HOW PEOPLE TAKE OPIATES
Most
opiate drugs enter the bloodstream easily from many different
routes because they dissolve in fatty substances and so
can cross intocells. Heroin and
fentanyl represent one extreme—they are so fat-soluble that they can be absorbed across the mucosal lining
of the nose. Most other opiates are
not quite that fat-soluble and cannot be absorbed well after snorting. However, some opiates including the
natural ingredients of the opium
poppy form a vapor if heated and can be absorbed into the body if they are smoked—that is the basis of the
use of the "opium pipe" as
the traditional device of ancient as well as more recent history. Almost all opiates can be absorbed from the stomach,
although injection is a much more
efficient route for some, like morphine, that are more poorly absorbed from the stomach than others.
Intravenous injection
is the route that delivers opiates into the bloodstream the fastest. Because intravenous injection
is more difficult and more dangerous
than other routes, many users do not start this way. Instead, they start by skin-popping—injecting drugs
subcutaneously (just beneath the
skin). Heroin powder is dissolved and injected. Morphine, fentanyl, and
meperidine almost always appear as legally prepared injection forms that have been diverted from medical use.
Snorting heroin has become a common
route for new drug users. In part, users are avoiding the stigma—and risk of infectious diseases
including hepatitis and AIDS—that
come with injecting a drug. In part, they may believe mistakenly that they cannot become addicted if they
don't inject drugs. Prescription
opiates like codeine, hydromorphone (Dilaudid), oxycodone (Percodan, OxyContin), meperidine (Demerol), and,
of course, methadone (Dolophine) are
available as pills. Sometimes drug users resort to grinding up pills of codeine, hydrocodone, or
methadone and injecting the
suspension when they cannot get opiates any other way. This is an extremely risky business because the other pill
components do not dissolve in
saline. Injecting particles into a blood vessel can irritate the blood vessel, thus setting off a chain of reactions that
lead to vascular inflammation and
permanent damage. In addition, a pill particle can lodge in a small vessel and block off the blood supply to an
area of the body.
