Natural Alkaloids : occur naturally in Opium .

1. Narcotic Analgesics Natural Alkaloids: occur naturally in Opium. Synthetics: chemically produced narcotic analgesics with no relation to opium but produce similar effects.

2. Three Characteristics • Relieve pain • Produce withdrawal signs in dependant users when drug use stops • Will suppress withdrawal signs of chronic morphine administration

3. Morphine Codeine Hydrocodone (Vicodin)

4. Percodan Percocet

5. OxyContin

6. Demerol

7. Natural Narcotic Analgesics Opium

8. Opium Processing Ready for shipment

9. Various Colors of Heroin

10. Heroin ready for insufflation

11. Heroin Baggies

12. Powder to Injection

13. Powder to Injection Track Marks

14. Needle Abuse

15. Heroin Girl

16. Heroin Street Slang Smack Thunder Hell dust Big H Nose drops Down H 800 bags of heroin

17. Methadone

18. Methadone

19. Methadone Developed in Germany during WWII First marketed in the us in 1947 Prescriptions for methadone have increased by nearly 700% from 1998 thru 2006.

20. http://www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdfhttp://www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdf

21. http://www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdfhttp://www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdf

22. http://www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdfhttp://www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdf

27. Methadone Maintenance Therapy “MMT” The patient remains physically dependant on an opioid but is freed from the uncontrolled, compulsive & disruptive behavior. - Improved subjects health - Decreased criminal activity - Increased employment

28. Methadone Effects are similar to morphine although they develop more slowly and last longer Withdrawal symptoms are slower and milder Advantages: Cannot be injected Longer duration than Heroin

29. Methadone Uses Relieves moderate to severe pain Suppress coughing

30. Maintenance Daily dose of Methadone allows the Heroin addict to function normally with no physical need for up to 24 hours

31. Typical Clinic

32. Typical Clinic

33. Current Methadone Use DAWN – Drug Abuse Warning Network Emergency Department Visits, 2005

34. Tolerance The same dose of the drug will produce diminishing effects. Steadily larger dose is needed to produce the same effects

35. Tolerance If using a “normal” dose he/she may exhibit little or no evidence of psychophysical impairment. Even tolerant users, when impaired, usually exhibit clinical evidence (vitals & eyes) Impairment is more evident with new users or tolerant users who exceed “normal” dose.

36. Dependence Neurons adapt to the repeated drug exposure Only function normally in the presence of the drug When the drug is withdrawn, several physiological reactions occur

37. Psychophysical Indicators Divided attention impairment Poor coordination and balance

38. Eye Indicators No nystagmus. Pupils will be constricted. Eyelids will be droopy. Miosis Ptosis

39. General Indicators Track marks “On the nod” Slowed reflexes Low, slow, raspy speech Facial itching Dry mouth Euphoria Flaccid muscle tone Inability to concentrate

40. Psychological Effects Relief from the symptoms of withdrawal Euphoria Relief from pain

41. Signs and Symptoms of Withdrawal Chills Aches of the muscle or joints Nausea Sweating Goose bumps Yawning Tearing of the eyes Runny nose Vomiting Begin 8-12 hours Intensify for 14-24 hours Insomnia at 24-36 hours Peak 2-3 days 5-10 days clear

42. Acute Action Vs Withdrawal Pain & irritability Panting & yawning Dysphoria & depression Restlessness & Insomnia Fearfulness & Hostility Increased BP Diarrhea Mydriasis Hyperthermia Tearing & runny nose Spontaneous ejaculation Chilliness & “gooseflesh” Analgesia Resp depression Euphoria Relaxation & Sleep Tranquilization Decreased BP Constipation Miosis Hypothermia Drying of secretions Reduced sex drive Flushed warm skin Psychopharmacology by Meyer & Quenzer

43. Drug Cravings When someone has a relapse, the primary cause is psychological, but physiological mechanisms play an important part in this process. After months or years of being drug-free, an individual may crave a drug because of the pleasant physiological effects that occur while using the substance. plpnemweb.ucdavis.edu

44. Drug Cravings This supports the idea that psychological factors may play a role in physiological factors. Drug addiction causes long-term changes in the brain. Psychologically, many individuals have relapses because they want to forget about their current situation, while physically the corticotropin-releasing hormone can trigger a drug craving when the individual feels stressed (Carlson, 2004).

45. Classic Evaluation Results Slow internal clock – drowsy Slow deliberate movement on SFSTs BP, pulse & temp will be down Miosis <3.0mm Reaction to light will be little to none If the drug is wearing off HIPPUS may be evident

46. Duration Of Effects Drug Onset Duration Heroin Methadone Dilaudid Percodan 5-30 Minutes 5-30 Minutes 15 Minutes 15 Minutes 4-6 Hours Up to 24 Hours 5 Hours 4-6 Hours

47. Downside “Downside Effect: An effect that may occur when the body reacts to the presence of a drug by producing hormones or neurotransmitters to counteract the effects of the drug consumed.”

48. Methods Of Ingestion Injected Smoked Snorted Suppositories

49. Other conditions that may cause similar symptoms Extreme fatigue Head injury Hypotension Severe depression Diabetic reaction

50. Overdose Signs and Symptoms Slow and shallow breathing Clammy skin Blue lips Pale or blue body Extremely constricted pupils NARCAN