5.16 Lecture Notes on Dangerous Drugs

Definition: Opiates (sometimes referred to as narcotics) are a class of drugs primarily used to reduce pain.
Abuse Potential: When abused, opiates can induce intense feelings of euphoria, leading to potential addiction and misuse.

Primary Use: Opiates are utilized in a medical context for pain relief. Common examples include:
- Morphine
- Oxycodone
- OxyContin
Historical Context: Historically, some opiates, like heroin, were perceived as benign and even sold over-the-counter for conditions such as coughs.

Endorphins: Opiates stimulate endorphin receptors in the brain.
- Definition of Endorphins: Endorphins are the body's natural morphine-like chemicals that alleviate pain.
- Example: The phenomenon known as "runner's high" occurs when runners experience a mood elevation and a burst of energy, attributable to an increased release of endorphins due to physical activity.

Addiction Potential: Opiates are highly addictive; tolerance can develop rapidly.
- Tolerance: As people continue to take opiates, they require higher dosages to achieve the same euphoric effects.
- Dependence: Physical dependence can lead to severe withdrawal symptoms, making it difficult for individuals to stop using these drugs.
Withdrawal Symptoms: The discomfort associated with withdrawal can discourage individuals from attempting to quit, leading to continued drug use solely to avoid negative physical side effects.

Naloxone: A critical drug used to counteract opiate overdoses.
- Mechanism of Action: Naloxone binds to the endorphin receptors similar to opiates but does not produce psychoactive effects. It effectively blocks opiates from binding to their receptors, reversing the effects of an overdose.
- Pain Effects on Control Subjects: In control subjects, naloxone can increase pain perception since it prevents endogenous endorphins from exerting their pain-relieving effects.
- Placebo Effect: Naloxone can negate the placebo effect, as the expectation of a pain medication relies on the release of natural endorphins.

Current Relevance: The opioid crisis, particularly in North America and Europe, has drawn significant attention due to rising overdose rates, often associated with fentanyl.
- Fentanyl: A potent type of opiate that is highly addictive. Its illegal variants are prevalent in the black market.
- Lacing: Many opioids are being laced with fentanyl, resulting in increased addiction rates and overdose incidents.
Broad Impact: The crisis extends beyond stereotypical demographics (e.g., not limited to homeless individuals) because prescription opioids were heavily marketed as non-addictive by pharmaceutical companies.
- Impact on Society: Everyday individuals receiving prescriptions initially became addicted when their medication supplies ceased, leading them to seek black market alternatives.
- Quality Concerns: Users face increased risks due to the unregulated nature of black market drugs, which can vary significantly in quality and potency.

Methadone Treatment: A synthetic opiate used in treatment programs for individuals recovering from addiction.
- Mechanism of Action: Methadone binds to endorphin receptors but does not produce a high, thus reducing withdrawal symptoms without escalating the addiction cycle.
- Treatment Process: Gradual reduction of Methadone helps individuals detox from heroin or fentanyl.

Class Action Lawsuits: Various municipalities and provincial governments have initiated lawsuits against pharmaceutical companies for misleading marketing of opioids as safe alternatives.
Government Argument: These lawsuits assert that opioid manufacturers should bear responsibility for the healthcare costs resulting from widespread addiction and its societal impacts.