Diacetylmorphine Hydrochloride

Uses

Physicians prescribe diacetylmorphine hydrochloride to treat severe pain, such as pain resulting from an acute event such as a heart attack or a chronic, terminal illness such as cancer. Doctors sometimes prescribe diacetylmorphine hydrochloride to relieve labor pains because it works better and has fewer side effects than other drugs. While diacetylmorphine hydrochloride is illegal in the United States, it is still used in some countries to provide pain relief. Learn More About Diacetylmorphine Hydrochloride Uses

Other, off label uses for this medicine

In 2004, the National Institute for Health and Clinical Excellence provided guidance on administering diacetylmorphine hydrochloride during caesarian section. Drug rehabilitation specialists in the United Kingdom rarely prescribe diacetylmorphine hydrochloride as a maintenance drug to treat a handful of addicts, although this practice is controversial.

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Administration/Dosage

Brand name preparations of this drug include Diamorphine, Diagesil, Diamorf, Diaphin, Diamorphine and Linctus. A nurse may administer diacetylmorphine hydrochloride subcutaneously, intramuscularly, or intravenously. Drug abusers frequently smoke diacetylmorphine hydrochloride. The typical dose is during labor and delivery is between 5 and 10 mg. It is never appropriate to administer diacetylmorphine hydrochloride to a child.

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Action

Diacetylmorphine hydrochloride is an opioid pain reliever, which means it binds to certain pain receptors in your brain and CNS, or central nervous system. Diacetylmorphine hydrochloride functions as a morphine prodrug, which means your body metabolically converts diacetylmorphine hydrochloride to morphine. Injectable diacetylmorphine hydrochloride is more fat-soluble than is morphine and therefore more potent; it takes smaller doses of diacetylmorphine hydrochloride to provide relief from pain. Tolerance to opioids builds at equal rates with diacetylmorphine hydrochloride or morphine.

Diacetylmorphine hydrochloride induces relaxation and intense euphoria. Following injection, diacetylmorphine hydrochloride crosses the blood-brain barrier within 20 seconds. About 70 percent of the injected diacetylmorphine hydrochloride reaches the brain.

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Precautions

Do not take this drug if you are allergic to other narcotics, such as morphine or oxycodone. Call an ambulance, go to the hospital or contact a doctor at first sign of an allergic reaction. A person's condition can decline swiftly and without warning after exposure to a drug allergen. Common symptoms of a mild allergic reaction include hives, especially over the face and neck, nasal congestion, itching, rashes and watery, red eyes.

Anaphylaxis is a very serious, potentially deadly form of an allergic reaction that usually occurs within minutes of exposure to the drug. Without medical help, a person can die from anaphylaxis within 15 minutes of contact.

Symptoms of a moderate or severe reaction include:

  • Abdominal Cramps or Pain.
  • Chest Discomfort or Tightness.
  • Difficulty Breathing or Wheezing.
  • Difficulty Swallowing.
  • Feeling Dizzy.
  • Feeling Light-Headed.
  • Fear or Feeling of Apprehension or Anxiety.
  • Flushing or Redness of the Face.
  • Nausea, Vomiting or Diarrhea.
  • Palpitations.
  • Swelling of the Face, Eyes or Tongue.
  • Weakness.
  • Unconsciousness

It is important your physician or rehabilitation specialist know about your significant medical history. Some medical conditions or the treatment for those conditions may change the way diacetylmorphine hydrochloride works in your system. Your condition may affect your rehabilitation from dependence on diacetylmorphine hydrochloride.

It is especially important that your doctor know if you have a history of:

  • Adrenal Insufficiency.
  • Alcoholism.
  • Asthma.
  • Decreased Kidney Function.
  • Decreased Liver Function.
  • Decreased Lung Function.
  • Delirium Tremens.
  • Enlarged Prostate.
  • History of Substance Abuse.
  • Increased Pressure in the Brain.
  • Inflammation of the Pancreas or Pancreatitis.
  • Inflammatory Bowel Disease.
  • Low Blood Pressure.
  • Low Circulating Blood Volume.
  • Seizure.
  • Underactive Thyroid.
  • Urinary Retention.

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Warnings

Do not use this medication to treat hronic obstructive pulmonary disease, commonly known as COPD. Do not use to treat pain relating to a head injury or diseases of the bile ducts. People who have taken monoamine-oxidase inhibitor antidepressants in the last 14 days should not use diacetylmorphine hydrochloride. Do not use diacetylmorphine hydrochloride if you are experiencing respiratory depression, characterized by slow and shallow breathing. During respiratory depression, your lungs do not adequately exchange oxygen for carbon dioxide. Do not use to treat tumor of the adrenal gland.

Do not take diacetylmorphine hydrochloride while pregnant or breastfeeding your baby; doing so could have a profound impact on your child. Your baby may become dependent on diacetylmorphine hydrochloride and suffer withdrawal symptoms after birth. Using diacetylmorphine hydrochloride during pregnancy may cause premature birth, lower your baby's birth weight, breathing problems, low blood sugar, bleeding within the brain and death.

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Drug Interactions

Do not use diacetylmorphine hydrochloride if you have used an MAO inhibitor in the past 14 days. Examples of MAO inhibitors include the antidepressants phenelzine, tranylcypromine and isocarboxazid. Taking diacetylmorphine hydrochloride while an MAO inhibitor is still in your system can cause a dangerous or fatal drug interaction.

Alcohol and some antipsychotic drugs such as haloperidol may enhance drowsiness associated with diacetylmorphine hydrochloride use, as can barbiturates such as phenobarbital and amobarbital. Benzodiazepines such as diazepam will increase drowsiness when taken with diacetylmorphine hydrochloride as can temazepam and other opioids such as codeine and tramadol. Sedating antihistamines such as chlorphenamine and hydroxyzine increase drowsiness associated with diacetylmorphine hydrochloride. Sleeping tablets, especially zopiclone, and tricyclic antidepressants such as amitriptyline increase the drowsy effects of diacetylmorphine hydrochloride.

Cimetidine increases the risk for breathing problems associated with diacetylmorphine hydrochloride. Diacetylmorphine hydrochloride may interfere with the way domperidone and metoclopramide work in your body. Rifampin or ritonavir could reduce the amount of diacetylmorphine hydrochloride and make it less effective.

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Side effects

People have reported side effects from using diacetylmorphine hydrochloride. Most commonly reported side effects are not serious. Common side effects include drowsiness, disorientation and delirium. One of the most damaging effects of diacetylmorphine hydrochloride is physical dependence and addiction. Some side effects of diacetylmorphine hydrochloride can be serious, life threatening medical emergencies. If you experience any serious side effect after using diacetylmorphine hydrochloride, seek immediate medical care. Serious side effects include respiratory arrest, coma and death.

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Overdose

The estimated lethal dose of diacetylmorphine hydrochloride is 200 mg but a person who has developed tolerance for diacetylmorphine hydrochloride may take up to ten times that amount. If you believe you or someone you know has taken an overdose of diacetylmorphine hydrochloride, contact poison control center at 1-800-222-1222 or go to the emergency room. Overdose symptoms include:

  • Blue Lips and Fingernails.
  • Cold, Clammy Skin.
  • Coma.
  • Confusion.
  • Constipation.
  • Delirium.
  • Disorientation.
  • Drowsiness.
  • Dry Mouth.
  • Extreme Drowsiness.
  • Hallucination.
  • Low Blood Pressure.
  • Muscle Spasms.
  • Pinpoint Pupils.
  • Seizures .
  • Stomach Pains.
  • Stopped Breathing.
  • Weak Pulse.

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Abuse

Diacetylmorphine hydrochloride is most widely abused after adulteration to its freebase form, known as heroin. Diacetylmorphine hydrochloride is a schedule I controlled substance, which means it, has a high potential for abuse. Recreational doses for diacetylmorphine hydrochloride can be as high as 100 mg.

To abuse a drug means to use it for non-medical purposes, either by using a prescription drug without a prescription to reduce symptoms or to use these drugs to get high. Prescription drug abuse is a growing problem in the United States. Drug abusers no longer prefer illegal drugs like cocaine and diacetylmorphine hydrochloride but now favor using prescription drugs to get high. According to the Centers for Disease Control and Prevention, or CDC, more than 12 million Americans admit to using narcotics for non-medical purposes in 2010. Two million of these people reported using the drugs non-medically for the first time that year. Almost all drug overdose deaths in the United States were from drugs originally legally obtained with a prescription. About 55 percent of people who abuse prescription drugs such as hydrocodone got the drugs free from a friend or relative, as compared to just over 4 percent of people who purchased opioids from a drug dealer. More than three out of four people who misuse prescription drugs abuse a medicine originally prescribed to another person. A minority of physicians prescribe the majority of opioids: approximately 20 percent of authorized prescribers write 80 percent of the prescriptions for painkillers

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Withdrawal

A 2002 report by the Centers for Disease Control and Prevention, or CDC, states that at least 980,000 Americans are addicted to diacetylmorphine hydrochloride and other opioids. Withdrawal symptoms are a normal, predictable outcome of using diacetylmorphine hydrochloride , opioids and some other substances. When you discontinue medication on which your body has grown physically dependent to, your system struggles to stabilize its chemical balance and, as a result, you feel unpleasant withdrawal symptoms. Withdrawal symptoms are a physical response to a substance. Withdrawal symptoms can be overpowering, preventing you from discontinuing diacetylmorphine hydrochloride without the help of qualified professionals. Consult with your doctor or a rehabilitation specialist if your withdrawal symptoms stop you from quitting this medication. Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities and joint stiffness. These symptoms peak between 48 and 72 hours after the last dose of diacetylmorphine hydrochloride. Sudden cessation may be fatal to heavily dependent individuals in very poor health.

Detox

Dependence on diacetylmorphine hydrochloride is a complex medical condition requiring expert rehabilitation. Treatment is especially challenging to those dependent upon diacetylmorphine hydrochloride. About 40 percent of those who use diacetylmorphine hydrochloride for recreational purposes also use cocaine. You may not be able to stop taking diacetylmorphine hydrochloride without the help of qualified professionals. Successful rehabilitation from dependence on drugs involves several components of medical care, including withdrawal management, detoxification and counseling. During standard rehabilitation, doctors prescribe medicines to ease withdrawal symptoms, cleanse the body of drugs and restore the body's chemical balance before the patient attends counseling sessions to address any issues that may have contributed to or were the result of drug abuse. Methadone and buprenorphine are effective tools in rehabilitation from dependence on diacetylmorphine hydrochloride. One dose of methadone blocks the effects of diacetylmorphine hydrochloride for about 24 hours. The CDC notes that those who discontinue methadone maintenance treatment later relapse and start using drugs again.

Rapid detox is a more advance and humane form of detoxification. During rapid detox, specially trained physicians administer the standard detoxification and anti-withdrawal drugs along with anesthesia and sedatives so that the patient sleeps through the demoralizing and overwhelmingly unpleasant withdrawal symptoms. Rapid detox helps the patient retain a sense of dignity and self-worth that often deteriorates with standard slow and painful methods of detoxification. After rapid detox, the patient awakens with no recollection of withdrawal. Learn More About Diacetylmorphine Hydrochloride Detoxification Programs

Storage

Put diacetylmorphine hydrochloride out of the reach of children and pets. Do not allow adults to use this product willingly or by mistake. Diacetylmorphine hydrochloride is a controlled substance with the highest potential for abuse. To reduce the risk for theft, do not tell anyone other than a trusted caregiver that you have diacetylmorphine hydrochloride in your home.

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Miscellaneous information

In 1895, the Bayer Company marketed diacetylmorphine hydrochloride as an over-the-counter drug under the brand name Heroin. Makers derived the name from the Greek word "heros" because of the heroic effect it imparted to users. Bayer developed diacetylmorphine hydrochloride as an alternative to morphine as a cough suppressant because diacetylmorphine hydrochloride has fewer associated side effects. While Bayer marketed diacetylmorphine hydrochloride as being non-addictive, heroin would soon have the highest dependency rate of all opioids of the time.

Diacetylmorphine hydrochloride is derived from opium poppies. Presently, most poppies are grown in Afghanistan and Southeast Asia. Afghanistan is the largest producer. By 1980, 60 percent of the heroin sold in the United States came from Afghanistan. Opium production peaked in 1999. In 2000, the Taliban outlawed opium, a move that reduced production by 94 percent. Removal of the Taliban in that country has caused a resurgence in poppy production that results in more opium and diacetylmorphine hydrochloride.

Miscellaneous Information About Diacetylmorphine Hydrochloride