Opium, heroin, overdoses and harm reduction: How these concepts are related

One of the most powerful and ancient painkillers in the world, opium has already caused wars and is today responsible for a huge crisis in North America. Aren’t you aware of that? Come and find out everything about the topic with us.

Some news are incredibly difficult to receive, understand and integrate. For me, the death of the American musician Mac Miller was exactly one of those. To this day it is strange to hear the albums and think that he will not be here anymore, he will play any more live concerts or even release more incredible records, as he always did. According to the press, he overdosed using, among other substances, fentanyl – a synthetic opioid that can be fifty times stronger than heroin.

And it was so remarkable in my life that it made perfect sense to discover Harm Reduction, and to understand how thousands of people work day and night to reduce the incidence of events like this.

Opium and its derivatives are of enormous importance for science, and have been, since ancient times, potent analgesics used by the most diverse peoples in their routines. But, like any drug, its use requires a lot of care and can end up becoming problematic. In the United States, the overdose crisis concept emerged: in 2018, every day, 128 people died due to the substance overdose.

As we already know, the first step to reduce damage is to bring information and create bonds. Therefore, we are here to discuss these issues in an open and non-stigmatized way with you. Here on the site, we do not condone the use of any potentially dangerous substance, we just believe that bringing real, taboo-free data can be a way of saving lives, as well as opening eyes to the greatest risks of each situation.

After all, what is opium and what are its main derivatives? What are their effects and what risks can they bring to the body? And how are countries where its use is common dealing with more and more users at risk? Here in this post, we will show everything we found on this subject after a lot of research! Come with us!

What is opium and where does it come from?

Opium is a substance found in the dried latex in the seed pod of a poppy species (Papaver somniferum). Traditionally, the unripened pod is cut and the sap runs and dries on the outer surface of the pod. The resulting yellowish-brown latex, which is scraped from the pod, has a bitter taste and contains varying amounts of alkaloids, such as morphine, codeine, thebaine and papaverine.

This extraction has been known and done for many, many years, since approximately 3400 BC, when the first records of its cultivation and use were found. In ancient Greece and Rome, opium was used as a potent pain reliever. In Southeast Asia too, and there this type of poppy became known as the “joy plant”, or Hul Gil, by the Sumerians.

The Assyrians and Egyptians also cultivated opium, and it traveled along the Silk Road (a series of travel routes) between Europe and China, which were involved in the beginning of the Opium Wars in the 19th century. Opium dens were places where opium could be bought and sold, and were also found worldwide, especially in Southeast Asia, China and Europe. If you have read Sir Arthur Conan Doyle’s books, you should know that even Sherlock Holmes has frequented these places in some stories.

In the USA in 1800, opium dens appeared in the west, as in San Francisco’s Chinatown, and spread eastward to New York. Chinese immigrants who came to the United States in search of railroads and gold rush work used to take their opium with them for its intoxicating and pain-relieving effects.

Over time, other synthetic or semi-synthetic opium derivatives have appeared, including fentanyl, methadone, oxycodone and hydrocodone. Many are used today in medicine because they act against severe pain in cancer patients, fractures, and several diseases.

What is the difference between opium and synthetics?

Opiates are substances obtained through opium, a substance in its natural state, harvested from poppies, as we have already mentioned. But opioids can be natural, when they do not undergo any modification (morphine, codeine), or semi-synthetic, when they result from partial modifications of natural substances (as is the case with heroin, obtained from morphine through a small chemical modification).

Human beings, in laboratories, were able to imitate nature by making several new substances with an action similar to that of opiates: meperidine, propoxyphene and methadone are some examples. These fully synthetic substances are called opioids (that is, similar to opiates). All of them have an analgesic and hypnotic effect, causing sleep.

In addition to chemical differences, substances are also physically different from each other, and can have different effects. Opium is similar to black, sticky tar, which is the latex (sap) of the opium poppy. It contains more than a dozen other substances, the main ones being:

  • Morphine;

  • Codeine;

  • Thebaine;

  • Papaverine.

These chemicals don’t all work the same way. Thebaine, for example, is a stimulant, unlike the others, which causes drowsiness and lethargy.

Heroin, on the other hand, is part of semi-synthetic opiates, created from morphine. Its effects are similar to those of morphine, only stronger. The effects of heroin and morphine are quite different from opium in its pure state, because of the mixture of chemicals found in natural opium.

Currently, one of the major points of attention in countries facing crises due to the epidemic use of opioids is fentanyl. It is perhaps the best known of synthetic opioids, as it has been widely researched and is one of the only substances approved for use under prescription. Discovered in the 1960s, fentanyl was used only for surgeries, but its clinical use expanded in the 1990s, when a prolonged-release skin patch was developed as a treatment for chronic pain. Its doses must be very low, as it is extremely potent, and can be fatal for unsuspecting users – as was the case with Mac.

Opium crop fonte: britanicca

What are its main effects?

As has already been said, opiates are generally used for their analgesic properties, which are felt because of a decrease in brain activity. The differences between them are experienced more in a quantitative sense: while some work in small doses, others need a larger amount to produce the desired sensation.

In the medical community, there is a specific table to measure these dosages:

For some drugs, the dose required for this effect is small, as is the case with morphine, heroin and fentanyl, which dosages must be extremely low so that there are no risks. In other versions, on the other hand, the doses must be five to ten times higher to produce the same effects, such as codeine and meperidine.

Some drugs may also have a more specific action, for example, to depress coughing fits – as is the case with codeine. Others can lead to a state of dependency more easily than others, such as heroin.

In addition to depressing the centers of pain, coughing and waking, all these drugs in doses a little higher than those used by the doctors end up depressing other regions of our brain, such as those that control breathing, heartbeat and blood pressure. Those who use these substances without a doctor’s prescription usually look for the characteristic effects of a general depression of the brain: a state of torpor, an isolation from the realities of the world, a lull where reality and fantasy mix, daydreaming, or a state without suffering.

How did drugs become what we know?

Opium is very important for us to understand how the term “drug” has changed over time, and our perception of substances as well. The word derives from the Dutch term “droog”, which, according to the incredible professor and historian Henrique Carneiro, was used in the 16th to 18th centuries to refer to dry products, that is, the set of herbs and other natural substances used both in food as in medicine.

At the time, the political and economic dominance of these substances was a source of wealth and power. These spices drove the “discovery” of the Americas. The production of sugar cane and its derivatives caused the boom in modern slavery. Chocolate and tobacco were also exploited and monopolized by sectors of the clergy. Opium, on the other hand, caused two wars, from England against China, motivated by the desire for free trade.

Prohibitionism, since the beginning of the 20th century, also has economic motivations. It is an instrument used to control people. After all, for what reasons are the uses of so many substances allowed, such as alcohol, coffee and sugar, and vetoed the use of others, such as cannabis, coca, and even mushrooms, which are sacred to so many?

They are instruments to combat not only physical pain, but also psychic pain, and that is why, since the dawn of civilization, they have been part of culture and religion, symbolizing deities and acting as “spiritual food”. In times of pain, like today, they become a kind of “walking stick” to support those who suffer. The ban, therefore, acts only as a way of making both uses and users invisible, until the moment when crisis explode and we are obliged to deal with the result of the lack of information, monitoring and dialogue.

Overdose prevention Center Vancouver

The overdoses crisis in North America

For many years, the United States has managed to hide what is, according to the US State Department itself, the worst drug crisis since the 1980s. One of the biggest differences (and perhaps the key to understanding why the country decided to deal with it on the low) is that the profile of the user has now changed: they are mostly white residents of middle-class neighborhoods. When the hardest hit are not part of minorities and marginalized groups, the truculent approach is no longer an option either, leaving the problem of such a racist society even more debated.

In addition to opening the eyes of many to this obvious conclusion, the crisis is becoming increasingly alarming because of its data.

  • Nearly 64,000 people died of a drug overdose in 2016, an impressive 22% increase over the previous year.

  • Almost two-thirds of deaths in 2016 (66%) involved prescription or illicit opioids.

  • Since 2010, heroin overdose mortality rates have more than quadrupled.

  • Recent increases in mortality are caused by synthetic opioids like fentanyl – deaths by synthetic opioids more than doubled from 2015 to 2016.

  • People aged 25 to 44 have the highest mortality rates.

  • Overdose deaths are increasing among racial groups, but non-Hispanic whites have the highest death rates.

“Nearly half a million Americans have died of an overdose in the past decade, and preliminary data suggests that another 69,000 people died in 2019. The opioid epidemic was declared a national emergency in the country in 2017, but the government does not provide the necessary support for organizations to take comprehensive action. According to experts, to reverse the situation, it would be necessary to invest about $ 50 billion a year. The White House devoted only $ 7.4 billion in 2018. ”

  • Excerpt from our post “CANNABIS AS THE OUTPUT FOR OTHER DRUGS”

This statistic includes dozens of celebrities, such as Mac Miller, singer Prince, actor Philip Seymour Hoffman, and others who survived their overdoses, such as singer and actress Demi Lovato and stylist Nicole Richie. Many start using it legally, but end up in a dependency relationship with the substance, which, due to the tolerance created by the body, ends up being taken in ever greater doses to contain withdrawal crises.

And the pandemic did not make any of this easier to deal with. More than 81,000 drug overdose deaths occurred in the United States from May 2019 to May 2020, the highest number of overdose deaths ever recorded in a 12-month period, according to recent provisional data from the Centers for Disease Control and Prevention (CDC). Although overdose deaths were already on the rise in the months prior to 2019’s new coronavirus disease pandemic (COVID-19), the latest figures suggest an acceleration of overdose deaths during that period.

This isn’t happening only in the United States. For example, closing the border between the country and its neighbor Canada has disrupted drug supply chains, increasing drug toxicity and extreme concentrations of fentanyl. Measures of social distancing and isolation, in combination with reduced access to places of supervised consumption and health care, have increased the number of opiate-related deaths in Canadian lands. In British Columbia, the epicenter of the country’s crisis, 1,548 people died of an overdose by November 2020.

Cannabis itself, along with drugs such as methadone and buprenorphine, is used as an alternative treatment for opioid withdrawal syndromes. In a study, patients who used cannabidiol (CBD) were found to have less negative effects from exposure to drugs than those who received placebo, with a decrease in anxiety and in their own desire to use it.

All of this, for better or worse, helped to strengthen the Harm Reduction strategies, with the creation of several specific centers for the prevention of overdoses. Much remains, but the first steps are being taken.

Drug testing in Canada

Strategies to deal with the Overdose Crisis

With all these data already shown, it is possible to see how much prohibition is a major factor in the crisis – after all, because of it, it is even more difficult for users to know what they are getting. Thus, they are exposed to several risks, such as the purchase of drugs adulterated with dangerous substances, which can easily lead to death. In this context, overdose prevention centers enter. They are not exactly a novelty, but they are one of the Drug Policy Alliance’s bets to reduce and end this big problem. The group, with a focus on Harm Reduction, has five main steps to achieve this goal:

1. Overdose prevention centers

Overdose prevention centers are also known as supervised consumption sites. They offer sterile and controlled environments for people to use pre-obtained medications under the supervision of trained professionals who can intervene in the event of an overdose or other complications. They also provide health care, counseling and referral to health and social services, including drug treatment. They are a proven way to reduce accidental deaths related to the consumption of opioids and other drugs, in addition to promoting a break in stigma around the user.

2. Drug verification and secure delivery

Recent increases in overdose deaths are caused by synthetic opioids such as fentanyl, which are mixed with heroin. Most users are not aware that their medications may contain these substances, which can lead to accidental overdoses.

Fentanyl test strips, originally designed for urine drug testing, are now being used to test for the presence or absence of additives. When people are aware of the presence of fentanyl in their medication, they can choose not to use it, use it more slowly, or use it with others who have naloxone – a medication used to reverse overdoses.

3. More open drug education programs

Saying to teenagers “Just say no” to drugs doesn’t work, and we can see that (after all, here we have our very own PROERD here in Brazil). Unlike abstinence-only programs, DPA’s drug education program, Safety First, is based on the Harm Reduction philosophy. It was designed to promote open and honest conversations about drugs and related risks, such as overdose, among teenagers, educators and parents.

4. Less barriers to methadone and buprenorphine therapies

Methadone and buprenorphine are drugs used to treat opioid addiction. These therapies can cut the risk of death from overdose in half – but the stigma associated with drug use has blocked the widespread adoption of life-saving treatment options like these.

In the United States, substances can only be accessed through opioid treatment programs (OTPs) licensed by the federal government, and most patients must attend these programs up to six days a week to receive their medication. This presents enormous barriers for people living in rural communities and in areas with limited access to transportation. Therefore, the fight for the universalization and facilitation of these treatments is constant.

5. Decriminalization of all drugs

Each year, there are more than 1.6 million drug arrests in the United States, most for possession alone. We know that prohibitionism is one of the most responsible for the problems we face with drugs, for its punitive approach and the creation of disinformation. Decriminalization, however, would prioritize the health and safety of people who use drugs rather than punishment. It would also reduce the stigma associated with drug use, so that more people are encouraged to seek treatment and support.

Heroin fonte: CNN

And how does it work in real life?

As we already told here on the website, in 2017, GG got to know the work of the Overdose Prevention Society (OPS), which has a project called High Hopes. It sought to offer affordable, or even free, cannabis products to Canadians as an alternative to opiates. In addition, the center seeks to provide residents, food, clothing, education and awareness to visitors, while also fulfilling all the steps described above.

Both Alice and Lorraina have already worked on the sites and could better understand how all these non-punitive alternatives make a difference in the lives of users, who can talk to qualified people, receiving more security without judgment. In Canada, where the prevention centers linked to OPS are located, people receive notifications via cell phones, such as the American Amber Alert, to avoid consumption.

It is interesting to share this information and bring this debate even further, which places Harm Reduction as a way out of the problems caused to date by prohibitionism. The illicit trade it promotes takes lives not only here in Brazil, with the whole “war on trafficking”, but throughout the world, and we need to understand that what we are facing are precisely the consequences of an extreme, fatal and propaganda-permeated ban.

We at Girls in Green are not here to encourage the indiscriminate use of any substance. Quite the contrary: we are here to open our eyes and show that each substance has its risks, and in no way do we want them to be taken on blindly. The information must be real, free of judgment, so that everyone can be aware and make every decision. After all, Harm Reduction is about that. We want everyone here, well, and together, to spread more and more what we discover on this journey through knowledge.

And Mac, rest in peace. This post goes from the editor’s heart to this great guy, who could still be here with us if it were for HR.

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