Opioids and Opiates - Understanding Addiction

• Opioids are naturally occurring substances derived from the opium poppy.  They have a long history of medicinal use.
• Opium delivers pleasure and relieves pain and anxiety. This is what makes it so popular in medical and recreational use.
• Papaver somniferum produces opium for only 7 to 10 days a year. All opioids are derived from this.
• As far back as 1500BC the medical use of opium is on record.  Galen, a Greek physician, emphasized caution in the use of opium but felt it was a cure all.
• Because of the dark ages the Arabic world is credited for bringing opioids to the world.  The Arabian world started to trade with India and China.
• Arabic civilization prospered and made grand contributions to medicine and history of opium.
• Biruni, an Arabic physician, wrote about opioid dependence in 1000AD.  At the same time Avicenna, an Arabic physician as well, used opium extensively in medical practice.  His work, along with Galen’s work set the base for medical education in Europe.
• By the 10^th century opium was integrated into Chinese medicine.
• In Europe a phenomenon named Paracelsus was a successful doctor who praised what he labeled the “stone of immortality”.
• Dr. Thomas Sydenham, who was called the English Hippocrates, believed that without opium medicine would not be.
• In 1805 writer Tomas De Quincey had a toothache and was given laudanum.  From that point he continued to take it and did not try to hide his opium use.  He wrote “The Confessions of an English Opium-Eater,” and gave insight into opium.  He enjoyed it so much he continued to use opium until his dependence on it made him unable to write.
• China was introduced to opium before 1000 AD but it did not come into favor except for the elite.
• When there was a ban on tobacco, opium use went up in China.
• The first law against opium smoking, called for opium shop owners to be strangled.
• Once opium was outlawed it was smuggled in from India. This started the road to the Opium wars.
• Many countries wanted to trade with China but China did not want to.  Under pressure, the port of Canton was opened but with very strict rules for foreigners.  While tea was the major export opium, thou illegal, was the primary import.  In 1839, the emperor of China sent a representative to deal with the opium problem.  He did and destroyed 20,000 British chests of opium, about $6 million worth, and sent the British merchants free.   Then drunken American and British sailors killed a Chinese citizen starting the Opium Wars in 1839.
• The British army arrived 10 months later and won within two years.  China lost Hong Kong to Great Britain and had to reimburse the merchants the $6 million whose opium was destroyed as well as give the British broader trading rights.
• In 1805, Frederich Serturner isolated the primary active ingredient in opium.  He named it morphium.
• Use of this new opioid, that is 10 times stronger then opium, did not happen until 1831 when the medical use of morphine had become so powerful.
• In 1832 another alkaloid was isolated named codeine.
• The hypodermic syringe and war helped morphine.  With the hypodermic syringe, morphine was delivered into the blood stream or tissue getting a faster reaction from the drug.  Military medicine is about fast reactions.  The American Civil War, the Prussian-American War and the Franco-Prussian War put morphine into many soldiers.
• Many came back dependent on morphine and the illness was called “soldier’s disease” or the “army disease”.
• In 1874, heroin was developed by adding two acetyl groups to morphine.
• This chemical change made heroin easier to pass through the brain barrier, making it three times stronger then morphine.
• Heroin and morphine effects are the same except that the reaction comes faster with heroin and it is more potent.
• Heroin was marketed as a non-habit-forming substitute for codeine.  Heroin was later found to be habit forming
• There were three types of opioid dependence developing at the end of the 19^th century: oral intake of opium, opium smoking and injection morphine.
• By the start of the 20^th century, more Americans were dependent on one or more of the opioids.  No real statistics are available but it is thought that 1% of the population was dependent.
• In 1880 the typical opioid user was a white woman between 30-50 years old.  She would buy opium or morphine at the local store.
• After the 1914 Harrison Act, many laws were passed that effecedt people dependent on opioids.
• In 1915 possession of smuggled opioids became a crime.  Users could still get their supply from their doctor until 1919 when that was outlawed.
• Even when a new law opened the avenue back up in 1925, most doctors chose not to prescribe opioids.
• For this and other reasons opioids became expensive on the black market.
• More and more people chose to injected morphine so they could get the most for their money.
• After World War II fewer stay-at-home moms were using, as were more entertainers and musicians, thieves and pickpockets, and pimps.
• In the 1960’s the use of heroin increased as did the use of other drugs.
• Heroin was very cheep and easy to get in Vietnam.  Some estimates are that 10 to 15 % of American troops in Vietnam were dependent on heroin.
• Operation Golden Flow was used to test solders for use.   What they found was that when the solders got back to the US few went back to using.  This exemplified the belief that if drugs were cheap and readily available and people were bored, then the chance that a person will use is high.
• The US spent $35 million in 1972 on Turkey to make up for destroyed crops and helped develop new cash crops. This and a cooperative effort with France helped take a large percentage of heroin off the streets.
• By 1975 the shortage of heroin was over because Mexican black tar was plentiful and cheap.
• Currently it is estimated that the majority of illicit heroin comes from South America.  The purity of the street product is better from South America (46%) then from Mexico (27%) and there is not much of a price difference.
• Opioids have long been used for there pain killing effects.
• Opioid antagonists were being developed to help block the action of morphine, heroin and other drugs.  In the early 1970’s, opioid receptors (that were long believed to be there) were found in the synapses of the brain.
• Enkephalins are naturally found in the brain.  They act like morphine but are more potent.  Endorphins were also detected to have opioid-like effects.
• Pain relief is the most common medical use of opioids.
• Morphine reduces the emotional response to pain and diminishes the patient’s awareness of and response to the aversive stimulus.
• Opioids also help with intestinal disorders.  They counteract diarrhea and help with colic.
• As a cough suppressants codeine is very helpful.  In the form of Dextromethorphan it is available over the counter.  At high doses hallucinogenic effects are seen.
• Opioids have a large dependence potential.
• Tolerance comes on relatively quick so an increased amount of the drug is needed for both medical and recreational results once tolerance is reached.
• There is a high-cross tolerance potential within all opioids.
• Physical dependence is also seen with opioids.
• The time needed to become dependent on opioids depends on the amount used and for how long.
• Psychological Dependence is easy to see through opioids positive reinforcement interaction.
• Once physical dependence is set negative reinforcement is seen in not using; thus making it had to stop using.
• There is a high toxicity potential of opioids.
• Acute toxicity leads to depressed respiratory action.  This is a very deadly reaction.
• Chronic toxicity was believed to make the user weak but there has been no scientific evidence of harm to the organ systems.  The largest chronic effect is that it takes more and more drug to get the effect and with that, overdose becomes more common.
• Due to the short-lived reaction of the drug, many people dependant on opioids must take the drug many times a day.  For this, the sheer time needed to find and take the drug is great.
• Not to mention the cost on the addiction.  Not only to you have to consider the cost of the drug but also the cost of the paraphernalia needed to use the drug.
• There are many misconceptions and preconceptions in opioid use.  Many believe that each time a person mainlines they get a feeling of a whole body orgasm.  This is not the case for most.  While they might have that feeling the first time they use, all subsequent uses are not as intense.  Others only feel nausea and discomfort the first time.
• Another misconception is that if you try heroin once, you are hooked for life.  No drug fits that mold.  All dependence takes time to develop.
• Remember: No drug can have an effect until it enters the body. Don’t take that first step.