Narcotics: Opium, Heroin, and Synthetic Opiates

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• Chapter 5
• Narcotics Opium, Heroin, and Synthetic Opiates

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OPIATES, OPIATE DERIVATIVES, AND SYNTHETIC OPIATES

• Opiates morphine, codeine, thebaine
• Opiate derivatives heroin, Numorphan, Percodan
  (Percocet), Hydodan (Vicodin)
• Synthetic opiates methadone, Demerol, Darvon,
  LAAM (Orlaam), tramadol (Ultram), buprenorphine
  (Subutex, Suboxone)
• Note Brand names are capitalized.

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OPIATES, OPIATE DERIVATIVES, AND SYNTHETIC OPIATES
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HIGHLIGHTS FROM THE HISTORY OF OPIATES

• Early 3rd century B.C. --- First record of opium
  use
• 1520 --- Paracelsus introduces liquid form of
  opium called laudanum
• 1680 --- Thomas Sydenham popularizes use of a
  variation of Paracelsus formula
• 1803 --- Friedrich W. A. Sertürner identifies
  morphine as the active
  ingredient in opium
• 1839-1860 --- Opium wars mandates opium
  importation in China and increases
  western trade
• 1800s --- Opium readily available in patent
  medicines
• 1898 --- Bayer Company introduces heroin
• 1960s-1970s --- Heroin abuse reaches peak in the
  U.S.
• mid-1990s --- Principal supplier of heroin shifts
  from Asia to South America
• mid-1990s --- Popularity of heroin returns, at
  dosages that permit non-injection
  administrations

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FORMS OF RECREATIONAL DRUG USE IN NINETEENTH
CENTURY AMERICA

• Men drank alcohol in the local saloon while
  women took opium drank laudanum at home.
• Edward Beecher,
• Licit and illicit drugs (1972)

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HEROIN ABUSE IN THE 1960s AND 1970s

• Crackdown on heroin smuggling results in
  significant shortage of street heroin and
  elevated prices.
• Youth counterculture experiments with heroin as
  well as other psychoactive drugs.
• Armed forces personnel in Southeast Asia discover
  high-potency heroin.

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SOURCES OF HEROIN
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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. China White also refers to a type of
  heroin from Southeast Asia.

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ACUTE EFFECTS OF HEROIN

• Almost immediate tingling sensation, sudden
  feeling of warmth in lower abdomen
• Intense euphoria
• Subsequent tranquil drowsiness
• Diminishment of sexual desire

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MORPHINE COMPARED TO ITS ANTAGONIST NALOXONE
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SYMPTOMS OF HEROIN WITHDRAWAL

• Elevated body temperature
• Increased blood pressure
• Piloerection (gooseflesh)
• Tearing, runny nose
• Diarrhea
• Yawning, panting, sneezing
• Spontaneous ejaculations and orgasms
• Restlessness, involuntary kicking movements
• Insomnia
• Pain and irritability
• Depression and anxiety

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DANGERS AND POTENTIAL LETHALITY OF HEROIN ABUSE

• Small LD/ED ratio (about 12-15)
• Toxic substances cut with the heroin
• Use with other drugs
• Unstable levels of tolerance tied to
  environmental setting
• Possible respiratory depression
• Allergic reaction to a massive release of
  histamine
• Increased risk of HIV or hepatitis if heroin

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LONG-RANGE HEROIN ABUSE TREATMENT

• Methadone maintenance
• LAAM (Orlaam) maintenance
• Buprenorphine maintenance
• Therapeutic communities (Daytop Village,
  Samaritan Village, Phoenix House)
• Multimodality programs

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NEW DEVELOPMENTS IN BUPRENORPHINE TREATMENT OF
OPIATE DEPENDENCE

• Buprenorphine (Subutex, Suboxone) is now
  available a sustained-release version that can be
  administered by injection on a once-per-month
  basis.
• Buprenorphine can be administered in primary care
  clinics and physicians offices.

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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 sleep-inducing effect

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MEDICAL USES OF NARCOTIC DRUGS

• Treatment of pain (analgesic action)
• Control of diarrhea (a symptom of dysentery and
  other intestinal disorders)
• Treatment of coughing (antitussive action)

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NARCOTIC ANALGESIC DRUGS

• Oxycodone (Percodan)
• Oxycodone with acetaminophen (Percocet)
• Hydrocodone (Hycodan)
• Hydrocodone with acetaminophen (Vicodin)
• OxyContin (time-release form of oxycodone)

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THE TWO SIDES OF OXYCONTIN POWERFUL
ANALGESIC/POTENTIAL DRUG OF ABUSE

• Problem for the physician
• A practicing physician has to be mindful that
  someone, even if they dont come with addict
  written all over them, may be one.The physician
  has to establish a relationship with the patient
  theyre taking care of on a long-term basis.