chapter 5

Chapter 5: Opioids - Opium, Heroin, and Opioid Pain Medications

Opium in History

  • The Opium War

    • Occurred in China in the 1800s.

    • Involved British and Indian raw opium; began in 1839.

Points of Consumption

  • Chinese Practices: Smoked opium in opium dens.

  • British Practices: Consumed laudanum, considered respectable and often given from birth.

  • Literary Figures:

    • Thomas DeQuincey: Authored "Confessions of an English Opium Eater."

    • Elizabeth Barrett Browning and Samuel Taylor Coleridge also indulged.

  • United States:

    • Cultivated opium poppies similar to England;

    • Issues of opium dependency paralleled those of alcohol and cocaine; racism fueled anti-opium movements.

Morphine and the Advent of Heroin

  • Morphine:

    • Isolated in 1803 by Friedrich Wilhelm Adam Serturner; 10% of opium weight and ten times stronger.

    • Other products include codeine and thebaine; administered via syringe.

  • Heroin:

    • Introduced by Bayer Company in 1898 as a cough suppressant.

    • Abuse potential recognized only after 1910; heroin is more potent than morphine.

Opioids in American Society

  • Late 19th century: 250,000 - 750,000 Americans opioid-dependent.

  • Concern regarding opioid dependency and associated crime.

The Harrison Act of 1914

  • Changed perception of abusers from victims to "contaminants."

  • Did not ban opioids; required doctor registration.

  • Supreme Court ruled it illegal to provide opioids for non-medical purposes, leading to heroin becoming a black market drug.

Neurochemical Basis

  • Opioids activate specific receptors in the body.

  • Antagonists (e.g., Naloxone) can reverse the effects of morphine.

  • Natural chemicals like enkephalins and endorphins interact with opiate receptors.

Patterns of Heroin Abuse

  • Administration Methods:

    • Injection (mainlining), smoking (less common), snorting, and oral (less effective).

  • Tolerance and Withdrawal:

    • Tolerance develops unevenly, with high euphoria tolerance but none in the GI system; withdrawal symptoms appear 4-6 hours after the last dose, lasting 5-10 days.

Lethality of Heroin Abuse

  • Low lethal dose/effective dose (LD/ED) ratio.

  • Risk of heroin being cut with toxic substances and variable tolerance levels.

Treatment for Heroin Abuse

  • Heroin Detoxification:

    • Requires medical supervision and may use drugs like Propoxyphene, Meperidine, or Methadone.

  • Methadone Maintenance:

    • Function: Legal controlled opioid to reduce cravings.

    • Treatment requirements include clean urinalysis.

Alternative Maintenance Programs

  • LAAM: Longer-lasting alternative.

  • Buprenorphine: Available at medical offices and carries less stigma.

Behavioral and Social-Community Programs

  • Therapeutic Communities:

    • Drug-free residential centers focusing on peer support.

  • Multimodal Programs:

    • Combine detoxification, naltrexone, psychotherapy for societal reintegration.

Beneficial Effects of Opioids

  • Pain Relief: Fentanyl is more effective than morphine.

  • Acute Diarrhea: Opioids slow GI tract (Imodium).

  • Cough Suppression: Codeine acts on the cough reflex center.

OxyContin Abuse

  • Use: Pill form as a painkiller, but crushed for effects similar to heroin.

  • Demographics: Affects various age and gender groups, particularly in rural areas.

Responses to OxyContin Abuse

  • Regulatory efforts include FDA warning labels and reformulations (e.g., OxyNeo).

Prevalence of Nonmedical Use of Opioid Pain Medications

  • 2013 statistics: 7.3 million young adults misused prescription pain medications; 16,000 deaths related to prescribed medications in 2012.

  • Notable decline in Vicodin abuse.