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Chapter 5 Narcotics: Opium, Heroin, and Synthetic Opiates © Copyright 2011, Pearson Education, Inc. All rights reserved. Opiates • Opiates are a form of narcotic drug that include opium and three natural components that can be extracted from it: morphine, codeine, and thebaine. © Copyright 2011, Pearson Education, Inc. All rights reserved. Figure 5.1 © Copyright 2011, Pearson Education, Inc. All rights reserved. Opium in History • A drug with a very long history, opium has been used for medicinal and recreational purposes for approximately 5,000 years. • During the nineteenth century, opium even figured in global politics as the instigating factor for the Opium War fought between China and Britain. © Copyright 2011, Pearson Education, Inc. All rights reserved. Opium in History • At the time, opium use was widespread in Britain and the United States at all levels of society. © Copyright 2011, Pearson Education, Inc. All rights reserved. Morphine and the Advent of Heroin • The discovery of morphine in 1803 as the principal active ingredient in opium revolutionized medical treatment of pain and chronic diseases. • At the end of the nineteenth century, heroin was introduced by the Bayer Company in Germany. • Initially, it was believed that heroin lacked the dependence-producing properties of morphine. © Copyright 2011, Pearson Education, Inc. All rights reserved. Opiates and Heroin in American Society • The abuse potential of morphine and especially of heroin was not fully realized until the beginning of the twentieth century. • Social and political developments in the United States after the passage of the Harrison Act in 1914 drove heroin underground, where it acquired a growing association with criminal life. © Copyright 2011, Pearson Education, Inc. All rights reserved. Opiates and Heroin in American Society • Heroin abuse became associated with African American and other minority communities in urban ghettos after World War II; later, the drug revolution and the military involvement in Vietnam during the 1960s and 1970s brought the issue of heroin abuse to a wider population. © Copyright 2011, Pearson Education, Inc. All rights reserved. Effects on the Mind and the Body • The effects of narcotic drugs such as heroin include euphoria, analgesia, gastrointestinal slowing, and respiratory depression. • Respiratory depression is the major risk factor for heroin intake. © Copyright 2011, Pearson Education, Inc. All rights reserved. How Opiates Work in the Brain • Since the 1970s, we have known that the effects of morphine and similar drugs are the result of the activation of morphine-sensitive receptors in the brain. © Copyright 2011, Pearson Education, Inc. All rights reserved. Figure 5.2 © Copyright 2011, Pearson Education, Inc. All rights reserved. How Opiates Work in the Brain • Three families of chemical substances produced by the brain bind to these receptors. • These chemicals are collectively known as endorphins. © Copyright 2011, Pearson Education, Inc. All rights reserved. Patterns of Heroin Abuse • Chronic heroin abuse is subject to tolerance effects over time. © Copyright 2011, Pearson Education, Inc. All rights reserved. Table 5.1 © Copyright 2011, Pearson Education, Inc. All rights reserved. Patterns of Heroin Abuse • Withdrawal effects include intense craving for heroin and physical symptoms such as diarrhea and dehydration. • One of the major problems surrounding heroin abuse is the unpredictability in the content of a heroin dose. © Copyright 2011, Pearson Education, Inc. All rights reserved. Table 5.2 © Copyright 2011, Pearson Education, Inc. All rights reserved. Treatment for Heroin Abuse • Treatment for heroin abuse includes short-term detoxification and long-term interventions that address the continuing craving for the drug and physical dependence factors in the body. © Copyright 2011, Pearson Education, Inc. All rights reserved. Treatment for Heroin Abuse • Methadone-maintenance programs focus primarily on the physiological needs of the heroin abuser, whereas therapeutic communities and support groups focus on his or her long-term reintegration into society. © Copyright 2011, Pearson Education, Inc. All rights reserved. Opiate Use, Misuse, and Abuse • In medical settings, narcotic drugs have been extremely helpful in the treatment of pain, in the treatment of dysentery, and in the suppression of coughing. © Copyright 2011, Pearson Education, Inc. All rights reserved. Table 5.3 © Copyright 2011, Pearson Education, Inc. All rights reserved. Opiate Use, Misuse, and Abuse • Side effects of opiate-based medications include respiratory depression, intestinal spasms, and sedation. • There has been great concern since the late 1990s that prescription pain relievers have been diverted to nonmedical purposes and are subject to abuse. © Copyright 2011, Pearson Education, Inc. All rights reserved. Opiate Use, Misuse, and Abuse • Three medications of this type are OxyContin, Vicodin, and Percocet. • More than half of young adults who have used a prescription pain reliever for nonmedical reasons report that the drug was obtained free from a friend or relative. © Copyright 2011, Pearson Education, Inc. All rights reserved.