CODEINE.- Codeine is another derivative of opium. It appears on the market in tablet, capsule, and liquid form, and can be administered orally or by injection. It ranges in concentrations of 0.7 to 2.5 percent.

Figure 7-5.-Various forms of morphine.

Codeine can create both mental and physical dependence in the abuser, but is milder in effect than morphine or heroin. It is prescribed extensively in medicine and is the base of many pain relievers and cough remedies. Codeine is normally used by drug abusers when more powerful opiates are not available. It is found in opium, but produced from morphine.

THEBAINE.- Although it is chemically close to codeine and morphine, thebaine produces a stimulant rather than a depressant effect. Thebaine is not used in the United States for medical purposes, but it is converted into a variety of medically important compounds, including codeine, hydrocodone, oxcodone, oxymorphone, nalbuphine, naloxone, and the Bentley compounds. It is controlled in the Schedule II of the FCSA as well as under international law.

Semisynthetic Narcotics

The following narcotics are among the more significant synthetic substances that have been derived by modification of the chemicals contained in opium.

HEROIN.- Heroin (diacetylmorphine) like morphine usually appears as a crystalline white powder and may be sold illegally in glassine, aluminum foil packets, or in capsules. It may be a brownish color (Mexican) (fig. 7-6) or in the form of small chunks, called rock, which may be red or purplish. Dark heroin usually contains more impurities. Heroin has no odor or taste, and any odor or taste noted is that of the diluent used to "cut" the heroin.

Heroin in its pure form (Southwest Asian) 7) is about four to five times stronger than morphine (fig. 7

and is normally the drug addict's choice among drugs that cause physical dependence because of its durability of action whatever the percentage of dose. Pure heroin is rarely sold on the street.

Methods of use and effects of heroin are similar to those of morphine to include mental and physical dependence. A lethargic, drowsy, "on-the-nod" physical state can be expected as a result of the dose of heroin. Inhaling heroin causes redness and rawness around the nostrils due to an acid content in the substance.

Heroin is the most commonly injected narcotic. Normally, narcotic abusers do not start their needle habit by injecting directly into a vein, but begin with

Figure 7-6.-Mexican heroin.

Figure 7-7.-Southwest Asian heroin.

intradermal injections, or scratching just under the skin. Skin popping, or subcutaneous injection, refers to entry of the needle beneath the skin's surface. An intramuscular injection goes into the muscle and flesh of the body. Finally, intravenous injection directly into the bloodstream by piercing the vein will bring on the quickest reaction to the drug. (Injecting heroin leaves visible scars or "track marks" that are usually found in the inner surface of the arms and elbows. Some heroin users may inject into the body where needle marks may not be seen, such as between the toes or behind the knees or under the tongue.)

A syringe, bent spoon or bottle cap, eye or medicine dropper, matches, cotton, a nail or bent razor blade, a belt or tie, and needles are all items that can be found in or as part of a kit used to prepare and administer heroin. Heroin is also placed in cigarettes and smoked.

Heroin sold on the streets is diluted compared to the heroin as it initially enters this country. For instance, heroin coming from Europe in most cases is over 90 percent pure. By the time it is cut or adulterated with milk, sugar, quinine, procaine, mannitol, and so on, the average street dose probably contains no greater than 10 percent heroin.

To increase the bulk of the material sold to the addict, diluents are mixed with the heroin in ratios of from 9 to 1 to much as 99 to 1. The substances used to cut heroin are used because they are like heroin in color; they readily dissolve in water with the heroin when the user prepares for a dose or a "fix," and they stretch the supplier's heroin for greater profits. A "bag"-slang for a single dosage unit of heroin-may weigh about 100 milligram (mg), and usually contains 5 percent heroin.

BLACK TAR HEROIN.- Black tar heroin has also become increasingly available in recent years, especially in the western United States. Black tar heroin is a crudely processed form of heroin illicitly manufactured in Mexico. It maybe sticky like roofing tar or hard like coal, and it is dark brown to black in color. Black tar heroin is often sold on the street in its tarlike state, sometimes at purities ranging as high as 40 to 80 percent. Black tar heroin is sometimes diluted. However, by adding materials of similar consistency, such as burnt cornstarch, or by converting the tar heroin into a powder and adding conventional diluents, such as mannitol or quinine, it is most commonly used through injection.

HYDROMORPHONE.- Most commonly known as dilaudid, hydromorphone is the second oldest semisynthetic narcotic analgesic. Marketed both in tablet and injectable form, it is shorter acting and more sedative than morphine, but its potency is from two to eight times as great. It is, therefore, a highly abusable drug, much sought after by narcotic addicts who usually obtain it through fraudulent prescription or theft. The tablets, stronger than available liquid forms, may be dissolved and injected.

OXYCODONE.- Oxycodone is synthesized from thebaine. It is similar to codeine, but more potent and with a higher dependence potential. It is effective orally and is marketed in combination with other drugs such as Percodan for the relief of pain. Addicts take Percodan orally or dissolve tablets in water, filter out the insoluble material, and "mainline" the active drug.

PAREGORIC.- Paregoric is a camphorated tincture of opium usually taken for the relief of diarrhea and intestinal pain.