R?cr?ation du Guitariste Op.51

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Treatment of heroin addiction often includes behavioral therapy and medications. Heroin was first made by C. Alder Wright in from morphine, a natural product of the opium poppy. The original trade name of heroin 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. Its popularity with recreational drug users, compared to morphine , reportedly stems from its perceived different effects. Short-term addiction studies by 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 abuse and addiction. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids. In 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 subcutaneous , intramuscular , intrathecal or intravenously.

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 is more common to use morphine or other strong opioids in these situations. In 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. 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 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 in palliative care. A number of European countries prescribe heroin for treatment of heroin addiction. 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 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 [23] in established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: In the Brain Committee recommended that only selected approved doctors working at approved specialised centres be allowed to prescribe diamorphine and benzoylmethylecgonine cocaine to users.

The law was made more restrictive in Beginning in the s, the emphasis shifted to abstinence and the use of methadone; currently only a small number of users in the UK are prescribed diamorphine. In , Switzerland began 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 involved users, although enrollment was later expanded to , based on the apparent success of the program. The trials proved diamorphine maintenance to be superior to other forms of treatment in improving the social and health situation for this group of patients.

They are required to contribute about Swiss francs per month to the treatment costs. The previous trials were based on time-limited executive ordinances. The success of the Swiss trials led German, Dutch, [29] and Canadian [30] cities to try out their own diamorphine prescription programs. Since January , Denmark has prescribed diamorphine to a few addicts that have tried methadone and subutex without success. It was supposed that around addicts would be able to receive free diamorphine. However, Danish addicts would only be able to inject heroin according to the policy set by Danish National Board of Health.

In July , the German Bundestag passed 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 On August 26, 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 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 onset of heroin's effects depends upon the route of administration. Studies have shown that the subjective pleasure of drug use the reinforcing component of addiction is proportional to the rate at which the blood level of the drug increases. Ingestion does not produce a rush as 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 potential risk for psychological 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 the UK.

John Bodkin Adams is also known to have used heroin as a murder weapon. Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, [ medical citation needed ] it is often difficult to determine whether a heroin lethal overdose was accidental, suicide or homicide. Chronic use of heroin and other opioids has been shown to be a potential cause of hyponatremia , resultant because of excess vasopressin secretion.

Use of heroin by mouth is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent. Heroin's oral bioavailability is both dose-dependent as is morphine's and significantly higher than oral use of morphine itself, reaching up to 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 the east-coast United States is most commonly found in the hydrochloride salt form, requiring just water and no heat to dissolve.

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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. Users who have used this route of administration often develop a deep vein thrombosis. The dose of heroin used for recreational purposes is dependent on the frequency and level of use: 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, which is heated by an underneath flame, 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 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 experience 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. 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 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. Like most opioids , unadulterated heroin may lead to adverse effects. The purity of street heroin varies greatly, leading to overdoses when the purity is higher than they 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 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 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. Nausea , vomiting , and severe itching may also occur. After the initial effects, users usually will be drowsy for several hours; mental function 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. 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.

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 is reduced abruptly. Intravenous use of heroin and any other substance with needles and syringes or other related equipment may lead to:.

Heroin overdose is usually treated with an opioid antagonist , such as naloxone Narcan. This reverses the effects of heroin and other opioids and causes an immediate return of consciousness but may result in withdrawal symptoms. The half-life of naloxone is shorter than most opioids, so that it has to be administered multiple times until the opioid has been metabolized by the body. 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.

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 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.

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Napoléon Coste – Récréation du Guitariste, op. 51 – No. 13, Pas Redoublé

When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation , making it a prodrug for the systemic delivery of morphine. The contribution of these receptors to the overall pharmacology of heroin remains unknown. A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses, includes the clinically used strong analgesics nicomorphine Vilan , and dipropanoylmorphine ; there is also the latter's dihydromorphine analogue, diacetyldihydromorphine Paralaudin.

Two other 3,6 diesters of morphine invented in —75 along with diamorphine, dibenzoylmorphine and acetylpropionylmorphine , were made as substitutes after it was outlawed in and, therefore, sold as the first " designer drugs " until they were outlawed by the League of Nations in Heroin is derived from opium through a process involving various chemicals such as acetone and acetic anhydride. The major metabolites of diamorphine, 6-MAM, morphine, morphineglucuronide and morphineglucuronide, may be quantitated in blood, plasma or urine to monitor for abuse, confirm a diagnosis of poisoning or assist in a medicolegal death investigation.

Most commercial opiate screening tests cross-react appreciably with these metabolites, as well as with other biotransformation products likely to be present following usage of street-grade diamorphine such as 6-acetylcodeine and codeine. However, chromatographic techniques can easily distinguish and measure each of these substances.

When interpreting the results of a test, it is important to consider the diamorphine usage history of the individual, since a chronic user can develop tolerance to doses that would incapacitate an opiate-naive individual, and the chronic user often has high baseline values of these metabolites in his system. The opium poppy was cultivated in lower Mesopotamia as long ago as BCE.

Diamorphine was first synthesized in by C. Alder Wright , an English chemist working at St. Mary's Hospital Medical School in London. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine or morphine diacetate.

The compound was sent to F. Pierce of Owens College in Manchester for analysis. Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. Wright's invention did not lead to any further developments, and diamorphine became popular only after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann. Instead, the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself.

Bayer scientists were not the first to make heroin, but their scientists discovered ways to make it, and Bayer led commercialization of heroin. In , the German drug company Bayer marketed diacetylmorphine as an over-the-counter drug under the trademark name Heroin. Morphine at the time was a popular recreational drug, and Bayer wished to find a similar but non-addictive substitute to market. However, contrary to Bayer's advertising as a "non-addictive morphine substitute," heroin would soon have one of the highest rates of addiction among its users.

From through to , diamorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant. In , the United States Congress banned its sale, importation, or manufacture. It is now a Schedule I substance , which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States. The Health Committee of the League of Nations banned diacetylmorphine in , although it took more than three years for this to be implemented. In the meantime, the first designer drugs , viz. Second Interlude and Plymouth Hoe-Down, 4.

Rondo La Ronde, 5. Song Without Words in D minor, 6. Danza di cala luna, 2. El mercado Testaccio, 9.


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  4. The Magic Box, Nkosi Sikelel' iAfrika, Paying supporters also get unlimited streaming via the free Bandcamp app. Purchasable with gift card. He came there at the age of 24 and studied under Fernando Sor, another great guitarist of the period. This instrument featured one extra string floating next to its neck.

    This string could not be fretted and was tuned to D. Seeing that the extra string is not crucial to the music, I didn't hesitate to play a 6-string romantic guitar.