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37 Cards in this Set
- Front
- Back
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Opiates
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Most potent painkillers. The most dramatic example of the double-edged sword character of drugs. Prototype addictive drug: Heroin
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Opium poppy (papaver somniferum)
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Native to the Middle East
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Seed pod of the poppy
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secretes opium
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Opium was cultivated how many years ago?
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6,000 years ago
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Opium was used medically where?
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Ancient Egypt, Greece, and Rome
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Who did not prohibit the use of opium?
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Islam
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China tried to first control opium use when?
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1729
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How did opium use spread?
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By Arab traders to India and China
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Opium use in the 19th century
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Serious problem in China (opium usually smoked). Widespread medical use in Europe and USA (usually ingested in liquid form with fewer problems). Recreational use in Europe and USA increased problems
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Technology advances
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Serturner isolates morphine (1803). Hypodermic needle allows injection of morphine (1850s). Wounded soldiers became addicted to morphine ("Soldier's disease")
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More technology advances
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1874: Wright invents diacetylmorphine
1898: Dreser finds that diacetylmorphine is twice as potent as morphine, names it heroin. Marketed as a cough suppressant and pain reliever |
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Harrison Narcotics Act
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1914, restricted opiates to medical use
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1915
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Only prescribe if doses were decreasing over time
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1917
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No prescriptions for addicts
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1924
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No prescriptions for heroin. Subsequently, opiates move to the black market
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Before 1914
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Opiates were used by all classes and across the country
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After 1914
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Opiate usage concentrated in cities. Heroin becomes the preferred opiate. Organized crime involved. Users were poor, young, and poorly educated men
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Current suppliers
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Afghanistan (87% of world's supply) & Pakistan
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"Golden triangle"
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Laos, Myanmar, Thailand
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South and Central America
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Colombia and mexico
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Prescription opiates
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Many opiates are available. Illicit use of prescription opiates has tripled in the last 15 years
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"China White" (fentanyl)
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Much more potent than heroin
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Errors in synthesis
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MPTP instead of MPPP
Causes symptoms of Parkinson's Disease |
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Heroin vs. Morphine
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Heroin reaches the brain better. In the brain, heroin becomes morphine
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Metabolism of opiates
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Most opiates are metabolized in the liver. Excretion is in urine. 90% excreted within a day. Traces detectable for 2-4 days
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Mechanisms of action
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Discovery of endorphins:
1960s: Naloxone blocks morphine 1970s: Receptors for opiates 1975: Natural, morphine-like substances in the brain: endorphins, endogenous morphine. Thus, opiated act on endorphin systems |
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Action of endorphins
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A natural pain relief system. Acupuncture may activate endorphins: Naloxone blocks acupuncture's pain relief
Placebos may activate endorphins: Naloxone blocks placebo pain relief |
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Medical use of opiates
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Pain relief or analgesia. Tolerance develops to the pain relief provided by opiates.
The greater potency of heroin could help terminal cancer pain |
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Other medical uses for opiates
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Diarrhea relief
Cough suppression Heroin addiction: Methadone withdrawal, methadone maintenance |
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Making opiates safer
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Combine opiates for pain relief with ultraslow naltrexone, an opiate antagonist
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Naltrexone
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An opiate antagonist:
Enhances the pain relief Blocks rewarding effects Slows development of tolerance Reduces severity of withdrawal |
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Acute effects of opiates
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Euphoria: Drowsiness, body warmth, heavy limbs
Reduced sexual interest Impaired social interaction Vivid dreamlike experience: "pipe dreams" |
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More acute effects of opiates
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Cognitive impairment - Animal studies show impaired learning and memory(methadone maintenance clients)
Respiratory depression & lowered body temperature Nausea, vomiting, pinpoint pupils |
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Chronic effects
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Tolerance: Chronic users steadily increase the dose
Withdrawal: motivation for use switched from positive to negative reinforcement, to avoid withdrawal symptoms |
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Opiate withdrawal symptoms ( First, 8-12 hours after last dose)
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First, 8-12 hours after last dose:
Runny nose and eyes, sweats, irritability, tremor |
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Opiate withdrawal symptoms (later, peaking 48-72 hours)
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More severe early symptoms, plus
Pupil dilation, anorexia, and piloerection (goose-bumps) |
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Treating opiate withdrawal
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No treatment ("Cold turkey" or "Kicking the habit")
Detoxification with methadone withdrawal High risk of relapse (90% within 6 months), especially on returning to the same environment |
