CP

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.