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THE HISTORY OF OPIUM Steve Weaver MD
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DISCLOSURES I have no disclosures Board Certified in Internal Medicine
Subspecialty Certification in Addiction Medicine Masters In Counseling
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TERMS IN ADDICTION MEDICINE
Narcotic Opiate Opioid
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CLASSIFICATION OF OPIOIDS
Relationship to Opium Naturally occurring Morphine Codeine Thebaine Papaverine
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CLASSIFICATION OF OPIOIDS
Relationship to Opium Naturally occurring Morphine Codeine Thebaine Papaverine Semi-synthetic Diacetylmorphine Hydromorphone Buprenorphine Oxycodone Synthetic Meperidine Fentanyl Carfentanyl
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CLASSIFICATION OF OPIOIDS
The Opioid receptor where they exert their effect Mu Kappa Delta
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CLASSIFICATION OF OPIOIDS
Effect at the receptor Agonist Partial agonist Antagonist
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HISTORY OF OPIOIDS PAPAVER SOMNIFERUM
SUMERIANS IN MESOPATAMIA….THE JOY PLANT ANCIENT EGYPTIANS ALEXANDER THE GREAT GLADIATORS
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HISTORY OF OPIOIDS PARACELSUS
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HISTORY OF OPIOIDS 1492 Colombus New route to India….for what
Spices and opium Tobacco New delivery system for opium
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HISTORY OF OPIOIDS CHINA 1800: 1/3 of population addicted to opium
British grew it in India and sold it in China British Empire was built on slaves and opium Opium Wars FIRST NATIONAL OPIOID EPIDEMIC
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HISTORY OF OPIOIDS Frederic Serterner Hypodermic Needle Civil War
Morphine Hypodermic Needle Civil War Butcher knives, saws and wire cutters GOM Soldiers Disease or the Army Disease FIRST AMERICAN OPIOID EPIDEMIC
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HISTORY OF OPIOIDS PATENT MEDICINES
Typical addict around 1900 was a white mc woman on patent medicines SECOND NATIONAL OPIOID EPIDEMIC
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HISTORY OF OPIOIDS 1898 THIRD NATIONAL OPIOID EPIDEMIC Bayer
Diacetylmorphine Heroin Cough medicine Pneumonia TB THIRD NATIONAL OPIOID EPIDEMIC
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HISTORY OF OPIOIDS Freud Halstead Osler
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HISTORY OF OPIOIDS Harrison Narcotic Act 1970’s-Vietnam War DATA 2000
The Controlled Substances Act Methadone DATA 2000
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HISTORY OF OPIOIDS Dr Jane Porter, 1980, NEJM Journal “Pain”
Only 4/12,000 patients treated with opioids for pain became addicted Journal “Pain” Less than 6% of people treated for pain with chronic opioids become addicted 1990’s….Doctors began to get sued for undertreating pain 5th Vital sign…JCAHO Big Pharma 2007…. Purdue….oxycontin
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WAYS TO TREAT ADDICTION
Kill addicts Lock all addicts up Prohibition Psychosocial treatment Pharmacotherapy
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