Chapter 4
The Major Narcotics: Opium,
Morphine, and Herion
Objectives




After completing this chapter, you
should know the following:
The history of opium and opium-derived
drugs.
The effects of narcotic drugs on the
mind and body.
The basis for opiate effects.
Objectives




Patterns of heroin abuse.
The potential lethality of heroin abuse.
The issue of controlled heroin intake.
Treatment strategies for heroin
dependence.
Opium History


4000b.C. –The medicinal
properties.
19th century- introduced into India
(via Muslims), and spread to china.
Opium History (Cont’d)

Early in the 19th century, British
merchants began smuggling opium
into china in order to balance their
purchases of tea for export to
Britain, an act that set the stage
for the opium wars.
Opium History (Cont’d)


Chinese emigranted to the united
states, who were employed to
build the transcontinental railroad,
brought the opium-smoking habit
to the west coast.
During the 19th cent. Opium was
grown in the united states as well
as imported.
Opium History (Cont’d)

Opiates-available in the united states.




Tonics and patent medicines.
Smoking in opium dens.
Late 1800s-epidemic of opiate
addiction.
Civil war-addiction from medicinal
purposes.

The generous use of morphine in treating
wounded soldiers.
Opium History (Cont’d)


In 1906 the pure food and drug act
required accurate labeling of patent
medicines.
In 1914-the Harrison narcotics act
taxed and regulated the sale of
narcotics.


Prohibition-maintenance doses to addicts
who made no effort to recover.
Physicians arrested and maintenancetreatment clinics closed.
Opium History (Cont’d)


Numerous laws passed to regulate
importation, availability, use, and
treatment.
Concern with opium addiction
replaced by:



Cocaine.
Marijuana.
Methadone and other illegal drugs.
What Is Herion?

Heroin…



Is an illegal, highly addictive drug.
The most abused and the most rapidly
acting of the opiates.
Sold in the form of;


A white or brownish powder.
Black sticky substance known on the streets as
"black tar heroin."
Short –Term Effects of
Herion





"Rush."
Depressed respiration.
Clouded mental functioning.
Nausea and vomiting.
Suppression of pain.
Short –Term Effects of
Herion (Cont’d)

Spontaneous abortion
heroin – highly addictive-rapidly enter
into the brain.



Rush-accompanied by a warm flushing of
the skin.
Dry mouth, a heavy feeling in the
extremities.
Nausea, vomiting, and severe itching.
Herion

Heroin is "cut" with
other drugs or with
substances;


Such as sugar, starch,
powdered milk or quinine
and/or strychnine or
other poisons.
Heroin-special problems
transmission of HIV and
other diseases that can
occur from sharing
needles or other injection
equipment.
Herion Administration

Heroin is injected, sniffed/snorted, or
smoked.



Abuser usually inject 4x’s daily.
Intravenous injection-rapid onset of
euphoria (7 to 8 seconds).
Intramuscular injection-slow onset of
euphoria (5 to 8 minutes).
Herion Administration
(Cont’d)




Sniffed or smoked, peak effects are usually
felt within 10 to 15 minutes.
Smoking and sniffing heroin do not produce a
"rush" as quickly or as intensely as
intravenous injection.
All three forms of heroin administration are
addictive.
Injection, the predominant method of heroin
use among addicted users seeking treatment.
Opiates and the Brain
s
Long-term Effects of Herion



Addiction
Infectious diseases, for
example, HIV/AIDS and
hepatitis B and C
Collapsed veins
Long-term Effects of Herion
(Cont’d)


Physical dependence develops with
higher doses of the drug.
With physical dependence, the body
adapts to the presence of the drug and
withdrawal symptoms occur if use is
reduced abruptly.
Long Term Effects of
Herion


Withdrawal may occur within a few
hours after the last time the drug is
taken.
Symptoms of withdrawal include;

Restlessness, muscle and bone pain,
insomnia, diarrhea, vomiting, cold flashes
with goose bumps ("cold turkey"), and leg
movements.
Long-term Effects of Herion




Abscesses
Infection of heart lining and valves
Arthritis and other rheumatic problems
Bacterial infections
Long Terms Affects of Herion
(Cont’d)
Major withdrawal symptoms.

Peak between 24 and 48 hours after the
last dose of heroin and subside after
about a week.
Long Terms Affects of Herion
(Cont’d)



Can show withdrawal signs for many
months.
Withdrawal is never fatal to healthy
adults.
Can cause death to the fetus of a
pregnant addict.
Medical Complications

Heroin abuse complications during pregnancy.




Including miscarriage and premature delivery.
Children born to addicted mothers are at greater
risk of SIDS (sudden infant death syndrome).
Should not be detoxified from opiates because of
the increased risk of spontaneous abortion or
premature delivery.
Methadone treatment recommended.
Herion Abuse and Needles


Heroin addicts often
share needles and
other injection
equipment.
Herion addict are at
special risk of
contracting HIV and
other infectious
diseases.
HIV/AIDS and Hepatitis B and C

Infection of injection-drug users with HIV




Reuse of contaminated syringes and needles or
other paraphernalia by more than one person.
Through unprotected sexual intercourse with HIVinfected individuals.
For nearly one-third of Americans infected
with HIV, injection drug use is a risk factor.
Drug abuse is the fastest growing vector for
the spread of HIV in the nation.
Classifications of Opioids




Natural substance (i.E., Opium, morphine,
codeine)
Semisynthetic narcotics (i.E., Heroin modifying chemicals in opium)
Synthetic products (i.E., Demerol,
methadone)
Endogenous opioids (i.E., Endorphin –
natural body substances)
Examples of Natural
Substance Opioids




Opium (mother drug)
Morphine (chief alkaloid ingredient
of opium)
Codeine (minor alkaloid ingredient)
Thebaine (minor component but has
stimulant effect)
Examples of
Synthetic Narcotics



Meperidine (first synthetic
narcotic produced)
Darvon (close relative to
methadone)
Fentanyl (intravenous
analgesic-anesthetic)
Endogenous Opioids


Naturally produced by the body
(brain/g.I. Tract)
Enkephalins (found in the pituitary
gland and brain)
Endogenous Opioids


Endorphin (opioid chemical) found
to be 40 times stronger than
enkephalins.
Alleviation of pain factor from the
body decreases with the use of
external opioids
Symptoms of
Opioid Overdose





Deep sleep/stupor
Low respiration
Blue lips/skin
Pupils are pinpoints
Possible needle marks on body
What Are the Treatments for
Heroin Addiction?



Treatment-more effective when
heroin abuse is identified early.
Treatments varies-depending on the
individual
Methadone, a synthetic opiate


Blocks the effects of heroin
Eliminates withdrawal symptoms
What Are the Treatments for
Heroin Addiction?

LAAM, like methadone, is a
synthetic opiate that can be used to
treat heroin addiction. LAAM can
block the effects of heroin for up to
72 hours with minimal side effects
when taken orally.
Treatment of Narcoticdependent Individuals

Detoxification.




Relieve withdrawal symptoms while patients
adjust to a drug-free state.
Not a treatment for addiction.
Useful step only when it leads into long-term
treatment that is either drug-free (residential
or outpatient) or uses medications as part of
the treatment.
The best documented drug-free treatments
are the therapeutic community residential
programs lasting at least 3 to 6 months.
Treatment of Narcoticdependent Individuals

Methadone programs.


Methadone treatment has been used
effectively and safely to treat opioid
addiction for more than 30 years.
The programs use methadone as a
substitute for heroin.
Treatment (Cont’d)

Methadone-properly prescribed



Non-intoxicating or sedating
Do not interfere with ordinary
activities. The medication is taken
orally.
Suppresses narcotic withdrawal for
24 to 36 hours.
Treatment-methadone (Cont’d)



Patients are able to perceive pain
and have emotional reactions.
Relieves the craving associated with
heroin addiction; Craving is a major
reason for relapse.
Heroin is ineffective at producing
euphoria, thus making the use of
heroin more easily extinguishable.
Treatment-Methadone (Cont’d)


Methadone's effects last for about
24 hours -- four to six times as long
as those of heroin -- so people in
treatment need to take it only once
a day.
Also, methadone is medically safe
even when used continuously for 10
years or more.
Treatment-methadone

Combined with behavioral therapies
or counseling and other supportive
services, methadone enables
patients to stop using heroin (and
other opiates) and return to more
stable and productive lives.
LAAM and Other Medications


LAAM, like methadone, is a
synthetic opiate that can be used to
treat heroin addiction.
LAAM can block the effects of
heroin for up to 72 hours with
minimal side effects when taken
orally.
LAAM and Other Medications

In 1993 the food and drug
administration approved the use of LAAM
for treating patients addicted to heroin.

Its long duration of action permits dosing just
three times per week, thereby eliminating the
need for daily dosing and take-home doses
for weekends. LAAM will be increasingly
available in clinics that already dispense
methadone.
Naltrexone


Naltrexone has long-lasting effects,
ranging from 1 to 3 days, depending
on the dose.
Naltrexone blocks the pleasurable
effects of heroin and is useful in
treating some highly motivated
individuals.
Treatment-others

Naloxone and naltrexone are
medications that also block the
effects of morphine, heroin, and
other opiates. As an antagonists,
they are especially useful as
antidotes.
Treatment-Behavioral Therapies.


Behavioral and pharmacologic
treatments can be extremely useful
when employed alone, but
integrating both types of treatments
is the most effective approach.
These can include residential and
outpatient approaches.
Opioid Analog

One of the most commonly known opioid
analog is Demerol.


Introduced in 1968 by a Belgian
pharmaceutical company as a synthetic
narcotic to be used as an analgesic in
surgical procedures because of its minimal
effects on the heart.
Demeral is particularly dangerous because it
is 50 times more potent than heroin and can
rapidly stop respiration.
Opioid Analog (Cont’d)


During surgical procedures, not a
problem, machines are used to help
patients breathe.
On the street, users have been found
dead with the needle used to inject the
drug still in their arms.
What Are the Opioid Analogs and
Their Dangers?


Drug analogs are chemical
compounds that are similar to other
drugs in their effects but differ
slightly in their chemical structure.
Some analogs are produced by
pharmaceutical companies for
legitimate medical reasons.
Opioid Analogs

Other analogs, referred to as
"designer" drugs, can be produced
in illegal laboratories and are often
more dangerous and potent than
the original drug.
Naltrexone


Naltrexone has long-lasting effects,
ranging from 1 to 3 days, depending
on the dose.
Naltrexone blocks the pleasurable
effects of heroin and is useful in
treating some highly motivated
individuals.