Opiate
From Drug Rehab Wiki
An opiate is a class of controlled substance commonly referred to as a narcotic. Opiates are drugs produced from the latex sap of the opium poppy, Papaver somniferum.
Uses of Opiates
Legitimately produced and used opiates and their derivatives are considered by the Drug Enforcement Agency (DEA) to be Schedule II analgesics used medically as pain relievers for moderate to severe and/or persistent pain. They are also used in compounds for cough suppressants and for maintenance treatment of substance dependence.
Active Components of Opiates
All opiates are benzylisopquinoline alkaloids which are biologically active components found in opium and used to produce the derivative drugs. Benzylisopquinoline alkaloids that can be extracted from the opium poppy are:
• morphine
• narcotine
• narceine
• codeine
• thebaine
• papaverine
Opiates as Controlled Substances
Due to their use in medical and illegal drug industries, morphine, codeine and thebaine are internationally controlled substances. They are considered Schedule II controlled substances by the DEA indicating their high potential for abuse and addiction but legitimate medical use. They are used in the manufacture of pharmaceutical medications which are legally prescribed by physicians and administered under the care and supervision of physicians. Such medications produced from the benzylisopquinoline alkaloids are also diverted to become illicitly obtained and illicitly used substances of abuse and addiction. Some derivatives of the opium poppy have no legitimate medical use and are available only as illicit substances. One such derivative is heroin (diacetylmorphine). It is considered a Schedule I controlled substance by the DEA indicating no legitimate medical use.
All drugs derived from morphine, codeine or thebaine have profound risks for abuse and addiction. Some of these are:
• codeine
• diacetylmorphine (heroin)
• hydrocodone (Vicodin)
• hydromorphone (Dilaudid)
• oxycodone (OxyContin, Percoset, Percodan)
• meperidine (Demerol)
• desomorphine
• nicomorphine
• dipropanoylmorphine
• benzylmorphine
• ethylmorphine
Natural and Synthetic Opiates
Morphine and codeine occur naturally in the opium poppy and are considered, in strict definition, to be opiates. Other drugs listed above are considered opioids-- drugs with opiate-like effects either produced from opiates (semi-synthetic) or produced as fully synthetic drugs that mimic the effects of opiates.
Morphine
Morphine, a naturally occurring opiate, is produced in multiple medication forms for pain management. Marketed formulations of morphine include:
• Apokyn
• Astramorph
• Avinza
• DepoDur
• Dulcontin
• Duromorph
• Epimorph
• Kadian
• M-Eslon
• Morphine Extra-Forte
• Morphine Forte
• Morphine H.P
• Morphine IR
• Ms Contin
• Oramorph SR
• Roxanol
• Statex
Codeine
Codeine, a naturally occurring opiate, is marketed as several medications for pain and cough suppression. These include the following:
• Codicept
• Coducept
• Tylenol with Codeine
Opioids
Substances derived from the naturally occurring opiates, morphine and codeine, have opiate-like sedative and analgesic effects. These are known as semi-synthetics or opioids. While commonly referred to as opiates, these substances are derivatives and include:
• diacetylmorphine (heroin)
• hydrocodone (Vicodin)
• hydromorphone (Dilaudid)
• oxycodone (OxyContin, Percoset, Percodan)
• meperidine (Demerol)
• desomorphine
• nicomorphine
• dipropanoylmorphine
• benzylmorphine
• ethylmorphine
• buprenorphine
Fully Synthetic Opioids
Other substances with opiate-like effects are fully synthetic and are not derived from the naturally occurring alkaloids morphine and codeine. These mimic the effects of opiates and opiate derivatives. Some fully synthetic opioids are:
• Fentanyl (Sublimaza)
• methadone (Dolophine)
• propoxyphene (Darvon)
• pentazocine (Talwin)
Methods of Use
Opiates are used medically as oral medications and injectibles. As drugs of abuse and addiction, opiates are used orally, intranasally, subcutaneously, intravenously and at times are smoked and eaten.
Immediate Effects of Opiate Use
The immediate effects of opiate use include:
• relieved pain
• drowsiness
• euphoria
• suppressed cough
• respiratory depression
• constricted pupils
• lethargy
• dizziness
• dry mouth
• headache
• itchiness
• sensations of tingling
• poor appetite
Long-Term Effects of Opiate Use
The effects of long-term opiate use include:
• physiological dependence
• psychological dependence
• constipation
• irregular menses
• weight loss
• loss of libido
• infertility
Opiate-related Substance Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists Opioid Dependence (addiction) as the diagnostic category for dependence upon all natural, semi-synthetic and fully synthetic drugs with opiate effects and opiate-like effects. Related substance disorders are listed as:
• Opioid Intoxication—the state of being under the influence of a recently ingested opioid
• Opioid Withdrawal—experiencing symptoms directly caused by the cessation of opioid use
• Opioid Abuse—continuing use of an opioid with at least one negative consequence resulting from use
• Opioid-induced Psychotic Disorder—experiencing hallucinations or delusions resulting from opioid use or discontinued use
• Opioid-Induced Mood Disorder—experiencing symptoms of mood disturbance resulting from opioid use or discontinued use
• Opioid-Induced Sexual Dysfunction—experiencing disturbance in sexual arousal or functioning resulting from opioid use
• Opioid-Induced Sleep Disorder—experiencing sleep disturbance resulting from opioid use
• Atypical Opioid Disorder (Opioid Disorder NOS)—experiencing clinically significant symptoms resulting from opioid use that are not better described by other opioid-related diagnoses
Opiate Overdose
Symptoms of opiate overdose can include all symptoms of opiate use in combination with other symptoms such as the following:
• bloody urine
• fever
• flushed skin
• hives
• seizures
• stopping breathing
• swollen face, lips, tongue or throat
• coma, death
Symptoms of Opiate Withdrawal
Symptoms of withdrawal from opiates include:
• cravings
• anxiety
• tremors
• cold sweats
• diarrhea
• nausea
• vomiting
• runny nose
• insomnia
• agitation
Treatment
Treatment for opiate dependence begins with medical supervision during withdrawal and detoxification which induce severe discomfort physically and psychologically. Individuals in treatment for opiate dependence are typically treated during detoxification with the administration of medications such as methadone, buprenorphine or naltrexone to control severe withdrawal symptoms.
Stages of treatment that follow detoxification from opiate dependence are those typically used for treatment of other substance dependencies. Treatment modalities can include individual and group therapy, family counseling, psychiatric services, self-help groups, nutrition, exercise, relaxation, stress management, behavioral therapy, replacement therapy and education.
Opiate Replacement Therapy (ORT)
Some opiate dependent individuals will use an opiate replacement such as methadone or buprenorphine for maintenance of abstinence. Known as ORT, Opiate Replacement Therapy can eliminate cravings and other withdrawal symptoms without the euphoric effect of opiates. Opiate Replacement Therapy services are provided in clinics or medical offices depending upon the specific agent used and laws governing its administration.
