The opiate family includes heroin (aka mack, shit, junk), codeine (often in Vicodin, Tylenol #3), etc. One of the most popular forms currently is BLACK TAR, especially from mexico. It is black and gummy, as shown in the picture. Be sure to enquire how the person is doing the drug (e.g., orallly, IV, rectal, etc).
There are occasional epidemics of Parkinsonian symptoms in young adults. This is often due to contamination of synthetic heroin, commonly 'designer meperidine'. The contaminant in question, MPTP (1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine) is formed during sloppy synthesis. It affects the dopaminergic neurons of the substantia nigra and thus give rise to Parkinsonian symptoms. Some people have posted instructions for "cleaning" heroin.

Sometimes people recover from MPTP poisoning, but more often it is permanent and irreversible.
Black Tar is typically smoked, but can be inserted into almost any orifice. It is about 40-90% pure but contains plant impurities.
Opiates have enjoyed their popularity since the 1800's. They were put in just about everything at the time. Morphine was derived in 1806 and, with the advent of the hypodermic syringe in 1848, morphine could be directly injected. Heroin was created in the late 1800's in an effort to find a less addictive form of morphine. This didn't happen: heroin crosses the blood brain barrier more rapidly than morphine and thus gives a quicker rush. Non-medical opiates were declared illegal in the early 1900's.

Heroin, which is actually diacetyl morphine, is derived from the opium poppy, typically in southeast Asia. Heroin is frequently injected, but can be smoked.
Sometimes you may wish to convert someone from one opiate to another, such as when one drug isn't on formulary or you want to begin methadone. There is a handy conversion table for opiates as well as their half-lives, etc.
Opiate Withdrawal Orders: Clonidine Protocol

    Admit _______

Diet:_____

Allergies:______

VS q 2h while awake x 48h, then q 4h while awake

Privileges: Maintain on unit during withdrawal

Labs: CBC, Panel 7, LFT, Urine Tox screen

Place PPD unless pt is known positive or documented negative in past 6 months

    Medications:

      Clonidine 0.1 mg po q 2h prn HR > 100, DBP > 100, SBP > 160 (MDD = 1 mg)

      Perchlorpromazine 10 mg im or 25 mg po prn nausea & vomiting

      ibuprofen 600 mg po q 6h prn aching

      acetaminophen 650 mg po q 4h prn temp > 100F

      Kaopectate 30 cc after each loose BM (MDD = 12 doses)

      Maalox Plus 15cc po q 4h prn stomach upset

      MOM 30cc po q hs prn constipation

      MVI one po qd

 

Opiate Withdrawal Orders: Buprenorphine Protocol

    Admit ________

Diet:_____

Allergies:______

VS q 2h while awake x 48h, then q 4h while awake

Privileges: Maintain on unit during withdrawal

Labs: CBC, Panel 7, LFT, Urine Tox screen

Place PPD unless pt is known positive or documented negative in past 6 months

    Medications:

      buprenorphine taper

      0.4 mg IM q 8h x3 doses, then
      0.3 mg IM q 8h x3 doses, then
      0.2 mg IM q 8h x3 doses, then stop

      Perchlorpromazine 10 mg im or 25 mg po prn nausea & vomiting

      ibuprofen 600 mg po q 6h prn aching

      acetaminophen 650 mg po q 4h prn temp > 100F

      Kaopectate 30 cc after each loose BM (MDD = 12 doses)

      Maalox Plus 15cc po q 4h prn stomach upset

      MOM 30cc po q hs prn constipation

      MVI one po qd