PSYC 222 1st Edition Lecture 25Outline of Last Lecture • Opioids• opioids• opium cultivation• history of opium• morphine• heroin• benefical uses• dependence potential• opioid treatment• toxicity potentialOutline of Current Lecture i. Life of Heroin addictii. Abuse of prescription Opioidsiii. Prescription pain medication misuse and abuseiv. Mechanism of actionv. Opioid antagonistsvi. Opioid use after Harrison Actvii. Heroin use in vietnam viii.Heroin Production and purityix. MisconceptionsCurrent Lecturei. "No vacation". 3 to 4 injections needed daily to prevent withdrawl. Expensive habit; costs of drugs and paraphernalia. Health concerns; risks of overdose due to variable potency of different batches. Skin Infections; blood borne infections.ii. Popular prescription Opioids; hydrocordone (Vicodin, Lortab). Oxycodone (Oxycotin, Percocet). Prevalence of use: 1) 2012: 2% of Americans 12 and older reported past month use. 2) Routes of administration include oral insufflation injection. Safety Concerns: DAWN data- prescription opioids rank 3rd for ER visits and 1st in deaths. Mostopioids overdoses occur in combination with other sedatives such as alcohol. iii. Side effects of opiate-based medications include respiratory depression, intestinal spasms, and sedation. Great concern of misuse since 1990s. 3 medicines of this type: Oxycotin, Vicodin, Percocet. Vicodin and Percocet have increased risk of overdose. In 2009 pain medicines were responsible for 15000 deaths in the U.S exceeding cocaine or heroin. iv. Naturally occurring opioid-like neurotransmistters. Enkephalins: morphene-like neurotransmitters found in the brain and adrenals. Endorphins: morphene-like neurotransmitters found in the brain and pituitary gland. Endogenous opioids and opioiddrugs are agonists of several types of opioid receptors. Mu and Kappa (pain perception). Delta (not well understood)v. Drugs tha block the action of opioids. Example: Naloxone (narcan) and Nalorphine. Effects: reversed depressed respiration from opioid overdose. Participate withdrawl syndrome. Prevent dependent individual from experiencing a high from subsequent opioid use. Harm reduction strategy: U.S cities initiated programs that provide naloxone to heroin users. Results fewer OD deaths. Patent medicines were socially accepted. Opioid addiction was viewed as a "vice of middle life". Typical User: 30-50 year old middle class white woman. Drugs purchased legally in potent medicines.vi. Enforcement of the 1914 Harrison Act made opioids difficult to obtain. Only sources of drugs were illegal dealers. Resulted in changes in opioid use patterns oral use declined. Primary remaining group of users were those who injected morphine or heroin. Cost andrisk of use increased. Addicts were looked upon as criminals rather than victims. After WWII the use of heroin increased in low-income areas of large cities. The 1960s and 70s;heroin use further increased in large cities. Heroin use was associated with minority poplation. In New York users were prosecuted under the Rockefeller drug laws vii. Heroin in Vietnam was relatively inexpensive, pure, and easy to obtain. About 5% of personnel tested positive for opioids. Due to purity, most users smoked or sniffed the drug. Most stopped when they returned to U.S. Vietnam experience showed a relativelyhigh percent of individuals will use heroin recreationally. Heroin addiction is inevitable among occasional users.viii.Most of the heroin used in the U.S is derived from poppies grown in Mexico and Colombia. Purity of heroin has increased dramatically in recent years. Mid-1970s: purity 5%. 1980s: 25%. Currently: 20-40%. Few Americans use heroin. 0.2% report past-year use. A large number of heroin users "mature out".ix. Intense pleasure unequaled by any other experience. Some people report nasea and discomfort but continue use. Then tolerance to negative effects develps more rapidly compared to Euphoric effects. Withdrawl is always excruciating. Withdrawl similar to intestinal fin. After 1 injection you are hooked for life. Dependency takes time and