CHAPTER 11
Opioid Use and Misuse
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
11.1: Understand the history of natural and synthetic opioids
•
11.3: Comprehend the complications of opioid use when used medically
•
11.5: Comprehend the scope of the problem of opioid misuse
•
11.7: Understand the DSM criteria for opioid– related disorders
CHAPTER OUTLINE
A Short History of the Natural and Synthetic Opioids
The Medical Applications of Narcotic Analgesics
The Classification of Narcotic Analgesics
The Problem of Pain
Where Opium Is Produced
Current Medical Uses of Narcotic Analgesics
Pharmacology of the Narcotic Analgesics
Non-Opioid Analgesics
Peripheral Mu Opioid Receptor Antagonists
Neuroadaptation to Narcotic Analgesics
Subjective Effects of Narcotic Analgesics When Used in Medical Practice
Complications Caused by Narcotic Analgesics When Used in Medical Practice
Section Summary
Opiates as Drugs of Misuse
Why Do People Misuse Opiates?
The Mystique of Heroin
Other Opioids of Misuse
Methods of Opiate Misuse
Sources of Illicit Narcotics
The Development of Tolerance
Scope of the Problem of Opiate Misuse and Opiate Use Disorders
Complications Induced by Opiate Misuse or Opiate Use Disorder
Overdose of Illicit Narcotics
Opioid Use or Misuse and the Diagnostic and Statistical Manual of Mental Disorders (5th
Edition)
CHAPTER OVERVIEW
This chapter briefly reviews the history of narcotic analgesics in the United States. It is split into
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two sections. In the first section, their classification as controlled substances used by physicians
for the treatment of pain is explored, as are their medical applications, main effects, and side
effects. In the second section, the narcotics as drugs of misuse are discussed, and the scope of
narcotics misuse and opioid use disorder, why individuals choose tothe reason for misuse
individuals’ narcotic analgesics misuse, and the physical consequences of opiate misuse and
opioid use disorder are reviewed.
DISCUSSION QUESTIONS
Next, the patent medicine was sold in an era when there were few effective pharmaceuticals
beyond opium, or its later concentrated derivative, morphine. This was available without a
prescription, and many forms of patent medicines contained large amounts of opium or
morphine. They might not have been effective in treating the patient’s condition, but certainly
made the patient less uncomfortable. Also, the relative profit margins inherent in the
manufacture and sale of a patent medicine allowed for significant investments in advertising,
which both increased sales volume and helped to shape the practice of newspaper advertising
until the present day (Johnson, 2006).
Questions
1. Are there any modern-day equivalents of the patent medicine being sold in today’s world?
Have you ever seen any such compound being sold?
2. When you hear about product recalls in the news, do you consider them to fall into this
category? Why or why not?
3. What kinds of folk remedies still exist today? Do you believe they work? Is there anything that
you do to keep from getting sick that might be considered “folk” medicine?
Break-Out Discussion #2:
Assume that you are a physician, treating a patient who is terminally ill with cancer. As the
cancer progresses, and as neuroadaptation to the narcotic analgesic develops, you have
Questions
1. What would you do in this situation? Why?
2. What are the various factors that need to be taken into account in this case? What does your
answer to question 1 imply about which of these factors is the most important?
3. Now imagine that the patient has a prior history of an substance use disorderSUD and of poor
compliance with treatment. Should you refuse to administer narcotic analgesics for such a
patient who is living at home? What would be the reasoning behind either choice?
4. How can the physician identify legitimate pain from addictive behaviors? Should the doctor
rely on the patient’s word, or should the physician order urine toxicology testing to confirm the
presence of prescribed medications?
Reference
Johnson, S. (2006). The Ghost Map. New York: Riverhead Books.
KEY CONCEPTS AND TERMS
Dysentery: A painful infection of the lower intestinal tract, usually caused by the ingestion of
contaminated water. The infected person will develop massive diarrhea, sometimes intermixed
with blood and mucus. Unless the fluid loss caused by the diarrhea is rapidly controlled,
dysentery can prove to be fatal after only a short period of time. Dysentery was common in the
crowded, unsanitary military camps of the 1700s and 1800s, as well as in many cities throughout
history, and major epidemics of dysentery were recorded before the cause of the disorder was
identified
Dysphoria: Feelings of sadness, sorrow, depression, etcand so on. The opposite of euphoria
Gamma-amino-butyric acid (GABA): During the period of embryonic brain development, GABA
serves as a stimulatory function, assisting in the development of neurons in the growing brain.
Following birth, GABA’s role changes until it becomes the brain’s main inhibitory
Amygdala: A region in the brain that is shaped like an almond, located in each temporal lobe.
This region is thought to be involved in the process of attaching emotional context to memory
and modulating emotional responses to external reality. This includes behaviors centered on the
process of obtaining reward(s), and the anxiety and panic responses
Prodrug (pro-drug): Compound that must be biotransformed into another compound to have
the desired effect
Torsade des pointes: Cardiac arrhythmia that is potentially fatal
Ventricular tachycardia: Cardiac arrhythmia in which the normal pattern of electrical discharge
and repolarization in the ventricles of the heart is interrupted, disrupting the normal heart
rhythm. This condition is potentially fatal if not immediately corrected
First-pass metabolism: Over time, the body has developed a safety mechanism in which
materials absorbed through the gastrointestinal tract are first carried to the liver, so that toxic
compounds ingested might be subjected to detoxification before they can injure the body
Discontinuance syndrome: The manifestations of the body’s reaction when a compound
regularly used as prescribed is either discontinued or markedly reduced. This is essentially a
withdrawal syndrome from that compound, a term that offended many patients who were
taking the compound as prescribed. To differentiate between the process of withdrawal from a
prescribed as opposed to an illicit substance, the term discontinuance syndrome is used with the
person who is withdrawing from a prescribed medication
Miosis: cConstriction of the pupils of the eyes
Peristalsis: Rhythmic contractions of the muscles that surround the intestines, pushing the
ingested material through
““Make”“ a doctor: A variation of doctor shopping in which the individual with a substance use
disorder obtains a prescription under false pretenses. Sometimes this involves switching to a
Fillers: When drugs are prepared for oral administration, pharmaceutical companies will mix the
active agent with compounds designed to give the pill or capsule shape and form. These
Chippers: aA subgroup of individuals who use a substance, who evidence a non–daily need to
use that substance or use it only occasionally only occasionally
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard— – CACREP
A Short History of the
Natural and Synthetic
Opioids
11.1:
Understand
the history of
natural and
synthetic
opioids
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
The Medical Applications
of Narcotic Analgesics
11.2:
Understand
the medical
uses of
opioids
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
The Medical Applications
of Narcotic Analgesics
11.3:
Comprehend
the
complications
of opioid use
when used
medically
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Opiates as Drugs of
Misuse
11.4:
Describe the
consequences
of opioid
misuse
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Opiates as Drugs of
Misuse
11.5:
Comprehend
the scope of
the problem
of opioid
misuse
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Opiates as Drugs of
Misuse
11.6:
Understand
the
complications
caused by
misuse of
opioids
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Opioid Use or Misuse and
the Diagnostic and
Statistical Manual of
Mental Disorders, 5th
Edition
11.7:
Understand
the DSM
criteria for
opioid–
related
disorders.
3d: theories and etiology of addictions
and addictive behaviors
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