DREXEL PSY 310 - Chapter 13- Opioids (6 pages)

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Chapter 13- Opioids



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Chapter 13- Opioids

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6
School:
Drexel University
Course:
Psy 310 - Drugs & Human Behavior
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Chapter 13 Opioids Opium is a naturally occurring substance derived from the poppy plant Papaver somniferum Opium has a 6 000 year history of medical use Opioids are either Drugs derived directly from opium or Synthetic drugs with opium like effects Major effects of opioids relieves pain and suffering delivers pleasure and relief from anxiety Opium Cultivation Opium is collected for only a few days of the plant s life Opium harvesters make shallow cuts into the unripe seedpods The resinous substance that oozes from the cuts is scraped and collected Opium products Morphine extracted from raw opium Heroin is derived from morphine History of Opium Egypt 1500 BC Ebers papyrus described medical uses Greece Had an important role in medicine Arabic world Opium used as a social drug Physicians wrote widely about use of opium and described opioid dependence Europe Opium used widely beginning in the sixteenth century Physicians developed a preparation called laudanum a combination of strained opium and other ingredients Writers and Opium 1821 Thomas De Quincey Confessions of an English Opium Eater Elizabeth Barrett Browning and Samuel Taylor Coleridge famously used opium The Opium Wars 1729 Opium smoking outlawed in China But smuggling was widespread British East India Company was involved in opium trade Legally in India and illicitly but indirectly in China Pressure grew and eventually war broke out between the British and Chinese Morphine Morphine is the primary active ingredient in opium First isolated in 1806 Named morphium after Morpheus the god of dreams 10 times as potent as opium Codeine is a secondary active alkaloid First isolated in 1832 Named codeine from the Greek word for poppy head Morphine use spread due to two developments Technological development o 1853 Hypodermic syringe allowed delivery of morphine directly into the blood Political development o Widespread use during war provided relief from pain and dysentery Veterans returned dependent on morphine Dependence was later called soldier s disease or army disease Heroin Heroin diacetylmorphine 1874 two acetyl groups were attached to morphine 1898 marketed as Heroin brand name by Bayer Three times as potent as morphine due to increased lipid solubility of the heroin molecule Originally Marketed as a non addictive cough suppressant Replacement for codeine and morphine Later linked to dependence Opioid Abuse Before Harrison Act Three types of opioid dependence in the U S 1 Oral intake via patent medicines 2 Opium smoking mostly by Chinese laborers 3 Injection of morphine o the most dangerous form of use of population dependent on opioids Peaked at the start of 20th century Possibly as high as 1 of the population Initially opioid dependence was not viewed as a major social problem Opium smoking was limited to certain ethnic groups Patent medicines were socially acceptable Opioid dependence was viewed as a vice of middle life Typical user 30 to 50 year old middle class white woman Drugs purchased legally in patent medicines Opioid Use After Harrison Act 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 and risk of use increased o Thus the most potent method intravenous injection of heroin was favored Addicts were looked upon as criminals rather than as victims After WWII 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 populations In New York users were prosecuted under the Rockefeller Drug Laws o Strictest drug laws in U S Heroin Use in Vietnam Heroin in Vietnam was relatively Inexpensive Pure Easy to obtain About 5 of personnel tested positive for opioids Due to the purity most users smoked or sniffed the drug Most users stopped when they returned to the U S Vietnam experience showed Under certain conditions a relatively high percent of individuals will use opioids recreationally Opioid dependence is not inevitable among occasional users Heroin Production and Purity 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 1970s purity was 5 1980s 25 Currently 40 60 Important note few Americans use heroin 0 2 report past year use Abuse of Prescription Opioids Popular prescription opioids Hydrocodone Vicodin Lortab Oxycodone Oxycontin Percocet Prevalence of use 2010 12 million Americans reported past year use Routes of administration include oral insufflation injection Safety concerns DAWN data prescription opioids rank 3rd for ER visits and 1st for deaths Most opioid overdoses occur in combination with other sedatives such as alcohol Opioid Chemical Characteristics Narcotic agents isolated or derived from opium Prescription Narcotic Analgesics Natural products Morphine Codeine Semisynthetics Heroin Synthetics Methadone Meperidine Oxycodone Oxymorphone Hydrocodone Hydromorphone Dihydrocodeine Propoxyphene Pentazocine Fentanyl Mechanism of Action Naturally occurring opioid like neurotransmitters Enkephalins morphinelike neurotransmitters found in the brain and adrenals Endorphins morphinelike neurotransmitters found in the brain and pituitary gland Endogenous opioids and opioid drugs are agonists of several types of opioid receptors mu and kappa play a role in pain perception delta function not well understood Opioid Antagonists Drugs that block the action of opioids Examples Naloxone Narcan and nalorphine Effects Reverse depressed respiration from opioid overdose Precipitate withdrawal syndrome Prevent dependent individuals from experiencing a high from subsequent opioid use Harm reduction strategy Several U S cities have initiated programs that provide naloxone to heroin users Results in fewer overdose deaths Beneficial Uses Pain relief Reduces the emotional response to pain Diminishes the patient s awareness of and response to the aversive stimulus Typically causes drowsiness but does not induce sleep Treatment of intestinal disorders Counteracts diarrhea and the resulting dehydration Decreases number of peristaltic contractions Cough suppressant Codeine has long been used for its antitussive properties Dextromethorphan OTC antitussive is an opioid analogue Dependence Potential Fast acting injectable opioids are most


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