Chapter 5 Narcotics: Opium, Morphine and Opioids

Chapter 5

Narcotics:Opium, Morphine and

Opioids

Opiates and OpioidsOpiates are a class of narcotics that include opium and three natural components that can be extracted from it:

morphinecodeinethebaine

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.

thebaine

morphine

codeine

heroin

Figure 5.1

oxycontin

Morphine, codeine, and thebaine are all natural components of __________.

A. heroinB. CNS depressantsC. opiumD. coca leavesE. opioids

Opium in History Used for medicinal and recreational purposes for ~5,000 years.

Poppy was the “joy plant” of Sumarians 3400 B.C.

~1500Portugese began smoking opium

1527Paracelsus introduced medicinal opium to Europe in the form of

laudanum

1750 British East India Co. assumes control of

Bengal and Bihar provinces of India, exportsopium to China

1803morphine 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.

1827Merck pharmaceutical company (Germany) begins

the manufacture of morphine

1839Opium 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

1895heroin (diacetyl morphine)was introduced by the BayerCompany in Germany. It wasbelieved to lack the dependence-producing properties of morphine.

Used at turn of the century to treat morphine addicts

Opiates and Heroinin American Society

Early 1900sabuse potential of heroin & morphine realized opium (but not heroin) banned in 1905

1914

Harrison Narcotics Tax Act passeddoctors must register and pay tax to

prescribe narcoticsheroin trade went undergroundfed drug-related criminal activities

Opiates and Heroinin American Society

Post WWIIHeroin abuse became associated with urban American ghettos

1960s-70sheroin use among soldiers in Viet Nam blossomed

spread to wider population in a permissiveenvironment as soldiers returned home

Effects on the Mindand the Body

Acute effects of narcotics such as heroin euphoriaanalgesiagastrointestinal slowingrespiratory depression

Central respiratory depression is the major risk factor for acute heroin intake

How Opiates Workin the Brain

1970s

opioids activate opiate receptors in the brain

endogenous opiates (can the brain be addicted to itself?)mu (μ): analgesia, respiratory depression

delta (δ): spinal analgesia

kappa (κ): spinal and supraspinal analgesia

sigma (σ): dysphoria, hallucinations, cardiac stimulation

How Opiates Workin 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 dopaminergicactivity, depresses noradrenergic activity

Figure 5.2

Naloxone andnaltrexone aretwo opiate antagoniststhat are commonlyused to reverseeffects of opiates

The three families of endogenous opiates are

A. heroin, morphine and opiumB. Oxycontin, Vicodin and PercosetC. Larry, Moe and Curly JoeD. enkephalin, beta-endorphin and dynorphinE. 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, opiumB. morphine, opium, heroinC. heroin, morphine, opiumD. heroin, opium, morphineE. 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.



Table 5.1

Patterns of Heroin Abuse

Withdrawal effects craving for heroinphysical 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.

Nai

ve

Tole

rant

Tolerance to different actions of a drug maydevelop at different rates or to differing degrees.

Safety margin (ratio between ED 99 and LD 1) may changeas a result of differential tolerance to different effects of a drug.

Table 5.2

Treatment for Heroin Abuse

Treatment for heroin abuseshort-term detoxificationlong-term interventions

address the continuing craving physical dependenceand 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.

1974Narcotic Addict Treatment Act use of methadone in treatment for opioid addiction

2000physicians 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.

© Copyright 2011, Pearson Education, Inc. All rights reserved.

Table5.3


• 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 & NameExamples of Commercial

& Street NamesDEA Schedule How Administered*

Heroin

Diacetylmorphine: smack, horse, brown sugar, dope, H, junk, skag, skunk, white horse, China white; cheese (with OTC cold medicine and antihistamine)

I ?Schedule I drugs have a high potential for abuse. They require greater storage security and have a quota on manufacturing, among other restrictions. Schedule I drugs are available for research only and have no approved medical use.

Injected, smoked, snorted

Acute Effects - Euphoria; drowsiness; impaired coordination; dizziness; confusion; nausea; sedation; feeling of heaviness in the body; slowed or arrested breathingHealth Risks - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose

Opioids

Category & Name

Examples of Commercial & Street Names

DEA Schedule How Administered*

OpiumLaudanum, paregoric: big O, black stuff, block, gum, hop

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 (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.

Swallowed, smoked

Acute Effects - Euphoria; drowsiness; impaired coordination; dizziness; confusion; nausea; sedation; feeling of heaviness in the body; slowed or arrested breathingHealth Risks - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose

Opioids and Morphine Derivatives**

NameExamples of Commercial & Street Names


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)


injected, swallowed




MorphineRoxanol, Duramorph; M, Miss Emma, monkey, white stuff

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. Schedule II drugs are available only by 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.

injected, swallowed, smoked




Methadone

Methadose, Dolophine; fizzies, amidone, (with MDMA: chocolate chip cookies)

II ?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 (unrefillable) and require a form for ordering.

swallowed, injected

Fentanyl & analogs

Actiq, Duragesic, Sublimaze; Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash

II ?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 (unrefillable) and require a form for ordering.

injected, smoked, snorted




Other opioid pain relievers: Oxycodone HCL, Hydrocodone Bitartrate Hydromorphone, Oxymorphone, Meperidine, Propoxyphene

Vicodin, Lortab, Lorcet; Vike, Watson-387Dilaudid; juice, smack, D, footballs, dilliesOpana, Numporphan, Numorphone; biscuits, blue heaven, blues, Mrs. O, octagons, stop signs, O bombDemerol, meperidine hydrochloride; demmies, pain killerDarvon, Darvocet


chewed, swallowed, snorted, injected, suppositories

Intoxication Effects - Pain relief, euphoria, drowsiness, sedation, weakness, dizziness, nausea, impaired coordination, confusion, dry mouth, itching, sweating, clammy skin, constipationPotential 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 depressantsAlso for fentanyl - 80-100 times more potent analgesic than morphineAlso for oxycodone - muscle relaxation/twice as potent analgesic as morphine; high abuse potentialAlso for codeine - less analgesia, sedation, and respiratory depression than morphineAlso 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..


• 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.

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Chapter 5 Narcotics: Opium, Morphine and Opioids