Drugs in Society: Chapter 9

Dextromethorphan

- a synthetic used in cough remedies and can be purchased without a prescription. From 1998-2008 there were 72 reported cases of dextromethorphan related deaths. Symptoms of abuse include altered perceptions, sense of floating and hallucinations. Young people are becoming aware of it's abuse potential through the internet

Mepridine

- is a synthetic drug that frequently is used as an analgesic for treatment of moderate pain. This drug is sometimes given too freely by some physicians because tolerance develops, requiring larger doses to maintain in therapeutic action. With continual use, it causes physical dependence.

Proxoyphene

- much weaker analgesic and is half as potent as codeine. This is no more effective in relieving pain than using aspirin and was removed from the market by the FDA in 2010.

MPTP

A sloppy synthesis of meperidine and create classic symptoms of Parkinson's disease in the user. MPTP is now used as a tool to study why Parkinson's disease occurs and how to treat it effectively

Discuss generally the patterns of opioid abuse.

Heroin use among adolescents is seen to be rising after decrease in costs and increase in purity. Because of greater purity, new users are able to administer heroin in less efficient ways such as smoking and snorting in order to avoid the dangers of intravenous use. Also there are approximately 190,000 emergency room visits each year due to heroin overdoses.

State generally the uses of heroin in historical perspective (several different stages are covered in the book).

Heroin was first used in the US as a cough suppressant and also to combat other addictions. In other countries it was prescribed as a analgesic. During the Vietnam war era heroin was used by some to combat the stress and frustrations of unpopular military action. Heroin smoking become popular in the mid 1980s in response to the AIDS epidemic. Soldiers turn to heroin to try to cope with life in a war zone.

Pentaocine

It is not commonly abused because its effects can be unpleasant which can result in dysphoria and is scheduled as a class IV drug.

Define and discuss the origins of morphine, codeine and thebaine.

Morphine is an opiate, derived from the poppy plant. It is classified as a narcotic and is commonly prescribed to manage pain. Morphine was discovered by the German Fredrick Sertuner in 1803 after partially purifying the ingredients of opium. Codeine is used to relieve mild to moderate pain. It belongs to the group of medicines called narcotic analgesics (pain medicines). This was discovered in 1832 and named after the Greek word for "poppy capsule". Theabine

Define narcotics, opioids, and opium and their respective classifications.

Narcotics are depressants that produce instability or stupor. This also designates drugs and substances with pharamalogical properties related to opium ingredients and their drug derivatives. Natural opium derivatives are classified as natural narcotics. Opioids are related to drugs that are derived from opium. Opioids are classified as a form of narcotics. Opium is An opioid or narcotic, made from the white liquid in the poppy plant.

Discuss the effect of opioids on the mind, body and brain (relate endogenous opioid peptides).

Opioids can cause constipation, drowsiness, mental clouding, respiratory depression, nausea and vomiting, itching, inability to urinate, drop in blood pressure and constricted pupils. Endogenous opoioid peptides and their receptors are integral components of neuronal circuits

Discuss the tolerance and withdrawal symptoms associated with opioids as well as the associated lethality.

The process of tolerance begins with the first dose of the narcotic but is not clinically evident until 2 to 3 weeks of frequent use. Occurs most rapidly with high doses given in short intervals and is a common result of the extended clinical use of prescription opioid pain killers. Because of tolerance the doses of these drugs must be increased to retain or regain therapeutic or nonmedical narcotic effects. Withdrawal effects of opioids can include exaggerated pain responses, agitation, anxiety, stomach cramps and vomiting, joint and muscle aches, runny nose, and overall flu like feeling. These symptoms are not fatal but are extremely aversive and encourage continuation of the narcotic habit. Quinine is an irritant and can cause vascular damage, acute and potentially lethal disturbances in heartbeat, depressed respiration, comma and death from respiratory arrest. Death associated with heroin injection is usually due to concurrent use of alcohol or barbiturates- not the heroin alone.

Clonidine

This is an nonaddictive, noneuphorigenic prescription medication with demonstrated efficacy in relieving some of the effects of opiate withdrawal. Dosing regimen is usually a 7 or 14 day inpatient treatment for opiate withdrawal. It can cause serious side effects such as as lowered blood pressure.

OxyCodone

a moderate narcotic analgesic that in the past decade has been increasingly abused as the proprietary product OxyContin which is an effective therapy for the treatment of severe pain from cancer or other lingering diseases. The abuse rate for Vicodin which is the less potent version of OxyContin is almost double due to easier access. Deaths from OxyContin are becoming more and more common

Fetanyls

belong to a family of very potent narcotic analgesics that are often administered intravenously for general anesthesia. They are also used in transdermal systems and as lollipops in the treatment of chronic

Tramadol

causes activation of opioid receptors in the brain and may have some anti-depressant effects. For some patients proxoyphene can cause severe opioid dependence. From 1998 to 2006 there was a six-fold increase in admissions for treatment of tramadol-related dependence. Even though it is marketed as low risk for dependence it is clear that some patients can become addicted

speedballing

combining heroin and cocaine

antitussives

drugs that block the coughing reflex

Analgesics

drugs that relieve pain without affecting consciousness

Codeine

naturally occurring constituent of opium and is prescribed to treat minor to moderate pain and used as a cough suppressant. Although it is not powerful Codeine can still be abused because it can be bought as a cough product without a prescription. Abuse of codeine is not common and those who do abuse it have usually developed narcotic dependence previously with one of the more potent opioids.

Opioid

relating to the drugs that are derived from opium

morphine

the standard by which other narcotic analgesic agents are measured. It has been used to relive pain since it was first isolated in 1803. Commonly used to relieve to relieve moderate to severe pain. In addiction therapeutic doses depress respiratory activity and produces irregular breathing. Continual use can lead to a euphoric response and dependence. Tolerance to the effects of morphine can develop very quickly if the drug is used continuously

Buprenorphine

this is a mild to moderate narcotic analgesic and in 2002 was approved as an effective medication for the treatment of narcotic abuse and dependence. It has minimal potential for abuse and has been approved for treatment of opiate dependence in an office setting.

mainline

to inject a drug of abuse intravenously

methadone

Methadone is often substituted for heroin the treatment of narcotic dependent people. It is an effective analgesic, equal to morphine if injected and is more potent if taken orally. Methadone addicts receiving maintenance treatment sometimes become euphoric if the dose is increased too rapidly. Large quantities of methadone are being stolen from legitimate businesses such as hospitals and pharmacies for personal use or to sell. It is also being misused by patients who received their methadone by legitimate prescriptions for pain.

Naloxone

Prevent narcotic drugs such as morphine and heroin from having an effect. By themselves these antagonists do not cause much change, but potently block or reverse the effects of all narcotics. If not used carefully the analgesic action of narcotics can be blocked and initiate severe withdrawal effects.

What are some of the treatment options associated with heroin and other opioids?

opioids? One popular treatment option is to substitute a long lasting synthetic narcotic such as methadone for the short acting heroin. The substitute narcotic is made available through drug treatment centers under the direction of trained medical personnel. Although the substitute narcotic may have abuse potential the onset of action is too slow to cause a rush like that associated with heroin use which means that its abuse potential is substantially less. Methadone helps drug addicts reduce their drug craving. Buprephonie has also been approved for treatment of narcotic dependence. Because it is an opioid agonist and antagonist, it has minimal potential for dependence and is easy to manage. Some studies have suggested that Buprenorphine is more effective and safer treatment. Another drug to treat heroin addiction is Vivitrol which is an opioid antagonist.

Hydromorphine

prepared from morphine and used as an analgesic and cough suppressant. It is used to treat severe to moderate pain. It is becoming more popular with addicts because of its potency.