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Opioids | What is an opioid?
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What is an opioid?

 

Opioid refers to natural and synthetic narcotics that have the same effects as opiates despite the fact that it is not obtained from opium. The terms opioid, opiates and narcotics are customarily used interchangeably.

 

History of opioids

Since time immemorial opioids have played a great part in the field of medicine. The Sumerians and Egyptians in the ancient world have made full use of its euphoric and analgesic effects. The issue of opium addiction concerns started in 1909. The world has developed an awareness of the adverse effects of this drug during the time of President Roosevelt when he attended the convention in china aimed to stop its perilous effects. This convention has triggered series of legislation designed to control narcotic addiction.

Prescription and regulation of narcotics was enforced in 1915. After 2 years, opioid addiction was not allowed to be treated with opioids due to the US court's interpretation of Harrison Narcotics Tax Act. The Narcotic Addict Treatment Act of 1974 set the use of methadone in the opioid addiction management. It was only in 2000 that the US government allowed eligible physicians to treat opiate addiction with opioids.

 

How opioids work

 

There are opioid receptors or proteins in the GI tract, spinal cord and the brain. Opioids bind on these receptors and block pain perception. It also induces euphoria or feelings of pleasure. In order to intensify the pleasant feeling, some opioid users increase the dosage and use it habitually. This results to opioid addiction, dependence and fatal opioid overdose.

The following are the effects of opioids:

• Constipation

• Drowsiness

• Nausea

• Shallow respiration

Medically-approved indications of Opioids

• Anxiety

• Constipation

• Cough

• Diarrhea/Irritable Bowel Syndrome

• Drowsiness

• Enhance effects of other medications in surgical operations

• Hyperalgesia

• Induction and maintenance of anesthesia

• Itching

• Moderate to severe pain

• Nausea

• Opioid dependence

• Vomiting

Types of opioids

Natural.This type includes endorphins, enkephalins, morphine, and opium.

Semi-synthetic. Chemical compounds are obtained from natural sources like plants. Examples are Dihydrocodeine, Heroin, Hydrocodone, Hydromorphone, Nicomorphine, Oxycodone, and Oxymorphone.

Synthetic.Synthetic opioids are made using total fusion, in which large molecules are created from an amalgamation of tiny and inexpensive petrochemical components. Examples are alfentanil, buprenorphine, codeine, fentanyl, levorphanol, meperidine, methadone, and propoxyphene.

Endogenous. These are peptides that are produced inside the human body like dynorphins, endomorphins, endorphins, and enkephalins.

 

Table I. Chart of Synthetic Opioids

Anilidopiperidines

Benzomorphan derivatives

 

 

Phenylpiperidines

 

 

Diphenylpropylamine derivatives

 

Alfentanil

 

Dezocine

 

Allylprodine

 

Bezitramide

 

Alphamethylfentanyl

 

Pentazocine

Ketobemidone

 

Dextromoramide

 

Carfentanyl

 

Phenazocine

MPPP

 

Dextropropoxyphene

 

Fentanyl

 

PEPAP

 

Difenoxin

 

Ohmefentanyl

 

Pethidine (meperidine)

 

Diphenoxylate

 

Remifentanil

 

Prodine

 

Dipipanone

 

Sufentanil

 

Levomethadyl Acetate (LAAM)

 

Loperamide

 

Methadone

 

Piritramide

 

Propoxyphene

 

 

Table I-A. Chart of synthetic opioids

 

Oripavine derivatives

 

Morphinan derivatives

Other Opioids

 

Buprenorphine

 

Butorphanol

Lefetamine

 

Dihydroetorphine

 

Nalbuphine

 

Meptazinol

 

Etorphine

 

Levorphanol

 

Tapentadol

 

Levomethorphan

 

Tilidine

 

Tramadol

 

 

Terminologies

Opiate addiction. This is a condition characterized by the behavioral and psychological set of symptoms like uncontrollable use of narcotics, drug craving and a high possibility of relapse following withdrawal.

Opioid dependence. This refers to the state in which the use of opioid becomes the highest priority in one's life. There is also a remarkable reduction in the control of one's desire to use narcotics.

Opioid abuse. Itrefers to the dysfunctional pattern of using opioids characterized by medically remarkable damage or suffering in the person's career, school or personal relationships.DSM-IV-TRfurther maintains that the social and interpersonal relations can be severely affected and the person is frequently prone to legal issues due to the incessant desire to purchase the drug regardless of the cost. In addition, the opioid dependent may possibly use opioids in spite of perilous conditions like machine operation and driving.

 

Signs of Opioid abuse

It is stated in theDiagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision that a person suffering from opiate abuse may exhibit one or all of the following signs:

1. Tolerance

This refers to the persons need to increase the dosage of opioids in order to attain its initial result. Tolerance to euphoria may increase. In simple terms, there is a decrease in reaction to large doses of opioids by repetitive use. There is also a possibility of developing tolerance to the following adverse effects of narcotics:

• Nausea

• Respiratory depression

• Sedation

 

2. Withdrawal

Because of continued use of opiates, the body develops dependence to the drugs. Once the person abstains from taking the narcotics, withdrawal symptoms appear. Sudden discontinue of the drugs after a minimum of 2 days regular use may already set into effect the withdrawal syndrome.

• Opiate withdrawal symptoms:

• Abdominal cramps

• Agitation

• Cravings

• Diaphoresis

• Diarrhea

• Dispersed muscle aches

• Drug cravings

• Emesis

• Flu-like symptoms

• Insomnia

• Lacrimation

• Muscle aches

• Nausea

• Painful bones

• Piloerection

• Rhinorrhea

• Shivering

• Tremors

 

3. Giving up a job or poor work performance

4. Inability to stop using opioid in spite of relentless yearning to do so

5. Opioids are taken in increased dosage

6. Persistent use of opioids in spite of the negative effects on one's life

7. Reduced social interactions

8. Shows lack of interest in recreational activities

 

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