2. Chapter 4 The Major Narcotics: Opium, Morphine, and Herion

3. Objectives After completing this chapter, you should know the following: The history of opium and opium-derived drugs. The effects of narcotic drugs on the mind and body. The basis for opiate effects.

4. Patterns of heroin abuse. The potential lethality of heroin abuse. The issue of controlled heroin intake. Treatment strategies for heroin dependence. Objectives

5. Opium History 4000b.C. –The medicinal properties. 19 th century- introduced into India (via Muslims), and spread to china.

6. Opium History (Cont’d) Early in the 19th century, British merchants began smuggling opium into china in order to balance their purchases of tea for export to Britain, an act that set the stage for the opium wars.opium wars

7. Opium History (Cont’d) Chinese emigranted to the united states, who were employed to build the transcontinental railroad, brought the opium-smoking habit to the west coast. During the 19th cent. Opium was grown in the united states as well as imported.

8. Opium History (Cont’d) Opiates-available in the united states. Tonics and patent medicines. Smoking in opium dens. Late 1800s-epidemic of opiate addiction. Civil war-addiction from medicinal purposes. The generous use of morphine in treating wounded soldiers.

9. Opium History (Cont’d) In 1906 the pure food and drug act required accurate labeling of patent medicines. In 1914-the Harrison narcotics act taxed and regulated the sale of narcotics. Prohibition-maintenance doses to addicts who made no effort to recover. Physicians arrested and maintenance- treatment clinics closed.

10. Opium History (Cont’d) Numerous laws passed to regulate importation, availability, use, and treatment. Concern with opium addiction replaced by: Cocaine. Marijuana. Methadone and other illegal drugs.

11. What Is Herion? Heroin… Is an illegal, highly addictive drug. The most abused and the most rapidly acting of the opiates. Sold in the form of; A white or brownish powder. Black sticky substance known on the streets as "black tar heroin."

12. Short –Term Effects of Herion "Rush." Depressed respiration. Clouded mental functioning. Nausea and vomiting. Suppression of pain.

13. Short –Term Effects of Herion (Cont’d) Spontaneous abortion heroin – highly addictive-rapidly enter into the brain. Rush-accompanied by a warm flushing of the skin. Dry mouth, a heavy feeling in the extremities. Nausea, vomiting, and severe itching.

14. Herion Heroin is "cut" with other drugs or with substances; Such as sugar, starch, powdered milk or quinine and/or strychnine or other poisons. Heroin-special problems transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.

15. Herion Administration Heroin is injected, sniffed/snorted, or smoked. Abuser usually inject 4x’s daily. Intravenous injection-rapid onset of euphoria (7 to 8 seconds). Intramuscular injection-slow onset of euphoria (5 to 8 minutes).

16. Herion Administration (Cont’d) Sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection. All three forms of heroin administration are addictive. Injection, the predominant method of heroin use among addicted users seeking treatment.

17. Opiates and the Brain s

18. Long-term Effects of Herion Addiction Infectious diseases, for example, HIV/AIDS and hepatitis B and C Collapsed veins

19. Long-term Effects of Herion (Cont’d) Physical dependence develops with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly.

20. Long Term Effects of Herion Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include; Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements.

21. Long-term Effects of Herion Abscesses Infection of heart lining and valves Arthritis and other rheumatic problems Bacterial infections

22. Long Terms Affects of Herion (Cont’d) Major withdrawal symptoms. Peak between 24 and 48 hours after the last dose of heroin and subside after about a week.

23. Long Terms Affects of Herion (Cont’d) Can show withdrawal signs for many months. Withdrawal is never fatal to healthy adults. Can cause death to the fetus of a pregnant addict.

24. Heroin abuse complications during pregnancy. Including miscarriage and premature delivery. Children born to addicted mothers are at greater risk of SIDS (sudden infant death syndrome). Should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery. Methadone treatment recommended. Medical Complications

25. Herion Abuse and Needles Heroin addicts often share needles and other injection equipment. Herion addict are at special risk of contracting HIV and other infectious diseases.

26. HIV/AIDS and Hepatitis B and C Infection of injection-drug users with HIV Reuse of contaminated syringes and needles or other paraphernalia by more than one person. Through unprotected sexual intercourse with HIV- infected individuals. For nearly one-third of Americans infected with HIV, injection drug use is a risk factor. Drug abuse is the fastest growing vector for the spread of HIV in the nation.

27. Classifications of Opioids Natural substance (i.E., Opium, morphine, codeine) Semisynthetic narcotics (i.E., Heroin - modifying chemicals in opium) Synthetic products (i.E., Demerol, methadone) Endogenous opioids (i.E., Endorphin – natural body substances)

28. Examples of Natural Substance Opioids Opium (mother drug) Morphine (chief alkaloid ingredient of opium) Codeine (minor alkaloid ingredient) Thebaine (minor component but has stimulant effect)

29. Examples of Synthetic Narcotics Meperidine (first synthetic narcotic produced) Darvon (close relative to methadone) Fentanyl (intravenous analgesic-anesthetic)

30. Endogenous Opioids Naturally produced by the body (brain/g.I. Tract) Enkephalins (found in the pituitary gland and brain)

31. Endogenous Opioids Endorphin (opioid chemical) found to be 40 times stronger than enkephalins. Alleviation of pain factor from the body decreases with the use of external opioids

32. Symptoms of Opioid Overdose Deep sleep/stupor Low respiration Blue lips/skin Pupils are pinpoints Possible needle marks on body

33. What Are the Treatments for Heroin Addiction? Treatment-more effective when heroin abuse is identified early. Treatments varies-depending on the individual Methadone, a synthetic opiate Blocks the effects of heroin Eliminates withdrawal symptoms

34. What Are the Treatments for Heroin Addiction? LAAM, like methadone, is a synthetic opiate that can be used to treat heroin addiction. LAAM can block the effects of heroin for up to 72 hours with minimal side effects when taken orally.

35. Treatment of Narcotic- dependent Individuals Detoxification. Relieve withdrawal symptoms while patients adjust to a drug-free state. Not a treatment for addiction. Useful step only when it leads into long-term treatment that is either drug-free (residential or outpatient) or uses medications as part of the treatment. The best documented drug-free treatments are the therapeutic community residential programs lasting at least 3 to 6 months.

36. Treatment of Narcotic- dependent Individuals Methadone programs. Methadone treatment has been used effectively and safely to treat opioid addiction for more than 30 years. The programs use methadone as a substitute for heroin.

37. Treatment (Cont’d) Methadone-properly prescribed Non-intoxicating or sedating Do not interfere with ordinary activities. The medication is taken orally. Suppresses narcotic withdrawal for 24 to 36 hours.

38. Treatment-methadone (Cont’d) Patients are able to perceive pain and have emotional reactions. Relieves the craving associated with heroin addiction; Craving is a major reason for relapse. Heroin is ineffective at producing euphoria, thus making the use of heroin more easily extinguishable.

39. Treatment-Methadone (Cont’d) Methadone's effects last for about 24 hours -- four to six times as long as those of heroin -- so people in treatment need to take it only once a day. Also, methadone is medically safe even when used continuously for 10 years or more.

40. Treatment-methadone Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives.

41. LAAM and Other Medications LAAM, like methadone, is a synthetic opiate that can be used to treat heroin addiction. LAAM can block the effects of heroin for up to 72 hours with minimal side effects when taken orally.

42. LAAM and Other Medications In 1993 the food and drug administration approved the use of LAAM for treating patients addicted to heroin. Its long duration of action permits dosing just three times per week, thereby eliminating the need for daily dosing and take-home doses for weekends. LAAM will be increasingly available in clinics that already dispense methadone.

43. Naltrexone Naltrexone has long-lasting effects, ranging from 1 to 3 days, depending on the dose. Naltrexone blocks the pleasurable effects of heroin and is useful in treating some highly motivated individuals.

44. Treatment-others Naloxone and naltrexone are medications that also block the effects of morphine, heroin, and other opiates. As an antagonists, they are especially useful as antidotes.

45. Treatment-Behavioral Therapies. Behavioral and pharmacologic treatments can be extremely useful when employed alone, but integrating both types of treatments is the most effective approach. These can include residential and outpatient approaches.

46. Opioid Analog One of the most commonly known opioid analog is Demerol. Introduced in 1968 by a Belgian pharmaceutical company as a synthetic narcotic to be used as an analgesic in surgical procedures because of its minimal effects on the heart. Demeral is particularly dangerous because it is 50 times more potent than heroin and can rapidly stop respiration.

47. Opioid Analog (Cont’d) During surgical procedures, not a problem, machines are used to help patients breathe. On the street, users have been found dead with the needle used to inject the drug still in their arms.

48. What Are the Opioid Analogs and Their Dangers? Drug analogs are chemical compounds that are similar to other drugs in their effects but differ slightly in their chemical structure. Some analogs are produced by pharmaceutical companies for legitimate medical reasons.

49. Opioid Analogs Other analogs, referred to as "designer" drugs, can be produced in illegal laboratories and are often more dangerous and potent than the original drug.

50. Naltrexone Naltrexone has long-lasting effects, ranging from 1 to 3 days, depending on the dose. Naltrexone blocks the pleasurable effects of heroin and is useful in treating some highly motivated individuals.