Opium, the first opioid, is derived from the sap of opium poppies, whose growth and cultivation dates back to the ancient civilization of Mesopotamia around 3400 BC. Opium was initially used by Egyptians and Persians, eventually spreading to various parts of Europe and to India and China. During the 18th century, physicians in the U.S. used opium as a therapeutic agent for multiple purposes, including relieving pain in cancer, spasms from tetanus, and pain attendant to menstruation and childbirth. It was only towards the end of the 18th century that some physicians came to recognize the addictive quality of opium.
In 1805, morphine and codeine were isolated from opium, and morphine was used as a cure for opium addiction since its addictive characteristics were not known. Morphine’s use as a treatment for opium addiction was initially well received as morphine has about ten times more euphoric effects than the equivalent amount of opium. Over the years, however, morphine abuse increased.
Heroin was synthesized from morphine in 1874 by an English chemist, but was not produced commercially until 1898 by the Bayer Pharmaceutical Company. Attempts were made to use heroin in place of morphine due to problems of morphine abuse. However, it turned out that heroin was also highly addictive, and was eventually classified as an illegal drug in the United States. [1,3] Today, heroin in the United States comes mostly from Southeast Asia, Southwest Asia, Latin America and Mexico.[4,5] It is typically sold in a white or brownish powder form or as a black sticky substance known as “black tar” heroin (black tar from Mexico is the most common form of the drug in Arizona). Heroin found on the streets is usually mixed with other drugs or substances such as sugar, starch, powdered milk, talc, baking soda, caffeine, cocaine, or quinine, though some reports indicate that pure forms of heroin are becoming more widely available.[3,6,7]
There have been at least two major heroin epidemics in the United States. The first one began after World War II and the second began in the late 1960s. During the first epidemic, the highest incidence of use occurred in the late 1940s and early 1950s; during the second, the highest incidence occurred between 1971 and 1977. Both epidemics appear to have subsided due to lack of purity in the heroin that was available, and the increasing cost of heroin.
At the time of the second epidemic, heroin use was prevalent among enlisted men serving in Vietnam during the Vietnam War. From 1969 to 1971, opiates were cheaply available in that country. Because most of the enlisted men were 18-20 years old and not allowed to buy liquor on the base, they may have had an added incentive to try heroin as an available alternative. The most common way the enlisted men used heroin was by snorting it or mixing it with tobacco or marijuana and smoking it.
Street names for heroin include black tar, chiva, china white, junk, Mexican brown, skag, and smack.