1. OPIOIDS I. Where do they come from? / synthesized in 1803
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 Heroin compared to non-medical use of rx
Pain meds:
Lifetime Past Year Current
2010: H: ___% ___% ___%
P: ___% ___% ___%

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. A diagram of Siegel’s rat experiment
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: %
Overdose rate: %
A diagram of Siegel’s rat experiment
To some degree, drug tolerance is associated with environmental factors. Tolerance may disappear or decrease if a drug is used in an unfamiliar environment.

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 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 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. Evolving Landscape of Drugs of Abuse
Farming
Pharming 13

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

15. Why Has the Abuse of Prescription Drugs Been Increasing?
Increasing numbers of prescriptions
Others?
Attention by the media & advertising (television and newspaper)
Easier access (e.g. internet availability)

16. Number of Prescriptions (in 1000s)
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
10000
20000
30000
40000
50000
60000
70000
80000
1994
1995
1996
1997
1998
1999
2000
2001
6000
12000
18000
24000
ED Mentions .