Heroin: An Accidental History

Opium poppies, from which heroin derives, have been cultivated for over 5000 years, from as early as 3400 BCE.  Diacetylmorphine was first synthesised in 1874 by the English chemist, C. R. Alder Wright.  However, it was not produced on a wide-scale until 1895 when a chemist named Felix Hoffman working at German pharmaceutical company Bayer produced diacetylmorphine by accident, instead of codeine as instructed.  It was realised that diacetylmorphine or ‘heroin’, as Bayer called it, was 1.5 to 2 times more potent than morphine.

Heroin was initially marketed by Bayer as being a non-addictive morphine substitute and a cough suppressant.  However, far from being a non-addictive morphine substitute, it was quickly discovered that heroin is rapidly metabolised into morphine in the body and is effectively a faster acting form of morphine.  This became a historical embarrassment for Bayer and within 30 years the drug had been banned internationally for non-medical sale, use or manufacture.[1]

Following the 1931 Single Convention on Narcotic Drugs it became illegal to manufacture, possess or sell heroin without a licence in countries such as Germany, India, the United States, Canada, Ireland, the United Kingdom and Australia.  Today it is estimated that 90% of the supply of heroin in international black markets is sourced from Afghanistan.

Contemporary Medical Use of Heroin

Heroin continues to be prescribed lawfully as diamorphine, particularly in the United Kingdom as a strong painkiller.  It is used predominantly in palliative care for end-stage cancer patients and for chronic pain associated with other terminal illnesses, such as AIDS.  The advantage of using diamorphine over the more commonly prescribed morphine is the increased solubility of the drug and the increased potency.  Lower quantities can be prescribed of diamorphine for the same analgesic effect as larger quantities of morphine.  When given via injection into the lower-most layer of skin, as is often necessary with palliative patients who cannot swallow oral painkillers, the increased solubility and potency are both advantageous factors.

Additionally, heroin may also be used in drug maintenance programs and heroin assisted treatment programs, where substitution drugs such as methadone have not proved effective.  It has been supplied in supervised harm minimisation injecting centres as was the case at the now-closed Sydney Medically Supervised Injecting Centre in Kings Cross, Sydney.

Conclusion

Heroin has certainly had an interesting history.  The global regulation of heroin in the past century has diversified into a regime ranging from permissible but controlled medical use in some countries, to the criminal prohibition and resultant death penalty for possession of large quantities in countries such as Malaysia and Singapore.  Neither the prescription nor regulation of heroin continue without controversy and criticism.