Narcotics: Opium, Morphine and Opioids 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 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 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 Naive Tolerant 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 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 2000 use of methadone in treatment for opioid addiction 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.

© Copyright 2011, Pearson Education, Inc. All rights reserved. Table 5.3 © Copyright 2011, Pearson Education, 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.

Examples of Commercial & Street Names Opioids Category & Name Examples of Commercial & Street Names DEA 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 breathing Health Risks - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose

Examples of Commercial & Street Names Opioids Category & Name Examples of Commercial & Street Names DEA Schedule How Administered* Opium Laudanum, 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 breathing Health Risks - Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose

Opioids and Morphine Derivatives** Name Examples of Commercial & Street Names DEA Schedule How Administered* 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 (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. injected, swallowed

Opioids and Morphine Derivatives** Name Examples of Commercial & Street Names DEA Schedule How Administered* Morphine Roxanol, 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

Opioids and Morphine Derivatives** Name Examples of Commercial & Street Names DEA Schedule How Administered* 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 injected, smoked, snorted

Opioids and Morphine Derivatives** Name Examples of Commercial & Street Names DEA Schedule How Administered* Other opioid pain relievers: Oxycodone HCL, Hydrocodone Bitartrate Hydromorphone, Oxymorphone, Meperidine, Propoxyphene Vicodin, Lortab, Lorcet; Vike, Watson-387 Dilaudid; juice, smack, D, footballs, dillies Opana, Numporphan, Numorphone; biscuits, blue heaven, blues, Mrs. O, octagons, stop signs, O bomb Demerol, meperidine hydrochloride; demmies, pain killer Darvon, Darvocet 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. chewed, swallowed, snorted, injected, suppositories

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.