By: Reilly Cuttle, Stan Barnett, Adam Bell Opiates/Opioids By: Reilly Cuttle, Stan Barnett, Adam Bell

Drug Category: Depressants Drug Category: Depressants. Opioids have analgesic and central nervous system (CNS) depressant effects, as well as the potential to cause euphoria. Scientific name: Opioid combines Opium + oid meaning “opiate-like” (Opiates being Morphine, Heroin, Oxycodone, Codeine and similar drugs derived from opium.) Street name: Percocet, Tar, Dope, H, Apache, Perc-a-pop, etc. NOTE: To change images on this slide, select a picture and delete it. Then click the Insert Picture icon in the placeholder to insert your own image.

History of Opioids: The Use of Opioids dates back all the way to 3400 B.C where people started to cultivate the opium poppy. The Samarians named this plan “Hul Gil” which means “Joy plant”. In 1573 A.D Swiss-German alchemist, Paracelsus, who founded the discipline of toxicology, introduced opium pills containing citrus juice and “quintessence” of gold as an analgesic. In 1806 A.D German Chemist named Friedrich Wilhelm Ostwald Isolated Morphine from Opium. He named it Morphine after the god of dreams, Morpheus. Heroin was synthesized as a derivative of morphine in 1898. The German chemical company Bayer offered Heroin as a cough suppressant and as a “non-addictive” morphine substitute for medical use. In 1909, Congress passed the Opium Exclusion Act barring importation of opium for the purposes of smoking. The Opium Exclusion Act has been considered the opening shot in the U.S. war on drugs. The Drug Enforcement Agency was created by Executive Order in 1973, and President Richard Nixon declared the War on Drugs noting that “America has the largest number of heroin addicts of any nation in the world. Heroin addiction is the most difficult to control and the most socially destructive form of addiction in America today.”

Opium Poppy Friedrich Wilhelm Ostwald (Creator of Morphine) NOTE: To change images on this slide, select a picture and delete it. Then click the Insert Picture icon in the placeholder to insert your own image. Opium Poppy Friedrich Wilhelm Ostwald (Creator of Morphine)

Medical Uses for the Drugs: Pain Relief: Acute pain after surgery, injury or trauma, cancer pain, pain arising from disease. Anesthesia: Involves three main aspects: pain relief or analgesia, loss of memory of the surgery, and muscle relaxation to facilitate surgery and manipulation. The analgesic effect is often achieved using opioids. i.e.: fentanyl, oxymorphone, hydromorphone or morphine Cough suppression: side effect of opioids is that they may act to suppress a cough, so they are sometimes used for this purpose. Includes codeine, dihydrocodeine, ethylmorphine, hydrocodone, and hydromorphone. Also used is a opioid derivative called dextromethorphan and is often used as a cough suppressant because it does not have the adverse effect of potentially becoming addictive. Diarrhea suppression: Side effect of opioid is causes constipation, and therefore used to control diarrhea. Diphenoxylate and loperamide are used in treating irritable bowel syndrome. De-addiction: Some opioids such as methadone and buprenorphine are used to help wean patients off some of the more potent opioids such as heroin. Methadone is given in low doses after stopping heroin to reduce dependency on the opioid but without causing severe withdrawal symptoms. (Used in Vancouver to help addicts return to a normal life.) Medical Uses for the Drugs:

Forms of the Drugs: Tablets, capsules, syrups, liquids for injection, nose sprays, skin patches, suppositories, injection with needles, smoked

Effects of the Drugs: Short Term: Drowsiness Constipation Nausea and vomiting Headaches, dizziness and confusion Difficulty breathing Euphoria (feeling high) Itching and sweating Relaxation Pain Relief Reduced anxiety Impaired alertness and coordination Long Term: Increased tolerance to the drug, so that drug is needed to produce the same pain relieving effect Dependence Withdrawal symptoms Potential addiction Risk of human immunodeficiency virus (HIV/AIDS) or hepatitis C (from sharing needles) Heightened anxiety Weight loss Memory deterioration

Accessibility More and more people are using opioids than ever before, meaning it is now more available than it ever has been. Legal opioid drugs can be obtained through prescriptions from doctors, drugs such as; OxyContin, Percocet, Palladone, Vicodin, Percodan, Tylox, and Demerol. Heroin is also an opiate, which is harder to attain than the others. It is only available on the streets. Afghanistan is responsible for about 66% of the world's opium production. Created there, then shipped worldwide.

How Opioids Work 1) How the drugs works to create a “high” – Opioids act by attaching to and activating opioid receptor proteins, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they inhibit the transmission of pain signals. 2) Where damage occurs in the body – Opiate narcotics act upon the opioid receptors in the central nervous system and the brain. Prolonged usage may lead to brain damage which can stop the body from producing natural opiates – a neurotransmitter called “endorphins.” 3) Is this damage reversible? – No, this damage is not reversible. An opiate overdose typically leads to unconsciousness and a very depressed central nervous system, which is responsible for your respiratory drive while sleeping. Essentially, when someone overdoses, the body can forget to breathe. When the body forgets to breath, the brain does not get an adequate oxygen amount, thus causing brain damage. Permanent brain damage due to an opiate overdose is a very real, life-altering consequence of opiate abuse.

Who Uses the Drug Most Often Age: 669,000 Americans reported using heroin in the past year, a number that has been on the rise since 2007. This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. However, this is only when speaking about heroin, and excluding other opiates. Gender: Throughout their lives men are more likely to try elicit drugs such as heroin, although women are more likely to pick up a serious addiction. Demographic: Recent studies have shown that the demographics of heroin users have changed over the years. No longer are heroin addicts confined to the limits of urban environments. According to recent studies done by organizations such as the Center for Disease Control, as much as ninety percent of heroin users are now white suburban residents. A survey of 9,000 residents at various treatment centers show that 23 was the average age for heroin users in treatment. Often, the gateway for heroin use is prescription painkillers such as Oxycontin. Evidence has also shown that while heroin abuse has been occurring since the ‘40s, the data gathered from tracking heroin use in the ‘70s had been skewed due to the assumption that heroin use was primarily an inner city issue. Heroin use has actually been just as bad an issue in white neighborhoods for the past 40 years as they have been in urban environments and inner cities.

Withdrawal Symptoms from Opioids Opioid withdrawal can be extremely uncomfortable. The important thing to remember is that opioid withdrawal is not life threatening if you are withdrawing only from opioids and not a combination of drugs. Opioid withdrawal symptoms include: low energy, irritability, anxiety, agitation, insomnia, runny nose, teary eyes, hot and cold sweats, goose bumps, yawning, muscle aches and pains, abdominal cramping, nausea, vomiting, and diarrhea.

Treatment For Addiction Addiction treatment usually includes a combination of Addiction counselling and support Detoxification (managing withdrawal) Medication

References Booth, M. (1996) A brief history of opium. Retrieved from https://www.opioids.com/timeline/ Dzierżanowski, T., & Ciałkowska-Rysz, A. (2016) Accessibility of opioid analgesics and barriers to optimal chronic pain treatment in Poland in 2000–2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266781/ Government of Canada. (2017) About opioids. Retrieved from https://www.canada.ca/en/health-canada/services/substance abuse/prescription-drug-abuse/opioids/about.html Jones, D. (2014) Heroin User Demographics Are Changing. Retrieved from http://guardianlv.com/2014/05/heroin-user-demographics-are-changing/ Mandal, MD, A. (2013) Opioid uses. Retrieved from http://www.news- medical.net/health/Opioid-Uses.aspx