drug abuse treatment and prevention

83 Pages·2007·2.08 MB·English

D A T
RUG BUSE REATMENT AND
P
REVENTION
STUDY MANUAL
FOR
MEDICAL STUDENTS AND YOUNG
DOCTORS
Volume 2
Editors:
Regina Komsa-Penkova
University of Medicine – Pleven
Bulgaria
Paul Verbanck
Universite Libre de Bruxelles
Belgium
Authors:
Valeria Valentinova Milena Spasova Olga Pudovka
Tatyana Genadieva Gergana Bacheva Rojo Raj
Zlatina Georgieva Darjan Micevski Dheeraj Khatri
Kire Temov
ii
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Training of Medical Students and
Young People as Promoters of Prevention of Drug Abuse
Leonardo da Vinci Programme
Pilot Project: BG/04/B/F/PP-166016
ISBN-10: 954-756-068-9
ISBN-13: 978-954-756-068-0
Chapter 3
Substances use and health
problems
Modules developed by students

OPIOIDS - HISTORY, CHARACTERISTICS AND EFFECTS 181
Module 3.1
Opioids - history, characteristics
and effects
Rojo Raj
Olga Pudovka
University of Medicine - Pleven
Bulgaria
Key messages Contents
• Opioids are, substances producing 1. Description and classification
effects similar to morphine. They are 1.1 Various opiates
classified by their chemical structure, 1.2 Morphine
the way of production and effects; 1.3 Codeine
• The opioids produce their effects by 1.4 Heroin
interacting with a specific receptor; 1.5 Oxycodone
• Opioid dependence (addiction) is 2. Common and brand names and
defined as a cluster of cognitive, formulas
behavioral, and physiological 3. History
symptoms in which the individual 4. Effects
continues use of opiates despite 4.1 Acute
significant opiate-induced problems; 4.2 Chronic
• The opiate addiction can lead to 5. Criminal activity
financial, health problems and high 6. Health care costs
level of the criminal activity and 7. Joblessness
mortality. 8. Mortality
9. What the opiate addiction is?
10. Opioid receptors
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182 DRUG ABUSE TREATMENT AND PREVENTION
1. Description and classification preparations. Codeine is also used to a
lesser extent as an injectable solution for
1.1 Various opiates the treatment of pain. Codeine products
are diverted from legitimate sources and
Opioids are substances with effects are encountered on the illicit market.
similar to morphine:
• Natural opioids, opiates; 1.4 Heroin
• Semi-synthetic opioids;
• Synthetic opioids; When morphine is heated with acetic
• Active metabolic products from acid anhydrides, diacetylmorphine
heroin and morphine; is produced. This substance was
• Endogenic opioids, opioid peptides. synthesized for the first time in 1874 by
A. Wright and was put on the market
1.2 Morphine commercially by the Bayer Company
under the name by which the substance
Morphine is in a class of drugs called is still known – heroin.
narcotic analgesics. It is used to treat
moderate-to-severe pain. Brand names: What does heroin look like?
Avinza, Kadian, MS Contin, MSIR, OMS, • Pure heroin is a white powder with a
Oramorph SR, Rescudose, RMS, Roxanol, bitter taste;
Roxanol 100, Roxanol-T. • Most illicit heroin varies in color from
white to dark brown;
1.3 Codein • “Black tar” heroin is sticky like
roofing tar or hard like coal, and its
In 1832 another opiate was isolated from color may vary from dark brown to
opium: codeine, which is used mostly as black.
a cough remedy.
1.5 Oxycodone
Codeine is medically prescribed for
the relief of moderate pain and cough OxyContin® is the brand name of a
suppression. Compared to morphine, time-release formula of the analgesic
codeine produces less analgesia, chemical oxycodone. OxyContin, which
sedation, and respiratory depression, is produced by the pharmaceutical
and is usually taken orally. company Purdue Pharma, is prescribed
as a pain medication. Instances of abuse
It is made into tablets either alone of this drug have increased in recent
or in combination with aspirin or years.
acetaminophen (i.e., tylenol with
codeine). As a cough suppressant, Street terms for Oxycodone: Hillbilly
codeine is found in a number of liquid heroin, Oxy, Oxycotton.
STUDY MANUAL FOR MEDICAL STUDENTS AND YOUNG DOCTORS
OPIOIDS - HISTORY, CHARACTERISTICS AND EFFECTS 183
2. Common and brand names Meperidine (Demerol), Fentanyl,
and formulas Methadone (Dolophine), Darvon, Talwin.
Different names of opiates Street Names
Opiates are derived from a sap taken Smack, Horse, Junk, “H”, Hard Stuff,
from a seedpod of the plant “papaver Shit, Mexican Brown, China White, Chiva,
somniferum”. Collectively, opiates and Goma, Gumball, Schoolboy, Downtown,
synthetic opiates are called opioids. Dolls, Dollies, Drug Store Heroin, Miss
Emma, Morf, “M”, Morpho, Big H, Black
Brand/generic names Tar, Boy, Brown Sugar, Crown Crap,
Raw Opium, Opium, Codeine, Morphine, Doogie, Hairy, Harry, Hazel, Henry,
Heroin, Hydromorphone (Dilaudid), George Smack, Him, Horse Radish, Joy
Oxycodone (Percodan), Oxymorphone Powder, Mud, Muzzle, Scag, Schmeck,
(Numorphan), Hydrocodone (Vicodin), Smeck, Tecata, White Lady.
Table 1 Opiates
Morphine Analgesic, natural opioid
Morphium Duration of effect: 4-5
hours, in retard form 6-
12 hours
Elimination half-life: 3
hours (also in retard
form)
LD: 25 mg i.v.
LD: 50 mg p.o.
Codeine Antitussivum,
3-ortho-methyl- (analgesic), natural
morphine opioid
Duration of effect: 4-6
hours
Elimination half-life: 3-4
hours
Papaverine Spasmolytic, in itself no
opioid effect
Phosphodiesterase
inhibitor
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184 DRUG ABUSE TREATMENT AND PREVENTION
Table 2 Semi-Synthetic Opioids
Heroin Analgesic
Diamorphine Duration of effect:
DAM 3,6-O- 4-5 hours
Diacetylmorphine Elimination half-
life: 0.5 hours
LD: 25 mg i.v.
produced
from morphine
through
acetylation
by acetic acid
anhydride
Hydrocodone Antitussivum
Dihydrocodeinone Duration of effect:
8-10 hours
Elimination half-
life: 4 hours
Buprenorphine Analgesic
Duration of
analgetic effect:
6-8 hours
Duration of
withdrawal
prevention effect
in high doses up
to 48 hours
Elimination half-
life: 5 hours
Agonist/
Antagonist;
synthetised out of
Thebain
STUDY MANUAL FOR MEDICAL STUDENTS AND YOUNG DOCTORS
OPIOIDS - HISTORY, CHARACTERISTICS AND EFFECTS 185
Table 3 Synthetic Opioids
Methadone Analgesic
Duration of analgetic
effect: 8-48 hours
Duration of withdrawal
prevention effect in high
doses: rarely less than
24 hours
Elimination half-life: 15-
22 hours
LD: 25 mg i.v., 50 mg
p.o., 25 mg L-Methadone
p.o
Tilidine Analgesic
Duration of effect: 4-6
hours
Elimination half-life: 3-5
hours
Oxicodone Analgesic
Metabolism: Hepatic
Half life: 3 - 4.5 hours
Excretion: Urine
3. History cocktail of morphine (10%-15%),
codeine (1%-3%), noscapine (4%-8%),
Opium has been used for hundreds years papaverine (1%-3%), and thebaine
to relieve pain. Word opium is derived (1%-2%).
from “opos” - juice in Greek. Opium
is the dried milky juice of the unripe The opioid analgesics are of inestimable
seed capsule of the poppy, the Papaver value because they reduce or abolish pain
somniferum. It is a complex chemical without causing a loss of consciousness.
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186 DRUG ABUSE TREATMENT AND PREVENTION
They also relieve coughs, spasms, fevers Medicinal use of opium was stimulated
and diarrhea. by the famous physician Paracelsus
at the end of the Middle Ages by the
Archaeological evidence and fossilized introduction of tincture of opium.
poppy seeds suggest that Neanderthal
man may have used the opium poppy An attempt to forbid the import of opium
30,000 BC. into China by the authorities, led to the
so-called “Opium War” between England
The first known written reference to the and China, launched by the biggest, and
poppy “hul gil” - plant of joy appears in a richest perhaps drug cartel the world has
Sumerian text dated around 4,000 BC. ever known, the British Empire.
The art of poppy-culling continued from In 1805 morphine was first isolated from
Sumerians to Assyrians, Babylonians opium by a German pharmacist, Wilhelm
who passed their knowledge to the Sertürner (1783-1841). Sertürner named
Egyptians. it morphium - after Morpheus, the Greek
god of dreams.
460 B.C. Hippocrates, “the father
of medicine”, dismissed the magical In 1874, English pharmacist Alder Wright
attributes of opium but acknowledged had boiled morphine and acetic acid
its usefulness as a narcotic and styptic to produce diacetylmorphine, a white,
in treating internal diseases, diseases of odourless, bitter, crystalline powder.
women and epidemics.
Heinrich Dreser - a head of Bayer’s
330 B.C. Alexander the Great introduced pharmacological laboratory from 1897 to
opium to the people of Persia and India. 1914 was the first to see its commercial
potential. Under his instructions it was
Stoic philosopher and illustrious opium- synthesized by Hoffmann in Bayer
eater Emperor Marcus Aurelius (reigned laboratory and was named heroin
AD 161 - 180) wrote Meditations where (hero).
he explained how moral life leads to
tranquility. He recommended opium- In 1898, heroin was introduced as
eating for headache, dizziness, epilepsy, the ideal nonaddictive substitute for
asthma, fever, leprosy and other ills of morphine.
the flesh.
By 1899, Bayer was producing about a
Arabic physicians used opium quite often ton of heroin a year, and exporting the
and Arabic traders brought opium from drug to 23 countries. There were heroin
pastilles, heroin cough lozenges, heroin
the eight century on, first to the East, to
tablets, water-soluble heroin salts and a
India and China, and later to Europe.
heroin elixir in a glycerine solution.
STUDY MANUAL FOR MEDICAL STUDENTS AND YOUNG DOCTORS