Opiates Overview - Chapter 11

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Questions and Answers

Which compound accounts for the highest percentage of raw opium?

Morphine (correct)

Thebaine

Codeine

Psychoactive alkaloids

Which of the following statements about naturally occurring opioids is true?

Opium is derived from a tropical plant species.

Opioids are synthesized entirely in laboratories.

Thebaine is one of the major compounds found in raw opium. (correct)

Codeine is present in higher concentrations than morphine in raw opium.

What is the source of naturally occurring opioids?

Cotton plant

Opium poppy (correct)

Cacti species

Cocoa plant

How is the term 'narcotic' most accurately defined in relation to opioids?

A type of analgesic that includes both opioids and dissimilar drugs. Signup and view all the answers

Which of the following is NOT considered an opioid?

Ibuprofen Signup and view all the answers

What is the primary use of opioids in medical practice?

To provide pain relief through analgesic properties Signup and view all the answers

Which of the following compounds is most abundant in raw opium?

Morphine Signup and view all the answers

What distinguishes naturally occurring opioids from synthetic compounds?

Natural opioids are derived from living plants, while synthetics are chemically manufactured. Signup and view all the answers

Which of the following is NOT a major compound derived from the opium poppy?

Fentanyl Signup and view all the answers

What percentage range of raw opium does codeine typically account for?

0.75% - 2.5% Signup and view all the answers

What are opioids primarily used for?

To relieve pain due to their analgesic properties Signup and view all the answers

Which of the following is a naturally occurring opioid derived from the opium poppy?

Codeine Signup and view all the answers

Which statement differentiates naturally occurring opioids from synthetic ones?

Naturally occurring opioids are derived from the opium poppy. Signup and view all the answers

What is the sap extracted from the opium poppy known as?

Opium Signup and view all the answers

Which opioid compound is most significant in terms of its percentage content in raw opium?

Morphine Signup and view all the answers

Which statement accurately describes the pharmacological actions of opiates?

Opiates mimic endorphins and can inhibit the release of neurotransmitters through multiple mechanisms. Signup and view all the answers

What is the significance of the metabolization of heroin and codeine in the body?

Both heroin and codeine are inactive until they are metabolized into morphine. Signup and view all the answers

How does parenteral administration of opiates affect their distribution in the body?

Parenteral administration allows for rapid absorption into the bloodstream, leading to high concentrations in the brain area. Signup and view all the answers

What powers does Section 14 of the Act grant regarding the control of drugs?

The Governor in Council can add any drug to the Schedule if its use becomes widespread. Signup and view all the answers

What is a common misconception regarding the effects of opiate use in infants born to addicted mothers?

Infants may exhibit withdrawal symptoms due to the exposure to substances in utero. Signup and view all the answers

What is a significant effect of naloxone when administered to an individual using opiates?

It induces withdrawal symptoms. Signup and view all the answers

Which historical figure recommended laudanum for a wide range of ailments around the second century AD?

Galen Signup and view all the answers

What was the primary purpose of laudanum in the 18th century?

To relieve menstrual pain. Signup and view all the answers

Which of the following statements correctly differentiates naloxone from naltrexone?

Naltrexone exhibits mild agonistic effects. Signup and view all the answers

What was the primary composition of the medicinal drink laudanum introduced in 1520?

A combination of opium, wine, and various spices. Signup and view all the answers

Why were mothers in the 18th century likely to administer laudanum to their children?

To alleviate anxiety and keep them quiet. Signup and view all the answers

What primary medical function has been attributed to opiate antagonists?

To manage overdoses effectively. Signup and view all the answers

What societal view was held towards opium use up until the mid-1800s?

It was accepted socially without regard for addiction. Signup and view all the answers

Which action was taken in San Francisco in 1875 regarding opium?

Outlawing of opium dens. Signup and view all the answers

What was a common misconception about the use of opium in relation to moral impacts?

Home drinking of opium had no moral ramifications. Signup and view all the answers

What reflects one of the motives behind governmental regulation of opium in the mid-1800s?

To combat anti-Chinese prejudice and protect societal values. Signup and view all the answers

In the context of opium use, what does the phrase 'opium drinking' refer to?

Consuming opium in a tinctured form. Signup and view all the answers

What was an opium den's characteristic feature in terms of clientele?

Open to all social classes. Signup and view all the answers

Which legislative action was implemented in Britain in 1868 regarding opiates?

Designation of pharmacies as the sole legal source of opiates. Signup and view all the answers

What is suggested about the perception of opium use from the quote regarding women and young girls in opium dens?

Their involvement was perceived as morally corrupting. Signup and view all the answers

What emerging trend regarding opium use is noted in the late 1800s?

Regulatory efforts prompted by addiction issues. Signup and view all the answers

Which of the following best describes the state of opium as a controlled substance prior to the mid-1800s?

Largely unregulated and widely available. Signup and view all the answers

What does DeQuincy suggest is the primary revelation experienced through opium use?

A sudden access to divine enjoyment and happiness Signup and view all the answers

What was a significant cultural development regarding opium in the 18th century?

The invention of opium dens in Europe Signup and view all the answers

Which best describes the setting and experience in opium dens as described in the content?

Social hubs with diverse clientele and varying luxury levels Signup and view all the answers

What was a common feature of the opium smoking apparatus used in dens?

A unique heating lamp necessary for vaporizing opium Signup and view all the answers

How did patrons usually position themselves when smoking opium?

Reclining to comfortably manage their pipes Signup and view all the answers

What is indicated about the accessibility of opium throughout history?

It was widely available to various social classes Signup and view all the answers

What sentiment does DeQuincy convey about the relationship between pain and opium use?

Pain relief is an insignificant aspect of opium Signup and view all the answers

What aspect of happiness related to opium does DeQuincy highlight?

It can be easily packaged and accessed Signup and view all the answers

In which century did Galen make observations about opium cakes and candies being sold?

2nd Century AD Signup and view all the answers

What was the primary focus of the Opium Act of 1908?

To prohibit the importation and sale of opium for non-medical purposes Signup and view all the answers

Which demographic was primarily targeted by the enforcement of the Opium Act of 1908?

Chinese opium dealers Signup and view all the answers

What significant role did Mackenzie King play in the development of the Opium and Narcotic Drug Act of 1911?

He introduced the bill addressing opium and other drugs Signup and view all the answers

What was a key reason cited by Mackenzie King for introducing the Opium and Narcotic Drug Act of 1911?

To address concerns raised by the Shanghai Commission Signup and view all the answers

What maximum punishment was imposed for violations of the Opium Act of 1908?

A maximum prison term of three years and/or a fine up to $1,000 Signup and view all the answers

Which component of the Opium Act of 1908 was emphasized regarding medical usage?

Opium could only be utilized for medicinal purposes with authorization Signup and view all the answers

What was a common consequence of the introduction of the Opium and Narcotic Drug Act in 1911?

Special powers granted to police for enforcement Signup and view all the answers

What type of actions did the Opium Act of 1908 specifically criminalize?

The importation and sale of opium without authorization Signup and view all the answers

What new legislation followed the introduction of the Opium Act in 1908?

Opium and Narcotic Drug Act, 1911 Signup and view all the answers

What was the societal concern that influenced the creation of the Opium and Narcotic Drug Act of 1911?

Public panic caused by cocaine use in Montreal Signup and view all the answers

What is a significant reason users prefer fentanyl over heroin in street use?

Fentanyl provides a greater rush and is cheaper. Signup and view all the answers

How is heroin chemically altered to increase its potency?

Adding acetyl groups to the morphine molecule. Signup and view all the answers

Which of the following synthetic compounds is used to treat chronic pain and is considered equally potent as morphine?

Methadone Signup and view all the answers

What distinguishes hydromorphone from other opiates?

It is more than 10 times more potent than morphine. Signup and view all the answers

What is the primary characteristic of the opium collected from the poppy seedpods after the sap has oxidized?

It forms small, heavy, gumlike balls resembling tar. Signup and view all the answers

Which semi-synthetic opiate is derived from codeine?

Hydrocodone Signup and view all the answers

What percentage of raw opium does thebaine typically represent?

< 1% Signup and view all the answers

Which receptor types are best understood to have agonist action by opiates?

Mu, kappa, and delta Signup and view all the answers

What is the significance of the half-life of methadone in relation to its clinical use?

Allows for less frequent dosing due to 10-25 hours half-life Signup and view all the answers

How does the administration route affect the distribution of opiates in the body?

Intravenous administration leads to immediate systemic distribution Signup and view all the answers

What mechanism allows opiates to decrease neuronal firing rates?

Inhibition of calcium influx and enhancement of potassium flow Signup and view all the answers

What problem might arise from infants born to addicted mothers regarding drug exposure?

Infants may show withdrawal symptoms after birth Signup and view all the answers

What is a primary difference between naloxone and naltrexone in terms of their effects?

Naltrexone possesses mild agonist properties. Signup and view all the answers

Which historical figure is noted for introducing laudanum and recommending it for various ailments?

Paracelsus Signup and view all the answers

What role did laudanum play in the 18th century regarding its use among women?

It served as a remedy for mood disorders. Signup and view all the answers

Which opiate antagonist is noted for reversing depressed breathing due to an overdose?

Naloxone Signup and view all the answers

What was a significant reason for the use of laudanum in the 19th century?

It was widely recognized for its pain-relieving properties. Signup and view all the answers

What was a key historical characteristic of laudanum formulations by the 1800s?

They had varying compositions with alcohol levels up to 46%. Signup and view all the answers

In what context did Thomas DeQuincy write about his experiences with opium?

Regarding an addiction he developed after dental use. Signup and view all the answers

What unique experience does DeQuincy describe as a result of opium use?

An emergence of blissful inner knowledge Signup and view all the answers

How did historical medicinal practices reflect on the societal view of opium usage?

It was embraced as a primary remedy for numerous ailments without criticism. Signup and view all the answers

Which of the following accurately describes the physical setup of opium dens?

They provided patrons with specialized equipment for consumption. Signup and view all the answers

What was the general societal perspective on opium use prior to the mid-1800s?

It was considered a necessary evil for health. Signup and view all the answers

What trend regarding laudanum use emerged in the late 1800s?

Increased regulation and reduction in prescriptions. Signup and view all the answers

What motivated the emergence of opium dens in the 18th century?

The Chinese invention of opium smoking. Signup and view all the answers

Which statement best represents a common misconception about opium's effects?

Opium can lead to complete physical dependence without psychological effects. Signup and view all the answers

What was a notable characteristic of opium pipes used in dens?

They typically had specialized designs to enhance airflow. Signup and view all the answers

In which context did Galen comment on opium in the 2nd Century AD?

He observed its commercial distribution in edible forms. Signup and view all the answers

What aspect of happiness does DeQuincy particularly emphasize regarding opium?

The immediacy and affordability of achieving happiness. Signup and view all the answers

What societal class frequented opium dens in 18th-century China?

All levels of society, reflecting financial diversity. Signup and view all the answers

What did the Opium Act of 1908 primarily prohibit?

The importation, manufacture, and sale of opium for non-medicinal purposes Signup and view all the answers

What was a significant enforcement target of the Opium Act of 1908?

Opium dealers, particularly of Chinese descent Signup and view all the answers

Which of the following was NOT a reason cited by Mackenzie King for introducing the Opium and Narcotic Drug Act of 1911?

Personal experience with narcotics Signup and view all the answers

What maximum penalty was stipulated for violations of the Opium Act of 1908?

Three years imprisonment and/or a fine not exceeding $1,000 Signup and view all the answers

What was a major change introduced with the Opium and Narcotic Drug Act of 1911 compared to the Opium Act of 1908?

It included provisions for the improper use of other drugs Signup and view all the answers

Who was responsible for introducing the Opium and Narcotic Drug Act of 1911 to the House?

Mackenzie King Signup and view all the answers

How did the Opium Act of 1908 distinguish between users and dealers?

It focused enforcement primarily on dealers rather than users Signup and view all the answers

What significant social issue did Mackenzie King mention as a reason to enforce the Opium and Narcotic Drug Act of 1911?

The panic caused by the rising use of cocaine Signup and view all the answers

Which provision was included in the Opium Act of 1908 regarding opium importation?

Only authorized personnel could import opium Signup and view all the answers

What was a primary purpose of the Opium and Narcotic Drug Act of 1911 as introduced by Mackenzie King?

To enhance law enforcement powers against drug violations Signup and view all the answers

Study Notes

Learning Outcomes for Opiates

Opiates are discussed in Chapter 11 of the text
Includes historical use, names of common natural and synthetic opiates
Details potency, metabolism, medical uses, administration methods, pharmacological actions, effects of tolerance, withdrawal, and psychological dependence. Methadone use for treatment is included.

Opioids Overview

Opioids are a class of naturally occurring, derived, and synthetic compounds with analgesic properties.
Often referred to as narcotic analgesics, though this term can be confusing as it includes other dissimilar drugs.

Naturally Occurring Opioids

Sources are derived from the opium poppy (Papaver somniferum).
Opium is the sap extracted from the seedpods.
Major compounds include:
- Morphine (10% of raw opium)
- Codeine (0.75-2.5% of raw opium).
- Thebaine (<1% of raw opium)
Opium extraction:
- Incisions are made in the seedpod after the petals fall
- Milky white juice (raw opium) oozes out.
- The juice oxidizes to reddish-brown tar-like balls.
- The balls have a smell similar to new-mown hay.
- Opium production lasts for 10 days after the petals drop.

Opiate Derivatives/Semi-Synthetics

Heroin: Derived from morphine, 3x more potent, and more lipid-soluble, increasing its ability to cross the blood-brain barrier.
Other derivatives include:
- Hydromorphone (10x more potent than morphine)
- Oxycodone (commonly prescribed for pain)
- Oxymorphone (1.5x more potent than morphine)
- Hydrocodone (slightly more potent than morphine)

Synthetic Opioids

Meperidine (Demerol): A less potent synthetic opioid, often used as a painkiller.
Methadone: Used to treat chronic pain and opioid dependency, with similar analgesic effects to morphine but less euphoria. Methadone is used in opioid maintenance programs for individuals recovering from heroin addiction.
Fentanyl: A potent synthetic opioid available in several forms (e.g., oral transmucosal lozenges, sublingual tablets, nasal sprays, transdermal patches). Fentanyl can also be smoked or injected. It is now frequently abused.
Other synthetic opioids mentioned include LAAM (Levo-alpha-acetylmethadol).

Opiate Antagonists

Naloxone (Brand Name: Narcan): Can reverse opioid effects, especially respiratory depression, within minutes. Administered intravenously (IV) or intramuscularly (IM). Often used for overdoses.
Naltrexone: Has mild agonist effects resembling morphine-like activity, but can last longer than Naloxone. Primarily used in opioid addiction treatment.

Medical Uses of Opioids

Pain relief (morphine is a key agent)
Diarrhea treatment (loperamide)
Cough suppression (codeine)

Opioids: Historical Medical Uses

Opium was documented in Egyptian medical scrolls (Ebers Papyrus) in 1550 BC.
Used for various conditions, including excessive crying in children.
Galen (Greek physician) prescribed opium for multiple conditions. Laudanum was a popular medicinal preparation combining opium, wine, and spices.

Opioids: Historical Recreational Uses

Opium use dates back to the Bronze Age (evidence of ceramic opium pipes found in Cyprus).
Widespread availability of opium cakes and candy was evident by the 2nd Century AD.
Opium smoking became widespread in the 18th century (China) resulting in the rise of opium dens. Opium dens offered specialized pipes and equipment and catered to all social classes.

Opium was widely accepted for medical and recreational use in the early to mid-1800s, but addiction issues were not viewed as a predominant medical or social problem.
Increased regulation began in the U.S. and Britain in the mid to late 1800s due to concerns about chronic use, anti-Chinese prejudice, and the negative consequences linked to opium dens. Regulation was driven by a combination of public health concerns, social perception shifts, and political considerations regarding social ills and perceived impacts on individuals, families and societies. Quotes describe social concerns regarding the negative impact of widespread addiction and the dangers associated with opioid use.

Opioids: History and Canada's Opium Act (1908 & 1911)

The Opium Acts focused on prohibiting the importation, manufacture, and sale of opium for non-medical purposes. Medical use was restricted.
Stricter controls (e.g., limiting sales to pharmacies) were a feature of the 1911 Act.
The Acts restricted use to medical purposes, and manufacturing, selling, and possession of opium for smoking was prohibited.
The 1911 Act also expanded the scope of regulation, adding substances like cocaine, morphine, and eucaine to the list of controlled substances. Legislative details are provided in the text, including the history of Bill C-205 and its progression to the 1908 Opium Act.

Methods of Administration

Oral: Examples (pills, capsules, liquid forms). Slower onset due to first-pass metabolism.
Parenteral: Examples (IM, SC, IV). Injected directly into the body, bypassing the GI tract. Includes skin popping and mainlining (intravenous injection).
Inhalation: Smoking opium, or vaporized fentanyl. Rapid absorption into the bloodstream.
Transdermal: Examples (Fentanyl patches for chronic pain) Absorbed through the skin.

Opioids: Metabolism

Many opioids are inactive until metabolized into their active forms in the liver.
Metabolization is generally rapid, except for some synthetic opioids.
Specific enzymes and half-lives are referenced for various key opioids including Heroin, Codeine, Methadone, LAAM, and Fentanyl.

Opioids: CNS Effects

Analgesic effects (act on Mu, Delta, and Kappa receptors in the spinal cord to block pain signals).
Euphoria, dysphoria (unpleasant feelings).
Decreased concentration (sedative effects).
Emotional pain dulling (acting on receptors within the limbic system and frontal lobe). Specific receptor types involved are detailed, including significant differences in effectiveness and activity between opioids within the same system.

Opioids: Tolerance & Dependence

Tolerance develops to certain effects with continued use (e.g., respiratory depression, analgesia).
Tolerance to some effects, such as constipation or pupil constriction, does not develop. Conditions leading to different tolerances are described.

Dependence: Characteristics of Withdrawal

Initial symptoms (restlessness, agitation, yawning, fever, chills).
Peak symptoms (intensify and reached peak 36-72 hours after last use)
Physical symptoms (cramps, limb twitching, profuse sweating, nausea, muscle pain, loss of body fluids, and possible hallucinations). Variations in severity are described. Life-threatening aspects of withdrawals are detailed. Severity and duration are affected by the type of opioid used and frequency of use.
Psychological dependence is more challenging to treat than physical addiction; treatment options are mentioned. The text describes the challenges and difficulties associated with treating psychological addiction.

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Description

Explore the crucial aspects of opiates as discussed in Chapter 11. This quiz delves into the history, types, potency, medical uses, and effects of opiates, including their administration methods and treatment for withdrawal. Gain a deeper understanding of both naturally occurring and synthetic opiates.