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Narcotics: Opium, Heroin, and Synthetic Opiates

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'Men drank alcohol in the local saloon while women took opium [drank laudanum] at ... Restlessness, involuntary kicking movements. Insomnia. Pain and irritability ... – PowerPoint PPT presentation

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Title: Narcotics: Opium, Heroin, and Synthetic Opiates


1
  • Chapter 5
  • Narcotics Opium, Heroin, and Synthetic Opiates

2
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.

3
OPIATES, OPIATE DERIVATIVES, AND SYNTHETIC OPIATES
4
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

5
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)

6
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.

7
SOURCES OF HEROIN
8
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.

9
ACUTE EFFECTS OF HEROIN
  • Almost immediate tingling sensation, sudden
    feeling of warmth in lower abdomen
  • Intense euphoria
  • Subsequent tranquil drowsiness
  • Diminishment of sexual desire

10
MORPHINE COMPARED TO ITS ANTAGONIST NALOXONE
11
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

12
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

13
LONG-RANGE HEROIN ABUSE TREATMENT
  • Methadone maintenance
  • LAAM (Orlaam) maintenance
  • Buprenorphine maintenance
  • Therapeutic communities (Daytop Village,
    Samaritan Village, Phoenix House)
  • Multimodality programs

14
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.

15
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

16
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)

17
NARCOTIC ANALGESIC DRUGS
  • Oxycodone (Percodan)
  • Oxycodone with acetaminophen (Percocet)
  • Hydrocodone (Hycodan)
  • Hydrocodone with acetaminophen (Vicodin)
  • OxyContin (time-release form of oxycodone)

18
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.
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