Where was opium used historically?
Egyptians and Greeks to get babies to stop crying
Used in Arabia because alcohol forbidden by Koran
What caused the opium war?
china’s ban on tobacco
Britain smuggled it in
What was Heroin first marketed as?
cough suppressant by Bayer
What are opioids used for?
- pain control (better for dull than sharp pain)
- sedation
- reduces emotional response to pain
- sometimes diarrhea
- suppress cough
What is the analgesic standard to which all other analgesics are compared?
morphine
Synthetic opioids
fentanyl
more potent
Price of heroin
$200/gram
Heroin use % among young
stayed relatively stable 2009-2014
Chasing the dragon
inhalation of heroin (or sometimes crack)
speedballing
combining heroin and cocaine (sometimes amphetamine)
Cheese
low dose heroin combined with a caused diphenhydramine/acetaminophen combination product such as Tylenol PM or with Xanax then snorted
- low cost, popular in school
- deaths reported
what is the most common parenteral opioid used?
morphine
Mepheridine
used primarily parenterally
can cause seizures
misused by nurses
minimally effect of pupils
Fentanyl
- anesthesia
- injectable most misused
- buccal tablets
- lozenges
- patches
Methadone
- long duration opioid
Codeine
- used mainly orally for pain or cough
- reduced by significant GI upset and low potency
- purple drank
Oxycodone
- many Rx drug addicts
- chronic pain management
- crush tablet and snort
Tolerance and opiates
- tolerance occurs, some may be learned
- physical and psychological dependence results from prolonged opioid use
OUDs
- obtain high
- cross dependency can occur
- can be habituated to ritual of needle use than to opioid itself
- death usually from respiratory arrest
- not associated with organ damage
adverse effects of opioids
- nausea and vomiting
- pupil constriction
- drowsiness
- inability to urinate
- mental clouding
Withdrawal from opioids
- nausea and discomfort
- never fatal
- resembles flu
What can help with withdrawal from opioids
- clonidine to help with diarrhea and vomiting
- does not help with craving or aches
Opioids and neonates
- can cross placenta
- can experience withdrawal after birth
- irritability
- poor feeding
How long can opiates be detected in urine?
2-5 days after use
