Although opiates are prescribed for pain they are also used illicitly. Opiates can cause euphoria. This trait means that opiates have value on the street as recreational drugs. Prescription opiate abuse is a tremendous problem in the United States and other countries. Abuse of non-prescription opiates centers around the use of heroin. Heroin is simply morphine with two additional acetyl-groups. Heroin is a very potent opiate that is taken intravenously and causes intense euphoria and narcosis. Heroin addiction often follows prescription opiate use. Patients prescribed opiates can become dependent and then addicted. When their prescription is no longer obtainable, some resort to illicit opiate use, which is typically heroin. There is no doubt that poor pain management practices and overuse of opiates has fueled, and is likely the root, of the current heroin crisis in the United States.
When heroin is metabolized in the body it will initially lose one acetyl group. The resulting compound is 6-acetyl-morphine (abbreviated 6-AM). A finding of 6-AM is conclusive for heroin use. However 6-AM is rapidly cleared so it is often detected only in those who have used heroin in the last few hours.
Immunoassays for codeine, morphine, and 6-acetyl-morphine are commonly used in acute care settings, emergency settings, and pain management settings.