Transcript OPIOIDS
OPIOIDS
I.
Where do they come from?
– poppy plant: from middle east and Asia
– dried sap from plant is opium; cultivated annually BUT
plant produces drug within only 10 day window
over 87% of world’s opium comes from Afghanistan
(2005 U.N. report)
– major active ingredient in opium: morphine
/ synthesized in 1803
/ named after the Greek god of dreams Morpheus
/ morphine altered in late 1800s into heroin a “heroic” TX
(3-10x as strong as morphine)
/ Fentanyl
OPIOIDS
Other names they go by?
- Oxycodone
- Codeine: Lean; Purple stuff (cough syrup with
sprite and jolly ranchers)
- others? ______________
OPIOIDS
II.
Medical Uses
– As pain reliever (morphine, demerol, codeine, lortab,
lorcet, percodan, percocet, vicodin, oxycontin)
– with chronic pain or terminal patients
– in some cough suppressants
– treatment of diarrhea, which is dehydrating
OPIOIDS
III. Prevalence
Heroin compared to non-medical use of rx
Pain meds:
Lifetime
2004: H: 1.3%
P: 13.2%
Past Year
Current
0.2%
4.7%
0.1%
1.8%
- new heroin users may smoke, sniff or snort it rather than
inject……why ?
OPIOIDS
IV. Mechanisms of action
• opiates trigger our own brain chemicals,
the endorphins (short for “endogenous
morphine”) to relieve pain
• naloxone ____________ effects of
opiates by blocking opiate receptor sites
OPIOIDS
V. Effects
• produces short-lived euphoria, profound
relaxation, body warmth (lowers body temp)
• tolerance develops rapidly so increasing doses is
very common
• drug taking becomes a chore to avoid withdrawal
SX - illustrates ? reinforcement
Rats:
heroin
tolerant
Received
injection of
heroin 15
mg/kg in
familiar
environment
Overdose
rate:
%
Rats:
heroin
tolerant
Received
injection of
heroin 15
mg/kg in
unfamiliar
environment
Overdose
rate:
%
Received
injection of
heroin 15
mg/kg for first
time
Overdose
rate:
%
Control
rats: No
heroin
tolerance
A diagram of Siegel’s rat experiment
OPIOID WITHDRAWAL
• Stoppage (or reduction] in opioid use that has
been heavy and prolonged (several weeks +)
• OR administration of opioid antagonist after
period of use
• Symptoms include: (need at least 3 for DSM criteria)
–
–
–
–
–
–
dysphoric mood
diarrhea
muscle aches
insomnia
nausea or vomiting
runny eyes or nose
- yawning
- fever
- dilation of pupils, piloerection
or sweating
OPIOIDS
VI.
Treatment
- methadone TX: peak concentration occurs 2-4 hours
after taken, in contrast to effects of other opiates
which kick in right away like a hammerblow;
metabolites of methadone are inactive, unlike other
narcotics
- blood levels of methadone, when given orally, is below
ED level in tolerant patients, and is safely above the
threshold for withdrawal...so, methadone combines
safety and long action
-
LAAM, naltrexone, buprenorphine
-
TCs
OPIOIDS - Controversy
• Needle exchange programs to prevent HIV:
are you pro/con?
• Should heroin be given to terminal
patients? Do terminal patients have right to
die with drugs?
• Should non-terminal pain patients be
freely medicated with morphine or even
stronger painkillers?
Prescription Opioid Abuse Historical
Aspects 1990 - Current
• Through the efforts of pain control advocates, organized
medicine, scientific journals, & malpractice suits,
prescribing opiates for pain became more common during
the last decade of the 20th Century
• Opioid therapy became accepted (although often
inadequately) for treating acute pain, pain due to cancer, &
pain caused by a terminal disease
• Still disputed is the use of opioids for chronic pain not
associated with terminal disease
Evolving Landscape of Drugs of Abuse
Farming
Pharming
13
Potential subpopulations of prescription
Opioid Abusers
Persons who abuse or are dependent on only
prescription opioids
Abusers of other opioids, e.g., heroin, when they
cannot get their drug of choice
Polydrug abusers
Pain patients who develop abuse or dependence
problems on these drugs in the course of
legitimate medical treatment
Why Has the Abuse of Prescription
Drugs Been Increasing?
•
Increasing numbers of prescriptions
•
Others?
As Prescriptions Increase, ER Reports Have
Increased at the Same or Faster Rate
Number of Prescriptions (in 1000s)
24000
80000
70000
Hydrocodone
. 18000
prescriptions
emergency
60000
50000
12000
40000
30000
Oxycodone
prescriptions
emergency
20000
6000
10000
0
1994
1995
1996
1997
1998
1999
2000
0
2001
Source: IMS Health for Prescriptions and SAMHSA (DAWN) for Emergency Department Mentions