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Unformatted text preview: Opium, Morphine, and Heroin Chapter 5 Chapter 5 Narcotics: OPIATES, OPIATE OPIATES, OPIATE DERIVATIVES, AND SYNTHETIC OPIATES Note: Brand names are capitalized. Opiates: morphine, codeine, thebaine (THEbane) Opiate derivatives from morphine: heroin, Numorphan, Percodan (Percocet), Hydodan (Vicodin) Synthetic opiates: methadone, Demerol, Darvon, LAAM (Orlaam), buprenorphine (Subutex, Suboxone) Early 3rd century B.C. — First records of opium use Chinese use opium in limited quantities primarily for medicinal use Late 1770’s – 1840ish – Britain trades Opium from India to China in exchange for tea 1898 — Bayer Company introduces heroin 1800s thru early 1900’s – US culture contained many household products with opium, heroin and cocaine Early 1900’s – Backlash in US against opium based on antiChinese prejudice 1914 Harrison Act – required M.D.s to pay fee to IRS to prescribe opiate drugs and cocaine – beginning of heroin’s black market Typical heroin user was white, affluent female prior to legislation; post legislation – typical user is white urban males 1960s–1970s — Heroin abuse reaches peak in the U.S. Heroin use in Vietnam among veterans high (due to availability, purity, price) while in combat – low numbers (2%) continue to use after return to US mid–1990s — Principal supplier of heroin shifts from Asia to South America mid–1990s — Popularity of heroin returns, at dosages that permit noninjection administrations HIGHLIGHTS FROM THE HIGHLIGHTS FROM THE HISTORY OF OPIATES NEW FORMS OF HEROIN NEW FORMS OF HEROIN IN THE 1980s Black tar — relatively pure and inexpensive, originating in Mexico and illegal drug laboratories in the United States Fentanyl (China White) — a prescription narcotic drug, 10 to 1,000 times stronger than heroin ACUTE EFFECTS OF HEROIN ACUTE EFFECTS OF HEROIN ADMINISTRATION AND WITHDRAWL
Lowered body temp Decreased blood pressure Skin flushed and warm Constipation Decreased sex drive Muscular relaxation Nodding, stupor Analgesic (pain killer) Withdrawal
Elevated body temp Increased blood pressure Gooseflesh Diarrhea Spontaneous ejaculations and orgasms Restlessness, involuntary twitching and kicking Insomnia Pain and irritability DANGERS AND POTENTIAL DANGERS AND POTENTIAL LETHALITY OF HEROIN ABUSE Relatively small LD/ED ratio (about 12–15) Death by overdose is everpresent risk Possible adverse effects from toxic substances “cut” with the heroin Many deaths associated with heroin are due to toxicity of ‘other’ drug present “xcrossing” — heroin use with other illicit drugs such as cocaine or licit drugs such as alcohol Unstable levels of tolerance tied to environmental setting Possible respiratory depression from inhibition of the medulla Allergic reaction to a massive release of histamine Increased risk of HIV or hepatitis infection from nonsterile needles, if heroin is injected Possible Parkinson’s disease from MPTP in synthetic heroin Lifestyle of heroin user is often more dangerous than the heroin Are heroin users doomed? Are heroin users doomed? Typical compulsive Heroin user, stereotype “Chipper” – occasional, controlled use with different patterns of use and different motives Inconclusive studies Many former chronic heroin users fully recover the longterm effects of heroin on the body are less severe than the longterm effects of alcohol MEDICAL USES OF NARCOTIC MEDICAL USES OF NARCOTIC DRUGS Treatment of pain (analgesic action) Control of diarrhea (a symptom of dysentery and other disorders) Treatment of coughing (antitussive action) POSSIBLE ADVERSE EFFECTS POSSIBLE ADVERSE EFFECTS OF OPIATE TREATMENT Respiratory depression if patient suffers from asthma, emphysema, or pulmonary heart disease Nausea and vomiting Intestinal spasms due to decreased secretion of hydrochloric acid Undue sleepinducing effect Abuse NARCOTIC ANALGESIC DRUGS NARCOTIC ANALGESIC DRUGS OPIUM MORPHINE CODEINE Oxycodone (Percodan) Oxycodone with acetaminophen (Percocet) Hydrocodone (Hycodan) Hydrocodone with acetaminophen (Vicodin) OxyContin (timerelease form of oxycodone) Heroin, Percodan, Vicodin, Oxycontin LONGRANGE HEROIN ABUSE LONGRANGE HEROIN ABUSE TREATMENT Synthetic opiates such as Methadone and Darvon are used to treat heroin’s withdrawal during detox. Methadone maintenance is a substitute for heroin – longterm, daily; controversial but prevents dangerous lifestyle (HIV) LAAM (Orlaam) maintenance, similar to Methadone but only need to take every 3 days Ultrarapid opoid detox: naloxone blocks morphine receptors combined with clonidine which inhibits norepinephrine during withdrawal NeedleExchange Programs – Harm Reduction Needle Exchange Programs Needle Exchange Programs N.E.P. do reduce the spread of HIV and Hepatitis N.E.P.s do NOT increase drug use NEPs provide health care to hardtoreach population US – about 110 NEPs; Australia and G.B. 2000 NEPs On the one hand: drug users who are healthy and have support system have better chance of recovery On the other hand: do NEPs send the message that drug use is safe if clean needles are used? Is this a misleading message? Which goal is more important: Reducing HIV and other infections or Abstaining from drug use? ...
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- Fall '08