SOC 204 Drugs & Society

Goldberg Chapter 8 Narcotics

Narcotics

(Opioids)

Chapter 9

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entire class. How are you doing in

this class?

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13%

57%

30% 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?

35%

9%

57% 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 AIDS More 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.

5%

95% 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

0%10%

76%

14%

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

15%

0%0%

85%

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:

0%

90%

0%

10%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

30%

0%

30%

40%

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

10%15%

60%

15%

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?

0%

0% 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

43%

57%

0%0%

I think Needle Exchange

Programs are a good idea.

A. True

B. False

True

False

0%0%