1. Opiates

2. Narcotics A drug that in therapeutic doses diminishes sensibility, relieves pain, and produces sleep, but in large doses causes stupor, coma or convulsions; any drug with properties similar to morphine, identified as a narcotic drug by federal law. A drug that in therapeutic doses diminishes sensibility, relieves pain, and produces sleep, but in large doses causes stupor, coma or convulsions; any drug with properties similar to morphine, identified as a narcotic drug by federal law. Gould’s Medical dictionary Gould’s Medical dictionary

3. Source Opium poppy Opium poppy Papaver somniferum L Papaver somniferum L Papaver – Greek for poppy Papaver – Greek for poppy Somniferum – Latin – to dream or sleep Somniferum – Latin – to dream or sleep Grows in India, Turkey, China, Mexico, SW Asia, Afghanistan Grows in India, Turkey, China, Mexico, SW Asia, Afghanistan

4. Harvest Petals fall from the opium seed pod Petals fall from the opium seed pod Approximately two weeks later unripe pods are incised Approximately two weeks later unripe pods are incised Opium oozes out and dries in about 24 hours Opium oozes out and dries in about 24 hours Then collected by hand Then collected by hand

5. Yields Four kilos of opium per acre Four kilos of opium per acre 80 mgs per plant 80 mgs per plant 10 kilos of opium yield about 1 kilo of morphine and morphine to heroin is a 1 to 1 conversion 10 kilos of opium yield about 1 kilo of morphine and morphine to heroin is a 1 to 1 conversion

6. Opium derivatives Opium Opium Morphine Morphine Codeine Codeine Thebaine Thebaine

7. Semi – Synthetic Derivatives Heroin – diacetylmorphine Heroin – diacetylmorphine Eythylmorphine –Dionine Eythylmorphine –Dionine Dihydrocodeine – Paracodin Dihydrocodeine – Paracodin Hydromorpone – Dilaudid Hydromorpone – Dilaudid Dihydrocodeinone – Kycodan Dihydrocodeinone – Kycodan Oxycodone - Percodan Oxycodone - Percodan

8. Synthetics Meperidine – Demorol Meperidine – Demorol Methadone – Methadon, Dolophine Methadone – Methadon, Dolophine

9. Earliest recorded use of opiates, circa 1500 BC in the Ebers papyrus Earliest recorded use of opiates, circa 1500 BC in the Ebers papyrus Pharmacology book (Biruni 1000 AD) describing opiate dependence Pharmacology book (Biruni 1000 AD) describing opiate dependence Early 16 th century, Paracelsus created laudanum, a mixture of wine and opium Early 16 th century, Paracelsus created laudanum, a mixture of wine and opium

10. Dr. Thomas Sydenham (The English Hippocrates) modified laudanum mixture, John Bell Hood Dr. Thomas Sydenham (The English Hippocrates) modified laudanum mixture, John Bell Hood Morphine was isolated by Frederich Serturner in 1806 Morphine was isolated by Frederich Serturner in 1806 Codeine (poppy head) was isolated in 1832 Codeine (poppy head) was isolated in 1832 English developed trade with China in the 19 th century through the East India Company English developed trade with China in the 19 th century through the East India Company

11. China had the problem of increasing opium addiction and banned the importation of opium China had the problem of increasing opium addiction and banned the importation of opium This lead to the Opium War in 1840 to 1842 in which England took control of Hong Kong This lead to the Opium War in 1840 to 1842 in which England took control of Hong Kong

12. 1853 the hypodermic needle was invented 1853 the hypodermic needle was invented U. S. Civil War lead to the “Soldier’s Disease” U. S. Civil War lead to the “Soldier’s Disease” Heroin was transformed in 1874, thought to be 3X more powerful than morphine Heroin was transformed in 1874, thought to be 3X more powerful than morphine

13. Influx of Chinese laborers caused an increase in opium smoking Influx of Chinese laborers caused an increase in opium smoking 1890 Heroin was marketed by the Germans, may be derived from the German heroisch meaning heroic, dynamic or powerful 1890 Heroin was marketed by the Germans, may be derived from the German heroisch meaning heroic, dynamic or powerful

14. Opiate abuse developed in the mid-19 th century Opiate abuse developed in the mid-19 th century Harrison Act in 1914 (drugs secured by a physician) Harrison Act in 1914 (drugs secured by a physician) WWII heroin use increased in the “lower classes” WWII heroin use increased in the “lower classes”

15. 1960’s saw an increase in the use of heroin as well as other drugs 1960’s saw an increase in the use of heroin as well as other drugs Vietnam war created the opportunity for increased use of heroin among U.S. military personnel Vietnam war created the opportunity for increased use of heroin among U.S. military personnel In the 1970’s “black tar” from Mexico became available In the 1970’s “black tar” from Mexico became available

16. Current use includes upper – middle class use with purity of heroin increasing (40 to 60 %) Current use includes upper – middle class use with purity of heroin increasing (40 to 60 %)

17. Effects of Opium Derivatives Primarily an analgesic Primarily an analgesic Constricted pupils, DRE Constricted pupils, DRE Depressed respiration Depressed respiration Constipation Constipation Nausea Nausea Drowsiness Drowsiness Euphoria Euphoria

18. Apathy Apathy Decreased sexual drive Decreased sexual drive Tolerance Tolerance Physical dependency Physical dependency

19. Dosage form and use (heroin) White powder White powder Brown powder Brown powder Black tar – smoked Black tar – smoked Snorted Snorted Injected Injected Skin popping Skin popping Smoked Smoked

20. Chemical Characteristics Raw opium contains 10% morphine and small amounts of codeine Raw opium contains 10% morphine and small amounts of codeine Heroin is produced by the addition of 2 acetyl molecules thus producing diacetylmorphine Heroin is produced by the addition of 2 acetyl molecules thus producing diacetylmorphine Fentanyl (pain reliever) resulted in improved anesthesia Fentanyl (pain reliever) resulted in improved anesthesia

21. Narcotic antagonists (Naloxone) can reverse overdoses Narcotic antagonists (Naloxone) can reverse overdoses

22. Mechanism of Action Leu-enkephalin and met–enkephhalin act like morphine Leu-enkephalin and met–enkephhalin act like morphine Endorphins found in brain tissue Endorphins found in brain tissue Midbrain (pain reception site) interaction Midbrain (pain reception site) interaction Endorphins are released by the pituitary and perhaps act in the spinal column but have an unsubstantiated effect on the brain Endorphins are released by the pituitary and perhaps act in the spinal column but have an unsubstantiated effect on the brain

23. Dependence Potential Tolerance develops with narcotic drugs Tolerance develops with narcotic drugs Psychological dependence Psychological dependence Behavior reinforcement of needle usage Behavior reinforcement of needle usage

24. Withdrawal Peaks in 24 to 36 hours Peaks in 24 to 36 hours Lasts 3 to 5 days Lasts 3 to 5 days Tearing of the eyes Tearing of the eyes Runny nose Runny nose Sweating Sweating Dilated pupils Dilated pupils

25. Loss of appetite Loss of appetite Gooseflesh “Cold Turkey” Gooseflesh “Cold Turkey” Restlessness Restlessness Irritability Irritability Tremor, convulsions Tremor, convulsions Insomnia Insomnia

26. Depression Depression Nausea and vomiting Nausea and vomiting Cramps and diarrhea Cramps and diarrhea Muscle spasms – Kicking the habit Muscle spasms – Kicking the habit

27. Toxicity Potential Acute toxicity effects, Acute toxicity effects, Respiration Respiration Decreased mental ability Decreased mental ability Nausea/vomiting Nausea/vomiting

28. Chronic Toxicity Sores at injection sites Sores at injection sites HIV/AIDS HIV/AIDS Hepatitis Hepatitis No long-term change in tissues or organs No long-term change in tissues or organs

29. Treatment Narcotic antagonists Narcotic antagonists Methadone Methadone LAAM (L-alpha-acetyl-methadol) LAAM (L-alpha-acetyl-methadol) Buprenorphine Buprenorphine Heroin/morphine maintenance Heroin/morphine maintenance Rapid opioid detoxification Rapid opioid detoxification Delancy Street Delancy Street

30. Questions?