Morphine and heroin are white, crystalline powders. Illicit heroin may vary in color from white to dark brown due to impurities, or may appear as a black tar-like material, which is commonly referred to as “black tar” heroin.
Morphine: Astramorph®, Duramorph®, Infumorph®, Kadian®, Morphine Sulfate®, MSIR®, MS-Contin®, Oramorph SR®, Roxanol®.
Heroin: Diacetylmorphine, diamorphine; Mexican brown or black tar heroin; bags, blue-steel, China white, H, horse, junk, silk, skag, smack. Scramble (cut heroin), bone (uncut heroin for smoking), chippers (occasional users).
Morphine is a naturally occurring substance extracted from the seedpod of the poppy plant, Papavar somniferum. The milky resin that seeps from incisions made in the unripe seedpod is dried and powdered to make opium, which contains a number of alkaloids including morphine. Morphine concentration in opium can range from 4-21%. An alternate method of harvesting is by the industrial poppy straw process of extracting alkaloids from the mature dried plant, which produces a fine brownish powder.
The majority of heroin sold in the United States comes South America (Columbia) and Mexico. Some of the heroin comes from Southeast Asia. Low purity Mexican black tar heroin is common on the West coast, while high purity Columbian heroin is common in the East and most mid-western states.
Medical Uses: Morphine is used medicinally for the relief of moderate-to-severe pain in both acute and chronic management. It can also be used to sedate a patient pre-operatively and to facilitate the induction of anesthesia. Heroin has no currently accepted medical uses in the United States; however, it is an analgesic.
Recreational Use: Heroin has a long history of recreational abuse. It creates euphoria and an acute sense of well-being, relaxation, drowsiness, sedation, lethargy, disconnectedness, self-absorption, mental clouding and delirium. It’s potential for severe addiction has been well known.
Potency, Purity and Dose: The dosage of morphine is patient-dependent. A usual adult oral dose of morphine is 60-120 mg daily in divided doses, or up to 400 mg daily in opioid tolerant patients. Recreationally, daily heroin doses of 5-1500 mg have been reported, with an average daily dose of 300-500 mg. Addicts may inject heroin 2-4 times per day. Depending on the demographic region, the street purity of heroin can range from 11-72% (average U.S. purity is about 38%). Heroin may be cut with inert or toxic adulterants such as sugars, starch, powdered milk, quinine, and ketamine. Heroin is often mixed with methamphetamine or cocaine (“speedball”) and injected; or co-administered with alprazolam, MDMA (Ecstasy), crack cocaine, or diphenhydramine.
Morphine: Oral, intra-muscular, intravenous, rectal, epidural, and intrathecal administration. Morphine tablets may be crushed and injected, while opium can be smoked.
Heroin: Smoked, snorted, intravenous (“mainlining”), and subcutaneous (“skin popping”) administration. Black tar heroin is typically dissolved, diluted and injected, while higher purity heroin is often snorted or smoked.
Pharmacodynamics: Morphine produces its major effects on the CNS primarily through m-receptors, and also at k- and d-receptors. m 1-receptors are involved in pain modulation, analgesia, respiratory depression, miosis, euphoria, and decreased gastrointestinal activity; m 2-receptors are involved in respiratory depression, drowsiness, nausea, and mental clouding; k-receptors are involved in analgesia, diuresis, sedation, dysphoria, mild respiratory depression, and miosis; and d-receptors are involved in analgesia, dysphoria, delusions, and hallucinations. Heroin has little affinity for opiate receptors and most of its pharmacology resides in its metabolism to active metabolites, namely 6-acetylmorphine, morphine, and morphine-6-glucuronide.
Pharmacokinetics: The oral bioavailability of morphine is 20-40%, and 35% is bound in plasma. Morphine has a short half-life of 1.5 - 7 hours and is primarily glucuroconjugated at positions 3 and 6, to morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), respectively. A small amount (5%) is demethylated to normorphine. M6G is an active metabolite with a higher potency than morphine, and can accumulate following chronic administration or in renally impaired individuals. The half-life of M6G is 4 +/- 1.5 hours. Close to 90% of a single morphine dose is eliminated in the 72 hours urine, with 75% present as M3G and less than 10% as unchanged morphine. Heroin has an extremely rapid half-life of 2-6 minutes, and is metabolized to 6-acetylmorphine and morphine. The half-life of 6-acetylmorphine is 6-25 minutes. Both heroin and 6-acetylmorphine are more lipid soluble than morphine and enter the brain more readily.
Blood Test Results: According to NHTSA, tolerance makes interpretation of blood or plasma morphine concentrations extremely difficult. Peak plasma morphine concentrations occur within an hour of oral administration, and within 5 minutes following intravenous injection. Average plasma concentrations of 0.065 mg/L are necessary to keep patients ambulatory. Anesthetic concentrations can reach beyond 2 mg/L in surgical patients. Following oral doses of 10-80 mg, corresponding peak morphine concentrations in serum were 0.05-0.26 mg/L. Following an intravenous dose of 8.75g/70 kg, a peak serum concentration of 0.44 mg/L was reached. In 10 intravenous drug fatalities, where morphine was the only drug detected, postmortem whole blood morphine concentrations averaged 0.70 mg/L (range 0.20-2.3 mg/L). Following a single 12 mg intravenous dose of heroin, a peak heroin concentration of 0.141 mg/L was obtained at 2 minutes, while the 6-acetylmorphine and morphine concentrations were 0.151 and 0.044, respectively. A single 5 mg intravenous dose of heroin produced a peak plasma morphine concentration of 0.035 mg/L at 25 minutes, while intravenous doses of 150-200 mg have produced plasma morphine concentrations of up to 0.3 mg/L. Intranasal administration of 12 mg heroin in 6 subjects produced average peak concentrations of 0.016 mg/L heroin in plasma within 5 minutes; 0.014 mg/L of 6-acetylmorphine at 0.08-0.17 hours; and 0.019 mg/L of morphine at 0.08-1.5 hours.
Urine Test Results: Positive morphine urine results generally indicate use within the last two to three days, or longer after prolonged use. Detection of 6-acetylmorphine in the urine is indicative of heroin use. High concentrations may indicate chronic use of the drug. It is important to hydrolyze urine specimens to assess a urine morphine concentration.
Effects: The effects of morphine or heroin depend heavily on the dose, the route of administration, and previous exposure to the drug. Following an intravenous dose of heroin, the user generally feels an intense surge of euphoria (“rush”) accompanied by a warm flushing of the skin, dry mouth, and heavy extremities. The user then alternates between a wakeful and drowsy state, often referred to as being “on the nod.”
Psychological: Euphoria, feeling of well-being, relaxation, drowsiness, sedation, lethargy, disconnectedness, self-absorption, mental clouding, and delirium.
Physiological: Depressed heart rate, respiratory depression, CNS depression, nausea and vomiting, reduced gastrointestinal motility, constipation, flushing of the face and neck, cramping, sweating, fixed and constricted pupils, diminished reflexes, and depressed consciousness.
Overdose can include slow, shallow breathing, clammy skin, convulsions, extreme somnolence, severe respiratory depression, apnea, circulatory collapse, cardiac arrest, coma, and death.
Duration of Effects: Depending on the morphine dose and the route of administration, onset of effects is within 15-60 minutes and effects may last 4-6 hours. Following heroin use, the intense euphoria lasts from 45 seconds to several minutes, peak effects last 1-2 hours, and the overall effects wear off in 3-5 hours, depending on the dose.
Tolerance, Dependence and Withdrawal Effects: Both morphine and heroin have high physical and psychological dependence. Withdrawal symptoms may occur if use is abruptly stopped or reduced. Withdrawal can begin within 6-12 hours after the last dose and may last 5-10 days. Early symptoms include watery eyes, runny nose, yawning and sweating. Major withdrawal symptoms peak between 48-72 hours after the last dose and include drug craving, restlessness, irritability, dysphoria, loss of appetite, tremors, severe sneezing, diarrhea, nausea and vomiting, elevated heart rate and blood pressure, chills alternating with flushing and excessive sweating, abdominal cramps, body aches, muscle and bone pain, muscle spasms, insomnia, and severe depression.
Alcohol increases the CNS effects of morphine such as sedation, drowsiness, and decreased motor skills. There is a higher risk of respiratory depression, hypotension and profound sedation or coma with concurrent treatment or use of other CNS depressant drugs such as barbiturates, benzodiazepines, hypnotics, tricyclic antidepressants, general anesthetics, MAO inhibitors, and antihistamines. Morphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression. Small doses of amphetamine substantially increase the analgesia and euphoriant effects of morphine and may decrease its sedative effects. Antidepressants may enhance morphine’s effects. Partial agonists such as buprenorphine, nalbuphine, butorphanol, and pentazocine will precipitate morphine withdrawal.
Performance Effects: Laboratory studies have shown that morphine may cause sedation and significant psychomotor impairment for up to 4 hours following a single dose in normal individuals. Early effects may include slowed reaction time, and depressed consciousness.
Effects on Driving: The drug manufacturer states that morphine may impair the mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car, and patients must be cautioned accordingly. Driving ability in cancer patients receiving long-term morphine analgesia (mean 209 mg daily) was considered not to be impaired by the sedative effects of morphine to an extent that accidents might occur. There were no significant differences between the morphine-treated cancer patients and a control group in vigilance, concentration, motor reactions, or divided attention. A small but significant slowing of reaction time was observed at 3 hours. In several driving under the influence case reports where the subjects tested positive for morphine and/or 6-acetylmorphine, observations included slow driving, weaving, poor vehicle control, poor coordination, slow response to stimuli, delayed reactions, difficulty in following instructions, and falling asleep at the wheel.
Classification of risk depends on tolerance, dose, time of exposure, acute or chronic use, presence or absence of underlying pain, physiological status of individual, and the presence of other drugs. Non-tolerant individuals can be moderately to severely impaired. Morphine is mildly to moderately impairing if used as medication on a regular basis for chronic pain. It is severely impairing in acute situations if used orally, or as an intravenous medication, or if either drug is taken illicitly.
DEC Profile: Horizontal gaze nystagmus not present; vertical gaze nystagmus not present; lack of convergence not present; pupil size constricted; little or no reaction to light; pulse rate down; blood pressure down; and body temperature down. Other characteristic indicators may include presence of fresh injection marks, track marks, flaccid muscle tone, droopy eyelids, drowsiness or “on-the-nod,” and low, raspy, slow speech.
If you or a loved one has been charged with driving under the influence of heroin and/or morphine, contact the DUI Lawyers of the Law Office of Barry T. Simons for a free, no-cost, DUI Consultation and DUI Case Evaluation.