Understanding Opioids and Sedative-Hypnotics: Uses, Side Effects, and Addiction, Study notes of Psychology

Download Understanding Opioids and Sedative-Hypnotics: Uses, Side Effects, and Addiction and more Study notes Psychology in PDF only on Docsity! Uppers, Downers & All Arounders Chapter 4 Downers: Opiates/Opioids & Sedative-Hypnotics Copyright 2004, CNS Productions, Inc. 1 Downers (depressants) Opiates/Opioids Opium, codeine, morphine, heroin Vicodin , OxyContin  Sedative-Hypnotics Benzodiazepines, e.g., Valium  Barbiturates, e.g., Seconal  Others, e.g., Rohypnol , Miltown  Alcohol Beer, wine, hard liquor General Classification II. Minor Depressants 1.Skeletal muscle relaxants a. Synthetically designed to depress areas in the brain responsible for muscle coordination and activity b. Prescribed for muscle tension and pain 2. Antihistamines a. Synthetic drugs used to treat allergies, ulcers, shock, rashes and motion sickness b. Produces drowsiness c. Blocks the release of histamine d. Can induce depression e. Abused for depressant effects General Classification II. Minor Depressants 1. Over-the-counter downers a. Nytol, Sominex: marked as sleep aids and sedatives 2. Lookalike downers: • Looked like prescription downers • Rarely found, except in magazine ads for legal downers Opiates/Opioids • Oldest and best-domented of psychoactive drugs • Discovery of neurotransmitters/own body’s natural painkillers: – endorphins & enkephalins changed scientists understanding of opiates/opioids – & field of addiction Opiates/Opioids • History of Use – Used by ancient Sumerians, Egyptians & Chinese as medicine, pleasure and poison – Opium originally chewed, eaten and drunk in liquids – Bitter taste limited addiction – Used throughout Middle Ages – Smoking opium: • increased nonmedical use • Increased intensity of effects • Multiplied its abuse potential • Actively promoted by British in China • Introduced to U.S. by Chinese immigrants Opiates/Opioids • Refinement of Morphine, codeine & heroin from opium increasing its strength • Codeine only 1/5 strength of morphine • Used in cough syrups & other drugs • Heroin was refined from morphine • IV use began in 1853 with invention of hypodermic needle • Patent medicines introduced mid-1880s • Used in tonic • Physician induced addiction was common Opiates/Opioids • Snorting was popular method of taking heroin • More than half of addicts that enter treatment began by snorting • 20th century – Nonmedical use declared illegal at beginning of 20th century – Pur Food and Drug Act 1906 and Harrison Narcotics Act in 1914 – Est. 3.5 million Americans use prescription opiates/opioids monthly – Est 120,00 to 800,000 heroin users in U.S. – 5-10 milion regular users world wide – U.S. consumes only 3% – Afghanistan produces 70% of world supply – China White (Golden Triangle in Asia) – Black Mexican Tar – Colombian cartels Side effects of Opioids • Physical: – Felt in almost every part of body – Noticeable: Droopy eyelids, nodding, slurred speech – Suppression of cough center – Digestive and hormonal – Nausea and constipation • Tolerance: – Occurs when body tries to neutralize heroin • Speeds-up metabolism • Desensitizes nerve cells • Excreting drug from body • Altering the brain and body to compensate of effects of drug • Develops at different rate for different body systems Side effects of Opioids • Tissue Dependence – Adaptation to the effects can alter brain chemistry temporarily or permanently – Body relies on drug to stay normal • Withdrawal – Acute withdrawal occurs 2-3 weeks after abstinence – Protracted or Post Acute Withdrawal (PAWS) can occur for months – Heroin & morphine more severe Side effects of Opioids • Neonatal: Opioids cross the placenta resulting in risk of miscarriage, – placenta separation, – premature labor, – stillbirth, – Seizures – Addiction of infant: withdrawal is severe (death in some cases) • Overdose in older users can be fatal – Severe respiratory depression – Opioid antagonist: Narcan can counteract overdose but victim will still experience severe withdrawal Opioids • Cost: – $20 - $200 daily depending on level of use – 60% of cost through consensual crime – 73% of heroin users are gainfully employed • Polydrug use: – Stop withdrawal symptoms – Speed to get energetic – Mixing drugs – Morphing use of multiple drugs to counter the effects of original drug – Cycling: giving up drug to lower tolerance – Sequential: using one drug then to another drug Morphine & Other Opioids • Morphine: – Refined from opium – Liver converts morphine into metabolites – Can be detected in urine fro several days – Therapeutic pain control – Patient become more sensitive to pain after long-term use because the body produces fewer of its own painkillers – Down regulates opioid receptor sites Morphine & Other Opioids • Codeine – Extracted from opium or refined from morpjine – Analgesic use to control coughs – Most widely prescribed and abused prescription drug – Vicodin now more prescribed (produces less nausea) – Last 3 hours in system – Detectable in urine 2 to 3 days Morphine & Other Opioids • Propoxyphene (Darvon, Darvocet) – Prescribed for mild-moderate pain – Last 4-6 hours – Can be used to detox heroin addicts • Fentanyl (Sublimaze) – Most powerful opioid (50-100 X’s as strong as morphine) – Used right after surgery for severe pain Morphine & Other Opioids • Designer heroin – Street versions of fentanyl – 100-20,000 Xs stronger than regular heroin – Can contain MPTP (street demerol) that destroys dopamine-producing cells that control voluntary muscular movements – Mimics Parkinson Disease – Causes condition called “frozen addict.” – Addict can lose the ability to make any physical movements Morphine & Other Opioids • LAAM – Long lasting opioid used for heroin replacement therapy – Unsuitable for pain management • Naloxone (Narcan) & Natrexone (Revia) – Opioid antagonist that block effects of opioids – Effective in treating overdoses – Revia can be used to treat craving for cocaine and alcohol • Buprenorphine – Power opioid agonist at low doses and antagonist at high doses – Alternative to methadone Benzodiazepines • Most widely used as: – anti-anxiety drugs, – Sleep aids, – Sedatives – Control seizures • Prescribed for panic attacks • Insomnia • Skeletal muscular spasms • Control seizures • Anesthetic for seizures Benzodiazepines • Non Medical Use: – Often abused with other drugs • To come down off fo methamphetamine, cocaine • Substitute as heroin • To prevent alcohol withdrawal symptoms • Abusers then to be over 30 years, White, weel-educated and female – Neurotransmitter GABA – Converted by live to metabolites more strong that original drug – Tolerance develops as liver becomes more efficient in processing drug – Younger person can tolerate higher doses Benzodiazepines • Tissue Dependence – Addiction develops 10-20 times the normal dosage is taken for several months • Withdrawal – Can be severe – Can involve seizures, convulsions and death – Takes several months to taper off drug – Withdrawal can come in cycles separated from 2-10 days – Symptoms may persist several months (PAWS) Barbiturates • Tolerance – Develops in variety of ways – Dispositional tolerance increase the efficiency of metabolism – Pharmacodynamic tolerance • Reduces nerve cell and tissue sensitivity to the drug – Tissue dependence occurs when 8-10 Xs the dosage is taken daily for 30 days Barbiturates • Withdrawal – Anxiety, – Agitation, – Loss of appetite, – Vomiting – Increased heart rate – Excessive sweating – abdominal cramps – Tremors – Can result in in convulsions within 12 hours to 1 week from last dose Other Sedative/Hypnotics • GHB: – Popular among bodybuilders – Has a similar effect to methaqualone or alcohol intoxication – Popular in rave clubs – Has been used a date rape drug • GBL: – Metabolized to GBH in the body – Also an ingredient in paint strippers • Methaqualone (Quaaludes, Mandrax) – Withdrawn from the market in 1984 – Counterfeit versions on market – Sought for overall sedative effect