Transcript
SOC 204 Drugs & Society
Hanson Chapter 9 Narcotics
Narcotics
(Opioids)
Chapter 9
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6%
65%
29% A. Awesome!
B. I’m keeping up.
C. I’m lost…help!
Narcotics
Opioids
Opiates
Do you know someone who has used
opioids recreationally in the last 30 days?
26%
16%
58% A. No
B. Yes, one person
C. Yes, more than one person
Opium
Morphine Codeine Heroin
Heroin AbuseHeroin is classified as a Schedule I drug.
One of the most widely abused illegal drugs in the world; accounts for >$120 billion sales/year
Illicitly used more than any other drug of abuse in the United States (except for marijuana) until 20 years ago, when it was replaced by cocaine
Some of the recent increases in heroin use likely due to increased abuse of prescription opioid painkillers
Heroin Combinations Pure heroin is a white powder.
More than 90% of world’s
heroin is from Afghanistan.
Heroin is usually “cut” (diluted)
with lactose.
When heroin first enters the
United States, it may be 95%
pure; by the time it is sold, it
may be 3% to 70% pure.
If users are unaware of the
variance in purity and do not
adjust doses accordingly,
results can be fatal.
Heroin Combinations (continued)
Heroin has a bitter taste and is often cut with
quinine, which can be a deadly adulterant.
Heroin plus the artificial narcotic fentanyl can
be dangerous due to its unexpected potency.
Heroin is most frequently used with alcohol.
Heroin combined with cocaine is called
“speedballing.”
Facts About Heroin Abuse
What is the estimated number of heroin addicts in the United
States?
600,000 What are “shooting galleries”?
Locations that serve as gathering
places for addicts
Heroin and Crime Factors related to crime:
Pharmacological effects encourage
antisocial behavior that is crime-related
Heroin diminishes inhibition
Addicts are often self-centered, impulsive,
and governed by need
Cost of addiction
Similar personality of criminal and addict
Patterns of Heroin Abuse
Heroin has become purer (60% to 70% purity)
and cheaper (~$10/bag).
Greater purity leads users to administer heroin in
less efficient ways.
Many youth believe that heroin can be used
safely if not injected.
Patterns of Heroin Abuse
(continued)
Because of its association with popular fashions
and entertainment, heroin has been viewed as
glamorous and chic, especially by many young
people, although lately this attitude has been
changing.
Emergency room visits due to narcotic overdoses
were over 190,000 in 2009.
Stages of Dependence
Initially, the effects of heroin are often unpleasant.
Euphoria gradually overcomes the aversive effects.
The positive feelings increase with narcotic use, leading to psychological dependence.
In addition to psychological dependence, physical dependence occurs with daily use over a 2-week period.
If the user abruptly stops taking the drug after physical dependence has developed, severe withdrawal symptoms result.
Methods of
Administration
Sniffing the
powder
Injecting it into a
muscle
(intramuscular)
Smoking
Mainlining
(intravenous
injection)
Heroin Addicts and AIDSMore than 250,000 patients in United States contracted AIDS by drug injection, of which most were heroin users.
Fear of contracting HIV from IV heroin use has contributed to the increase in smoking or snorting heroin.
Many who start by smoking or snorting progress to IV administration due to its more intense effects.
Heroin and Pregnancy Heroin use by a pregnant woman leads to:
Physical dependence on heroin in the newborn
Withdrawal symptoms after birth in the newborn (Note: similar withdrawal occurs in newborns of any woman who uses significant amounts of opiate drugs during pregnancy, including prescribed opiate painkillers)
At one time, heroin
was given to morphine
addicts to help them
break their addiction to
morphine.
0%
100% A. True
B. False
1914 Harrison Act
Made opioids difficult to obtain
Oral use declined
Cost and risk increased
View of addicts changed
Vietnam
Use among troops was about 10-15%
Most users stopped upon returning to US
Review: Which two compounds
are in the opium plant resin?
A. Oxycontin and heroin
B. Morphine and heroin
C. Morphine and codeine
D. Hydrocodone and codeine
Oxyco
ntin and h
eroin
Morp
hine a
nd hero
in
Morp
hine a
nd codein
e
Hydroco
done and codein
e
6%0%
94%
0%
Review: What impact did the
Harrison Act have on opium use?
A. Opium use increased
B. Opium was no longer readily available
C. Illegal IV use decreased
D. Oral use increased
Opium
use
incr
eased
Opium
was n
o longer r
ea...
Illegal IV
use
decr
eased
Oral u
se in
creas
ed
13%
0%0%
88%
Review: Upon returning to the US, soldiers
who used opiates in Vietnam:
A. 70% were arrested for illegal drug use
B. 67% became homeless
C. 95% stopped using the drug
70% w
ere a
rrest
ed for i
ll...
67% b
ecam
e hom
eless
95% st
opped usin
g the d
rug
0%
100%
0%
Prescription Narcotics
Hydrocodone & OxyContin
Narcotic Doses
Drug Therapeutic Dose Tolerant Dose Lethal Dose
Morphine 15-30 mg 100 mg 500 mg
Heroin 10-15 mg 60 mg 200 mg
Fentanyl 25 micrograms 2 mg
OxyContin 10 mg 40 mg 160 mg
1 mg = 1000 micrograms
Pharmacology
Raw opium is about 10% morphine, smaller
amount of codeine
Heroin is made by adding two acetyl
groups
Allows passing through blood-brain barrier faster
Mouse Party
Enkephalins – adrenal gland
Endorphins – pituitary gland
http://ezproxy.wwcc.edu:2048/login?url=htt
p://digital.films.com/PortalPlaylists.aspx?ai
d=7539&xtid=45461
Medical Uses
Pain relief
Treatment of intestinal
disorders
Cough suppressant
Physical Effects
Drowsiness (nodding out), vomiting,
nausea, and difficulty concentrating
Euphoria
Gradually anesthetizing sensations
Difficulty urinating, constipation
Constricted pupils
Opioid Side Effects
Drowsiness
Respiratory depression
Nausea/vomiting
Inability to urinate
Constricted pupils
Constipation
Physical dependence and withdrawal
Emotional Effects
Relief from anxiety, hostility, feelings of
inadequacy, and aggression
Difficulty regulating inhibitions and
frequently make risky decisions
Social Effects
Alienated from and hostile toward friends
and family
Correlated with criminal behavior,
unemployment, and violence
Review: Heroin’s effects do not
include:
11%
78%
0%
11%A. Sleepiness
B. Euphoria
C. Agitation
D. Pain relief
Review: which of the following is
NOT a medical use for narcotics?
A. Cough
suppressant
B. Stop diarrhea
C. Induce sleep
D. Pain relief
Cough su
ppress
ant
Stop d
iarrhea
Induce
sleep
Pain re
lief
29%
0%
46%
25%
Dependency
About half of narcotic abusers become dependent:
Tolerance
Positive reinforcement
Negative reinforcement
Can develop in less than two weeks
Average addiction is six to eight years (aging out)
Acute ToxicityBehavioral
Respiratory depression can be fatal
Synergistic effect when combined with
depressants
Opioid Triad Coma
Depressed respiration
Pinpoint pupils
Chronic Toxicity
Blood borne pathogens
Contaminants
Infections
Which is an example of chronic
physiologic toxicity?
A. Making bad decisions
while high
B. Committing crimes to
obtain the drug
C. Acquiring an HIV
infection through use of
unclean needles
D. Depressed respiration
Makin
g bad d
ecisio
ns wh...
Comm
ittin
g crim
es to o
b...
Acquiri
ng an H
IV in
fect
i..
Depress
ed resp
iratio
n
0% 0%0%0%
Withdrawal
Factors affecting the difficulty of withdrawal:
Social support network
Desire to stop
Physical environment during withdrawal
Alternative opiates
Signs Heroin or
Morphine
Methadone
Craving for drugs, anxiety 6 24
Yawning, perspiration, running nose, teary eyes 14 34-48
Increase in above signs plus pupil dilation, goose bumps,
tremors, hot and cold flashes, aching bones and
muscles, loss of appetite
16 48-72
Increased intensity of above, plus insomnia; raised blood
pressure; increased temperature, pulse rate, respiratory
rate and depth; restlessness; nausea24-36
Increased intensity of above, plus curled-up position,
vomiting, diarrhea, weight loss, spontaneous ejaculation
or orgasm, hemoconcentration, increased blood sugar
36-48
(hours after last dose)
Narcotic
Withdrawal
Opioid Antagonists/Agonists
Naloxone - Narcan
Suboxone
Naloxone & Buprenorphine
Methadone
Treatment
Opinion: Do you agree with the
use of suboxone or methadone to
help a person quit using opioids?
57%
43% A. Yes
B. No
Which drug has the most
dangerous withdrawal syndrome?
A. Heroin
B. Morphine
C. LSD
D. Alcohol
Heroin
Morp
hine
LSD
Alcohol
33%
59%
7%
0%
I think Needle Exchange
Programs are a good idea.
A. True
B. False
True
False
0%0%
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