Opiates : Did you know?

1. Opiates: Did you know? An in-depth look at opiates and their effects

2. What is an Opiate? Opiates are a type of narcotic drug that act as depressants in the central nervous system(CNS). Opiates come from opium, which can be produced naturally from poppy plants or derived from semi-synthetic alkaloids. Some of the most common opiates include morphine, codeine, heroin, hydrocodone and oxycodone.

3. Types of Opiates • Opium Opium is extracted from seedpods of Papaversomniferum, the opium poppy. Known to the ancient Egyptians, Greeks and Romans, smoking opium produces an addicting sense of relaxation. • Morphine The first medicinal plant alkaloid ever isolated, morphine was extracted from opium in 1817. Morphine is injectable and is a controlled substance in the United States under the controlled substances act of 1970. Used clinically to treat the pain of heart attack, it may also be added to spinal and epidural anesthesia for prolonged post-surgery comfort. Hydromorphone (Dilaudid) is a more potent semi-synthetic opioid derived from morphine. • Heroin The chemical acetic anhydride is used in the production of diacetylmorphine, or heroin, from morphine. Heroin can cross the blood-brain barrier more readily than morphine. • Codeine Extracted from opium in 1832, codeine is an effective cough suppressant and is the most commonly used narcotic in the world. Combined with non-narcotic fever medicines like aspirin, ibuprofen or acetaminophen (Tylenol), it is useful for toothaches and other acute pain. • Thebain Thebaineis a weak opiate. Chemical modifications of codeine and thebaine have produced the opioids hydrododone (Vicodin) and oxycodone (Oxycontin), both of which are stronger than codeine and are popular drugs of abuse.

4. Common Prescription and Illicit Opiates Prescription Opiates • Morphine • Codeine • Hydrocodone • Oxycodone • Methadone • Fentanyl • Meperidine • Vicodin • Fentanyl • Norco • Darvocet • Dilaudid • Tramadol • Lortab • Percocet Illicit Opiates • Heroin *** Any prescription opiate that is obtained without a prescription is considered an illicit opiate. ***

5. Opiate Street Names Opium Heroin • Big O • Black stuff • Block • Gum • Hop • Dover’s powder • Dope • Smack • H • Train • Thunder • Black tar • China whitehorse • Junk • Antifreeze • Brown sugar • Henry • Horse • Skag • Hero • Hell dust

6. Opiate Street Names Fentanyl Morphine • Apache • China girl • China white • Dance fever • Friend • Goodfella • King ivory • Murder 8 • TNT • Tango • Cash • M • Miss Emma • Monkey • White stuff • Dreamer

7. Opiate Street Names Hydrocodone and Oxycodone Codeine Hydrocodone • Vikes • Viko • Norco • Hydro Oxycodone • Ox • Oxicotten • Oxycet • Schoolboy • Cough syrup • T-three’s (Tylenol #3 with codeine)

8. Therapeutic Uses of Prescription Opiates • Opioids are prescribed by licensed medical practi­tioners to people with acute or chronic pain resulting from disease, surgery or injury. Opioids are also prescribed to people with moderate to severe coughs and diarrhea. Methadone and buprenorphine are opioids that are prescribed to treat addiction to other opioids, such as heroin or oxycodone (e.g., OxyContin).

9. Physiological Effects of Opiates • The physiological effect of the opiate exists particularly in a decrease of pain; it can with increasing dosage also release cramps. Investigations of R. Tremmel (1975) refer to certain chemoreceptors in the brain, so-called opiate receptors, particularly in the "limbic system" and in the "amygdale", in which opiate deposit preferentially. These brain areas play particularly with fear and escape reactions a role as well as with the emotional and affective processing of sensory perceptions. In these brain regions morphine is able to affect the routings for pain (decrease of pain effect) and euphoria to release (euphoric effect). • According the WHO, opioid means the generic term applied to alkaloids from the opium poppy (Papaversomniferum), their synthetic analogues, and compounds synthesized in the body, which interact with the same specific receptors in the brain, have the capacity to relieve pain, and produce a sense of well-being (euphoria). The opium alkaloids and their synthetic analogues also cause stupor, coma, respiratory depression in high doses. Endogenously occurring compounds with opioid actions include the endorphins and enkephalins.

10. Physiological Effects of Opiates • Physical Dependence Physical dependence is the phenomenon whereby the body adjusts to having the opiate drug in the system. Any reduction in the levels of the opiate drug forces the body to re-adjust. This is what we refer to as withdrawal phase. When the stopping of a substance causes the body to "rebound" and results in symptoms of withdrawal, we say that the individual has developed physical dependence. Dependency is a predictable behavior and is controllable by professional counseling and treatment therapies. • Addiction One of the common long-term side effects of chronic use of opiates is developing an addiction to the drug. Opiate addiction is an uncontrollable situation that affects the individual in a biochemical, physical and psychological way. Addiction is a complex phenomenon characterized by substance abuse, relapse and eventually death. The management of opiate addiction is monitored and supervised under a professional health care provider, medical doctor, and a supportive team of counselors and behavioral therapists. Individuals addicted to opiate drugs are typically placed on a 12-step detoxification treatment program.

11. Physiological Effects of Opiates • Physical Signs and Symptoms Long-term effects can manifest in physical signs and symptoms in chronic abusers or user of opiates. Some common signs are needle tracks and collapsed veins. Frequent infections, acne, and other skin problems can develop due to poor hygiene care and poor health. Other medical complications, such as heart and valve infections and liver problems, can develop over time because long-term use of opiates will weaken the immune system in the body. Opiates can cause respiratory depression and increase the risks of getting pulmonary and respiratory problems such as pneumonia and bronchitis.

12. Withdrawal Effects from Opiates** See note below** Early symptoms of withdrawal include: • Agitation • Anxiety • Muscle aches • Increased tearing • Insomnia • Runny nose • Sweating • Yawning Late symptoms of withdrawal include: • Abdominal cramping • Diarrhea • Dilated pupils • Goose bumps • Nausea • Vomiting

13. Health Risks from Opiate Abuse Infectious Risks • Opiates work by latching to specific receptors scattered throughout the body and the brain. While people could swallow or sniff some types of opiates in order to get the drugs to connect with the receptors, most addicts find that they can achieve the greatest high in this shortest amount of time if they mix the drugs with some sort of liquid (or buy them in liquid form) and inject the drugs directly into the bloodstream with needles. This might be the most effective way to take drugs in order to cause euphoria, but it can be disastrous in terms of health, as many people who inject drugs also inject infections. People who inject drugs may share needles with other people, and even the tiniest amount of a virus located on a needle could translate into an infection when that needle is used again.

14. Health Risks from Opiate Abuse Heart Damage • Prescription medications containing opiate-like ingredients might not contain these sorts of hazardous ingredients, but they can contain inactive ingredients that help the medications to stick together. These ingredients may be harmless when they pass through the digestive tract, but when they are injected, they can cause problems. • Injecting these sorts of ingredients means placing somewhat insoluble or definitely insoluble particles directly into the bloodstream. These tiny molecules can move to the soft tissues of the heart and create small pockets of infection. These small pockets of inflammation can lead to heart failure, or even death, and they’re quite common in people who inject drugs.

15. Health Risks from Opiate Abuse Mental Health and Cognition Issues • It’s no secret that having an addiction can be hard on a person’s mental health and sense of self. As the addiction begins to take over, and the person begins to lose control of the ability to think clearly, plan for the future and make good decisions, people can begin to feel lost and out of sorts. Depression can quickly set in when people feel this way. Not surprisingly, depression is quite common in people who abuse opiates.

16. Health Risks from Opiate Abuse Additional Complications There are other problems that might strike smaller groups of opioid abusers. These include: • Scarred veins • Collapsed veins • Pneumonia • Tuberculosis • Some people even develop specific types of arthritis due to the drugs. According to a study published in the journal Seminars in Arthritis and Rheumatism, over a five-year period, 36 cases of septic arthritis were diagnosed in 35 heroin addicts. While about 90 percent of these cases responded to antibiotic treatment, eight of these cases required a surgical intervention. Arthritis can be incredibly painful, and going through surgery can be quite expensive, so this isn’t a minor concern.

17. Treatment Approaches to Opiate Abuse and Dependence Outpatient Treatments • Buprenorphine and Naloxone are often used in outpatient clinical care settings because they both greatly reduce the painful withdrawal symptoms that accompany opiate detoxification. Patients often can continue everyday activities during this process. Buprenorphine was originally used in the United States for pain management, but was approved by the Federal Drug Administration (FDA) in 2003 for opiate detoxification. Buprenorphine, also known as Suboxone or Subutex, is available in tablet form or by liquid injection and inhibits the euphoric sensations caused by opiates. Over time, relapsing substance abusers began to combine buprenorphine with other opiates to produce intoxication. As a result, Naloxone is administered in combination with buprenorphine, because it quickly counteracts the effects of opiates and is often used in emergency overdose situations. The daily frequency of dosage and overall detoxification time depend on the nature and severity of the addiction.

18. Treatment Approaches to Opiate Abuse and Dependence Methadone Treatment Centers • Methadone is a double edged sword because it is both addictive and useful for long term detoxification maintenance. Methadone is often prescribed to patients suffering from cancer or other terminal illnesses causing severe pain. Unfortunately, methadone has become widely available and is abused by at least 1 percent of high school students, according to the National Drug Intelligence Center. Methadone typically does not produce the same level of intoxication as other opiates which cause users to ingest more than the recommended amount. However, methadone is used in treatment programs because it suppresses withdrawal symptoms for up to 36 hours. Lower doses of methadone are administered to patients over long periods of time to assist in sustained recovery from addiction.

19. Treatment Approaches to Opiate Abuse and Dependence Residential • Residential drug treatment can be broadly divided into two camps: 12 step programs or Therapeutic Communities. 12 step programs have the advantage of coming with an instant social support network, though some find the spiritual context not to their taste. These other programs may use a Cognitive-Behavioral Therapy approach, such as SMART Recovery, that looks at the relationship between thoughts, feelings and behaviors, recognizing that a change in any of these areas can affect the whole. CBT sees addiction as a behavior rather than a disease and subsequently curable, or rather, unlearnable. CBT programs recognize that for some individuals controlled use is a more realistic possibility.

20. Treatment Approaches to Opiate Abuse and Dependence Rapid Opiate Detox • Although many residential treatment centers offer rapid detox for opiate addiction, it is extremely dangerous and is not recommended by most licensed healthcare providers. Patients are put under anesthesia and pumped with a strong narcotic inhibitor cocktail to speed detoxification, but there is no evidence to support this claim. Rapid detox can be deadly because the body's reactions to withdrawal cannot be properly controlled under anesthesia and should not be administered outside of a hospital setting.

21. Treatment Approaches to Opiate Abuse and Dependence Behavioral programming • Behavioral programming is considered critical to helping those with addictions achieve abstinence. From the applied behavior analysis literature and the behavioral psychology literature several evidenced based intervention programs have emerged behavioral marital therapy; community reinforcement approach; cue exposure therapy; and contingency management strategies. In addition, behavioral treatment such as community reinforcement and family training (CRAFT) have helped family members to get their loved ones into treatment.

22. Treatment Approaches to Opiate Abuse and Dependence Alternative therapies • Alternative therapies, such as acupuncture, are used by some practitioners to alleviate the symptoms of drug addiction. In 1997, the American Medical Association (AMA) adopted as policy the following statement after a report on a number of alternative therapies including acupuncture: • There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies. • Acupuncture has been shown to be no more effective than control treatments in the treatment of opiate dependence.

23. Treatment Approaches to Opiate Abuse and Dependence • Spiritual Therapy uses alternative therapies such as yoga, breathing exercises, creative visualization, and meditation to help clients retain control over their lives so that they can make healthy choices • Family and Couples Therapy that helps clients build stronger relationships with their loved ones as well as identify interpersonal triggers that could lead to potential relapse

24. References • http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/oxycontin/Pages/opioids_dyk.aspx • http://www.drug-encyclopedia.eu/DW_EN/opiates.shtml • http://www.opiates.com/drugs/ • http://www.opiaterehabtreatment.com/street-names-opiates • http://www.livestrong.com/article/69026-list-opiate-prescriptions/ • http://www.livestrong.com/article/75425-types-opiate-drugs/ • http://psychology.about.com/od/oindex/g/what-are-opiates.htm • http://www.thecontrolcenter.com/what-we-treat/prescription-drug-abuse-treatment/opiate-addiction-treatment/