An in-depth look at opiates and their effects
Opiates are a type of narcotic drug that act as
depressants in the central nervous
system(CNS). Opiates come from opium,
which can be produced naturally from poppy
plants or derived from semi-synthetic
alkaloids. Some of the most common opiates
include morphine, codeine, heroin,
hydrocodone and oxycodone.
Types of Opiates
Opium
Opium is extracted from seedpods of Papaver somniferum, the opium poppy. Known to the ancient
Egyptians, Greeks and Romans, smoking opium produces an addicting sense of relaxation.
 Morphine
The first medicinal plant alkaloid ever isolated, morphine was extracted from opium in 1817. Morphine is
injectable and is a controlled substance in the United States under the controlled substances act of 1970.
Used clinically to treat the pain of heart attack, it may also be added to spinal and epidural anesthesia for
prolonged post-surgery comfort. Hydromorphone (Dilaudid) is a more potent semi-synthetic opioid derived
from morphine.
 Heroin
The chemical acetic anhydride is used in the production of diacetylmorphine, or heroin, from morphine.
Heroin can cross the blood-brain barrier more readily than morphine.
 Codeine
Extracted from opium in 1832, codeine is an effective cough suppressant and is the most commonly used
narcotic in the world. Combined with non-narcotic fever medicines like aspirin, ibuprofen or
acetaminophen (Tylenol), it is useful for toothaches and other acute pain.
 Thebain
Thebaine is a weak opiate. Chemical modifications of codeine and thebaine have produced the opioids
hydrododone (Vicodin) and oxycodone (Oxycontin), both of which are stronger than codeine and are
popular drugs of abuse.
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Common Prescription and Illicit
Opiates
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Prescription Opiates
Morphine
Codeine
Hydrocodone
Oxycodone
Methadone
Fentanyl
Meperidine
Vicodin
Fentanyl
Norco
Darvocet
Dilaudid
Tramadol
Lortab
Percocet
Illicit Opiates
 Heroin
*** Any prescription opiate that
is obtained without a
prescription is considered an
illicit opiate. ***
Opiate Street Names
Opium
 Big O
 Black stuff
 Block
 Gum
 Hop
 Dover’s powder
Heroin
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Dope
Smack
H
Train
Thunder
Black tar
China whitehorse
Junk
Antifreeze
Brown sugar
Henry
Horse
Skag
Hero
Hell dust
Opiate Street Names
Fentanyl
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Apache
China girl
China white
Dance fever
Friend
Goodfella
King ivory
Murder 8
TNT
Tango
Cash
Morphine
 M
 Miss Emma
 Monkey
 White stuff
 Dreamer
Opiate Street Names
Hydrocodone and
Oxycodone
Hydrocodone
 Vikes
 Viko
 Norco
 Hydro
Oxycodone
 Ox
 Oxicotten
 Oxycet
Codeine
 Schoolboy
 Cough syrup
 T-three’s (Tylenol #3 with
codeine)
Therapeutic Uses of
Prescription Opiates
 Opioids are prescribed by licensed medical practitioners to
people with acute or chronic pain resulting from disease,
surgery or injury. Opioids are also prescribed to people with
moderate to severe coughs and diarrhea. Methadone and
buprenorphine are opioids that are prescribed to treat
addiction to other opioids, such as heroin or oxycodone (e.g.,
OxyContin).
Physiological Effects of Opiates
 The physiological effect of the opiate exists particularly in a decrease of pain;
it can with increasing dosage also release cramps. Investigations of R.
Tremmel (1975) refer to certain chemoreceptors in the brain, so-called opiate
receptors, particularly in the "limbic system" and in the "amygdale", in which
opiate deposit preferentially. These brain areas play particularly with fear and
escape reactions a role as well as with the emotional and affective processing
of sensory perceptions. In these brain regions morphine is able to affect the
routings for pain (decrease of pain effect) and euphoria to release (euphoric
effect).
 According the WHO, opioid means the generic term applied to alkaloids from
the opium poppy (Papaver somniferum), their synthetic analogues, and
compounds synthesized in the body, which interact with the same specific
receptors in the brain, have the capacity to relieve pain, and produce a sense
of well-being (euphoria). The opium alkaloids and their synthetic analogues
also cause stupor, coma, respiratory depression in high doses. Endogenously
occurring compounds with opioid actions include the endorphins and
enkephalins.
Physiological Effects of Opiates
Physical Dependence
Physical dependence is the phenomenon whereby the body adjusts to having the opiate
drug in the system. Any reduction in the levels of the opiate drug forces the body to readjust. This is what we refer to as withdrawal phase. When the stopping of a substance
causes the body to "rebound" and results in symptoms of withdrawal, we say that the
individual has developed physical dependence. Dependency is a predictable behavior and is
controllable by professional counseling and treatment therapies.
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 Addiction
One of the common long-term side effects of chronic use of opiates is developing an addiction to
the drug. Opiate addiction is an uncontrollable situation that affects the individual in a
biochemical, physical and psychological way. Addiction is a complex phenomenon characterized
by substance abuse, relapse and eventually death. The management of opiate addiction is
monitored and supervised under a professional health care provider, medical doctor, and a
supportive team of counselors and behavioral therapists. Individuals addicted to opiate drugs are
typically placed on a 12-step detoxification treatment program.
Physiological Effects of Opiates
 Physical Signs and Symptoms
Long-term effects can manifest in physical signs and symptoms in
chronic abusers or user of opiates. Some common signs are needle
tracks and collapsed veins. Frequent infections, acne, and other skin
problems can develop due to poor hygiene care and poor health. Other
medical complications, such as heart and valve infections and liver
problems, can develop over time because long-term use of opiates will
weaken the immune system in the body. Opiates can cause respiratory
depression and increase the risks of getting pulmonary and respiratory
problems such as pneumonia and bronchitis.
Withdrawal Effects from
Opiates** See note below**
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Early symptoms of
withdrawal include:
Agitation
Anxiety
Muscle aches
Increased tearing
Insomnia
Runny nose
Sweating
Yawning
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Late symptoms of
withdrawal include:
Abdominal cramping
Diarrhea
Dilated pupils
Goose bumps
Nausea
Vomiting
Health Risks from Opiate Abuse
Infectious Risks
 Opiates work by latching to specific receptors scattered
throughout the body and the brain. While people could
swallow or sniff some types of opiates in order to get the drugs
to connect with the receptors, most addicts find that they can
achieve the greatest high in this shortest amount of time if
they mix the drugs with some sort of liquid (or buy them in
liquid form) and inject the drugs directly into the bloodstream
with needles. This might be the most effective way to take
drugs in order to cause euphoria, but it can be disastrous in
terms of health, as many people who inject drugs also inject
infections. People who inject drugs may share needles with
other people, and even the tiniest amount of a virus located
on a needle could translate into an infection when that needle
is used again.
Health Risks from Opiate Abuse
Heart Damage
 Prescription medications containing opiate-like ingredients might not
contain these sorts of hazardous ingredients, but they can contain
inactive ingredients that help the medications to stick together.
These ingredients may be harmless when they pass through the
digestive tract, but when they are injected, they can cause problems.
 Injecting these sorts of ingredients means placing somewhat
insoluble or definitely insoluble particles directly into the
bloodstream. These tiny molecules can move to the soft tissues of the
heart and create small pockets of infection. These small pockets of
inflammation can lead to heart failure, or even death, and they’re
quite common in people who inject drugs.
Health Risks from Opiate Abuse
Mental Health and Cognition Issues
 It’s no secret that having an addiction can be hard on a
person’s mental health and sense of self. As the addiction
begins to take over, and the person begins to lose control of
the ability to think clearly, plan for the future and make good
decisions, people can begin to feel lost and out of sorts.
Depression can quickly set in when people feel this way. Not
surprisingly, depression is quite common in people who abuse
opiates.
Health Risks from Opiate Abuse
Additional Complications
There are other problems that might strike smaller groups of opioid abusers.
These include:
 Scarred veins
 Collapsed veins
 Pneumonia
 Tuberculosis
 Some people even develop specific types of arthritis due to the drugs.
According to a study published in the journal Seminars in Arthritis and
Rheumatism, over a five-year period, 36 cases of septic arthritis were diagnosed
in 35 heroin addicts. While about 90 percent of these cases responded to
antibiotic treatment, eight of these cases required a surgical intervention.
Arthritis can be incredibly painful, and going through surgery can be quite
expensive, so this isn’t a minor concern.
Treatment Approaches to Opiate
Abuse and Dependence
Outpatient Treatments
 Buprenorphine and Naloxone are often used in outpatient clinical care
settings because they both greatly reduce the painful withdrawal symptoms
that accompany opiate detoxification. Patients often can continue everyday
activities during this process. Buprenorphine was originally used in the
United States for pain management, but was approved by the Federal Drug
Administration (FDA) in 2003 for opiate detoxification. Buprenorphine, also
known as Suboxone or Subutex, is available in tablet form or by liquid
injection and inhibits the euphoric sensations caused by opiates. Over time,
relapsing substance abusers began to combine buprenorphine with other
opiates to produce intoxication. As a result, Naloxone is administered in
combination with buprenorphine, because it quickly counteracts the effects
of opiates and is often used in emergency overdose situations. The daily
frequency of dosage and overall detoxification time depend on the nature and
severity of the addiction.
Treatment Approaches to Opiate
Abuse and Dependence
Methadone Treatment Centers
 Methadone is a double edged sword because it is both
addictive and useful for long term detoxification maintenance.
Methadone is often prescribed to patients suffering from
cancer or other terminal illnesses causing severe pain.
Unfortunately, methadone has become widely available and is
abused by at least 1 percent of high school students,
according to the National Drug Intelligence Center. Methadone
typically does not produce the same level of intoxication as
other opiates which cause users to ingest more than the
recommended amount. However, methadone is used in
treatment programs because it suppresses withdrawal
symptoms for up to 36 hours. Lower doses of methadone are
administered to patients over long periods of time to assist in
sustained recovery from addiction.
Treatment Approaches to Opiate
Abuse and Dependence
Residential
 Residential drug treatment can be broadly divided into
two camps: 12 step programs or Therapeutic
Communities. 12 step programs have the advantage of
coming with an instant social support network, though
some find the spiritual context not to their taste. These
other programs may use a Cognitive-Behavioral Therapy
approach, such as SMART Recovery, that looks at the
relationship between thoughts, feelings and behaviors,
recognizing that a change in any of these areas can
affect the whole. CBT sees addiction as a behavior
rather than a disease and subsequently curable, or
rather, unlearnable. CBT programs recognize that for
some individuals controlled use is a more realistic
possibility.
Treatment Approaches to Opiate
Abuse and Dependence
Rapid Opiate Detox
 Although many residential treatment centers offer rapid
detox for opiate addiction, it is extremely dangerous and
is not recommended by most licensed healthcare
providers. Patients are put under anesthesia and
pumped with a strong narcotic inhibitor cocktail to
speed detoxification, but there is no evidence to support
this claim. Rapid detox can be deadly because the
body's reactions to withdrawal cannot be properly
controlled under anesthesia and should not be
administered outside of a hospital setting.
Treatment Approaches to Opiate
Abuse and Dependence
Behavioral programming
 Behavioral programming is considered critical to helping
those with addictions achieve abstinence. From the
applied behavior analysis literature and the behavioral
psychology literature several evidenced based
intervention programs have emerged behavioral marital
therapy; community reinforcement approach; cue
exposure therapy; and contingency management
strategies. In addition, behavioral treatment such as
community reinforcement and family training (CRAFT)
have helped family members to get their loved ones into
treatment.
Treatment Approaches to Opiate
Abuse and Dependence
Alternative therapies
 Alternative therapies, such as acupuncture, are used by some
practitioners to alleviate the symptoms of drug addiction. In
1997, the American Medical Association (AMA) adopted as
policy the following statement after a report on a number of
alternative therapies including acupuncture:
 There is little evidence to confirm the safety or efficacy of most
alternative therapies. Much of the information currently
known about these therapies makes it clear that many have
not been shown to be efficacious. Well-designed, stringently
controlled research should be done to evaluate the efficacy of
alternative therapies.
 Acupuncture has been shown to be no more effective than
control treatments in the treatment of opiate dependence.
Treatment Approaches to Opiate
Abuse and Dependence
 Spiritual Therapy uses alternative therapies such as yoga,
breathing exercises, creative visualization, and meditation to
help clients retain control over their lives so that they can
make healthy choices
 Family and Couples Therapy that helps clients build
stronger relationships with their loved ones as well as identify
interpersonal triggers that could lead to potential relapse
References
 http://www.camh.ca/en/hospital/health_information/a_z_ment
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al_health_and_addiction_information/oxycontin/Pages/opioids_d
yk.aspx
http://www.drug-encyclopedia.eu/DW_EN/opiates.shtml
http://www.opiates.com/drugs/
http://www.opiaterehabtreatment.com/street-names-opiates
http://www.livestrong.com/article/69026-list-opiateprescriptions/
http://www.livestrong.com/article/75425-types-opiate-drugs/
http://psychology.about.com/od/oindex/g/what-areopiates.htm
http://www.thecontrolcenter.com/what-we-treat/prescriptiondrug-abuse-treatment/opiate-addiction-treatment/