Transcript Opium, heroine and synthetic opiates

Chapter 5
Narcotics:
Opium, Morphine and
Opioids
Opiates and Opioids
Opiates are a class of narcotics that include
opium and three natural components that can
be extracted from it:
morphine
codeine
thebaine
Opioids are synthetic compounds that act as
opiates in the body (e.g. heroine, methadone)
Narcotics, sleep-inducing compounds, now
used specifically in reference to opiates and
opioids. (Cocaine is mis-classified a narcotic.)
What are narcotics?
A B
T F ALL Schedule I or II drugs, as defined
by the FDA.
T F A sleep-inducing class of drugs.
T F A group of drugs that includes the opiates.
T F Any drugs that produce CNS depression.
T F Any drugs that reduce pain.
morphine
heroin
codeine
thebaine
Figure 5.1
oxycontin
Morphine, codeine, and thebaine are all natural components
of __________.
A. heroin
B. CNS depressants
C. opium
D. coca leaves
E. opioids
Opium in History
Used for medicinal and recreational purposes
for ~5,000 years.
Poppy was the “joy plant” of Sumarians 3400 B.C.
~1500
Portugese began smoking opium
1527
Paracelsus introduced medicinal opium to
Europe in the form of laudanum
1750
British East India Co. assumes control of
Bengal and Bihar provinces of India, exports
opium to China
1803
morphine identified as the principal active
ingredient in opium, used for medical treatment of
pain and chronic diseases.
Morphine is lauded as "God's own medicine" for
its reliablity, long-lasting effects and safety.
1827
Merck pharmaceutical company (Germany) begins
the manufacture of morphine
1839
Opium Wars (1830s-1850s) fought between China
and Britain.
China going broke buying opium from Britain,
demanded surrender of all opium shipments
(Eventually China ceded Hong Kong to Britain)
Morphine and Heroin
1895
heroin (diacetyl morphine)
was introduced by the Bayer
Company in Germany. It was
believed to lack the
dependence-producing
properties of morphine.
Used at turn of the century to
treat morphine addicts
Opiates and Heroin
in American Society
Early 1900s
abuse potential of heroin & morphine realized
opium (but not heroin) banned in 1905
1914
Harrison Narcotics Tax Act passed
doctors must register and pay tax to
prescribe narcotics
heroin trade went underground
fed drug-related criminal activities
Opiates and Heroin
in American Society
Post WWII
Heroin abuse became associated with urban
American ghettos
1960s-70s
heroin use among soldiers in Viet Nam blossomed
spread to wider population in a permissive
environment as soldiers returned home
Effects on the Mind
and the Body
Acute effects of narcotics such as heroin
euphoria
analgesia
gastrointestinal slowing
respiratory depression
Central respiratory depression is the
major risk factor for acute heroin intake
How Opiates Work
in the Brain
1970s
opioids activate opiate receptors in the brain
endogenous opiates (can the brain be
addicted to itself?)
mu (μ):
delta (δ):
kappa (κ):
sigma (σ):
analgesia, respiratory depression
spinal analgesia
spinal and supraspinal analgesia
dysphoria, hallucinations, cardiac
stimulation
How Opiates Work
in the Brain
Three families of chemical substances
produced by the brain bind to these receptors.
These chemicals are collectively known as
endorphins or endogenous opiates.
(enkephalins, β-endorphins, dynorphins)
Heroin indirectly increases dopaminergic
activity, depresses noradrenergic activity
Figure
5.2
Naloxone and
naltrexone are
two opiate
antagonists
that are commonly
used to reverse
effects of opiates
The three families of endogenous opiates are
A. heroin, morphine and opium
B. Oxycontin, Vicodin and Percoset
C. Larry, Moe and Curly Joe
D. enkephalin, beta-endorphin and dynorphin
E. codeine, morphine and fentanyl
Patterns of Heroin Abuse
Different effects of heroine show different
tolerance effects over time.
constipation shows little or no tolerance
pupillary responses show greater tolerance
mood, itching, urinary retention, and respiratory
depression show greatest tolerance
The degree of tolerance to each of these effects is
directly related to dose.
If you were to order the following from strongest to least strong,
it would be __________.
A. morphine, heroin, opium
B. morphine, opium, heroin
C. heroin, morphine, opium
D. heroin, opium, morphine
E. opium, morphine, heroin
Solomon, R.L. & Corbit, J.D. (1974) An opponent
process theory of motivation: I. Temporal dynamics of
affect. Psychological Review, 81, 119-145.
Solomon, R.L. & Corbit, J.D. (1974) An opponent process
theory of motivation: I. Temporal dynamics of affect.
Psychological Review, 81, 119-145.
Solomon, R.L. & Corbit, J.D. (1974) An opponent process
theory of motivation: I. Temporal dynamics of affect.
Psychological Review, 81, 119-145.
Table 5.1
Patterns of Heroin Abuse
Withdrawal effects
craving for heroin
physical symptoms
e.g. diarrhea and consequent dehydration
A major problem with heroin use/abuse is the
unpredictability of a heroin dose due to variations in
purity.
Tolerance to different actions of a drug may
develop at different rates or to differing degrees.
Safety margin (ratio between ED 99 and LD 1) may change
as a result of differential tolerance to different effects of a
drug.
Table 5.2
Treatment for Heroin Abuse
Treatment for heroin abuse
short-term detoxification
long-term interventions
address the continuing craving
physical dependence
and adjustment to life without drugs
Treatment for Heroin Abuse
Methadone-maintenance programs focus
primarily on the physiological needs of the
heroin abuser, whereas therapeutic
communities and support groups focus on his or
her long-term reintegration into society.
1974
Narcotic Addict Treatment Act
use of methadone in treatment for opioid addiction
2000
physicians allowed to treat opioid addiction with
opioids
Opiate Use, Misuse,
and Abuse
In medical settings, narcotic drugs have
been extremely helpful in the treatment of
pain, in the treatment of dysentery, and in
the suppression of coughing.
Table
5.3
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Inc. All rights reserved.
Opiate Use, Misuse,
and Abuse
• Side effects of opiate-based medications
include respiratory depression, intestinal
spasms, and sedation.
• There has been great concern since the
late 1990s that prescription pain relievers
have been diverted to nonmedical
purposes and are subject to abuse.
Opioids
Category & Name
Examples of Commercial
& Street Names
DEA Schedule
How Administered*
I ?Schedule I drugs
have a high potential
for abuse. They
Diacetylmorphine: smack,
require greater storage
horse, brown sugar,
security and have a
dope, H, junk, skag,
quota on
Injected, smoked,
Heroin
skunk, white horse, China
manufacturing, among snorted
white; cheese (with OTC
other restrictions.
cold medicine and
Schedule I drugs are
Acute Effects - Euphoria; antihistamine)
drowsiness; impaired coordination; dizziness; confusion;
available for research
nausea; sedation; feeling of heaviness in the body; slowed or arrested breathing
only and have no
Health Risks - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose
approved medical use.
Opioids
Category &
Name
Examples of Commercial &
Street Names
DEA Schedule
How Administered*
II, III, V ?Schedule II drugs
have a high potential for abuse.
They require greater storage
security and have a quota on
manufacturing, among other
restrictions. Schedule II drugs
Laudanum, paregoric: big are available only by
Opium
O, black stuff, block, gum, prescription (unrefillable) and Swallowed, smoked
hop
require a form for ordering.
Acute Effects - Euphoria; drowsiness; impaired coordination; dizziness; confusion;
Schedule III drugs are available
nausea; sedation; feeling of heaviness in the body; slowed or arrested breathing
by prescription, may have five
Health Risks - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose
refills in 6 months, and may be
ordered orally. Some Schedule
V drugs are available over the
counter.
Opioids and Morphine Derivatives**
Name
Examples of
Commercial &
Street Names
DEA Schedule
Codeine
Empirin with
Codeine, Fiorinal
with Codeine,
Robitussin A-C,
Tylenol with
Codeine; Captain
Cody, Cody,
schoolboy; (with
glutethimide:
doors & fours,
loads, pancakes
and syrup)
II, III, V ?Schedule II drugs have a
high potential for abuse. They require
greater storage security and have a
quota on manufacturing, among other
restrictions. Schedule II drugs are
available only by prescription
injected, swallowed
(unrefillable) and require a form for
ordering. Schedule III drugs are
available by prescription, may have
five refills in 6 months, and may be
ordered orally. Some Schedule V
drugs are available over the counter.
How Administered*
Opioids and Morphine Derivatives**
Name
Examples of Commercial &
DEA Schedule
Street Names
Morphine
II, III ?Schedule II drugs
have a high potential for
abuse. They require greater
storage security and have a
quota on manufacturing,
among other restrictions.
Roxanol, Duramorph; M,
Schedule II drugs are
injected, swallowed,
Miss Emma, monkey, white available only by
smoked
stuff
prescription (unrefillable)
and require a form for
ordering. Schedule III drugs
are available by prescription,
may have five refills in 6
months, and may be
ordered orally.
How Administered*
Opioids and Morphine Derivatives**
Name
Examples of Commercial &
DEA Schedule
Street Names
Methadose, Dolophine;
fizzies, amidone, (with
Methadone
MDMA: chocolate chip
cookies)
Fentanyl &
Actiq, Duragesic,
Sublimaze; Apache, China
girl, China white, dance
How Administered*
II ?Schedule II drugs have a high
potential for abuse. They require
greater storage security and have
a quota on manufacturing, among
swallowed, injected
other restrictions. Schedule II
drugs are available only by
prescription (unrefillable) and
require a form for ordering.
II ?Schedule II drugs have a high
potential for abuse. They require
greater storage security and have
a quota on manufacturing, among injected, smoked,
Opioids and Morphine Derivatives**
Name
Other opioid pain
relievers:
Oxycodone HCL,
Hydrocodone
Bitartrate
Hydromorphone,
Oxymorphone,
Meperidine,
Propoxyphene
Examples of Commercial &
DEA Schedule
Street Names
How Administered*
II, III, V ?Schedule II
drugs have a high
potential for abuse. They
Vicodin, Lortab, Lorcet;
require greater storage
Vike, Watson-387
security and have a quota
Dilaudid; juice, smack, D,
on manufacturing, among
footballs, dillies
other restrictions.
Opana, Numporphan,
Schedule II drugs are
Numorphone; biscuits, blue available only by
chewed, swallowed,
heaven, blues, Mrs. O,
prescription (unrefillable) snorted, injected,
octagons, stop signs, O
and require a form for
suppositories
bomb
ordering. Schedule III
Demerol, meperidine
drugs are available by
hydrochloride; demmies,
prescription, may have
Intoxication Effects - Pain relief, euphoria, drowsiness, sedation,
weakness, dizziness, nausea, impaired coordination, confusion, dry mouth,
itching, sweating, clammy skin, constipation
Potential Health Consequences - slowed or arrested breathing, lowered
pulse and blood pressure, tolerance, addiction, unconsciousness, coma,
death; risk of death increased when combined with alcohol or other CNS
depressants
Also for fentanyl - 80-100 times more potent analgesic than morphine
Also for oxycodone - muscle relaxation/twice as potent analgesic as
morphine; high abuse potential
Also for codeine - less analgesia, sedation, and respiratory depression
than morphine
Also for methadone - used to treat opioid addiction and pain; significant
overdose risk when used improperly
** Taking drugs by injection can increase the risk of infection through needle
contamination with staphylococci, HIV, hepatitis, and other organisms.
Injection is a more common practice for opioids, but risks apply to any
medication taken by injection..
Opiate Use, Misuse,
and Abuse
• Three medications of this type are
OxyContin, Vicodin, and Percocet.
• More than half of young adults who
have used a prescription pain reliever
for nonmedical reasons report that the
drug was obtained free from a friend or
relative.