Opiods 1

Question 0

What are opiates

Answer 0

 opiate refers only to naturally occurring drugs or drugs derived from naturally occurring compounds
Opiates include codeine and morphine

Question 1

What are opioids

Answer 1

 opioid is a term used to describe compounds both natural and synthetic that have properties similar to opium or morphine
 opiate refers only to naturally occurring drugs or drugs derived from naturally occurring compounds
 as clinical agents, renowned as powerful analgesics
 have a dramatic effect on the affective component of
pain (anxiety, worry, uneasiness etc)
 referred to as narcotics (causes sleep)

Question 2

What are some other names for opioids

Answer 2

 China white, smack, scag, junk, dope

Question 3

What is the psychological disorder of pain

Answer 3

Being aware of pain but not caring

Question 4

Wha are some of the legal uses of opioids

Answer 4

 morphine is the gold standard of pain killers
 in Canada, morphine is prescription only, tightly regulated
 codeine found in small amounts in OTC medica&ons
 heroin illegal except for experimental use

Question 5

Why do those using opioids for pain typically not get addicted

Answer 5

 pattern of high use with high pain, will decrease dose when pain diminishes

Question 6

What percentage of users are estimated to become addicted

Answer 6

 estimated that 2 - 6% of all long-term users may become addicted

Question 7

What is the main source of opium

Answer 7

 main source is a particular poppy, Papaver somniferum
 opium is in the sap of the plant
 plant makes drug in only 10 days of its life cycle
between petals dropping and seed pod maturing

Question 8

Explain the labour intensive process if harvesting opium

Answer 8

 workers scratch the seed pods in the evening so that white sap (latex) oozes out overnight
 it oxidizes into brown gummy substance black tar opium
 scrape it off by hand and compress it
 this is opium

Question 9

What country is the major source of opioids

Answer 9

Aphganistan

Question 10

What is in opium?

Answer 10

 a mixture of narcotic and non-narcotic alkaloids

two major narcotic components are morphine (from Morpheus the Greek god of sleep) (10%) and codeine (0.5%) (Greek for poppy head)

Question 11

What is morphine 10 fold more potent than

Answer 11

 morphine is 10-fold more potent than opium

Question 12

Explain what codeine is converted to in the liver and what happens if enzymes are deficient or overactive

Answer 12

 codeine converted to morphine in the liver and brain
 if enzyme is deficient, ( 6-10% of caucasians) codeine codeine produces no effect
 if overactive usually because of multiple copies of the gene (2% of popula&on), can get morphine intoxication from codeine use

Question 13

What is heroin

Answer 13

in 1874, two acetyl groups were added to morphine by Bayer giving diacetylmorphine
 given brand name Heroin (from heroish, german for heroic): feel invincible/heroic after use

Question 14

Explain the significance if the structure of heroine

Answer 14

two acetyl groups make heroin 10 times more lipid soluble than morphine and 3 times more potent:
 gets to the brain faster and in higher concentrations
 acetyl groups metabolically removed once in brain - converted into morphine which is then able to bind to receptors

Question 15

Explain the deacetylation of heroin: why it occurs and the products

Answer 15

 in the brain, one acetyl group at a &me is quickly removed
 get mixture of 6-monoacetyl- morphine (6-MAM) and 3-monoacetylmorphine (3-MAM)
 6-MAM binds to mu receptors and is psychoac&ve, 3- MAM does not
 both then converted into morphine
 6-MAM can only be produced from heroin and so is used in legal cases to prove heroin use

Question 16

Explain heroin purity over the years

Answer 16

 in North America in the 1970s, heroin was 4-6% pure
 rest (94 - 96%) was something else
 in the 1980s to early 1990s, was 25%
 in 2006, 30 - 36%
 some samples now 90% with most in a range from 7 - 75%
it is now cheaper for higher purity - more danger for addiction and overdose

Question 17

What is oxycodone

Answer 17

oxycodone - one of the most abused prescription analgesics

Question 18

What is oxycodone called when mixed with acetomenophine vs aspirin

Answer 18

Percocet, Percodan

Synergistic effect on pain control

Question 19

What is OxyContin

Answer 19

OxyContin is a tablet that contains many times the amount of oxycodone as a regular tablet - it was designed as a time-release formula - now a highly sought-after drug of abuse

Question 20

What is hydrocodone

Answer 20

hydrocodone (Vicodin, Lortab) is another prescription drug commonly abused

Question 21

What is OxyNeo

Answer 21

 Last year, a new version of slow-release oxycodone was brought to market
 OxyNeo replaced OxyContin
 Pills contain polyethylene oxide, a hydrophilic polymer
 OxyNeo is formulated so that if user tries to crush it, instead of a powder, it forms a gummy gel if exposed to fluid
 Some evidence that demand for it has gone down
 But also evidence that abusers are switching to heroin and other opioids

Question 22

What does recent data suggest about opioid anise particularly in relation to heroin

Answer 22

 recent data shows a substan&al increase in opioid abuse
 mostly due to prescrip&on (PO) opioids
 in fact, heroin use has decreased in Canada
 ratio of PO opioid:heroin abuse was 3:1 in Canadian cites

Question 23

What is Canada ranked in global prescription opioid consumption

Answer 23

 Canada ranked first globally for PO hydromorphone (Dilaudid) consumption per capita and second for oxycodone consumption per capita
 A study found that 4 out of every 5 patients seeking help at a Toronto methadone clinic were abusing PO opioids

Question 24

What is methadone

Answer 24

A safer opioid used to ween people off heroion

Question 25

What are the death tolls since the introduction of OxyContin

Answer 25

 with the introduc&on of oxycon&n:
 opioid-related deaths increased 41%
 oxycodone-related deaths increased by 416%

Question 26

What is fentanyl

Answer 26

Synthetic opioid
 fentanyl is used primarily as a surgical anaesthetic but also in lollipops and skin patches
 less euphoria, more analgesia compared to heroin
 100 times as potent as morphine due to high
lipophilicity
 short duration is useful in surgery, but may increase addictive potential
 lethal in individuals who think they are injecting heroin
 recent number of deaths due to heroin being cut with fentanyl - LD50 may be ten &mes lower than for heroin

Question 27

What is the street name for mixtures if heroin and fentanyl

Answer 27

MAC-22, “magic” “the bomb” are street names for potent mixture of heroin and fentanyl

Question 28

What are the general opioid abuse effects

Answer 28

 intense euphoria, drowsiness, mental clouding, sleepy sensation “nodding”
 a “rush” when taken IV, large amount enters brain rapidly - “body orgasm” effect followed by sedation (hour or so)
 analgesia may last 3 to 5 hours
 in some people, see a stimulant effect

Question 29

What are the classic physiological effects of opioids

Answer 29

 constriction of pupils (except meperidine/demerol) due to agonist effects on mu and kappa receptors in oculomotor nucleus important diagnosis tool in overdose as most other causes of coma produce pupillary dilation
 nausea and vomiting (via the chemoreceptor trigger zone in a region of the medulla - the area postrema)
 lowering of blood pressure (medulla effect)
 vasodilation may lead to profuse sweating

histamine release - hypotension, bronchoconstriction, itching

Question 30

What are the effects of opioids on mu receptors

Answer 30

 opioids are notorious for depressing respiration via ac&va&on of mu receptors even at therapeutic doses

associated with decrease in sensitivity to arterial CO2 and inhibition of respiratory rhythm generator in the medulla
 most deaths due to asphyxiation

Question 31

What are the effects of opioids on digestive system

Answer 31

disrupts coordination of digestive system so food passes slowly
 (anti-diarrheal) by activating mu opioid receptors in gastrointestinal tract and in the CNS
 results in increased muscular tone but less motility

Question 32

Explain the oral route if heroin and morphine

Answer 32

 heroin and morphine are weak bases that become ionized in acid stomach
 not well absorbed from GI
 heroin is 100 times less effective when given orally compared to IV
 oral route also has major first pass metabolism
 suppository form can be used to mostly avoid this

Question 33

Explain how heroin is smoked

Answer 33

 higher purity heroin has allowed for smoking to become a viable alternative
 chasing the dragon
 pure heroin is heated on tin foil until it
vaporizes
 user chases the smoke with a tube and inhales
 17 - 63% of heated heroin is vaporized
 can also use pipes to smoke it

Question 34

Explain how heroin is injected

Answer 34

 to inject, heroin usually mixed with water in a spoon
 lemon juice or something acidic may be added to help dissolve it
 heat it to help dissolve and warm it to body temp
 sometimes drawn up through cotton ball to “filter out impurities, bacteria and viruses”
 heroin can also be snorted (morphine cannot)

Question 35

Explain the problems with injecting heroin

Answer 35

 “track marks” are the scars le^ by frequent injec&ons, especially with dull reused needles
 mul&ple injec&ons result in collapsed veins due to scarring
 crushed pills seem especially dangerous to vein health due to fillers
 addicts frequently need to find new veins in which to inject
 seems especially bad with black tar heroin, a crude, gummy preparation from Mexico, Afghanistan
 blood is rerouted through deeper, smaller veins

Question 36

What is Krokodil

Answer 36

 A drug that surfaced in Russia several years ago
 Codeine, red phosphorous, gasoline, iodine and
hydrochloric acid used to generate desmorphine
 Final product is an unfiltered suspension
 Injected IV
 Immediate damage to blood vessels, muscle, bones
 Produces abscesses, gangrene, large-scale necrosis – crocodile-like skin is produced
 Called “the drug that eats junkies”

Question 37

What is doda

Answer 37

 doda is a powder made from grinding poppy heads
 typically made into a tea and used by workers to get a burst of energy (which seem paradoxical to known effects)
 popular with South Asian communi&es
 can be just as addictive and dangerous as any other opioid even though it is a very crude prepara&on
 in 2009, Edmonton had huge bust - 70 kg