Goldberg Chapter 8
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Transcript of Goldberg Chapter 8
![Page 1: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/1.jpg)
Chapter 8 Narcotics
![Page 2: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/2.jpg)
Attendance Question
A. Enter Answer Text
Enter A
nswer T
ext
0%
![Page 3: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/3.jpg)
Warm up
• What have you heard about narcotics?
• What do you want to learn about this class of drugs?
• http://ezproxy.wwcc.edu:2048/login?url=http://digital.films.com/PortalPlaylists.aspx?aid=7539&xtid=45461
![Page 4: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/4.jpg)
Terms
• Narcotic
• An opium-based central nervous system depressant used to relieve pain and diarrhea
• Opiate
• A class of drugs derived from opium
• Opioid
• Drugs with characteristics similar to those of opium
• Laudanum, a mixture of opium and alcohol, was developed in the 1500s by Paracelsus
![Page 5: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/5.jpg)
History
• The hypodermic needle hastened the effects of morphine
• Ironically, the drug promoted to help people overcome morphine dependency was heroin
![Page 6: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/6.jpg)
History
• By 1906, opium and its derivatives were found in more than 50,000 medicines
• By the late 1800s, an estimated 4.59 per 1,000 people were dependent on opiates
![Page 7: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/7.jpg)
History• The Harrison Act of 1914 made
narcotic use without a prescription illegal
• The typical opiate addict shifted from a middle-class woman to a young, lower-class man
• Perceptions of the opiate addict went from unfortunate victim to a deviant criminal who was a threat to society
![Page 8: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/8.jpg)
Do you know someone who has used narcotics recreationally in the last 30 days?
A. No
B. Yes, one person
C. Yes, more than one person
No
Yes, one p
erson
Yes, m
ore th
an one p
erson
33% 33%33%
Response
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Self-reporting
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Extent of Narcotic Use
• 68% of heroin addicts admitted into treatment are male, 59% are White, and ¾ have been in treatment previously
• Increase in abuse is significantly higher in rural areas than in metropolitan areas
• During the Vietnam War, 10-15% of US troops were addicted to heroin
![Page 11: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/11.jpg)
• During the 1930s, morphine abuse exceeded heroin abuse –by the 1940s, heroin addiction was greater
• Heroin use increased greatly beginning in the late 1960s and early 1970s.
• In 2010, about 200,000 Americans had used heroin in the previous month
• In the US, more than 800,000 people are addicted to heroin and other narcotics
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Worldwide Comparison
• More than 15 million people worldwide illegally use opium, morphine, and heroin
• China is believed to have the largest number of narcotic addicts
• An estimated 24 million to 34 million people throughout the world use opium
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Opium• Poppy grows throughout Asia and
the Middle East
• Seedpod is scraped, milky sap is collected and dried to a brown resin (opium)
• There is a ten-day window in which opium can be extracted
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Illicit Opium Production
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Illicit Opium Production
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Opium Poppies in Afghanistan
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Morphine• In 1803, Friedrich Serturner of Germany
synthesized morphine from opium and called it morphium
• Morphine is about ten times more potent than opium, although physicians thought it was safer and purer
• Codeine was isolated from opium 30 years later
• How morphine is administered and its dosage has a bearing on its effectiveness
![Page 18: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/18.jpg)
Heroin
• Heroin (diacetylmorphine) was first synthesized from morphine in 1874
• When heroin was introduced, it was believed not to be addicting
• When smoked, its effects are rapid – it is ineffective when ingested
• Heroin is three to ten times more powerful than morphine because it is more lipid-soluble
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Derived from opium
A. Enter Answer Text
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nswer T
ext
100%
Response
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Synthetic Opiates
• Fentanyl (Sublimaze)
• Synthetic narcotic 1,000 times more potent than heroin
• Greater risk of a fatal overdose than heroin
• China white
• Synthetic analgesic drug derived from fentanyl that mimics heroin but is considerably more potent
• Meperidine
• Synthetic derivative of morphine widely used as an analgesic –less potent than morphine
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Synthetic Opiates• Propoxyphene hydrochloride (Darvon)
• Mild narcotic that has the potential to cause dependence
• Methadone
• Drug given to heroin addicts to block withdrawal effects and euphoria
• Oxycodone (Percodan)
![Page 22: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/22.jpg)
OxyContin
• OxyContin is a particularly strong painkiller that blocks the pain signals from nerves
• Thousands have become addicted to it – the number of addicted babies has doubled or tripled over the past decade
• The manufacturer, Purdue Pharma, admits that dozens to hundreds of people have died from it
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Dosages (add oxy)
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Brain
• Mouse Party
• Opiates mimic endorphins in the brain
![Page 25: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/25.jpg)
Physical Effects
• Drowsiness (nodding out), vomiting, nausea, and difficulty concentrating
• Euphoria
• Gradually anesthetizing sensations
• Lethargy and sleep
• Difficulty urinating, constipation
• Difficulty achieving an erection
![Page 26: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/26.jpg)
Emotional Effects
• Relief from anxiety, hostility, feelings of inadequacy, and aggression
• Difficulty regulating inhibitions and frequently make risky decisions
![Page 27: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/27.jpg)
Social Effects
• Alienated from and hostile toward friends and family
• Correlated with criminal behavior, unemployment, and violence
![Page 28: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/28.jpg)
NEPs retard the spread of HIV/AIDS
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Needle-Exchange Programs• IV drug use increases HIV, hepatitis
risk
• Health care personnel favor NEPs
• 5.9% decrease in HIV infection rates in cities with NEPs
• Congress banned federal funding for NEPs in 1988
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Dependency
• Physical and psychological dependence, and tolerance develop quickly• Positive reinforcement
• Negative reinforcement
• Withdrawal symptoms can be severe
![Page 31: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/31.jpg)
Withdrawal
Hours after last dose 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
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A Day in the Life
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Dependency
• Factors affecting the difficulty of withdrawal:
• Social support network
• Desire to stop
• Physical environment during withdrawal
• Alternative opiates
![Page 34: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/34.jpg)
Dependency
• About half of narcotic abusers become dependent:
• Can develop in less than two weeks if they take increasing amounts of narcotics
• Average addiction is six to eight years (aging out)
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Toxicity
• Respiratory depression can be fatal
• Synergistic effect when combined with depressants
• Opioid Triad• Coma
• Depressed respiration
• Pinpoint pupils
• Death from an overdose of heroin is slow – people who die quickly are likely to die from anaphylactic shock
![Page 36: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/36.jpg)
Toxicity (risks)
• According to the CDC, painkillers kill twice as many people as cocaine and five times more people than heroin
• Increased risk of blood-borne disease and infections
• Physical problems frequently result from using narcotics in unclean, unsafe environments
• Sharing needles is a major risk for HIV infection
• Narcotics often are contaminated with other drugs, sugar, starch, powdered milk, quinine, or strychnine
![Page 37: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/37.jpg)
Medical Benefits
• Analgesic• Patients receiving morphine are aware of pain, but their
perception and response are altered in positive ways
• Gastrointestinal difficulties• In less-developed countries, narcotics treat diarrhea that is a
major cause of death among the young and elderly
• Cough suppressant (antitussive)• Narcotics slow activity of the cough control center
• Nonopiate dextromethorphan is chemically similar
![Page 38: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/38.jpg)
Treatment and Support Groups
• The recidivism (relapse) rate for narcotic addiction is high
• Gradual detoxification - 10 to 14 days on an inpatient basis
• Rapid detoxification
![Page 39: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/39.jpg)
Narcotic Antagonists
• Drugs that block narcotics from producing their reinforcing effects are called antagonists
• They remove the physical need for opiates, but not the psychic need
• Examples are (Suboxone) naltrexone, buprenorphine, nalorphine, naloxone, and cyclazocine
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Methadone –Narcotics Agonists
• Since 1960, methadone has been the drug used most frequently to treat heroin addiction
• Methadone is highly specific to opiate addiction
• Methadone use leads to addiction, though many people consider it preferable to heroin addiction
• Methadone has to be administered daily to avert withdrawal symptoms
![Page 41: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/41.jpg)
Common Narcotics
![Page 42: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/42.jpg)
Perceptions of Narcotics
• Narcotics were advertised as a cure for addiction to tobacco
![Page 43: Goldberg Chapter 8](https://reader036.fdocuments.us/reader036/viewer/2022070323/55a2256b1a28ab8d168b46ba/html5/thumbnails/43.jpg)
Extent of Narcotic Use
• Controlled users (chippers) fit the following pattern:
• Seldom used the drug more than once a day
• Could keep opiates around without using them
• Avoided opiates when addicts were present
• Did not use opiates to alleviate depression
• Seldom binged on opiates
• Knew the opiate source or dealer
• Took opiates for recreation or relaxation
• Did not take opiates to escape life’s daily hassles