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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.

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Presentation on theme: "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."— Presentation transcript:

1 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 –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

2 OPIOIDS Other names they go by? - Oxycodone - Codeine: Lean; Purple stuff - others? ______________

3 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

4 OPIOIDS III. Prevalence H eroin compared to non-medical use of rx P ain meds: Lifetime Past YearCurrent 2010: H: ___% ___% ___% P: ___%___% ___%

5

6 OPIOIDS IV. Mechanisms of action opiates trigger our own brain chemicals, _________________________________ naloxone ____________ effects of opiates by blocking opiate receptor sites

7 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

8 Rats: heroin tolerant Control rats: No heroin tolerance Received injection of heroin 15 mg/kg in familiar environment Received injection of heroin 15 mg/kg in unfamiliar environment Received injection of heroin 15 mg/kg for first time Overdose rate: % A diagram of Siegel’s rat experiment

9 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- yawning –diarrhea- fever –muscle aches- dilation of pupils, piloerection –insomnia or sweating –nausea or vomiting –runny eyes or nose

10 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 ________________________________________ ________________________________________ - LAAM, naltrexone, buprenorphine - TCs

11 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?

12 Prescription Opioid Abuse Historical Aspects 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 20 th 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

13 13 Evolving Landscape of Drugs of Abuse FarmingPharming

14 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  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

15 Why Has the Abuse of Prescription Drugs Been Increasing? Increasing numbers of prescriptions Others? Increasing numbers of prescriptions Others?

16 As Prescriptions Increase, ER Reports Have Increased at the Same or Faster Rate Number of Prescriptions (in 1000s) Source: IMS Health for Prescriptions and SAMHSA (DAWN) for Emergency Department Mentions Hydrocodone Oxycodone prescriptions emergency ED Mentions.


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