Chapter 13

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