1. Narcotics: Opium, Morphine and Opioids
Chapter 5
Narcotics: Opium, Morphine and Opioids

2. 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.)

3. 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.

4. morphine
heroin
codeine
thebaine

5. Figure 5.1
oxycontin

6. Morphine, codeine, and thebaine are all natural components of __________.
A. heroin
B. CNS depressants
C. opium
D. coca leaves
E. opioids

7. 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

8. 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) .

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Figure 5.2 Naloxone and naltrexone are two opiate antagonists
that are commonly
used to reverse
effects of opiates

16. 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

17. 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.

18. 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

19. Solomon, R.L. & Corbit, J.D. (1974) An opponent process theory of motivation: I. Temporal dynamics of affect. Psychological Review, 81,

20. Solomon, R.L. & Corbit, J.D. (1974) An opponent process theory of motivation: I. Temporal dynamics of affect. Psychological Review, 81,

21. Solomon, R.L. & Corbit, J.D. (1974) An opponent process theory of motivation: I. Temporal dynamics of affect. Psychological Review, 81,

22. Table 5.1

23. 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.

24. 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.

25. Table 5.2

26. Treatment for Heroin Abuse
short-term detoxification
long-term interventions
address the continuing craving physical dependence
and adjustment to life without drugs

27. 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.

28. 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

29. 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.

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

31. 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.

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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 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..

39. 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.