120-415: A smoking room (or smoking lounge ) is a room which is specifically provided and furnished for smoking , generally in buildings where smoking is otherwise prohibited. Smoking rooms can be found in public buildings such as airports , and in semi-public buildings such as workplaces. Such rooms are commonly equipped with chairs, ashtrays and ventilation, and are usually free to enter, although there may be
240-550: A cash crop . The demand quickly grew as tobacco, referred to as "golden weed", revived the Virginia Company from its failed expeditions in search for gold in the Americas. In order to meet demands from the old world, tobacco was grown in succession, quickly depleting the land. This became a motivator to settle west into the unknown continent, and likewise an expansion of tobacco production. Indentured servants became
360-400: A maintenance drug to assist the treatment of opiate addiction, normally in long-term chronic intravenous (IV) heroin users. It is only prescribed following exhaustive efforts at treatment via other means. It is sometimes thought that heroin users can walk into a clinic and walk out with a prescription, but the process takes many weeks before a prescription for diamorphine is issued. Though this
480-488: A prodrug for the systemic delivery of morphine. When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood–brain barrier because of the presence of the acetyl groups, which render it much more fat soluble than morphine itself. Once in the brain, it then is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), and then to morphine, which bind to μ-opioid receptors , resulting in
600-408: A rush as a forerunner to the high experienced with the use of heroin, which is most pronounced with intravenous use. While the onset of the rush induced by injection can occur in as little as a few seconds, the oral route of administration requires approximately half an hour before the high sets in. Thus, with both higher the dosage of heroin used and faster the route of administration used, the higher
720-404: A smoking age restriction. A cigarette company sometimes sponsors these smoking rooms, displaying its brand names on the room walls and financing the room or its maintenance. Cigarette companies have worked hard to ensure smoking was accommodated in major airports, which are high-profile locations serving many people who are often bored or nervous. Initially, providing smoking and no smoking areas
840-493: A comfortable velvet smoking jacket and cap . The velvet was intended to absorb the smoke, to avoid contaminating other rooms and clothes. In the United Kingdom smoking became illegal on 1 July 2007 in any enclosed public place, so that smoking rooms cannot be provided and facilities must be outdoors; apart from private homes, almost the only legal exception is for smoking rooms in tobacconists where customers may sample
960-474: A fast onset. Snorting heroin becomes an often unwanted route, once a user begins to inject the drug. The user may still get high on the drug from snorting, and experience a nod, but will not get a rush. A "rush" is caused by a large amount of heroin entering the body at once. When the drug is taken in through the nose, the user does not get the rush because the drug is absorbed slowly rather than instantly. Heroin for pain has been mixed with sterile water on site by
1080-426: A fetus. Smoking is a risk factor strongly associated with periodontitis and tooth loss . The effects of smoking on periodontal tissues depend on the number of cigarettes smoked daily and the duration of the habit. A study showed that smokers had 2.7 times and former smokers 2.3 times greater probabilities to have established periodontal disease than non‐smokers, independent of age, sex and plaque index, however,
1200-539: A few addicts who have tried methadone and buprenorphine without success. Beginning in February 2010, addicts in Copenhagen and Odense became eligible to receive free diamorphine. Later in 2010, other cities including Århus and Esbjerg joined the scheme. It was estimated that around 230 addicts would be able to receive free diamorphine. However, Danish addicts would only be able to inject heroin according to
1320-467: A heart attack, as well as in opioid replacement therapy . Medical-grade diamorphine is used as a pure hydrochloride salt . Various white and brown powders sold illegally around the world as heroin are routinely diluted with cutting agents . Black tar heroin is a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin. Heroin
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#17327724906381440-559: A history of long-term use, opioid withdrawal symptoms can begin within hours of the last use. When given by injection into a vein, heroin has two to three times the effect of a similar dose of morphine . It typically appears in the form of a white or brown powder. Treatment of heroin addiction often includes behavioral therapy and medications. Medications can include buprenorphine , methadone , or naltrexone . A heroin overdose may be treated with naloxone . As of 2015, an estimated 17 million people use opiates, of which heroin
1560-469: A law allowing diamorphine prescription as a standard treatment for addicts; a large-scale trial of diamorphine prescription had been authorized in the country in 2002. On 26 August 2016, Health Canada issued regulations amending prior regulations it had issued under the Controlled Drugs and Substances Act ; the "New Classes of Practitioners Regulations", the "Narcotic Control Regulations", and
1680-608: A more common cause of drug-related deaths. Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours. Death usually occurs due to lack of oxygen resulting from the lack of breathing caused by the opioid. Heroin overdoses can occur because of an unexpected increase in the dose or purity or because of diminished opioid tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other depressant drugs such as alcohol or benzodiazepines . Since heroin can cause nausea and vomiting,
1800-577: A natural product of the opium poppy . Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs , and it is generally illegal to make, possess, or sell without a license. About 448 tons of heroin were made in 2016. In 2015, Afghanistan produced about 66% of the world's opium. Illegal heroin is often mixed with other substances such as sugar, starch , caffeine , quinine , or other opioids like fentanyl . Bayer 's original trade name of heroin
1920-563: A new type of social activity and a form of drug intake which previously had been unknown. Perception surrounding smoking has varied over time and from one place to another: holy and sinful, sophisticated and vulgar, a panacea and deadly health hazard. In the last decade of the 20th century, smoking came to be viewed in a decidedly negative light, especially in Western countries. The history of smoking dates back to as early as 5000 BCE for shamanistic rituals. Many ancient civilizations, such as
2040-499: A period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in an overdose. It has been speculated that an unknown portion of heroin-related deaths are the result of an overdose or allergic reaction to quinine , which may sometimes be used as a cutting agent. When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation , making it
2160-409: A result of smoking. The risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female current smoker, in the absence of competing causes of death. The corresponding estimates for lifelong nonsmokers are a 1.1% probability of dying from lung cancer before age 85 for a man of European descent, and a 0.8% probability for a woman. Smoking just one cigarette a day results in
2280-415: A risk of coronary heart disease that is halfway between that of a heavy smoker and a non-smoker. The non-linear dose–response relationship may be explained by smoking's effect on platelet aggregation . Among the diseases that can be caused by smoking are vascular stenosis , lung cancer, heart attacks and chronic obstructive pulmonary disease (COPD). Smoking during pregnancy may cause ADHD to
2400-451: A robust economy caused many potential consumers to give up or fail to take up the habit. Recent years shows an increase in the consumption of vaporized heroin, methamphetamine and Phencyclidine (PCP). Along with a smaller number of psychedelic drugs such as Changa , DMT , 5-Meo-DMT , and Salvia divinorum . The most popular type of substance that is smoked is tobacco . There are many different tobacco cultivars which are made into
2520-483: A significant number of deaths attributed to heroin overdose are caused by aspiration of vomit by an unconscious person. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 600 mg. Illicit heroin is of widely varying and unpredictable purity. This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended. Also, tolerance typically decreases after
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#17327724906382640-412: A staunch anti-smoker and the author of A Counterblaste to Tobacco , tried to curb the new trend by enforcing a whopping 4000% tax increase on tobacco in 1604, it proved a failure, as London had some 7,000 tobacco sellers by the early 17th century. Later, scrupulous rulers would realise the futility of smoking bans and instead turned tobacco trade and cultivation into lucrative government monopolies. By
2760-428: A tightly rolled tube of paper, usually manufactured industrially and including a filter , or hand-rolled with loose tobacco. Other popular smoking tools are various pipes and cigars. A less common but increasingly popular alternative to smoking is vaporizers, which use hot air convection to deliver the substance without combustion, which may reduce health risks. A portable vaporization alternative appeared in 2003 with
2880-471: A trial diamorphine maintenance program for users that had failed multiple withdrawal programs. The aim of this program was to maintain the health of the user by avoiding medical problems stemming from the illicit use of diamorphine. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000, based on the apparent success of the program. The trials proved diamorphine maintenance to be superior to other forms of treatment in improving
3000-402: A variable single dose range using a hypodermic needle . The dose of heroin used for recreational purposes is dependent on the frequency and level of use. As with the injection of any drug, if a group of users share a common needle without sterilization procedures, blood-borne diseases, such as HIV/AIDS or hepatitis , can be transmitted. The use of a common dispenser for water for the use in
3120-538: A whole range of causes; vascular abnormalities such as stenosis , lung cancer, heart attacks, strokes, impotence , low birth weight of infants born by smoking mothers . 8% of long-term smokers develop the characteristic set of facial changes known to doctors as smoker's face . Tobacco smoke is a complex mixture of over 5,000 identified chemicals, of which 98 are known to have specific toxicological properties. The most important chemicals causing cancer are those that produce DNA damage since such damage appears to be
3240-402: A wide variety of mixtures and brands. Tobacco is often sold flavored, often with various fruit aromas, something which is especially popular for use with water pipes, such as hookahs . The second most common substance that is smoked is cannabis , made from the flowers or leaves of Cannabis sativa or Cannabis indica . The substance is considered illegal in most countries in the world and in
3360-458: Is also sometimes regulated to make smoking less appealing. Despite the many bans, European countries still hold 18 of the top 20 spots, and according to the ERC, a market research company, the heaviest smokers are from Greece, averaging 3,000 cigarettes per person in 2007. Rates of smoking have leveled off or declined in the developed world but continue to rise in developing countries. Smoking rates in
3480-787: Is among the leading causes of many diseases such as lung cancer , heart attack , COPD , erectile dysfunction , and birth defects . Diseases related to tobacco smoking have been shown to kill approximately half of long-term smokers when compared to average mortality rates faced by non-smokers. Smoking caused over five million deaths a year from 1990 to 2015. Non-smokers account for 600,000 deaths globally due to second-hand smoke . The health hazards of smoking have caused many countries to institute high taxes on tobacco products, publish advertisements to discourage use, limit advertisements that promote use, and provide help with quitting for those who do smoke. Smoking can be dated to as early as 5000 BCE, and has been recorded in many different cultures across
3600-405: Is attracting public attention. In the early 1980s, organized international trafficking of cocaine grew. However, overproduction and tighter legal enforcement for the illegal product caused drug dealers to convert the powder to "crack" – a solid, smokable form of cocaine that could be sold in smaller quantities to more people. This trend abated in the 1990s as increased police action coupled with
3720-466: Is clouded; heart function slows, and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage . Heroin use has also been associated with myocardial infarction . Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of
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3840-415: Is heated by a flame underneath it, with the resulting smoke inhaled through a tube of rolled up foil, a method also known as " chasing the dragon ". Another popular route to intake heroin is insufflation (snorting), where a user crushes the heroin into a fine powder and then gently inhales it (sometimes with a straw or a rolled-up banknote , as with cocaine) into the nose, where heroin is absorbed through
3960-418: Is higher than expected. Users report an intense rush , an acute transcendent state of euphoria , which occurs while diamorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin – although a more likely explanation
4080-498: Is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent. Heroin is entirely converted to morphine by means of first-pass metabolism , resulting in deacetylation when ingested. Heroin's oral bioavailability is both dose-dependent (as is morphine's) and significantly higher than oral use of morphine itself, reaching up to 64.2% for high doses and 45.6% for low doses; opiate-naive users showed far less absorption of
4200-404: Is more fat soluble and therefore more potent by injection, so smaller doses of it are needed for the same effect on pain. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary for palliative care. It is also used in the palliative management of bone fractures and other trauma, especially in children. In the trauma context, it
4320-699: Is more common to use morphine or other strong opioids in these situations. In 2004, the National Institute for Health and Clinical Excellence produced guidance on the management of caesarean section , which recommended the use of intrathecal or epidural diamorphine for post-operative pain relief . For women who have had intrathecal opioids, there should be a minimum hourly observation of respiratory rate, sedation and pain scores for at least 12 hours for diamorphine and 24 hours for morphine. Women should be offered diamorphine (0.3–0.4 mg intrathecally) for intra- and postoperative analgesia because it reduces
4440-629: Is one of the leading preventable causes of deaths globally and is the cause of over 8 million deaths annually, 1.2 million of which are non-smokers who die due to second-hand smoke . In the United States, about 500,000 deaths per year are attributed to smoking-related diseases and a recent study estimated that as much as one-third of China's male population will have significantly shortened lifespans due to smoking. Male and female smokers lose an average of 13.2 and 14.5 years of life, respectively. At least half of all lifelong smokers die earlier as
4560-802: Is one of the most common forms of recreational drug use . Tobacco smoking is the most popular form, being practised by over one billion people globally, of whom the majority are in the developing countries . Less common drugs for smoking include cannabis and opium . Some of the substances are classified as hard narcotics , like heroin , but the use of these is very limited as they are usually not commercially available. Cigarettes are primarily industrially manufactured but also can be hand-rolled from loose tobacco and rolling paper . Other smoking implements include pipes , cigars , bidis , hookahs , and bongs. Smoking has negative health effects , because smoke inhalation inherently poses challenges to various physiologic processes such as respiration . Smoking tobacco
4680-415: Is primarily given by nose in hospital; although a prepared nasal spray is available. It has traditionally been made by the attending physician, generally from the same "dry" ampoules as used for injection. In children, Ayendi nasal spray is available at 720 micrograms and 1600 micrograms per 50 microlitres actuation of the spray, which may be preferable as a non-invasive alternative in pediatric care, avoiding
4800-544: Is reduced abruptly. Intravenous use of heroin (and any other substance) with needles and syringes or other related equipment may lead to: The withdrawal syndrome from heroin may begin within as little as two hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose, and more typically begins within 6–24 hours after cessation. Symptoms may include sweating , malaise , anxiety, depression, akathisia , priapism , extra sensitivity of
4920-517: Is somewhat controversial among proponents of a zero-tolerance drug policy , it has proven superior to methadone in improving the social and health situations of addicts. The UK Department of Health's Rolleston Committee Report in 1926 established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing. In 1964,
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5040-512: Is the most common, and opioid use resulted in 122,000 deaths; also, as of 2015, the total number of heroin users worldwide is believed to have increased in Africa, the Americas, and Asia since 2000. In the United States, approximately 1.6 percent of people have used heroin at some point. When people die from overdosing on a drug, the drug is usually an opioid and often heroin. Heroin was first made by C. R. Alder Wright in 1874 from morphine,
5160-410: Is the rapidity of onset. While other opioids of recreational use produce only morphine, heroin also leaves 6-MAM, also a psycho- active metabolite . However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over
5280-409: Is to discourage smoking among minors and many states have passed laws against selling tobacco products to underage customers (establishing a smoking age ). Many developing countries have not adopted anti-smoking policies, leading some to call for anti-smoking campaigns and further education to explain the negative effects of ETS (Environmental Tobacco Smoke) in developing countries. Tobacco advertising
5400-648: Is typically injected , usually into a vein , but it can also be snorted, smoked, or inhaled. In a clinical context, the route of administration is most commonly intravenous injection ; it may also be given by intramuscular or subcutaneous injection, as well as orally in the form of tablets. The onset of effects is usually rapid and lasts for a few hours. Common side effects include respiratory depression (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and addiction . Use by injection can also result in abscesses , infected heart valves , blood-borne infections , and pneumonia . After
5520-450: Is typically used in non-medical settings. It is used as a recreational drug for the euphoria it induces. Anthropologist Michael Agar once described heroin as "the perfect whatever drug." Tolerance develops quickly, and increased doses are needed in order to achieve the same effects. Its popularity with recreational drug users, compared to morphine , reportedly stems from its perceived different effects. Short-term addiction studies by
5640-644: The American Civil War in the 1860s, from which the primary labor force transition from slavery to sharecropping . This compounded with a change in demand, lead to the industrialization of tobacco production with the cigarette. James Albert Bonsack , a craftsman, in 1881 produced a machine to speed the production of cigarettes. In the 19th century, the practise of smoking opium became widespread in China . Previously, opium had only been ingested via consumption, and then only for its medicinal properties (opium
5760-517: The Brain Committee recommended that only selected approved doctors working at approved specialized centres be allowed to prescribe diamorphine and cocaine to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently, only a small number of users in the UK are prescribed diamorphine. In 1994, Switzerland began
5880-632: The Great Depression , Adolf Hitler condemned his earlier smoking habit as a waste of money, and later with stronger assertions. This movement was further strengthened with Nazi reproductive policy as women who smoked were viewed as unsuitable to be wives and mothers in a German family. The movement in Nazi Germany did reach across enemy lines during the Second World War, as anti-smoking groups quickly lost popular support. By
6000-685: The Ming dynasty . Later, the Manchu rulers of the Qing dynasty , would proclaim smoking "a more heinous crime than that even of neglecting archery". In Edo period Japan, some of the earliest tobacco plantations were scorned by the shōgun as being a threat to the military economy by letting valuable farmland go to waste for the use of a recreational drug instead of being used to plant food crops. Religious leaders have often been prominent among those who considered smoking immoral or outright blasphemous. In 1634,
6120-460: The Patriarch of Moscow and all Rus' forbade the sale of tobacco and sentenced men and women who flouted the ban to have their nostrils slit and their backs whipped until skin came off their backs. The Western church leader Pope Urban VII likewise condemned smoking in a papal bull of 1590. Despite many concerted efforts, restrictions and bans were almost universally ignored. When James VI and I ,
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#17327724906386240-648: The United States , heroin is not accepted as medically useful. Under the generic name diamorphine, heroin is prescribed as a strong pain medication in the United Kingdom , where it is administered via oral , subcutaneous , intramuscular , intrathecal , intranasal or intravenous routes. It may be prescribed for the treatment of acute pain, such as in severe physical trauma , myocardial infarction , post- surgical pain and chronic pain , including end-stage terminal illnesses . In other countries it
6360-516: The developing countries , however, tobacco consumption continues to rise at 3.4% in 2002. In Africa, smoking is in most areas considered to be modern, and many of the strong adverse opinions that prevail in the West receive much less attention. Today Russia leads as the top consumer of tobacco followed by Indonesia , Laos , Ukraine , Belarus , Greece , Jordan , and China . At the global scale, initial ideas of an international convention towards
6480-505: The east-coast United States is most commonly found in the hydrochloride salt form, requiring just water (and no heat) to dissolve. Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, users resort to more dangerous areas of the body, such as the femoral vein in the groin. Some medical professionals have expressed concern over this route of administration, as they suspect that it can lead to deep vein thrombosis . Intravenous users can use
6600-457: The opiates (including heroin and morphine ). Smoking is a risk factor in Alzheimer's disease . While smoking more than 15 cigarettes per day has been shown to worsen the symptoms of Crohn's disease , smoking has been shown to actually lower the prevalence of ulcerative colitis . Smokers are 30-40% more likely to develop type 2 diabetes than non-smokers, and the risk increases with
6720-537: The respiratory tract , where they are rapidly absorbed into the bloodstream of the lungs and then reach the central nervous system . In the case of tobacco smoking , these active substances are a mixture of aerosol particles that includes the pharmacologically active alkaloid nicotine , which stimulates the nicotinic acetylcholine receptors in the brain . Other notable active substances inhaled via smoking include tetrahydrocannabinol (from cannabis ), morphine (from opium ) and cocaine (from crack ). Smoking
6840-422: The route of administration . Smoking is the fastest route of drug administration, although intravenous injection results in a quicker rise in blood concentration. These are followed by suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing). A 2002 study suggests that a fast onset of action increases the reinforcing effects of addictive drugs. Ingestion does not produce
6960-401: The tobacco plant, which have been rolled with a small rectangle of paper into an elongated cylinder called a cigarette . Other forms of smoking include the use of a smoking pipe or a bong . Smoking is primarily practised as a route of administration for psychoactive chemicals because the active substances within the burnt dried plant leaves vaporize and can be airborne-delivered into
7080-667: The "Food and Drug Regulations", to allow doctors to prescribe diamorphine to people who have a severe opioid addiction who have not responded to other treatments. The prescription heroin can be accessed by doctors through Health Canada 's Special Access Programme (SAP) for "emergency access to drugs for patients with serious or life-threatening conditions when conventional treatments have failed, are unsuitable, or are unavailable." Medicinal uses: Neurological: Psychological: Cardiovascular & Respiratory: Gastrointestinal: Musculoskeletal: Skin: Miscellaneous: The onset of heroin's effects depends upon
7200-519: The 1650s. Soon after its introduction to the Old World , tobacco came under frequent criticism from state and religious leaders. Murad IV , sultan of the Ottoman Empire 1623–40 was among the first to attempt a smoking ban by claiming it was a threat to public morality and health. The Chongzhen Emperor of China issued an edict banning smoking two years before his death and the overthrow of
7320-417: The 1920s, adverse health effects began to become more prevalent. In Germany, anti-smoking groups, often associated with anti-liquor groups, first published advocacy against the consumption of tobacco in the journal Der Tabakgegner (The Tobacco Opponent) in 1912 and 1932. In 1929, Fritz Lickint of Dresden, Germany, published a paper containing formal statistical evidence of a lung cancer–tobacco link. During
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#17327724906387440-549: The Babylonian and Chinese, burnt incense as a part of religious rituals, as did the Israelites and the later Catholic and Orthodox Christian churches. Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure, or as a social tool. The smoking of tobacco, as well as various hallucinogenic drugs, was used to achieve trances and to come into contact with
7560-814: The First and Second Opium Wars resulted in the legalization of the importation of opium into China. Opium smoking later spread with Chinese immigrants and spawned many infamous opium dens in Chinatowns around South and Southeast Asia, Europe and the Americas. In the latter half of the 19th century, opium smoking became popular in the artistic community in Europe, especially Paris; artists' neighborhoods such as Montparnasse and Montmartre became virtual "opium capitals". While opium dens that catered primarily to emigrant Chinese continued to exist in Chinatowns around
7680-451: The UK. Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin lethal overdose was accidental, suicide or homicide. Examples include the overdose deaths of Sid Vicious , Janis Joplin , Tim Buckley , Hillel Slovak , Layne Staley , Bradley Nowell , Ted Binion , and River Phoenix . Use of heroin by mouth
7800-525: The United States have dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults. The effects of addiction on society vary considerably between different substances that can be smoked and the indirect social problems that they cause, in great part because of the differences in legislation and the enforcement of narcotics legislation around the world. Though nicotine is a highly addictive drug, its effects on cognition are not as intense or noticeable as other drugs such as cocaine, amphetamines or any of
7920-400: The actual habit is a function of operant conditioning . During the early stages, smoking provides pleasurable sensations (because of its action on the dopamine system) and thus serves as a source of positive reinforcement . After an individual has smoked for many years, the avoidance of withdrawal symptoms and negative reinforcement become the key motivations. Like all addictive substances,
8040-513: The adverse health effects were previously unknown or lacked substantial credibility. Health authorities sided with these claims up until 1998, from which they reversed their position. The Tobacco Master Settlement Agreement , originally between the four largest US tobacco companies and the Attorneys General of 46 states, restricted certain types of tobacco advertisement and required payments for health compensation; which later amounted to
8160-502: The amount of exposure required to become dependent on nicotine can vary from person to person. Heroin Heroin , also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the dried latex of the opium poppy ; it is mainly used as a recreational drug for its euphoric effects. Heroin is used medically in several countries to relieve pain , such as during childbirth or
8280-406: The anus or vagina before the plunger is pushed. The rectum or the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining their walls. Heroin is classified as a hard drug in terms of drug harmfulness . Like most opioids , unadulterated heroin may lead to adverse effects . The purity of street heroin varies greatly, leading to overdoses when the purity
8400-544: The apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. In the mid-20th century psychologists such as Hans Eysenck developed a personality profile for the typical smoker of that period; extraversion was associated with smoking, and smokers tended to be sociable, impulsive, risk taking, and excitement-seeking individuals. Although personality and social factors may make people likely to smoke,
8520-496: The area of a tennis court). This can be used to administer useful medical as well as recreational drugs such as aerosols, consisting of tiny droplets of a medication, or as gas produced by burning plant material with a psychoactive substance or pure forms of the substance itself. Not all drugs can be smoked, for example the sulphate derivative that is most commonly inhaled through the nose, though purer free base forms of substances can, but often require considerable skill in administering
8640-562: The attending physician, and administered using a syringe with a nebulizer tip. Heroin may be used for fractures, burns, finger-tip injuries, suturing, and wound re-dressing, but is inappropriate in head injuries. Little research has been focused on the suppository (anal insertion) or pessary (vaginal insertion) methods of administration, also known as "plugging". These methods of administration are commonly carried out using an oral syringe . Heroin can be dissolved and withdrawn into an oral syringe which may then be lubricated and inserted into
8760-438: The brain's white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations. Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects. With physical dependence , the body adapts to the presence of the drug , and withdrawal symptoms occur if use
8880-963: The countries that tolerate public consumption, it is sometimes only pseudo-legal. Despite this, a considerable percentage of the adult population in many countries have tried it with smaller minorities doing it on a regular basis. Since cannabis is illegal or only tolerated in many jurisdictions, there is no industrial mass-production of cigarettes, meaning that the most common form of smoking is with hand-rolled cigarettes (often called joints ) or with pipes. Water pipes are also fairly common; water pipes used for cannabis include designs known as bongs and bubblers, among others. A few other recreational drugs are smoked by smaller minorities. Most of these substances are controlled , and some are considerably more intoxicating than either tobacco or cannabis. These include crack cocaine , heroin, methamphetamine and PCP . A small number of psychedelic drugs are also smoked, including DMT , 5-Meo-DMT , and Salvia divinorum . Even
9000-560: The credibility of this increase was sometimes disputed as late as 1950. For example, in Connecticut, reported age-adjusted incidence rates of lung cancer among males increased 220% between 1935–39 and 1950–54. In the UK, the share of lung cancer among all cancer deaths in men increased from 1.5% in 1920 to 19.7% in 1947. Nevertheless, these increases were questioned as potentially caused by increased reporting and improved methods of diagnosis. Although several carcinogens were already known at
9120-642: The drug at low doses, having bioavailabilities of only up to 22.9%. The maximum plasma concentration of morphine following oral administration of heroin was around twice as much as that of oral morphine. Injection , also known as "slamming", "banging", "shooting up", "digging" or "mainlining", is a popular method which carries relatively greater risks than other methods of administration. Heroin base (commonly found in Europe), when prepared for injection, will only dissolve in water when mixed with an acid (most commonly citric acid powder or lemon juice) and heated. Heroin in
9240-399: The drug properly. The method is also somewhat inefficient since not all of the smoke will be inhaled. The inhaled substances trigger chemical reactions in nerve endings in the brain due to being similar to naturally occurring substances such as endorphins and dopamine , which are associated with sensations of pleasure. The result is what is usually referred to as a "high" that ranges between
9360-404: The effect of tobacco on periodontal tissues seems to be more pronounced in men than in women. Studies have found that smokers had greater odds for more severe dental bone loss compared to non‐smokers; also, people who smoke and drink alcohol heavily have much higher risk of developing oral cancer (mouth and lip) compared with people who do neither. Smoking can also cause milanosis in
9480-400: The effects of heroin and causes an immediate return of consciousness but may result in withdrawal symptoms. The half-life of naloxone is shorter than some opioids, such that it may need to be given multiple times until the opioid has been metabolized by the body. Between 2012 and 2015, heroin was the leading cause of drug-related deaths in the United States. Since then, fentanyl has been
9600-558: The end of the 20th century, anti-smoking campaigns in Germany were unable to exceed the effectiveness of the Nazi-era climax in the years 1939–41 and German tobacco health research was described by Robert N. Proctor as "muted". In the UK and the US, an increase in lung cancer rates, formerly "among the rarest forms of disease", was noted by the 1930s, but its cause remained unknown and even
9720-642: The end of the Second World War, American cigarette manufacturers quickly reentered the German black market. Illegal smuggling of tobacco became prevalent, and leaders of the Nazi anti-smoking campaign were assassinated. As part of the Marshall Plan , the United States shipped free tobacco to Germany; with 24,000 tons in 1948 and 69,000 tons in 1949. Per capita yearly cigarette consumption in post-war Germany steadily rose from 460 in 1950 to 1,523 in 1963. By
9840-639: The existence of pipes to smoke opium in Cyprus and Crete as soon as the Bronze Age . Cannabis smoking was common in the Middle East before the arrival of tobacco, and was early on a common social activity that centered around the type of water pipe called a hookah . Smoking, especially after the introduction of tobacco, was an essential component of Muslim society and culture and became integrated with important traditions such as weddings, funerals and
9960-495: The fear of injection in children. A number of European countries prescribe heroin for treatment of heroin addiction . The initial Swiss HAT ( heroin-assisted treatment ) trial ("PROVE" study) was conducted as a prospective cohort study with some 1,000 participants in 18 treatment centers between 1994 and 1996, at the end of 2004, 1,200 patients were enrolled in HAT in 23 treatment centers across Switzerland. Diamorphine may be used as
10080-429: The genitals in females, general feeling of heaviness, excessive yawning or sneezing, rhinorrhea , insomnia , cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps, watery eyes, fever, cramp-like pains, and involuntary spasms in the limbs (thought to be an origin of the term "kicking the habit" ). Heroin overdose is usually treated with the opioid antagonist naloxone . This reverses
10200-408: The harmful long-term effects of smoking. Passive smoking , or secondhand smoking, which affects people in the immediate vicinity of smokers, is a major reason for the enforcement of smoking bans . These are laws enforced to stop individuals from smoking in indoor public places, such as bars, pubs and restaurants, thus reducing nonsmokers' exposure to secondhand smoke. A common concern among legislators
10320-702: The introduction of electronic cigarettes , battery-operated, cigarette-shaped devices which produce an aerosol intended to mimic the smoke from burning tobacco, delivering nicotine to the user without some of the harmful substances released in tobacco smoke. Other than actual smoking equipment, many other items are associated with smoking; cigarette cases , cigar boxes , lighters , matchboxes , cigarette holders , cigar holders, ashtrays , silent butlers , pipe cleaners , tobacco cutters, match stands, pipe tampers, cigarette companions and so on. Some examples of these have become valuable collector items and particularly ornate and antique items can fetch high prices. Smoking
10440-630: The largest civil settlement in United States history. From 1965 to 2006, rates of smoking in the United States have declined from 42% to 20.8%. A significant majority of those who quit were professional, affluent men. Despite this decrease in the prevalence of consumption, the average number of cigarettes consumed per person per day increased from 22 in 1954 to 30 in 1978. This paradoxical event suggests that those who quit smoked less, while those who continued to smoke moved to smoke more light cigarettes. This trend has been paralleled by many industrialized nations as rates have either leveled-off or declined. In
10560-537: The link, based on which the government issued advice that smoking and lung cancer rates were related. In 1964 the United States Surgeon General 's Report on Smoking and Health demonstrated the relationship between smoking and cancer. Further reports confirmed this link in the 1980s and concluded in 1986 that passive smoking was also harmful. As scientific evidence mounted in the 1980s, tobacco companies claimed contributory negligence as
10680-402: The mid-17th century every major civilization had been introduced to tobacco smoking and in many cases had already assimilated it into its culture, despite the attempts of many rulers to stamp the practice out with harsh penalties or fines. Tobacco, both product, and plant followed the major trade routes to major ports and markets, and then on into the hinterlands. The English language term smoking
10800-523: The mild stimulus caused by nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines . Inhaling smoke into the lungs, no matter the substance, has adverse effects on one's health. The incomplete combustion produced by burning plant material, like tobacco or cannabis, produces carbon monoxide , which impairs the ability of blood to carry oxygen when inhaled into the lungs. There are several other toxic compounds in tobacco that constitute serious health hazards to long-term smokers from
10920-403: The most primitive form of smoking requires tools of some sort to perform. This has resulted in a staggering variety of smoking tools and paraphernalia from all over the world. Whether tobacco, cannabis, opium or herbs, some form of receptacle is required along with a source of fire to light the mixture. The most common today is by far the cigarette, consisting of a mild inhalant strain of tobacco in
11040-487: The mouth. Smoking has been also associated with oral conditions including dental caries , dental implant failures , premalignant lesions , and cancer . Smoking can affect the immune-inflammatory processes which may increase susceptibility to infections; it can alter the oral mycobiota and facilitate colonization of the oral cavity with fungi and pathogenic molds. Many governments are trying to deter people from smoking with anti-smoking campaigns in mass media stressing
11160-404: The need for supplemental analgesia after a caesarean section. Epidural diamorphine (2.5–5 mg) is a suitable alternative. Diamorphine continues to be widely used in palliative care in the UK, where it is commonly given by the subcutaneous route, often via a syringe driver if patients cannot easily swallow morphine solution . The advantage of diamorphine over morphine is that diamorphine
11280-462: The number of cigarettes smoked. Inhaling the vaporized gas form of substances into the lungs is a quick and very effective way of delivering drugs into the bloodstream (as the gas diffuses directly into the pulmonary vein, then into the heart and from there to the brain) and affects the user within less than a second of the first inhalation. The lungs consist of several million tiny bulbs called alveoli that altogether have an area of over 70 m (about
11400-462: The other. Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness. The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities. Nausea , vomiting , and severe itching may also occur. After the initial effects, users usually will be drowsy for several hours; mental function
11520-485: The policy set by Danish National Board of Health . Of the estimated 1500 drug users who did not benefit from the then-current oral substitution treatment, approximately 900 would not be in the target group for treatment with injectable diamorphine, either because of "massive multiple drug abuse of non-opioids" or "not wanting treatment with injectable diamorphine". In July 2009, the German Bundestag passed
11640-409: The potential risk for psychological dependence / addiction . Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer Harold Shipman used diamorphine on his victims, and the subsequent Shipman Inquiry led to a tightening of the regulations surrounding the storage, prescribing and destruction of controlled drugs in
11760-500: The preparation of the injection, as well as the sharing of spoons and filters can also cause the spread of blood-borne diseases. Many countries now supply small sterile spoons and filters for single use in order to prevent the spread of disease. Smoking heroin refers to vaporizing it to inhale the resulting fumes, rather than burning and inhaling the smoke. It is commonly smoked in glass pipes made from glassblown Pyrex tubes and light bulbs. Heroin may be smoked from aluminium foil that
11880-710: The prevention of tobacco had been initiated in the World Health Assembly (WHA) in 1996. In 1998, along with the successful election of Dr. Gro Harlem Brundtland as the Director-General, the World Health Organization set tobacco control as its leading health concern and has begun a program known as the Tobacco Free Initiative (TFI) in order to reduce rates of consumption in the developing world. However, it
12000-701: The primary labor force up until Bacon's Rebellion , from which the focus turned to slavery . This trend abated following the American Revolution as slavery became regarded as unprofitable. However the practice was revived in 1794 with the invention of the cotton gin. A Frenchman named Jean Nicot (from whose name the word nicotine is derived) introduced tobacco to France in 1560. From France tobacco spread to England. The first report documents an English sailor in Bristol in 1556, seen "emitting smoke from his nostrils". Like tea, coffee and opium, tobacco
12120-871: The primary underlying cause of cancer. Cunningham et al. combined the microgram weight of the compound in the smoke of one cigarette with the known genotoxic effect per microgram to identify the most carcinogenic compounds in cigarette smoke. The seven most important carcinogens in tobacco smoke are shown in the table, along with DNA alterations they cause. Most tobacco smokers begin during adolescence or early adulthood. Smoking has elements of risk-taking and rebellion, which often appeal to young people. The presence of high-status models and peers may also encourage smoking. Because teenagers are influenced more by their peers than by adults, attempts by parents, schools, and health professionals at preventing people from trying cigarettes are not always successful. Smokers often report that cigarettes help relieve feelings of stress. However,
12240-443: The reinforcement of tobacco taxes and the implementation of smoke-free laws in 128 countries that led to the decrease of smoking prevalence in developing nations. In Nepal, "Smokers are not selfish", a health campaign lasting two weeks is started on the occasion of Valentine day and Vasant panchami to motiviate individuals to quit smoking as a sacrifice for their loved ones and making it a meaningful decision of life. This campaign
12360-521: The same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine. When compared to the opioids hydromorphone , fentanyl , oxycodone , and pethidine (meperidine), former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to misuse and causing dependence. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids. In
12480-444: The social and health situation for this group of patients. It has also been shown to save money, despite high treatment expenses, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency . Patients appear twice daily at a treatment center, where they inject their dose of diamorphine under the supervision of medical staff. They are required to contribute about 450 Swiss francs per month to
12600-427: The soft tissue in the mucous membrane of the sinus cavity and straight into the bloodstream. This method of administration redirects first-pass metabolism , with a quicker onset and higher bioavailability than oral administration, though the duration of action is shortened. This method is sometimes preferred by users who do not want to prepare and administer heroin for injection or smoking but still want to experience
12720-668: The spirit world. Substances such as cannabis , clarified butter ( ghee ), fish offal, dried snake skins and various pastes molded around incense sticks dates back at least 2000 years. Fumigation ( dhupa ) and fire offerings ( homa ) are prescribed in the Ayurveda for medical purposes, and have been practiced for at least 3,000 years while smoking, dhumrapana (literally "drinking smoke"), has been practiced for at least 2,000 years. Before modern times these substances have been consumed through pipes , with stems of various lengths or chillums . Archaeological findings also show
12840-466: The stress levels of adult smokers are slightly higher than those of nonsmokers. Adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus,
12960-588: The time (for example, benzo[a]pyrene was isolated from coal tar and demonstrated to be a potent carcinogen in 1933), none were known to be contained in adequate quantities in tobacco smoke . Richard Doll in 1950 published research in the British Medical Journal showing a close link between smoking and lung cancer. Four years later, in 1954 the British Doctors Study , a study of some 40 thousand doctors over 20 years, confirmed
13080-687: The treatment costs. A national referendum in November 2008 showed 68% of voters supported the plan, introducing diamorphine prescription into federal law. The previous trials were based on time-limited executive ordinances. The success of the Swiss trials led German, Dutch, and Canadian cities to try out their own diamorphine prescription programs. Some Australian cities (such as Sydney) have instituted legal diamorphine supervised injecting centers , in line with other wider harm minimization programs. Since January 2009, Denmark has prescribed diamorphine to
13200-467: The wares. Mental health units in the NHS providing long term in-patient care also have an exemption allowing the provision of designated smoking rooms for patients. Smoking Smoking is a practice in which a substance is combusted and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of
13320-737: The world, the trend among the European artists largely abated after the outbreak of World War I. The consumption of Opium abated in China during the Cultural Revolution in the 1960s and 1970s. Many people have been critical about tobacco use since it gained popularity. In 1798, Dr. Benjamin Rush (early American physician, signer of the Declaration of Independence , Surgeon General under George Washington , and anti-tobacco activist)
13440-503: The world. Early smoking evolved in association with religious ceremonies; as offerings to deities; in cleansing rituals; or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americas, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Sub-Saharan Africa, it merged with existing practices of smoking (mostly of cannabis). In Europe, it introduced
13560-420: Was "against the habitual use of tobacco" because he believed it (a) "led to a desire for strong drink," (b) "was injurious both to health and morals," (c) "is generally offensive to" nonsmokers, (d) "produces a want of respect for" nonsmokers, and (e) "always disposes to unkind and unjust behavior towards them." With the modernization of cigarette production compounded with the increased life expectancies during
13680-587: Was an anaesthetic ). The narcotic was also outlawed in China sometime in the early 18th century due the societal issues it caused. Due to a massive trade imbalance, however, foreign merchants started to smuggle opium into China via Canton , to the chagrin of the Chinese authorities. Attempts by Chinese official Lin Zexu to eliminate the trade led to the outbreak of the First Opium War . The Chinese defeat in
13800-676: Was coined in the late 18th century; before then the practice was referred to as drinking smoke . Tobacco and cannabis were used in Sub-Saharan Africa, much like elsewhere in the world, to confirm social relations, but also created entirely new ones. In what is today Congo , a society called Bena Diemba ("People of Cannabis") was organized in the late 19th century in Lubuko ("The Land of Friendship"). The Bena Diemba were collectivist pacifists that rejected alcohol and herbal medicines in favor of cannabis. The growth remained stable until
13920-461: Was expressed in architecture, clothing, literature and poetry. Cannabis smoking was introduced to Sub-Saharan Africa through Ethiopia and the east African coast by either Indian or Arab traders in the 13th century or earlier and spread on the same trade routes as those that carried coffee, which originated in the highlands of Ethiopia. It was smoked in calabash water pipes with terracotta smoking bowls, apparently an Ethiopian invention which
14040-483: Was just one of many intoxicants that was originally used as a form of medicine. Tobacco was introduced around 1600 by French merchants in what today is modern-day The Gambia and Senegal . At the same time caravans from Morocco brought tobacco to the areas around Timbuktu and the Portuguese brought the commodity (and the plant) to southern Africa, establishing the popularity of tobacco throughout all of Africa by
14160-442: Was later conveyed to eastern, southern and central Africa. Reports from the first European explorers and conquistadors to reach the Americas tell of rituals where native priests smoked themselves into such high degrees of intoxication that it is unlikely that the rituals were limited to just tobacco. In 1612, six years after the settlement of Jamestown , John Rolfe was credited as the first settler to successfully grow tobacco as
14280-556: Was not until 2003 that the Framework Convention on Tobacco Control (FCTC) was accepted in WHA and entered into force in 2005. FCTC marked a milestone as the first international treaty concerning a global health issue that aims to combat tobacco in multiple aspects including tobacco taxes, advertisement, trading, environmental affects, health influences, etc. The birth of this evidence-based and systematic approach has resulted in
14400-655: Was their goal, but when that policy failed they fell back on ventilated smoking rooms. When the Crimean War during the 1850s popularized Turkish tobacco in Great Britain, smoking gained in fashionable popularity there but was considered indelicate. After dinner in a large private house, the gentlemen might retreat from the ladies to a smoking room, furnished with velvet curtains and decorated to masculine tastes (wealthy owners would often choose Turkish themes and weapons collections), and replace his tail coat with
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