Opioids Lecture Review

Opiate Drugs

• Opiates (Opioids): Natural or synthetic drugs producing opiate effects.
  • Examples: Opium, Laudanum, Morphine, Codeine, Heroin.

Characteristic Effects of Opioids

• Analgesics: Pain relieving drugs.

History of Opioids

• Opium's use dates back to at least the early 3rd century BC.
• Morphine: Opium derivative named after the Greek god of dreams, Morpheus.
• Hippocrates used opium for treating diseases.

Three Waves of Opioid Abuse in USA

• First Wave: Late 1800s, Bayer developed heroin to combat morphine addiction.
• Second Wave: After WWII, combat veterans returned home.
• Third Wave: Current, opioids cause more deaths than any other drug.

The Third Wave of Abuse

• 2015-2018: 10.7% of U.S. adults aged 20+ used prescription pain medication.
• The U.S. consumes:
  • 99% of the world’s hydrocodone (Lortab).
  • 80% of the world’s oxycodone (Percodan).
  • 65% of the world’s hydromorphone (Dilaudid).

Neuroscience of Opiates

• Endorphins: Naturally produced neurotransmitters that bind to (mu) receptors, reducing pain signals.
• Opiates share similar chemical traits with endorphins.
• Opiates and endorphins:
  • Affect dopamine release.
  • Activate neural (mu) receptors that inhibit dopamine release inhibitors.
  • Result in pain reduction and euphoria.
  • Affect (mu) receptors affecting respiration.

Tolerance and Overdose

• Tolerance: Reduced drug reaction after repeated use, needing higher doses for the same effect.
  • Brain compensates by:
    • Making neurons less responsive.
    • Reducing receptors (down-regulation).
• Overdose Risk: Highest in unfamiliar locations or at unusual times.
• Homeostasis: Baseline state.
  • Brain prepares for drug by raising homeostasis (conditioned response).

Withdrawal

• Symptoms include:
  • Shivering
  • Sweating
  • Abdominal cramps
  • Increased sensitivity to pain
  • Muscle pains
  • Diarrhea

Treatment

• Naloxone (Narcan): Reverses breathing suppression from opiate overdose.
  • Antagonist that blocks opiates.
• Methadone and Buprenorphine: Substitute for heroin, reduces withdrawal symptoms.

Support Groups

• Narcotics Anonymous (NA): Global support organization for people with drug problems.
  • Peer support, not mental health professionals.

Current Crisis

• High pain pill distribution (e.g., 430 per person in West Virginia).
• Tied to manual labor and pain management.
• Newborns showing neurological symptoms due to maternal drug abuse.

Big Pharma's Role

• Accused of:
  • Downplaying addiction.
  • Aggressive marketing.
• Oxycodone sales: From $50M in 1996 to $1.6B by 2002, over 30B today.

Responsibility for the Crisis

• Lack of clear opioid withdrawal health plan.
• Over-prescription by physicians (US consumes 70% of world’s opioid supply).

Kratom

• Herbal extract stimulating opioid receptors.
  • Produces sedation, pleasure, and pain reduction.
  • Also produces increased energy, sociability, and alertness via other receptors.
• Used for opioid withdrawal symptoms.

Kratom's Safety Concerns

• Unregulated in the US.
• May cause cravings.
• Long-term use can lead to withdrawal symptoms similar to opioids.