Chapter 8 Narcotics

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Warm up• What have you heard about narcotics?• What do you want to learn about this class of drugs?

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Terms• Narcotic • An opium-based central nervous system depressant

used to relieve pain and diarrhea

• Opiate • A class of drugs derived from opium

• Opioid• Drugs with characteristics similar to those of opium

• Laudanum, a mixture of opium and alcohol, was developed in the 1500s by Paracelsus

History

• The hypodermic needle hastened the effects of morphine

• Ironically, the drug promoted to help people overcome morphine dependency was heroin

History

• By 1906, opium and its derivatives were found in more than 50,000 medicines

• By the late 1800s, an estimated 4.59 per 1,000 people were dependent on opiates

History•The Harrison Act of 1914 made narcotic use without a prescription illegal

•The typical opiate addict shifted from a middle-class woman to a young, lower-class man

•Perceptions of the opiate addict went from unfortunate victim to a deviant criminal who was a threat to society

Do you know someone who has used narcotics recreationally in the last 30 days?

A. NoB. Yes, one personC. Yes, more than one

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Response

Self-reporting

Extent of Narcotic Use

• 68% of heroin addicts admitted into treatment are male, 59% are White, and ¾ have been in treatment previously

• Increase in abuse is significantly higher in rural areas than in metropolitan areas

• During the Vietnam War, 10-15% of US troops were addicted to heroin

• During the 1930s, morphine abuse exceeded heroin abuse – by the 1940s, heroin addiction was greater

• Heroin use increased greatly beginning in the late 1960s and early 1970s.

• In 2010, about 200,000 Americans had used heroin in the previous month

• In the US, more than 800,000 people are addicted to heroin and other narcotics

Worldwide Comparison

• More than 15 million people worldwide illegally use opium, morphine, and heroin

• China is believed to have the largest number of narcotic addicts

• An estimated 24 million to 34 million people throughout the world use opium

Opium•Poppy grows throughout Asia and the Middle East

•Seedpod is scraped, milky sap is collected and dried to a brown resin (opium)

•There is a ten-day window in which opium can be extracted

Illicit Opium Production

Illicit Opium Production

Opium Poppies in Afghanistan

Morphine•In 1803, Friedrich Serturner of Germany synthesized morphine from opium and called it morphium

•Morphine is about ten times more potent than opium, although physicians thought it was safer and purer

•Codeine was isolated from opium 30 years later

•How morphine is administered and its dosage has a bearing on its effectiveness

Heroin

• Heroin (diacetylmorphine) was first synthesized from morphine in 1874

• When heroin was introduced, it was believed not to be addicting

• When smoked, its effects are rapid – it is ineffective when ingested

• Heroin is three to ten times more powerful than morphine because it is more lipid-soluble

Derived from opium

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Synthetic Opiates

•Fentanyl (Sublimaze)• Synthetic narcotic 1,000 times more potent than heroin• Greater risk of a fatal overdose than heroin

•China white • Synthetic analgesic drug derived from fentanyl that mimics

heroin but is considerably more potent

•Meperidine • Synthetic derivative of morphine widely used as an analgesic –

less potent than morphine

Synthetic Opiates•Propoxyphene hydrochloride (Darvon)

• Mild narcotic that has the potential to cause dependence

•Methadone • Drug given to heroin addicts to block

withdrawal effects and euphoria

•Oxycodone (Percodan)

OxyContin• OxyContin is a particularly strong painkiller that blocks the

pain signals from nerves

• Thousands have become addicted to it – the number of addicted babies has doubled or tripled over the past decade

• The manufacturer, Purdue Pharma, admits that dozens to hundreds of people have died from it

Dosages (add oxy)

Brain

•Mouse Party•Opiates mimic endorphins in the brain

Physical Effects

• Drowsiness (nodding out), vomiting, nausea, and difficulty concentrating

• Euphoria• Gradually anesthetizing sensations• Lethargy and sleep

• Difficulty urinating, constipation

• Difficulty achieving an erection

Emotional Effects

• Relief from anxiety, hostility, feelings of inadequacy, and aggression

• Difficulty regulating inhibitions and frequently make risky decisions

Social Effects

• Alienated from and hostile toward friends and family

• Correlated with criminal behavior, unemployment, and violence

NEPs retard the spread of HIV/AIDS

Needle-Exchange Programs•IV drug use increases HIV, hepatitis risk

•Health care personnel favor NEPs

•5.9% decrease in HIV infection rates in cities with NEPs

•Congress banned federal funding for NEPs in 1988

Dependency

• Physical and psychological dependence, and tolerance develop quickly• Positive reinforcement• Negative reinforcement

• Withdrawal symptoms can be severe

Withdrawal

Hours after last dose Signs Heroin orMorphine

Methadone

Craving for drugs, anxiety 6 24

Yawning, perspiration, running nose, teary eyes 14 34-48

Increase in above signs plus pupil dilation, goose bumps, tremors, hot and cold flashes, aching bones and muscles, loss of appetite

16 48-72

Increased intensity of above, plus insomnia; raised blood pressure; increased temperature, pulse rate, respiratory rate and depth; restlessness; nausea

24-36

Increased intensity of above, plus curled-up position, vomiting, diarrhea, weight loss, spontaneous ejaculation or orgasm, hemoconcentration, increased blood sugar

36-48

A Day in the Life

Dependency

• Factors affecting the difficulty of withdrawal:• Social support network• Desire to stop• Physical environment during withdrawal• Alternative opiates

Dependency• About half of narcotic abusers become dependent:• Can develop in less than two weeks if they take increasing amounts of

narcotics• Average addiction is six to eight years (aging out)

Toxicity

• Respiratory depression can be fatal• Synergistic effect when combined with depressants

• Opioid Triad• Coma• Depressed respiration• Pinpoint pupils

• Death from an overdose of heroin is slow – people who die quickly are likely to die from anaphylactic shock

Toxicity (risks)

• According to the CDC, painkillers kill twice as many people as cocaine and five times more people than heroin

• Increased risk of blood-borne disease and infections• Physical problems frequently result from using narcotics in

unclean, unsafe environments• Sharing needles is a major risk for HIV infection

• Narcotics often are contaminated with other drugs, sugar, starch, powdered milk, quinine, or strychnine

Medical Benefits

• Analgesic• Patients receiving morphine are aware of pain, but their

perception and response are altered in positive ways

• Gastrointestinal difficulties• In less-developed countries, narcotics treat diarrhea that is a

major cause of death among the young and elderly

• Cough suppressant (antitussive)• Narcotics slow activity of the cough control center• Nonopiate dextromethorphan is chemically similar

Treatment and Support Groups

• The recidivism (relapse) rate for narcotic addiction is high

• Gradual detoxification - 10 to 14 days on an inpatient basis

• Rapid detoxification

Narcotic Antagonists

• Drugs that block narcotics from producing their reinforcing effects are called antagonists

• They remove the physical need for opiates, but not the psychic need

• Examples are (Suboxone) naltrexone, buprenorphine, nalorphine, naloxone, and cyclazocine

Methadone – Narcotics Agonists

• Since 1960, methadone has been the drug used most frequently to treat heroin addiction

• Methadone is highly specific to opiate addiction

• Methadone use leads to addiction, though many people consider it preferable to heroin addiction

• Methadone has to be administered daily to avert withdrawal symptoms

Common Narcotics

Perceptions of Narcotics

• Narcotics were advertised as a cure for addiction to tobacco

Extent of Narcotic Use

• Controlled users (chippers) fit the following pattern:• Seldom used the drug more than once a day• Could keep opiates around without using them• Avoided opiates when addicts were present• Did not use opiates to alleviate depression• Seldom binged on opiates• Knew the opiate source or dealer• Took opiates for recreation or relaxation• Did not take opiates to escape life’s daily hassles