EXAM #2 Flashcards
What is the name for plant alkaloids derived from the opium poppy?
Opiate
What is the name for a compound resembling opium in addictive properties or physiological effects?
opioid
What is the name for dried latex obtained from the seed capsules of the opium poppy?
opium
What are narcotics?
drugs that relieve pain and dull the senses,
and the use of the word is most commonly associated with opioids
what is Heroin?
an opiate! It can be a white or brown powder or a black sticky substance (black tar).
Other common names for heroin include…
big H, horse, hell dust, and smack.
How do people use heroin?
People inject, sniff,
snort, or smoke heroin.
What is speedballing?
mix heroin with crack cocaine together.
what is fentanyl?
a synthetic opioid similar to morphine but 50-100 times more potent.
Street names for illegally used/made fentanyl are…
Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and
Tango & Cash.
When prescribed, how is fentanyl taken?
When prescribed, it can be given as a shot, a patch, or as lozenges.
When illegally used, how is fentanyl taken?
The illegally used synthetic fentanyl is sold as a powder, dropped onto blotter paper, put in eye droppers
and nasal sprays, or made into pills that look like other prescription opioids.
What do these sentences represent?
-Prescribed by doctors creates a false user-belief that they are safe, but tolerance causes many to seek other coping substances.
-The majority of abuse started from legitimate prescription use, while public gaze sees
Moral Model judgments and “junkies”
Gateway drug
Which country (4.6% of the world’s population), consumes ~80% of the world’s opioid supply and
99% of the world’s supply of hydrocodone (the opioid in Vicodin)
The United States!
Enormous growth of prescription opioid abuse =
Iatrogenic Epidemic
What is Doctor Shopping?
The assumption is that opioid prescription abusers “shop around” and use multiple
doctors in order to obtain high quantities of opioids.
in 2015, 1.7% of people 12 and over reported getting drugs from more than 1 doctor
Opioids act by binding to opioid receptors on neurons distributed throughout the nervous
system and immune system.
REMEMBER
endogenous peptides what are they?
naturally occuring in the body
endogenous peptides regulate and modulate several important functions, including the
following:
- Pain
- Stress
- Temperature
- Respiration
- Endocrine activity
- Gastrointestinal activity
- Mood
- Motivation
Does your brain change even with short term use of opioids?
YES!
What are some examples of opioids?
morphine, heroin, codeine, oxycodone, hydrocodone and fentanyl.
What is it called: the decrease of the receptors’ effectiveness?
Downregulation
GRISEL: “The romance is no longer hot when your lover is present,
but when your lover is absent your body and mind are
overcome with suffering.” (p. 75)
Imagine that satiated and dream-like state amplified hundreds of times ……what is this?
opioids!
Mental effects of opiods include:
- Euphoria
- Sedation
- Decreased anxiety
- Tranquility
- Indifference to pain
- Delirium and Coma (severe intoxication)
Chronic use of opioids creates…
tolerance and physical dependence
Remember !
Opioids with rapid onset of action and short half-lives have the greatest potential for
destructive addictive behaviours, as addicted individuals get immediate reward followed by
noticeable withdrawal symptoms. (IV injected heroin for example is a good example of this).
In recent animal studies, 3 conditions reliably induce opioid addiction
relapse:
- Stress
- Exposure to conditioned cues related to past drug use
- A dose of the previously administered drug or a drug with similar properties
Opioid use can cause:
- significant physical and psychological morbidities
- social, family, work, and legal difficulties.
- IV use of opioids increases risk of blood-borne infections like Hepatitis B and C and HIV.
- Abscesses
and collapsed veins are also common experiences from intravenous use.
5.
remember
Tolerance is so thorough that small-sized pupils may be the only observable sign of opioid
addiction. Inflamed nasal passages may be seen if heroin is snorted and “track marks” if injected.
Evidence ______suggest long term opiate use helps with chronic pain
does NOT
Evidence ______ suggest significant harm from long term opiate use
does
Pain and addiction are ________ mutually exclusive
NOT
Over ______ of people who take opioid therapy for 6 months will still be taking opioids years later
50%
WTF?? WHY? remember!
Pain management: A recent systematic review found that patients with chronic pain
(noncancer) who had comorbid substance use disorders are more likely to be prescribed
opioids and higher doses of opioid medications compared with patients who do not have a
history of substance use disorders despite similar pain outcomes.
People regualrly using opioids are ____ more liekly to attemept _______
People regualrly using opioids are 2X more likely to attempt suicide.
People who take __________ amounts of opioids for pain are at an increased risk of accidntal overdose death.
higher quantities
Even when someone is
very motivated to cut
down/quit opioid
(ab)use, it is extremely
difficult because…..
the
withdrawal symptoms
can be excruciating.
What are some INITIAL (some of the first) withdraw/detox synptoms when someone stops using opioids?
- muscle aches and spasms
-trouble sleeping
-racing heart
-anxiety
-sweating
-yawning
-hypertension
-fever
-agitation
When do withdrawal symptoms begin for short acting and long acting opiates?
Short: 6-12hrs
Long: 30 hrs
At 72 hours, what happens?
Symptoms peak! (The worst symptoms)
What are the peak symptoms of opitate withdrawl?
-nausea
-vomitting
-cramps
-diarrhea
-goosebumps
-depression
-drug cravings
Overall name some of the withdrawal symptoms that are associated with opiates?
- Irritability
- Extreme Agitation
- Restlessness
- Severe depression
- Untreatable insomnia
- Suicidal thoughts
- Anxiety and panic attacks
- Diarrhea
- Nausea
- Vomiting
- Stomach cramps
- Sweating
- Extreme joint pain
- Extreme muscle aches
- Spasms
- Runny nose
- Watery eyes
- Headaches
- High blood pressure
- Irregular / racing heartbeat
- Goose bumps
- Hot and cold chills
- Dilated pupils
- Yawning
- Intense cravings
Withdrawal from opioids always involves…..
significant pain - especially where old injuries or
surgeries occurred. This can make it hard to fight the thought that the medication was
preventing that pain, even if it is only withdrawal-induced pain
What are these things related to?
* can happen weeks or months later
* is associated with insomnia, anxiety, and severe depression
* often includes suicidal thoughts
* these symptoms can lead to relapse, which is a high risk for overdose due to lowered
tolerance since last use
Post-Acute Withdrawal
The half-life of a drug is the time it takes for the amount of a drug’s active substance in your body to reduce by half.
The half-life of a drug
what are some opiate detox factors?
-liver health
-kidney health
-age
-body fat/mass
-metabloism
-drug strength
-drug half life
-water intake
and others!
For treatment, current guidelines advocate for comprehensive treatment using _______________ in conjunction with ________________.
pharmacological
interventions (methadone, buprenorphine, or buprenorphine with naloxone) in
conjunction with psychosocial therapy.
No 2 people will EVER go thru the exact same ________
withdrawal expereince.
What is methadone?
-eliminates the rollercoaster of highs and lows you usually experience with opioids.
-Methadone is an opioid taken once/day as a liquid mixed with juice.
-It lasts 1-3 days in the body, whereas most opiates only last 1-3 hours.
-methadone can allow people with opioid dependency to stop chasing a “fix” and live relatively normal lives again.
-Methadone also blocks any high you would get using other opioids and therefore prevents cravings with regular use.
what can methadone cause?
- Drowsiness, sleepiness, nausea, reduced energy
- Reduced cough reflex and slower, shallower breathing
- Reduction of any physical pain
- Small pupils, constipation, dry mouth, lower blood pressure, and difficulty passing urine
- Reduced menstrual periods, reduced testosterone levels in men, reduced
sex drive and sugar cravings.
pharmacology is just one of the tools used to help someone get off of opiates. Medication is typically used in conjunction with _______________.
addictions counselling and attending AA/NA or SMART Recovery meetings.
Besides therapy, what are the pharmalogical treatments for opioid?
METHADONE
SUBOXONE
SUBLOCADE
NALOXONE
______________ is not approved for use in pregnancy, but ___________ is.
Suboxone is not approved for use in pregnancy, but methadone is!
more people die from opioid overdoses than car crashes T or F
True!
Remember
Opioids can cause severe, and sometimes fatal, depression of the respiratory system when
taken in large doses, when mixed with other depressants or when a user’s usual tolerance
has been compromised.
Naloxone, or Narcan®, is a ….
pure opioid antagonist
what is narcan?
It is an injectable medication that can reverse opioid overdose to regain normal breathing
and consciousness, usually in 2-5 minutes
In 2016, the Government of Canada replaced the National Anti-Drug Strategy with
the new Canadian Drugs and Substances Strategy – an evidence-based public
health approach to addiction and problematic substance use. Its four pillars are:
- Prevention
- Treatment
- Harm Reduction
- Enforcement
REMEMBER!!!!!! it WILL be on the exam!