Chapter 5 Notes - Summary Drug Use and Abuse PDF

Preview

Summary

Chapter 5 Notes...

Description

5.1 Opium in History 

Opium: an analgesic and euphoriant drug acquired from the dried juice of the opium poppy

5.1.1 The Opium War   





People in China took opium almost exclusively on a medical basis, consuming it orally in its raw state as a highly effective painkiller and treatment for diarrhea Then, British people discovered and fell in love with Chinese tea Sensing a business opportunity, British merchants in China sought a way to buy Chinese tea and transport it home for a handsome profit. o The answer was opium In 1773, Britain soon has conquered India and had a monopoly on raw opium In 1839, tensions had reached a peak. In a historic act of defiance against the European powers, including Britain, an imperial commissioner appointed by the Chinese emperor to deal with the opium problem once and for all, confiscated a shipment of opium and burned it publicly in Canton. In a treaty signed in 1860, China was required to legalize opium within its borders. The Opium War succeeded in opening up the gates of China, much against its will, to the rest of the world

5.1.2 Opium in Britain and the United States 

 

The important difference between China and Britain with respect to opium was not in the extent of its consumption but in the way it was consumed. o The acceptable form of opium use in Victorian England was opium drinking in the form of laudanum, whereas the Asian practice of opium smoking was linked to a perceived lifestyle of vice and degradation and associated with the very lowest fringes of society. Throughout the 1800s in the United States, opium coexisted alongside alcohol, nicotine (in tobacco products), and cocaine as the dominant recreational drugs of the day A federal law forbidding opium smoking soon followed, whereas the regulation of opium use by any other means failed to receive legislative attention at that time. By the beginning of the twentieth century, however, the desire for social control of opium dens became overshadowed by the emergence of opium-derived drugs that presented a substantially greater threat to society than smoked opium

5.1.3 Morphine and the Advent of Heroin    

Morphine: the major active ingredient in opium Codeine: one of the three ingredients in opium, used primarily to treat coughing Thebaine: one of the three active ingredients in opium Heroin: a chemical derivative of morphine; it is approximately three times as potent as morphine and a major drug of abuse

5.1.4 Opioids in American Society 

The end of the 19th century marked a turning point in the history of opium and its derivatives o By 1900, there were 250,000 opioid-dependent people in the US (but the actual number could have been closer to 750,000)

5.1.5 Opioid Use and Heroin Abuse after 1914 





The Harrison Act of 1914 ushered an era in which the abuser was no longer a victim of drugs worthy of society's sympathy o Instead, it was now viewed as weak, degenerate, and self-indulgent This ban did not ban opioids; it simply required that doctors register with the Internal Revenue Service the opioid drugs that they were prescribing to their patients and pay a small fee for the right to prescribe such drugs With the emergence of restrictive legislation, the demographic picture changed dramatically o Now it was young, predominantly white, urban adult males

5.1.6 Heroin Abuse in the 1960s and 1970s 

3 major social developments in the 1960s brought the heroin story back into the mainstream of the United States 1. Began in late 1961, when a crackdown on heroin smuggling resulted in a significant shortage of heroin on the street; the price of heroin increased and heroin dosages become more adulterated than ever 2. Beginning in the 1960s, affected the white majority more directly a. Fanned by extensive media attention, a youthful counterculture of hippies, flower children, and the sexually liberated swept the country 2. Finally, disturbing reports about heroin abuse began to appear that focused not only on Americans at home but also on American armed forces personnel stationed in Vietnam. Reports beginning in the late 1960s indicated an increasingly widespread recreational abuse of heroin, along with alcohol, marijuana, and other drugs, among U.S. soldiers. 5.1.7 Heroin and Other Opioids Since the 1980s   

 

At one time, the major source of white powder heroin smuggled into the United States was Turkey, where the opium was grown The center of heroin manufacture and distribution was Marseilles in southern France International control over the growing of Turkish opium in 1973 closed this route of heroin distribution, but it succeeded only in encouraging other parts of the world to fill the vacuum o Creation of the "Golden Triangle" - provided the United States with heroin Black tar: "Mexican heroin"; a potent form of heroin, generally brownish in color, originating from Mexico Fentanyl: a chemical derivative of thebaine, used as a prescription painkiller; the street name for fentanyl and related compounds is "China White"

5.2 Effects on the Mind and the Body 5.2.1 How Opioids Work in the Brain 

Naloxone: a pure antagonist for morphine and other opioid drug; known as Narcan o Intramuscular and intravenous injections of naloxone reverse the depressed breathing and blood pressure in a matter of a minute of so

 

Endogenous opioid peptides: endorphins; a class of chemicals produced inside the body that mimic the effects of opioid drugs Naltrexone: a long-lasting form of naloxone; brand name: ReVia

5.2.2 Patterns of Heroin Abuse 

The dominant route of administration in heroin abuse is intravenous injection, usually referred to as either mainlining or shooting

5.2.3 Tolerance and Withdrawal Symptoms  





The greatest signs of tolerance are seen in the degree of analgesia, euphoria, and respiratory depression The overall decline in heroin reactions is dope-dependent o If the continuing dose level is high, then tolerance effects will be more dramatic than if the dose level is low First sign of heroin withdrawal begins 4-6 hours after the previous dose and intensifies gradually to peak over the next 36-72 hours o The abuser is essentially over the withdrawal period in 5-10 days When dosage levels are less than 10%, the withdrawal symptoms are comparable to a moderate to intense case of the flu

5.2.4 The Lethality of Heroin Abuse 

Heroin is considered relatively nontoxic, particularly when compared to several other drugs of abuse o Organ systems are not damaged or impaired o There are no malformations, tissue damage, or physical deterioration

5.3 Heroin Abuse and Society 

Chipping: the taking of heroin on an occasional basis

5.4 Treatment for Heroin Abuse 5.4.1 Heroin Detoxification  

Detoxification: the process of drug withdrawal in which the body is allowed to rid itself of the chemical effects of the drug in the bloodstream In medical settings, opioid drugs such as the following are administered orally to replace heroin initially o Propoxyphene: a synthetic opioid useful in reducing paid o Methadone: a synthetic opioid useful in treating heroin abuse

5.4.2 Methadone Maintenance 

Methadone Maintenance: a treatment program for heroin abusers in which heroin is replaced by the long-term intake of methadone

5.4.3 Alternative Maintenance Programs  

LAAM: the synthetic narcotic drug levo-alpha-acetylmethadol, used in the treatment of heroin abuse; Orlaam Buprenorphine: a synthetic opioid used in the treatment of heroin abuse; Subutex, Suboxone

5.4.4 Behavioral and Social-Community Programs  

Therapeutic communities: living environments for individuals in treatment for heroin and other drug abuse, where they learn social and psychological skills needed to lead a drug-free life Multimodality programs: treatment programs in which a combination of detoxification, psychotherapy, and group support is implemented

5.5 Medical Uses of Opioid Drugs 5.5.1 Beneficial Effects   

The first and foremost medical use of opioids today is for the treatment of pain The second application capitalized on the effect of opioids in slowing down peristaltic contractions in the intestines that occur as part of the digestive process The third application focuses on the capacity of these drugs to suppress the cough reflex center in the medulla o Antitussive: having an effect that controls coughing o Dextromethorphan: a popular non-narcotic ingredient used in OTC cough remedies

5.6 Prescription Pain Medication Misuse and Abuse Medications that have been problematic:  OxyContin: a controlled-release form of oxycodone, used in the treatment of chronic pain  Vicodin  Percocet  Opana 5.6.1 OxyContin Abuse 

When OxyContin tablets are crushed and then either swallowed or inhaled as a powder, or injected after diluting that powder into a solution, the effect is similar to that of heroin

5.6.2 Responses to OxyContin Abuse 

Efforts have been made to reduce OxyContin abuse in a number of ways o An FDA-mandated warning label now states that the drug is as potentially addictive as morphine and that chewing, snorting, or injecting it could be lethal

5.6.3 Abuse of Other Opioid Pain Medications



Vicodin and Percocet are based on opioids that have been available for a longer period of time, and they unfortunately have a longer record of abuse and dependence...