1. Chapter 13
Opioids

2. Narcotics Are…
The term narcotic currently refers to naturally occurring substances derived from the opium poppy and their synthetic substitutes.
These drugs are referred to as the opioid (or opiate) narcotics because of their association with opium.

3. Narcotics Are…
For the most part, the opioid narcotics possess abuse potential, but they also have important clinical value (analgesic, antitussive).
The term narcotic has been used to label many substances, from opium to marijuana to cocaine.

4. History From an annual plant Egyptian and Greek cultures
India and China
Opioids dependence
Writers and Opium
Opium Wars
Started by outside incidents
Britain given the island of Hong Kong for winning

5. Side Effects
The principle side effects of the opioid narcotics, besides their abuse potential, include:
Drowsiness
Respiratory depression
Nausea, vomiting, and constipation
Inability to urinate
Drop in blood pressure

6. Pharmacological Effects
The most common clinical use of the opioid narcotics is as analgesics to relieve pain.
The opioid narcotics relieve pain by activating the same group of receptors that are controlled by the endogenous substances called endorphins.
Activation of opioid receptors blocks the transmission of pain through the spinal cord or brain stem.

7. Pharmacological Effects
Morphine is a particularly potent pain reliever and is often used as the analgesic standard by which other narcotics are compared.
With continual use, tolerance to the analgesic effects of morphine and other narcotics develops.
Physicians frequently under-prescribe narcotics, because of fear of causing narcotic addiction.

8. Abuse, Tolerance, Dependence, and Withdrawal
All the opioid narcotic agents that activate opioid receptors have abuse potential and are classified as schedule drugs.
Tolerance begins with the first dose of a narcotic, but does not become clinically evident until 2 to 3 weeks of frequent use.

9. Abuse, Tolerance, Dependence, and Withdrawal
Tolerance occurs most rapidly with high doses given in short intervals
Doses can be increased as much as 35 times in order to regain the narcotic effect
Physical dependence invariably accompanies severe tolerance
Psychological dependence can also develop with continual narcotic use

10. Morphine 1806 morphine was discovered 10 times as potent as opium
Hypodermic syringe and war time medicine
“Soldier’s disease”

11. Heroin Heroin is classified as a Schedule I drug
Heroin is the most widely abused illegal drug in European and Far Eastern countries
Until 15 years ago, Heroin was illicitly used more than any other drug of abuse in the U.S. (except for marijuana)
What was it replaced by?
Cocaine

12. Methods of Administration
Sniffing the powder
Injecting it into a muscle (intramuscular)
Smoked
Mainlining (intravenous injection)

13. Heroin Addicts And AIDS
Over 50% of IV heroin users have been exposed to the AIDS virus

14. Withdrawal Symptoms A single “shot” of heroin lasts 4 to 6 hours
After the effects of the heroin wear off, the addict has only a few hours in which to find the next dose before severe withdrawal symptoms begin
Withdrawal symptoms:
runny nose, tears,
minor stomach cramps, loss of appetite, vomiting, diarrhea, abdominal cramps,
chills, fever, aching bones, and muscle spasms

15. Treatment
Methadone, LAAM or buprenorphine are frequently used to help narcotic addicts
Oral methadone relieves the withdrawal symptoms
Methadone can cause psychological and physical dependence
Buprenorphine

16. Other Narcotics Morphine Methadone Fentanyl Hydromorphone Meperidine
MPTP
Codeine
Pentazocine
Propoxyphene