OPIATES
Drug Class: Opiate
analgesics. All of the drugs mentioned in this chapter are scheduled by the Drug Enforcement
Administration, but they vary from
Schedule 1 (heroin) to
Schedule IV (propoxyphene) based on their likelihood of abuse and medical use.
Individual Drugs: Opium, heroin,
morphine, codeine, hydromorphone (Dilaudid),
oxycodone (Percodan, OxyContin), meperidine (Demerol), diphenoxylate (Lomotil), hydrocodone (Vicodin),
fentanyl (Sublimaze), propoxyphene
(Darvon)
Common Terms: Chinese
molasses, dreams, gong, 0, skee, toys, zero
(opium); Big H, dreck, horse, mojo, smack, white lady, brown
(heroin);
speedballs (heroin and cocaine); Oxys,
OCs, Hillbilly heroin (oxycodone)
The Buzz: People who inject opiates experience a rush of
pleasure and then sink into a dreamy,
pleasant state in which they have little
sensitivity to pain. Their breathing
slows, and their skin may flush. Pinpoint pupils are another hallmark of opiate effects. Opiates
taken by ways other than injection
have the same effect, except that a pleasant drowsiness replaces the rush. Nausea and vomiting can accompany these effects, as well as constipation.
An injected heroin/cocaine combination (speedball) causes intense euphoria, the dreaminess of heroin, and
the stimulation of
cocaine. People who take opiates by mouth
experience the same effects, but the pleasure
has a slower onset and is less intense.
Overdose and Other Bad Effects: Opiate overdose
can be lethal whether users inject it or take pills. This is not a
cumulative effect of years
of misuse—it can happen the first time.
Breathing slows to the point that it ceases.
Fortunately, the opiate antagonist naloxone (Narcan) can almost immediately
reverse the dangerous effects of opiates if the user gets medical help quickly. Opiate overdoses are most common
with injectable forms of drug but can
occur with any dosage form if enough is taken. Medical attention is critical.
Dangerous Combinations with Other Drugs: Opiates
are especially dangerous when used in combination with other
drugs that suppress breathing. These include alcohol,
barbiturates (e.g., phenobarbital), Quaaludes (methaqualone),
and Valium-like drugs (benzodiazepines).
WHERE
OPIATES CAME FROM
No less a cultural icon
than Dorothy of The Wizard of Oz has experienced the effects of opiates (remember the field of poppies?). As we saw in The Wizard of Oz, you pretty much have to lack a brain to resist
the effects of opiates. For those with
a more classical bent, morphine derives its name from Morpheus, the Greek god of dreams, who was often depicted with a handful of opium poppies. Use of opiates began in
prehistoric times, probably with teas
prepared from opium poppies. The oldest historical references to the medicinal
use of opiates arise from the Sumerian and Assyrian/Babylonian cultures (about five thousand years ago). Opium pipes recovered from archeological sites in Asia,
Egypt, and Europe document the
smoking of opium between 1000 and 300 sc. Arab traders introduced opiates to China between AD 600 and Al) 900. Paralleling developments in Europe, medical use gradually
evolved into recreational use, and the
number of opium addicts grew. "lhe importation of opium into China became a major source of trade for
England and helped start a war
between China and England when China banned its importation in the early nineteenth century.
Use (and abuse) of
opiates in Europe was common during the Middle Ages. One agent of its
popularity was Paracelsus, who coined the term laudanum—meaning "to be praised"—for an opiate preparation. Later, many poets (Samuel Taylor Coleridge and Elizabeth
Barrett Browning, among others) used
and abused opium. Coleridge reported an opium experience in his famous "Kubla Khan."
Opium has been used
widely in the United States throughout its history It was popular long before the wave of Chinese immigration introduced
opium smoking to this country. Opium was a major ingredient in many of the patent medicines available before the
FDA was started, and the average
housewife was a major consumer in nineteenth-century America. As in the story of cocaine, the rising availability
of increasingly potent preparations
led to greater recognition of the drug's toxicity and addictive qualities.
In 1805 morphine, the major active ingredient in
the opium poppy, was purified; in 1853
Alexander Wood invented the hypodermic syringe. The first major wave of
addiction to injectable narcotics followed the wide use of injected morphine
during the American Civil War. The final improvement came courtesy of the Bayer Company in 1898, when the company's scientists discovered that adding an extra
chemical group onto morphine
made it more soluble in
fat, so that it would enter the brain faster. This improvement produced heroin, once a trade name for
the narcotic produced by Bayer.
Today, opiate drugs are
a mainstay of the medical treatment of pain. There just aren't substitutes for their effectiveness at reducing pain.
However, all opiate drugs are
addictive. Some doctors so fear addiction in their patients that they withhold
needed treatments. This was the reason for the introduction of national programs that rightly promoted the use of adequate medication
to treat pain. Unfortunately, this opened the door for a small number of unscrupulous doctors to run
"pill mills" that prescribe these
drugs to patients with very little verification of their medical need for such medication. Unfortunately, opiate drugs are
also the form of drug more abused than
any other except alcohol and marijuana. The majority (90 percent) of opiate abusers use pills that have
been diverted from medical use,
although heroin use remains a significant
problem as well.
