Presentation on theme: "OPIOIDS I. Where do they come from? / synthesized in 1803"— Presentation transcript:
1OPIOIDS I. Where do they come from? / synthesized in 1803 poppy plant: from middle east and Asiadried sap from plant is opium; cultivated annually BUT plant produces drug within only 10 day windowmajor 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
2OPIOIDS Other names they go by? - Oxycodone - Codeine: Lean; Purple stuff- others? ______________
3OPIOIDS II. Medical Uses As pain reliever (morphine, demerol, codeine, lortab, lorcet, percodan, percocet, vicodin, oxycontin)with chronic pain or terminal patientsin some cough suppressantstreatment of diarrhea, which is dehydrating
4OPIOIDS III. Prevalence Heroin compared to non-medical use of rx Pain meds:Lifetime Past Year Current2010: H: ___% ___% ___%P: ___% ___% ___%
6OPIOIDS IV. Mechanisms of action opiates trigger our own brain chemicals,_________________________________naloxone ____________ effects of opiates by blocking opiate receptor sites
7OPIOIDSV. Effectsproduces short-lived euphoria, profound relaxation, body warmth (lowers body temp)tolerance develops rapidly so increasing doses is very commondrug taking becomes a chore to avoid withdrawal SX illustrates ? reinforcement
8A diagram of Siegel’s rat experiment Rats: heroin tolerantControl rats: No heroin toleranceReceived injection of heroin 15 mg/kg in familiar environmentReceived injection of heroin 15 mg/kg in unfamiliar environmentReceived injection of heroin 15 mg/kg for first timeOverdose rate: %Overdose rate: %A diagram of Siegel’s rat experimentTo some degree, drug tolerance is associated with environmental factors. Tolerance may disappear or decrease if a drug is used in an unfamiliar environment.
9OPIOID WITHDRAWALStoppage (or reduction] in opioid use that has been heavy and prolonged (several weeks +)OR administration of opioid antagonist after period of useSymptoms include: (need at least 3 for DSM criteria)dysphoric mood - yawningdiarrhea - fevermuscle aches - dilation of pupils, piloerectioninsomnia or sweatingnausea or vomitingrunny eyes or nose
10OPIOIDSVI. Treatmentmethadone 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 narcoticsblood levels of methadone, when given orally, is below ED level in tolerant patients, and is ________________________________________________________________________________LAAM, naltrexone, buprenorphine- TCs
11OPIOIDS - ControversyNeedle 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?
12Prescription 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 CenturyOpioid therapy became accepted (although often inadequately) for treating acute pain, pain due to cancer, & pain caused by a terminal diseaseStill disputed is the use of opioids for chronic pain not associated with terminal disease
13Evolving Landscape of Drugs of Abuse FarmingPharming13
14Potential subpopulations of prescription Opioid Abusers Persons who abuse or are dependent on only prescription opioidsAbusers of other opioids, e.g., heroin, when they cannot get their drug of choicePolydrug abusersPain patients who develop abuse or dependence problems on these drugs in the course of legitimate medical treatment
15Why Has the Abuse of Prescription Drugs Been Increasing? Increasing numbers of prescriptionsOthers?Attention by the media & advertising (television and newspaper)Easier access (e.g. internet availability)
16Number of Prescriptions (in 1000s) As Prescriptions Increase, ER Reports Have Increased at the Same or Faster RateNumber of Prescriptions (in 1000s)Source: IMS Health for Prescriptions and SAMHSA (DAWN) for Emergency Department MentionsHydrocodoneOxycodoneprescriptionsemergency1000020000300004000050000600007000080000199419951996199719981999200020016000120001800024000ED Mentions.