heroin chic

The movie of Trainspotting came out the year I turned sixteen, and my friend Jamie was extra-cool because she'd seen it months earlier while living in Scotland as an exchange student. Heroin was fascinating. I read Trainspotting and several other Irvine Welsh novels, as well as Poppies: Odyssey of an Opium Eater, and found them interesting, funny and dark.

It's very different, now, to be learning about opiate analgesics in my pharmacology class. Since then I've known and cared for some opiate addicts and users, and it all seems far less glamorous and much more sad. And it's strange to have those old aches of lost friends and teenaged angst mingling with the aseptic simplicity of new drugs and practices of nursing school.

So it caught my attention when a little box in my textbook informed me that heroin is "biologically inactive" until the body degrades it into morphine. Huh? So why is heroin illegal, and why is it the drug of choice for opiate addicts?

Apparently heroin, which is a generic name for diacetylmorphine (morphine with two little acetyl molecules attached) is much more fat-soluble, and since the blood-brain barrier is a membrane made of lipids (fats), heroin passes across the barrier and into the brain much more easily than morphine. Once there it sheds its sheep costume, smiles a wolfish grin, and gets to work making the user bliss out. Clever, dangerous creature, that heroin.

p.s. heroin is illegal in the U.S. (of course) but is used legally in Europe in palliative care (usually in patients who are dying, as a comfort measure).