insomnia), cold sweats, chills, severe muscle and bone aches; nausea and vomiting, diarrhea, cramps, and fever.

Heroin prescription for addicts

Heroin assisted treatment

The UK Department of Health's Rolleston Committee report in 1926 established the British approach to heroin prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe heroin to users when withdrawing from it would cause harm or severe distress to the patient. This "policing and prescribing" policy effectively controlled the perceived heroin problem in the UK until 1959 when the number of heroin addicts doubled every 16th month during a period of ten years, 1959–1968. The failure changed the attitudes; in 1964 only specialized clinics and selected approved doctors were allowed to prescribe heroin to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone, until now only a small number of users in the UK are prescribed heroin.

In 1994 Switzerland began a trial heroin maintenance program for users that had failed multiple withdrawal programs. The aim of this program is to maintain the health of the user to avoid medical problems stemming from use of illicit street heroin. Reducing drug-related crime and preventing overdoses were two other goals. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000 based on the apparent success of the program. Participants are allowed to inject heroin in specially designed pharmacies for 15 Swiss francs per day.A national referendum in November 2008 showed 68% of voters supported the plan, introducing heroin prescription into federal law. The trials before were based on time-limited executive ordinances.

The success of the Swiss trials led German, Dutch, and Canadian cities to try out their own heroin prescription programs. Some Australian cities (such as Sydney) have instituted legal heroin supervised injecting centers, in line with other wider harm minimization programs.

Since January 2009 Denmark has prescribed heroin to a few addicts that have tried methadone and subutex without success. Beginning in February 2010, addicts in Copenhagen and Odense will be eligible to receive free heroin. Later in 2010 other cities including Århus and Esbjerg will join the scheme. In total, around 230 addicts will be able to receive free heroin. However, Danish addicts will only be able to inject heroin according to the policy set by Danish National Board of Health. Of the estimated 1500 drug users who do not benefit from the current oral substitution treatment, approximately 900 will not be in the target group for treatment with injectable heroin, either because of "massive multiple drug abuse of non-opioids" or "not wanting treatment with injectable heroin".

In July 2009, the German Bundestag passed a law allowing heroin prescription as a standard treatment for addicts; while heroin prescription was started in 2002, it was only authorized as a large-scale trial.

Popular culture

This "In popular culture" section may contain minor or trivial references. Please reorganize this content to explain the subject's impact on popular culture rather than simply listing appearances, and remove trivial references. (January 2010)

Literature

In the 1926 novel, The Murder of Roger Ackroyd, there is a discussion between the book’s protagonist, Hercule Poirot, and the book’s narrator, Dr. James Sheppard, regarding a discovery the former made in a summer house on the estate where the novel’s titular character was murdered. In Chapter 13, “The Goose Quill,” Poirot discovers a goose quill used by addicts to carry “snow,” as the powdered form of heroin was then known. This clue is considered integral to solving the murder.

“Yes, heroin ‘snow.’ Drug-takers carry it like this, and sniff it up the nose.”

“Diamorphine hydrochloride,” I murmured mechanically.

“This method of taking the drug is very common on the other side. Another proof, if we wanted one, that the man come from Canada or the States.”

Beat Generation author William S. Burroughs wrote about his experiences with heroin in numerous books, starting with the 1953 semi-autobiographical Junkie (aka Junky).

The Basketball Diaries is a 1978 book written by American author and musician Jim Carroll. It is an edited collection of the diaries he kept between the ages of 12 and 16. Set in New York City, his writings detail his daily life, sexual experiences, high school basketball career, Cold War paranoia, the counterculture movement, and, especially, his addiction to heroin, which began when he was 13. The book was made into a film under the same name in 1995 starring Leonardo DiCaprio.

Irvine Welsh's 1993 novel Trainspotting which was later made into a feature film under the same name explores the turbulent lives of an eccentric group of heroin users.

Allen Hoey's 2006 novel, Chasing the Dragon, examines the use of heroin among jazz musicians in the 1950s.

A 2007 book entitled The Heroin Diaries by author and musician Nikki Sixx from Mötley Crüe and Sixx:A.M. chronicles his heroin addiction in his diary between the years 1986–7, as well as his chronic extreme hedonism, attitudes, drug use and his inevitable route to dying and coming back to life.

A 2008 book entitled, The Death Proclamation of Generation X: A Self-Fulfilling Prophesy of Goth, Grunge and Heroin, by researcher Maxim W. Furek, investigates the prominence of heroin in music, motion pictures, and Generation X culture. Published by i-Universe. (ISBN 978-0-595-46319-0)

Musicians who have used heroin, or written about heroin use

David Bowie's first single "Space Oddity", was seemingly about his experience with heroin, as his 1980 single "Ashes to Ashes" included the lines that refer to Major Tom as "... a junkie/strung out on heaven's high/hitting an all-time low."

Kurt Cobain was a heavy heroin user and partially used heroin to commit suicide. Courtney Love used heroin at the same time, leading to some controversy that she was using the drug during her pregnancy with their daughter Frances Bean Cobain.

Rozz Williams's final album before his suicide, The Whorse's Mouth, dealt with his heroin addiction.

Sid Vicious from the Sex Pistols died of a heroin overdose, and allegedly stabbed his girlfriend to death while both were strung out on heroin.

Comedian Mitch Hedberg was arrested for heroin possession in 2003 and died of an accidental 'speedball' overdose in 2005. 

Nikki Sixx of Mötley Crüe released diaries from his time as a heroin addict named The Heroin Diaries: A Year in the Life of a Shattered Rock Star. An album was also produced based on the book.

Jerry Garcia, guitarist for the Grateful Dead, was a heroin user for many years. He died of heart failure while at the Serenity Knolls drug treatment center in San Francisco; undergoing treatment to get help for his heroin addiction after a recent relapse.

B.G., a rap artist from New Orleans, raps about his previous addiction to heroin (via injection) in numerous songs.

Film and TV

In 1916's short comedy The Mystery of the Leaping Fish (a parody of a coke-shooting Sherlock Holmes, played by Douglas Fairbanks), discovers a contraband container of opium (which he eagerly tastes).

The first serious film drama about heroin addiction by a major studio was Otto Preminger's The Man with the Golden Arm, released in 1955. This tells the story of a heroin addict (played by Frank Sinatra) who gets clean while in prison but struggles to stay that way in the outside world. The film was nominated for three Academy Awards, including Sinatra for Best Actor in a Leading Role. The movie also sparked a change in the Hollywood Production Code, allowing motion pictures more freedom to explore hitherto taboo subjects such drug abuse.

Quentin Tarantino's 1994 film Pulp Fiction fully depicts the steps of heroin injection by Vincent Vega (John Travolta), and subsequent near-fatal overdose by Mia Wallace (Uma Thurman) via snorting.

Darren Aronosfky's 2000 film Requiem for a Dream, based on the book of the same name, depicts the lives of a group of heroin addicts and the devastating results of their addiction.

The film Trainspotting, based on the book of the same name, revolves around a group of heroin users and the attempts of one of the group to quit.

The film Rent (2005), based on the musical by Jonathan Larson, includes a character, Mimi who struggles with a heroin addiction and has contracted AIDS from her usage.

The film Candy starring Heath Ledger focused on a couple very much in love and destroyed by heroin addiction.

Party Monster, a movie based on James St. James' true tales of New York City club kids in the late 1980s, shows an extreme use of heroin and other drugs such as ketamine (Special K) and cocaine.

The Film Gia based on a true story of model Gia Carangi is about her addiction and use of heroin and how it affected her.

The film Christiane F. portrays the troubles of young heroin users in Berlin.

The film Things We Lost in the Fire deals with Benicio del Toro's character's struggle to get clean.

The film American Gangster is based on real life drug lord Frank Lucas who sold heroin.

1971's The panic in needle park starring Al Pacino revolves around Pacino's character and his girlfriend's addictions to heroin and the repercussions of it. The film features graphic scenes of users injecting the drug.

Season 3 of the TV series 24 depicts Kiefer Sutherland starring as Jack Bauer struggling with a heroin addiction.

(source:wikipedia)

Methamphetamine also known as metamfetamine

Methamphetamine (metamfetamine),

Methamphetamine also known as metamfetamine (INN), dextromethamphetamine, methylamphetamine, N-methylamphetamine, desoxyephedrine, and colloquially as meth (not to be confused with methadone, sometimes referred to as "meth" by opioid users, or with mephedrone, sometimes referred to as "meph") or crystal meth, is a psychoactive stimulant (psychostimulant or psychoanaleptic) drug. It increases alertness, concentration, energy, and in high doses, can induce euphoria, enhance self-esteem, and increase libido. Methamphetamine has high potential for abuse and addiction by activating the psychological reward system via increasing levels of dopamine, norepinephrine and serotonin in the brain. Methamphetamine is approved by the U.S. Food and Drug Administration (FDA) for the treatment of attention-deficit hyperactivity disorder (ADHD) and exogenous obesity, under the trademark name Desoxyn.

History

Crystal methamphetamine was first synthesized in 1919 by Akira Ogata.

Methamphetamine was first synthesized from ephedrine in Japan in 1893 by chemist Nagai Nagayoshi. In 1919, crystallized methamphetamine was synthesized by Akira Ogata via reduction of ephedrine using red phosphorus and iodine. In 1943, Abbott Laboratories requested for its approval from the U.S. Food and Drug Administration (FDA) for the treatment of narcolepsy, mild depression, postencephalitic parkinsonism, chronic alcoholism, cerebral arteriosclerosis, and hay fever. Methamphetamine was approved for all of these indications in December, 1944.[citation needed] All of these indication approvals were eventually removed.The only two approved marketing indications remaining for methamphetamine are for attention-deficit hyperactivity disorder (ADHD) and the short-term management of exogenous obesity, although the drug is clinically established as effective in the treatment of narcolepsy.

Second World War

One of the earliest uses of methamphetamine was during World War II, when it was used by Axis and Allied forces. The German military dispensed it under the trade name Pervitin. It was widely distributed across rank and division, from elite forces to tank crews and aircraft personnel, with many millions of tablets being distributed throughout the war.From 1942 until his death in 1945, Adolf Hitler may have been given intravenous injections of methamphetamine by his personal physician Theodor Morell. It is possible that it was used to treat Hitler's speculated Parkinson's disease, or that his Parkinson-like symptoms that developed from 1940 onwards resulted from using methamphetamine.

In Japan, methamphetamine was sold under the registered trademark of Philopon (ヒロポン hiropon?) by Dainippon Sumitomo Pharma for civilian and military use. Similar to the situation in the rest of the world, the side effects of methamphetamine were not well studied, and regulation was not seen as necessary.

[edit]Post-war use

After World War II, a large Japanese military stockpile of methamphetamine, known by its trademark Philopon, flooded the market. The Japanese Ministry of Health banned it in 1951; since then, it has been increasingly produced by the Yakuza criminal organization. On the streets, it is also known as S, Shabu, and Speed, in addition to its old trademarked name.

In the 1950s, there was a rise in the legal prescription of methamphetamine to the American public. In the 1954 edition of Pharmacology and Therapeutics, indications for methamphetamine included "narcolepsy, postencephalitic parkinsonism, alcoholism, certain depressive states, and in the treatment of obesity."

The 1960s saw the start of significant use of clandestinely manufactured methamphetamine as well as methamphetamine created in users' own homes for personal use. The recreational use of methamphetamine continues to this day.

In the 1970s, Methedrine (methamphetamine in ampules for IV administration) was freely available to anesthesia providers (at least in California) for administration to patients with intraoperative hypotension. It was used in a manner similar to Ephedrine. DEA (at that time "BNDD") restrictions did not yet apply.

Legal restrictions

In 1983, laws were passed in the United States prohibiting possession of precursors and equipment for methamphetamine production. This was followed a month later by a bill passed in Canada enacting similar laws. In 1986, the U.S. government passed the Federal Controlled Substance Analogue Enforcement Act in an attempt to curb the growing use of designer drugs. Despite this, use of methamphetamine expanded throughout rural United States, especially through the Midwest and South.

Since 1989, five U.S. federal laws and dozens of state laws have been imposed in an attempt to curb the production of methamphetamine. Methamphetamine can be produced in home laboratories using pseudoephedrine or ephedrine, which, at the time, were the active ingredients in over-the-counter drugs such as Sudafed and Contac. Preventive legal strategies of the past 17 years have steadily increased restrictions to the distribution of pseudoephedrine/ephedrine-containing products.

As a result of the U.S. Combat Methamphetamine Epidemic Act of 2005, a subsection of the USA PATRIOT Act, there are restrictions on the amount of pseudoephedrine and ephedrine one may purchase in a specified time period and further requirements that these products must be stored in order to prevent theft. Increasingly strict restrictions have resulted in the reformulation of many over-the-counter drugs, and some, such as Actifed, have been discontinued entirely in the United States.

Pharmacology

A member of the family of phenethylamines, methamphetamine is chiral, with two isomers, levorotary and dextrorotatory. The levorotary form, called levomethamphetamine, is an over-the-counter drug used in inhalers for nasal decongestion. Levomethamphetamine does not possess any significant central nervous system activity or addictive properties. This article deals only with the dextrorotatory form, called dextromethamphetamine, and the racemic form.

Methamphetamine is a potent central nervous system stimulant that affects neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and emotional responses associated with alertness or alarming conditions. The acute physical effects of the drug closely resemble the physiological and psychological effects of an epinephrine-provoked fight-or-flight response, including increased heart rate and blood pressure, vasoconstriction (constriction of the arterial walls), bronchodilation, and hyperglycemia (increased blood sugar). Users experience an increase in focus, increased mental alertness, and the elimination of fatigue, as well as a decrease in appetite.

The methyl group is responsible for the potentiation of effects as compared to the related compound amphetamine, rendering the substance on the one hand more lipid-soluble, enhancing transport across the blood-brain barrier, and on the other hand more stable against enzymatic degradation by monoamine oxidase (MAO). Methamphetamine causes the norepinephrine, dopamine, and serotonin (5HT) transporters to reverse their direction of flow. This inversion leads to a release of these transmitters from the vesicles to the cytoplasm and from the cytoplasm to the synapse (releasing monoamines in rats with ratios of about NE:DA = 1:2, NE:5HT= 1:60), causing increased stimulation of post-synaptic receptors. Methamphetamine also indirectly prevents the reuptake of these neurotransmitters, causing them to remain in the synaptic cleft for a prolonged period (inhibiting monoamine reuptake in rats with ratios of about: NE:DA = 1:2.35, NE:5HT = 1:44.5).

Methamphetamine is a potent neurotoxin, shown to cause dopaminergic degeneration.High doses of methamphetamine produce losses in several markers of brain dopamine and serotonin neurons. Dopamine and serotonin concentrations, dopamine and 5HT uptake sites, and tyrosine and tryptophan hydroxylase activities are reduced after the administration of methamphetamine. It has been proposed that dopamine plays a role in methamphetamine-induced neurotoxicity, because experiments that reduce dopamine production or block the release of dopamine decrease the toxic effects of methamphetamine administration. When dopamine breaks down, it produces reactive oxygen species such as hydrogen peroxide.

It is likely that the approximate 1200% increase in dopamine levels and subsequent oxidative stress that occurs after taking methamphetamine mediates its neurotoxicity.

Recent research published in the Journal of Pharmacology And Experimental Therapeutics (2007)indicates that methamphetamine binds to and activates a G protein-coupled receptor called TAAR1. TAARs are a newly discovered receptor family whose members are activated by a number of amphetamine-like molecules called trace amines, thyronamines,and certain volatile odorants.

It has been demonstrated that a high ambient temperature increases the neurotoxic effects of methamphetamine.

Effects

Short- and long-term adverse physical and mental effects that may appear in methamphetamine use, including rare effects.

Physical effects

Physical effects can include anorexia, hyperactivity, dilated pupils, flushing, restlessness, dry mouth, headache, tachycardia, bradycardia, tachypnea, hypertension, hypotension, hyperthermia, diaphoresis, diarrhea, constipation, blurred vision, dizziness, twitching, insomnia, numbness, palpitations, arrhythmias, tremors, dry and/or itchy skin, acne, pallor, and, with chronic and/or high doses, convulsions, heart attack,stroke,and death can occur.

Psychological effects

Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, energy, self-esteem, self-confidence, sociability, irritability, aggression, psychosomatic disorders, psychomotor agitation, hubris, excessive feelings of power and invincibility, repetitive and obsessive behaviors, paranoia, and, with chronic and/or high doses, amphetamine psychosis can occur.

Withdrawal effects

Withdrawal is characterized by excessive sleeping, increased appetite and depression, often accompanied by anxiety and drug craving.

Pharmacokinetics

Methamphetamine pills

The half-life of methamphetamine is 9–15 hours. It is excreted by the kidneys, with the rate of excretion into the urine heavily influenced by urinary pH. Between 30-54% of an oral dose is excreted in urine as unchanged methamphetamine and 10-23% as unchanged amphetamine. Following an intravenous dose, 45% is excreted as unchanged parent drug and 7% amphetamine. The main metabolites of methamphetamine are amphetamine, 4-hydroxymethamphetamine and 4-hydroxyamphetamine.

Following oral administration, peak methamphetamine concentrations are seen in 2.6-3.6 hours, and the mean elimination half-life is 10.1 hours (range 6.4–15 hours). The amphetamine metabolite peaks at 12 hours. Following intravenous injection, the mean elimination half-life is slightly longer (12.2 hours). Methamphetamine is metabolized to amphetamine (active), p-OH-amphetamine and norephedrine (both inactive). Other drugs metabolized to amphetamine and methamphetamine include benzphetamine and famprofazone.[citation needed] Selegiline (marketed as Deprenyl, EMSAM, and others) is metabolized into the less active L-isomer of amphetamine and the inactive L-isomer of methamphetamine.[citation needed] Although only the D-Isomer of selegiline will metabolize into active metabolites, both isomers may cause a positive result for methamphetamine and amphetamine on a drug test, in certain cases.

Detection in biological fluids

Methamphetamine and amphetamine are often measured in urine, sweat or saliva as part of a drug-abuse testing program, in plasma or serum to confirm a diagnosis of poisoning in hospitalized victims, or in whole blood to assist in a forensic investigation of a traffic or other criminal violation or a case of sudden death. Chiral techniques may be employed to help distinguish the source of the drug, whether obtained legally (via prescription) or illicitly, or possibly as a result of formation from a prodrug such as famprofazone or selegiline. Chiral separation is needed to assess the possible contribution of l-methamphetamine (Vicks Inhaler) toward a positive test result.

Tolerance

As with other amphetamines, tolerance to methamphetamine is not completely understood but known to be sufficiently complex that it cannot be explained by any single mechanism. The extent of tolerance and the rate at which it develops vary widely between individuals, and, even within one person, it is highly dependent on dosage, duration of use, and frequency of administration. Tolerance to the awakening effect of amphetamines does not readily develop, making them suitable for the treatment of narcolepsy.

Short-term tolerance can be caused by depleted levels of neurotransmitters within the synaptic vesicles available for release into the synaptic cleft following subsequent reuse (tachyphylaxis). Short-term tolerance typically lasts until neurotransmitter levels are fully replenished; because of the toxic effects on dopaminergic neurons, this can be greater than 2–3 days. Prolonged overstimulation of dopamine receptors caused by methamphetamine may eventually cause the receptors to downregulate in order to compensate for increased levels of dopamine within the synaptic cleft. To compensate, larger quantities of the drug are needed in order to achieve the same level of effects.

Reverse tolerance or sensitization can also occur. The effect is well established, but the mechanism is not well understood.

Addiction

Methamphetamine is addictive.While the withdrawal itself may not be dangerous, withdrawal symptoms are common with heavy use and relapse is common. Various organizations, such as Crystal Meth Anonymous, are available to combat relapse.

Methamphetamine-induced hyperstimulation of pleasure pathways leads to anhedonia. It is possible that daily administration of the amino acids L-Tyrosine and L-5HTP/Tryptophan can aid in the recovery process by making it easier for the body to reverse the depletion of dopamine, norepinephrine, and serotonin. Although studies involving the use of these amino acids have shown some success, this method of recovery has not been shown to be consistently effective.

It is shown that taking ascorbic acid prior to using methamphetamine may help reduce acute toxicity to the brain, as rats given the human equivalent of 5–10 grams of ascorbic acid 30 minutes prior to methamphetamine dosage had toxicity mediated, yet this will likely be of little avail in solving the other serious behavioral problems associated with methamphetamine use and addiction that many users experience. Large doses of ascorbic acid also lower urinary pH, reducing methamphetamine's elimination half-life and thus decreasing the duration of its actions.

To combat addiction, doctors are beginning to use other forms of stimulants such as dextroamphetamine, the dextrorotatory (right-handed) isomer of the amphetamine molecule, to break the addiction cycle in a method similar to the use of methadone in the treatment of heroin addicts. There are no publicly available drugs comparable to naloxone, which blocks opiate receptors and is therefore used in treating opiate dependence, for use with methamphetamine problems. However, experiments with some monoamine reuptake inhibitors such as indatraline have been successful in blocking the action of methamphetamine. There are studies indicating that fluoxetine, bupropion and imipramine may reduce craving and improve adherence to treatment. Research has also suggested that modafinil can help addicts quit methamphetamine use.

Methamphetamine addiction is one of the most difficult forms of addictions to treat. Bupropion, aripiprazole, and baclofen have been employed to treat post-withdrawal cravings, although the success rate is low. Modafinil is somewhat more successful, but this is a Class IV scheduled drug. Ibogaine has been used with success in Europe, where it is a Class I drug and available only for scientific research. Mirtazapine has been reported useful in some small-population studies.

As the phenethylamine phentermine is a constitutional isomer of methamphetamine, it has been suggested that it may be effective in treating methamphetamine addiction. Phentermine is a central nervous system stimulant that acts on dopamine and norepinephrine. When comparing (+)-Amphetamine, (+/-)-ephedrine, and phentermine, one key difference among the three drugs is their selectivity for norepinephrine (NE) release vs. dopamine (DA) release. The NE/DA selectivity ratios for these drugs as determined in vitro [(EC(50) NE(-1))/(EC(50) DA(-1))] are (+/-)-ephedrine (18.6) > phentermine (6.7) > (+)-amphetamine (3.5).

Abrupt interruption of chronic methamphetamine use results in the withdrawal syndrome in almost 90% of the cases.

The mental depression associated with methamphetamine withdrawal lasts longer and is more severe than that of cocaine withdrawal.

Medical use

Desoxyn 10 mg tablets (US)

Methamphetamine has been approved by the FDA for use by children and adults under the trademark name Desoxyn. It is prescribed as a treatment for ADHD and exogenous obesity as well as off-label for the treatment of narcolepsy and treatment-resistant depression. Methamphetamine is known to produce central effects similar to other stimulants, but at smaller doses, with fewer peripheral effects. Methamphetamine's lipophilicity also allows it to enter the brain faster than other stimulants and is more stable against degradation by monoamine oxidase (MAO).

Other uses

A 2006 study by a group of University of Montana scientists showed that methamphetamine appears to lessen damage to the brains of rats and gerbils that have suffered strokes. Their preliminary research has found that small amounts of methamphetamine created a protective effect, while higher doses increased damage. The findings have showed that methamphetamine could be used medically to lessen stroke damage.

Health issues

Meth mouth

Methamphetamine users and addicts may lose their teeth abnormally quickly, a condition known as meth mouth. According to the American Dental Association, meth mouth "is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia (dry mouth), extended periods of poor oral hygiene, frequent consumption of high-calorie, carbonated beverages and bruxism (teeth grinding and clenching). Some reports have also speculated that the acidic nature of the drug is a contributing factor." Similar, though far less severe, symptoms have been reported in clinical use of regular amphetamine, where effects are not exacerbated by extended periods of poor oral hygiene.

Hygiene

Serious health and appearance problems can be caused by unsterilized needles, lack or ignoring of hygiene needs (more typical on chronic use), and obsessive skin-picking, which may lead to abscesses.

Increased risk of sexually transmitted disease

See also: Sex and drugs and Party and play

Men who use methamphetamine, cocaine, MDMA, and ketamine are twice as likely to have unprotected sex, according to British research.
Methamphetamine allows users to engage in prolonged sexual activity, which may cause genital sores and abrasions. Methamphetamine can also cause sores and abrasions in the mouth via bruxism (teeth clenching and grinding), which can turn typically low-risk sex acts, such as oral sex, into high-risk sexual activity. As with the injection of any drug, if a group of users share a common needle without sterilization procedures, blood-borne diseases can be transmitted. The level of needle sharing among methamphetamine users is similar to that among other drug injection users.

Use in pregnancy and breastfeeding

Methamphetamine passes through the placenta and is secreted in the breast milk. Half of the newborns whose mothers used methamphetamine during pregnancy experience neonatal withdrawal syndrome; this syndrome is relatively mild and requires medication in only 4% of the cases.

Public health issues

It has been found that the volatile remain products and even the methamphetamine itself can contaminate the "home" methamphetamine labs, thus making these places a public health hazard due to the possible consequences for new inhabitants, especially through the respiratory and conjunctiva mucosa, blood stream and central nervous system.

Routes of administration

Studies have shown that the subjective pleasure of drug use (the reinforcing component of addiction) is proportional to the rate at which the blood level of the drug increases. Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the most quickly, followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing). Ingestion does not produce a rush (an acute transcendent state of euphoria) as forerunner to the high experienced with the use of methamphetamine, which is most pronounced with intravenous use. While the onset of the rush induced by injection can occur in as little as a few seconds, the oral route of administration requires approximately half an hour before the high sets in. Thus, oral routes of administration are generally used by recreational and medicinal consumers of the drug, while other, more fast-acting routes of administration are used by addicts.

Injection

Injection is a popular method for use, also known as "slamming", "banging", "shooting up" or "mainlining", but carries serious risks. The hydrochloride salt of methamphetamine is soluble in water; intravenous users may use any dose range, from less than 100 milligrams to over one gram, using a hypodermic needle (although it should be noted that typically street methamphetamine is "cut" with a water-soluble cutting material, which constitutes a significant portion of a given street methamphetamine dose). Intravenous users often experience skin rashes (also known as "speed bumps") and infections at the site of injection. As with the injection of any drug, if a group of users share a common needle or any type of injecting equipment without sterilization procedures, blood-borne diseases, such as HIV or hepatitis, can be transmitted.

Smoking

Smoking amphetamines refers to vaporizing it to inhale the resulting fumes, not burning it to inhale the resulting smoke. It is commonly smoked in glass pipes made from blown Pyrex tubes, light bulbs, or on aluminium foil heated underneath by a flame. This method is also known as "chasing the white dragon" (whereas smoking heroin is known as "chasing the dragon"). There is little evidence that methamphetamine inhalation results in greater toxicity than any other route of administration. Lung damage has been reported with long-term use, but manifests in forms independent of route (pulmonary hypertension and associated complications), or limited to injection users (pulmonary emboli).

Insufflation

Another popular route to intake methamphetamine is insufflation (snorting), where a user crushes the methamphetamine into a fine powder and then sharply inhales it (sometimes with a straw or a rolled up banknote, as with cocaine) into the nose where methamphetamine is absorbed through the soft tissue in the mucous membrane of the sinus cavity and straight into the bloodstream. This method of administration redirects first pass metabolism, with a quicker onset and higher bioavailability than oral administration, though the duration of action is shortened. This method is sometimes preferred by users who do not want to prepare and administer methamphetamine for injection or smoking, but still experience a fast onset with a rush.

Suppository

Little research has been focused on the suppository (anal or vaginal insertion) method of administration. Anecdotal evidence of its effects are infrequently discussed, possibly due to social taboos in many cultures. The rectum and the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining its walls. This method is often known within methamphetamine communities as a "butt rocket", "potato thumping", "turkey basting", a "booty bump", "keistering", "plugging", "shafting", "bumming" and "shelving" (vaginal). It is anecdotally reported to increase sexual pleasure, while the effects of the drug last longer. As methamphetamine is centrally active in the brain, these effects are likely experienced through the higher bioavailability of the drug in the bloodstream (second to injection) and the faster onset of action (than insufflation).

Illicit production

Crystal methamphetamine

Synthesis

Methamphetamine is most structurally similar to methcathinone and amphetamine. When illicitly produced, it is commonly made by the reduction of ephedrine or pseudoephedrine. Most of the necessary chemicals are readily available in household products or over-the-counter cold or allergy medicines. Synthesis is relatively simple, but entails risk with flammable and corrosive chemicals, particularly the solvents used in extraction and purification. Clandestine production is therefore often discovered by fires and explosions caused by the improper handling of volatile or flammable solvents. Most methods of illicit production involve protonation of the hydroxyl group on the ephedrine or pseudoephedrine molecule. The most common method for small-scale methamphetamine labs in the United States is primarily called the "Red, White, and Blue Process", which involves red phosphorus, pseudoephedrine or ephedrine (white), and blue iodine (which is technically a purple color in elemental form), from which hydroiodic acid is formed. In Australia, criminal groups have been known to substitute "red" phosphorus with either hypophosphorous acid or phosphorous acid.This is a fairly dangerous process for amateur chemists, because phosphine gas, a side-product from in situ hydroiodic acid production, is extremely toxic to inhale.

Another common method uses the Birch reduction (also called the "Nagai method"), in which metallic lithium, commonly extracted from non-rechargeable lithium batteries, is substituted for difficult-to-find metallic sodium. However, the Birch reduction is dangerous because the alkali metal and liquid anhydrous ammonia are both extremely reactive, and the temperature of liquid ammonia makes it susceptible to explosive boiling when reactants are added.

Industrial-scale methamphetamine factory in Cikande, Indonesia.

A completely different procedure of synthesis uses the reductive amination of phenylacetone with methylamine, both of which are currently DEA list I chemicals (as are pseudoephedrine and ephedrine). The reaction requires a catalyst that acts as a reducing agent, such as mercury-aluminum amalgam or platinum dioxide, also known as Adams' catalyst. This was once the preferred method of production by motorcycle gangs in California, until DEA restrictions on the chemicals made the process difficult. Other less common methods use other means of hydrogenation, such as hydrogen gas in the presence of a catalyst.

Methamphetamine labs can give off noxious fumes, such as phosphine gas, methylamine gas, solvent vapors, acetone or chloroform, iodine vapors, white phosphorus, anhydrous ammonia, hydrogen chloride/muriatic acid, hydrogen iodide, lithium/sodium metal, ether, or methamphetamine vapors. If performed by amateurs, manufacturing methamphetamine can be extremely dangerous. If the red phosphorus overheats, because of a lack of ventilation, phosphine gas can be produced. This gas is highly toxic and, if present in large quantities, is likely to explode upon autoignition from diphosphine, which is formed by overheating phosphorus.

In recent years, reports of a simplified "Shake 'n Bake" synthesis have surfaced. The method is suitable for such small batches that pseudoephedrine restrictions are less effective, it uses chemicals that are easier to obtain (though no less dangerous than traditional methods), and it is so easy to carry out that some addicts have made the drug while driving. Producing methamphetamine in this fashion can be extremely dangerous and has been linked to several fatalities.

Production and distribution

Until the early 1990s, methamphetamine for the U.S. market was made mostly in labs run by drug traffickers in Mexico and California. Since then, authorities[which?] have discovered increasing numbers of small-scale methamphetamine labs all over the United States, mostly in rural, suburban, or low-income areas.[citation needed] Indiana state police found 1,260 labs in 2003, compared to just 6 in 1995, although this may be partly a result of increased police activity. As of 2007, drug and lab seizure data suggests that approximately 80 percent of the methamphetamine used in the United States originates from larger laboratories operated by Mexican-based syndicates on both sides of the border and that approximately 20 percent comes from small toxic labs (STLs) in the United States.

Mobile and motel-based methamphetamine labs have caught the attention of both the U.S. news media and the police. Such labs can cause explosions and fires and expose the public to hazardous chemicals. Those who manufacture methamphetamine are often harmed by toxic gases. Many police departments have specialized task forces with training to respond to cases of methamphetamine production. The National Drug Threat Assessment 2006, produced by the Department of Justice, found "decreased domestic methamphetamine production in both small and large-scale laboratories", but also that "decreases in domestic methamphetamine production have been offset by increased production in Mexico." They concluded that "methamphetamine availability is not likely to decline in the near term."

In July 2007, Mexican officials at the port of Lázaro Cárdenas seized a ship carrying 19 tons of pseudoephedrine, a raw material needed for methamphetamine. The shipment originated in Hong Kong and passed through the United States at the port of Long Beach prior to its arrival in Mexico.

Methamphetamine is distributed by prison gangs, outlaw motorcycle gangs, street gangs, traditional organized crime operations, and impromptu small networks.[citation needed] In the United States, illicit methamphetamine comes in a variety of forms with prices varying widely over time. Most commonly, it is found as a colorless crystalline solid. Impurities may result in a brownish or tan color. Colorful flavored pills containing methamphetamine and caffeine are known as yaa baa (Thai for "crazy medicine").

An impure form of methamphetamine is sold as a crumbly brown or off-white rock, commonly referred to as "peanut butter crank".Methamphetamine found on the street is rarely pure, but adulterated with chemicals that were used to synthesize it. It may be diluted or cut with non-psychoactive substances like inositol, isopropylbenzylamine or dimethylsulfone. Another popular method is to combine methamphetamine with other stimulant substances such as caffeine or cathine into a pill known as a "Kamikaze", which can be particularly dangerous due to the synergistic effects of multiple stimulants. It may also be flavored with high-sugar candies, drinks, or drink mixes to mask the bitter taste of the drug. Coloring may be added to the meth, as is the case with "Strawberry Quick".

Natural occurrence

Methamphetamine has been reported to occur naturally in Acacia berlandieri, and possibly Acacia rigidula, trees that grow in West Texas. Methamphetamine and regular amphetamine were long thought to be strictly human-synthesized,but Acacia trees contain these and numerous other psychoactive compounds (e.g., mescaline, nicotine, dimethyltryptamine), and the related compound β-phenethylamine is known to occur from numerous Acacia species.

Terminology

Nicknames for methamphetamine are numerous and vary significantly from region to region. Some common nicknames for methamphetamine include "ice", "meth", "crystal", "crystal meth", "crank", "glass", "chalk", "fire", "go-fast", "tweak", "nazi dope", "gack" and "jib" (Canada), "shabu" (Japan, Philippines, Malaysia), "tik" (South Africa), "Sissonville Slim Fast" (West Virginia), "ya ba" (Thailand), and "P" (New Zealand). The name most commonly used in the gay community is "Tina". Methamphetamine may often be referred to as "speed", a term that is also used for regular amphetamine without the methyl group.

Legality

 Legal status of methamphetamine

The production, distribution, sale, and possession of methamphetamine is restricted or illegal in many jurisdictions. Methamphetamine has been placed in schedule II of the United Nations Convention on Psychotropic Substances treaty.

(source:wikipedia)