Copyright Notice This presentation is copyrighted by the Psychopharmacology Institute. Subscribers can download it and use it for professional use. The contents of the presentation may be modified, but the Psychopharmacology Institute logo must remain visible in all slides.

What is an Opioid Use Disorder? Joji Suzuki, MD Director, Division of Addiction Psychiatry Department of Psychiatry, Brigham and Women’s Hospital Assistant Professor of Psychiatry, Harvard Medical School

Outline Opiates vs opioids Papaver Somniferum and the beginning of pharmaceutical opioid formulations Heroin: First tried as substitution treatment Opioid of choice in 70’s and 80’s Preparation and routes of administration

Outline Opiates vs opioids Papaver Somniferum and the beginning of pharmaceutical opioid formulations Heroin: First tried as substitution treatment Opioid of choice in 70’s and 80’s Preparation and routes of administration

Outline Opiates vs opioids Papaver Somniferum and the beginning of pharmaceutical opioid formulations Heroin: First tried as substitution treatment Opioid of choice in the 70’s and 80’s Preparation and routes of administration

Outline Opiates vs opioids Papaver Somniferum and the beginning of pharmaceutical opioid formulations Heroin: First tried as substitution treatment Opioid of choice in the 70’s and 80’s Preparation and routes of administration

Nomenclature: Opiates vs Opioids

Compounds that activate opioid receptors Opioids: Compounds that activate opioid receptors Opiates: Compounds derived from Papaver Somniferum Morphine Codeine

Compounds that activate opioid receptors Opioids: Compounds that activate opioid receptors Opiates: Compounds derived from Papaver Somniferum Morphine Codeine

Semisynthetic opioids Heroin (diacetylmorphine) Oxycodone Hydromorphone Buprenorphine Naloxone Hydrocodone Naltrexone

Semisynthetic opioids Heroin (diacetylmorphine) Oxycodone Hydromorphone Buprenorphine Naloxone Hydrocodone Naltrexone Structurally related to morphine and codeine Cross reaction with morphine urine tests

Synthetic opioids Meperidine Methadone Fentanyl Negative on morphine tests Not structurally related to morphine and codeine

Naturally occurring opioids Endorphins Salvinorin A (hallucinogenic mint-family plant)

Analgesia Euphoria Cough suppression Constricted pupils Constipation Sedation Respiratory depression Hormonal changes Nausea Mu receptors Dysphoria Hallucinations Kappa receptors Convulsant Delta receptors

Analgesia Euphoria Cough suppression Constricted pupils Constipation Sedation Respiratory depression Hormonal changes Nausea Mu receptors Dysphoria Hallucinations Kappa receptors Convulsant Delta receptors

Analgesia Euphoria Cough suppression Constricted pupils Constipation Sedation Respiratory depression Hormonal changes Nausea Mu receptors Dysphoria Hallucinations Kappa receptors Convulsant Delta receptors

Next: From P. Somniferum to Heroin