Opioids

3/12/25

• Includes natural (opium, heroin, mophine, scodine) and synethtic (methadone) blended as narcotics

  • long his of use

  • By

  • Most are

  • cause

• Medical use

  • Pain killer

  • each drug has diff streghth, speed of action, and tolerance level prescibed for pain

    • 86 mil over age 11 have taken med opiods in past year

    • 12% is illicict

    • Medical opiods

      • Morphine

      • codeine

      • oxycodone

      • fentanyl

    • Naturally derived opioids: opium, heroin

  • Timeline

    • Mid to late 1990’s

      • Perscription opiod painkillers trigger crisis deaths quietly growing

    • 2011

      • Heroin deaths begin to surge in the US metamphamine deaths grad start to increase

    • 2014

      • deaths from fentayl begin their rapid rise

    • 2016

      • cocaine deaths first exceed recent trends

    • 2020

    • Fental, meth, and cocaine deaths acclerate

• The lies about Oxycontin

  • Purdues marketing plan for OxyContin was to target the physicians who were the highest perscibers for opiods accross the contry

  • Patient starter coupon program for OxyContin that provided patients with a free limited time prescription for a 7-30 day supply

• Access to opiods

  • Bough from drug dealer /strager 6%

  • Bought/stolen from friend/relative

  • Prescibed by one or more physicians 37%

  • Got free from friend/reative 39%

  • other 5%

• The rise of fentanyl

  • shipped via mail in powder form

  • small lethal dose (even smaller than heroin) (means its more worth it to send fentenal because you can mix a small amount with something else and it will look like herioin or acctuall pill) (can make same amount of herioin and get more money for fental because you need less fetenal)

  • sent across border from china ti mexico, canada and US (then they cross into US and send it there)

• 3 waves of overdose deaths

  • rise in prescription opiod overdose deaths started in 1990’s

  • Herioin deaths 2010'

  • synathtic overdose deaths 2013

• DANGERS

  • most immediate is overdose

    • Narcan is a reversal of overdoes (saves lives)

  • Ignorance of tolerance

    • new location will reasase diff drop and change amount you can handle

  • Getting impure drugs

  • infections from dirty needles and other equitment

  • deadly subsentces mixed with opiods

  • Higher mortailty rates

  • infection from shared needles

    • hep C and HIV

• Tolerance and withdrawl

  • opiod use disorder

    • after a few weeks, users caught in pattern of abuse (and often dependance)

    • tolerance for the drug qucikly builds and withdrawl occurs when ingestion stops

    • Phsycial dependance alongside tolerance

    • early withdrawl symtoms include anxiety and restlessness, later symptoms include twitching aches fever vomiting diarrhea and weight loss from dehydration

    • increased doses requires to aviod withdrawl

    • these doses aren’t even to get high just to not feel withdrawl

• Biological mechanim

  • Opioids are agonists to the ǔ-opiod receptor

    • involed in pleasure and reducing pain

    • therapeutic pain sites are in spinal cord and thalmus where pain sig get relayed from the body into the brain

    • Opioids are highly effective at stimulatind second messengers from g-protein coupling

• Role in the addiction circut

  • Mu opioid receptors are on the pre-synaptic gaba neurons in the VTA

  • Activation of the opioid receptors reduce gaba release

  • reduce inibhition from gabba leads to increased dopamine to the nuceus accumbens

• Widespread addiction circut

  • I

• Overdose

  • vomiting (disapperars with tolerance)

  • Stupor

  • coma

  • respirtory depresion

    • reduced with tolerance

    • alters the response to CO2 builduo in the pons and medula

    • pinpoint pupils

    • convulsions

      • inhibits GABA release across CNS

  • Methadone treatment

    • Binds to the Mu- opioid receptor- but causes the receptor to be brought into the cell

    • has a very long half life (24-36 hours) compared to other opiates

    • need to slowly increase dose

    • interacts with alcohol, grapefruit juice and st johns wirt b/c of metabolism in the liver

  • Harm reduction

    • sig reduces drug injecting

    • b/c it reduces drug injecting, it reduces the death rate associated with opioid dependance

    • reduces crim activity by opioid users