Chapter 16: Opiates
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Drugs in the Media
Drugs in the Media: The Rise and Fall of Heroin “Epidemics.”
Related web sites:
www.edc.org/hec/news/hecnews/0823.html, Education Development Center: HEC News: Fighting a War Armed with Baby-Boomer Myths;
www.drugsense.org/dsw/2001/ds01.n181.html, DrugSense Weekly: America’s New Heroin Epidemics.
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Lecture Outline
A. Opium (p. 378) / Opium has been used for pleasure as well as for pain relief throughout history.
1. Early History of Opium (p. 378) / The Greeks and Romans probably used opium extensively.
2. Writers and Opium: The Keys to Paradise (p. 379) / Thomas De Quincey of England wrote frequently about his opium use in the nineteenth century.
3. The Opium Wars (p. 381) / The British fought the Chinese over the smuggling of opium into China.
B. Morphine (p. 382) / Morphine, the active agent in opium, is ten times as potent as opium.
C. Heroin (p. 382) / Heroin is about three times as potent as morphine.
D. Opiate Abuse Before the Harrison Act (p. 383) / Dependence developed in three ways: by ingesting of opium, smoking of opium, and injection of morphine.
E. Abuse After the Harrison Act (p. 385) / This act was discussed in detail in Chapter 4.
1. The Changing Population of Opioid Users (p. 386) / Heroin use increased in lower-class areas of large cities after World War II.
2. The 1960s (p. 387) / Heroin use increased in the 1960s along with use of other drugs.
3. Vietnam (p. 387) / Many service personnel used heroin while in Vietnam, but most did not continue using when they returned.
4. The 1970s and 1980s (p. 388) / Southwest Asia, Turkey, Mexico, and Southeast Asia were sources of supply.
5. Current Use of Heroin (p. 389) / Smoking of opiates again became popular.
II. Pharmacology of Opioids (p. 389)
A. Chemical Characteristics (p. 389) / Chemists have worked hard to produce effective painkillers from opiates.
B. Mechanism of Action (p. 392) / Enkaphalins and endorphins in the brain have actions similar to morphine.
III. Beneficial Uses (p. 394)
A. Pain Relief (p. 394) / Morphine reduces the emotional response to pain.
B. Intestinal Disorders (p. 394) / Narcotics have saved the lives of many dysentery victims.
C. Cough Suppressants (p. 394) / Codeine has been widely used to suppress cough.
IV. Causes for Concern (p. 394)
A. Dependence Potential (p. 394)
1. Tolerance (p. 394) / Increasing doses are needed to maintain a constant effect.
2. Physical Dependence (p. 395) / Withdrawal symptoms appear in those who have used the drug chronically and at high doses.
3. Psychological Dependence (p. 396) / Heroin alleviates withdrawal symptoms, producing negative reinforcement.
4. The Needle Habit (p. 396) / The behaviors surrounding heroin injection become rewarding in themselves.
B. Toxicity Potential (p. 397)
1. Acute Toxicity (p. 397) / Narcotics can cause death via respiratory depression.
2. Chronic Toxicity (p. 397) / The techniques used to consume narcotics (e.g., sharing needles) can be dangerous.
C. Patterns of Abuse (p. 398)
1. The Life of a Heroin User (p. 398) / Abusers face countless risks each day.
2. Misconceptions and Preconceptions (p. 399) / Some people experience only nausea and discomfort with their first use.
3. New Users, New Drugs (p. 400) / Increased purity of heroin has raised the danger of overdoses.
V. Treatment of Narcotic Dependence (p. 400)
A. History (p. 400) / Medical books of 100 years ago offered a variety of treatment approaches.
B. Current Medical Approaches (p. 401)
1. Narcotic Antagonists (p. 401) / These drugs block the effects of narcotics.
2. Methadone Maintenance (p. 402) / Methadone prevents withdrawal symptoms and blocks the pleasurable effects of opiates.
3. LAAM (p. 403) / LAAM has longer-lasting effects than methadone.
4. Buprenorphine (p. 404) / This drug has a long duration of action and a large margin of safety.
5. Heroin/Morphine Maintenance (p. 404) / Several countries have explored the idea of providing heroin to dependent users.
VI. Rapid Opioid Detoxification (p. 406) / One technique anesthetizes users and subjects them to withdrawal while they are unconscious.
Resource Outline
History of Opioids (p. 378)
Supplemental Information
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 1: Living with Drugs: Opium, Cocaine, and Marijuana in American History.
Opium (p. 378)
Early History of Opium (p. 378)
Supplemental Information
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 1: Living with Drugs: New Museum Traces History of Drugs in the U.S.
Writers and Opium: The Keys of Paradise (p. 379)
Supplemental Information
Course Integrator: Try It! Activity #1 (p. 153 of this Course Integrator).
The Opium Wars (p. 381)
Supplemental Information
Web: www.druglibrary.org/schaffer/heroin/opiwar1.htm. The Schaffer Library of Drug Policy: A Short History of the Opium Wars.
Morphine (p. 382)
Supplemental Information
Web: www.infoplease.com/ce6/sci/A0859772.html. Learning Network: Encyclopedia: Morphine: History.
Heroin (p. 382)
Supplemental Information
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 1: Living with Drugs: A Hundred-Year Habit.
Opiate Abuse before the Harrison Act (p. 383)
Abuse After the Harrison Act (p. 385)
In the Book
Taking Sides Box: Should Heroin Be Made Available for Medical Purposes? (p. 386)
Supplemental Information
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 3: The Major Drugs of Use and Abuse: Heroin and Cocaine—A Global Threat.
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 3: The Narco-Guerilla War.
The Changing Population of Opioid Users (p. 386)
Supplemental Information
Web: www.druglibrary.org/schaffer/Library/studies/cu/cu3.html. Schaffer Library of Drug Policy: What Kinds of People Used Opiates?
The 1960s (p. 387)
Vietnam (p. 387)
The 1970s and 1980s (p. 388)
In the Book
Fig. 16-1: Sources of illicit heroin for the United States (p. 390).
Current Use of Heroin (p. 389)
In the Book
Exploring Your Spirituality Box: Imitating Fashion Trends Versus Developing a Personal Style (p. 391).
Supplemental Information
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 3: The Major Drugs of Use and Abuse: Heroin High.
Pharmacology of the Opioids (p. 389)
Chemical Characteristics (p. 389)
In the Book
Fig. 16-2: Narcotic agents isolated or derived from opium (p. 392).
Table 16-1: Some Prescription Narcotic Analgesics (p. 393).
Mechanism of Action (p. 392)
Beneficial Uses (p. 394)
Supplemental Information
Web: www.nida.nih.gov/NIDA_Notes/NNVol16N3/Tearoff.html. NIDA Notes explains the beneficial uses as well as the risks of opioids.
Course Integrator: Try it! #2 (p. 153 of this Course Integrator).
Pain Relief (p. 394)
Supplemental Information
Web: www.time.com/. At Time magazine, search for The Case for Morphine.
Intestinal Disorders (p. 394)
Cough Suppressants (p. 394)
Causes for Concern (p. 394)
Supplemental Information
Course Integrator: Try It! #3 (p. 153 of this Course Integrator).
Dependence Potential (p. 394)
Supplemental Information
Web: www.nida.nih.gov/NIDA_Notes/NNVol16N3/Tearoff.html. NIDA Notes explores the potential for dependence of prescription drugs.
Tolerance (p. 394)
Physical Dependence (p. 395)
In the Book
Table 16-2: Sequence of Appearance of Some of the Abstinence Syndrome Symptoms (p. 395).
Psychological Dependence (p. 396)
Supplemental Information
Web: www.mayoclinic.com/invoke.cfm?id=DS00183. MayoClinic.com: Drug Addiction.
Web: www.nlm.nih.gov/medlineplus/ency/article/001522.htm . MedLinePlus: Drug Abuse and Dependence.
The Needle Habit (p. 396)
Supplemental Information
Web: www.globalchange.com/ttaa/ttaa%2013.htm. Global Change: Needle and Condom Distribution?
Toxicity Potential (p. 397)
Acute Toxicity (p. 397)
Supplemental Information
Web: http://165.112.78.61/ResearchReports/heroin/heroin3.html#chronic. National Institute on Drug Abuse: What Are the Immediate (Short-Term) Effects of Heroin Use?
Chronic Toxicity (p. 397)
Supplemental Information
Web: http://165.112.78.61/ResearchReports/heroin/heroin3.html#chronic. National Institute on Drug Abuse: Heroin: Abuse and Addiction: What Are the Medical Complications of Chronic Heroin Use?
Patterns of Abuse (p. 398)
The Life of a Heroin Abuser (p. 398)
Supplemental Information
Web: www.health.org/govpubs/RPo919/. The National Clearinghouse for Alcohol and Drug Information: Heroin Abuse in the United States.
Misconceptions and Preconceptions (p. 399)
In the Book
HealthQuest Activities Box: Drug F/X Exploration, assessment for heroin (p. 399).
New Users, New Drugs (p. 400)
Treatment of Narcotic Dependence (p. 400)
Supplemental Information
Web: www.wsoinc.com/. Narcotics Anonymous World Services.
Course Integrator: Suggested Activities #1 (p. 154 of this Course Integrator).
History (p. 400)
Current Medical Approaches (p. 401)
Supplemental Information
Web: PowerWeb (dushkin.com/powerweb): Drugs and Substance Abuse: Unit 6: Measuring the Social Costs of Drugs: Medical Care of Heroin Users.
Narcotic Antagonists (p. 401)
Supplemental Information
Web: www.whitehousedrugpolicy.gov/treat/treatment.html. The Office of National Drug Control Policy presents a summary of the various types of drug addiction treatment, including narcotic antagonist treatment.
Methadone Maintenance (p. 402)
Supplemental Information
Web: www.methadone.org/origin.html. The National Alliance of Methadone Advocates: The History of Methadone Maintenance.
LAAM (p. 403)
Supplemental Information
Web: www.health.org/govpubs/bkd170/. The National Clearinghouse for Alcohol and Drug Information: LAAM in the Treatment of Opiate Addiction.
Buprenorphine (p. 404)
Supplemental Information
Web: http://opioids.com/buprenorphine/. Opioids.com: Comparison of Buprenorpine and Methadone Maintenance in Opiate Addicts.
Heroin/Morphine Maintenance (p. 404)
In the Book
Taking Sides Box: Tough Moral Stances versus Harm Reduction (p. 405).
Supplemental Information
Course Integrator: Suggested Activity #2 (p. 154 of this Course Integrator).
Rapid Opioid Detoxification (p. 406)
Supplemental Information
Web: www.detox911.com/main.html. The Center for Narcotics Detoxification Under Anesthesia: Project Straight.
Chapter Review (p. 406)
In the Book
Summary (p. 406).
Try It! Box: Street Slang (p. 407).
Review Questions (p. 409).
Web Watch: Check Out Publications on Narcotics (p. 409).
Supplemental Information
Web: www.mhhe.com/catalogs/sem/hhp/faculty/labs/. MHHE Health & Human Performance Discipline Page: Faculty Support: Assessment Activities: Substance Abuse Labs.
Try It!
1. A classic book describing the effects of opium from a personal perspective was The Confessions of an Opium Eater by De Quincey. In addition, other books have been published dealing with narcotics on a subjective level. Write a book report on one such book.
2. Many people detest the use of medications. However, for suppression of pain, certain drugs can be very effective. Perhaps one’s resistance to pain-killing drugs is determined by the situation. In the following scenarios, indicate whether you would resist pain-killing drugs, prefer pain-killing drugs, or definitely want such drugs.
Event / No Drugs / Perhaps / Definitelya. Having a dental cavity filled. / ______/ ______/ ______
b. Recovering from a broken leg. / ______/ ______/ ______
c. Experiencing a migraine headache. / ______/ ______/ ______
d. Recovering from a moderately sprained wrist. / ______/ ______/ ______
e. Delivering a baby. / ______/ ______/ ______
f. Going to a family reunion. / ______/ ______/ ______
g. Experiencing a bout of diarrhea lasting several hours. / ______/ ______/ ______
3. The image of narcotics is very negative. To determine how you feel about narcotics, complete the following sentences:
a. Narcotics users are…
b. Narcotics sellers are…
c. The worst thing about narcotics is…
d. The best thing about narcotics is…
e. If I were offered narcotics, I would…
f. If I were hospitalized and narcotics were prescribed, I would…
Suggested Activities
1. What types of treatment are available to opiate abusers in your community? Talk to law enforcement officers, hospitals, and private clinics. Classify the treatments by type (e.g., methadone maintenance, use of narcotic antagonists). Try to determine the success rate of each program. Report your findings to the class.
2. Investigate the practice of supplying drug abusers with clean needles to prevent the spread of AIDS and hepatitis. How common is this practice? What are the arguments of proponents and opponents? Report to the class.