Download OPIOIDS

OPIOIDS
I.
Where do they come from?
– 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
OPIOIDS
Other names they go by?
- Oxycodone
- Codeine: Lean; Purple stuff
- others? ______________
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
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III. Prevalence
Heroin compared to non-medical use of rx
Pain meds:
Lifetime
2004: H: 1.3%
P: 13.2%
Past Year
Current
0.2%
4.7%
0.1%
1.8%
FIND 2010 DATA --------------------------------------------------------------
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IV. Mechanisms of action
• opiates trigger our own brain chemicals,
_________________________________
• naloxone ____________ effects of
opiates by blocking opiate receptor sites
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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
Rats:
heroin
tolerant
Received
injection of
heroin 15
mg/kg in
familiar
environment
Overdose
rate:
%
Rats:
heroin
tolerant
Received
injection of
heroin 15
mg/kg in
unfamiliar
environment
Overdose
rate:
%
Received
injection of
heroin 15
mg/kg for first
time
Overdose
rate:
%
Control
rats: No
heroin
tolerance
A diagram of Siegel’s rat experiment
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
diarrhea
muscle aches
insomnia
nausea or vomiting
runny eyes or nose
- yawning
- fever
- dilation of pupils, piloerection
or sweating
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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
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?
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
Evolving Landscape of Drugs of Abuse
Farming
Pharming
13
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
Why Has the Abuse of Prescription
Drugs Been Increasing?
•
Increasing numbers of prescriptions
•
Others?
As Prescriptions Increase, ER Reports Have
Increased at the Same or Faster Rate
Number of Prescriptions (in 1000s)
24000
80000
70000
Hydrocodone
. 18000
prescriptions
emergency
60000
50000
12000
40000
30000
Oxycodone
prescriptions
emergency
20000
6000
10000
0
1994
1995
1996
1997
1998
1999
2000
0
2001
Source: IMS Health for Prescriptions and SAMHSA (DAWN) for Emergency Department Mentions