Opioids and Their Effects

Opioids & Kratom

• Opioids reduce and relieve pain and can cause euphoria
• Opioids are highly addictive and habit-forming.
• Different opioid classes include morphine analogs, synthetic derivatives like hydromorphone (dihydro morons).
• Examples of prescription opioids include morphine, diamorphine (heroin), codeine, nalorphine, levallorphan, naloxone, pethidine, fentanyl, methadone, dextropropoxyphene, pentazocine, buprenorphine, etorphine and loperamide.

How Opioids Work

• Opioids act through specific G-protein coupled receptors
• They alter ion channels to impact neurotransmitter activity.

Opioid Side Effects

• Common side effects are drowsiness, sedation, mental confusion, nausea, vomiting, constipation, constricted pupils, slowed or depressed vital signs, body temperature changes, blood pressure changes, pulse changes, and potentially overdose and death.

Opioid Misuse/Dependence Signs & Symptoms

• Physical signs: change in appetite, pupil size, nausea, vomiting, sweating, shaking, opioid intoxication, and withdrawal.
• Behavioral signs: change in personality, friends, activities, attendance, isolation, secrecy; wearing long sleeves, moodiness, irritability, nervousness, dizziness, nodding off, and stealing.

Opioid Withdrawal Symptoms

• Stage I (up to 8 hours): anxiety, drug craving
• Stage II (8-24 hours): anxiety, insomnia, GI disturbances, rhinorrhea, mydriasis, diaphoresis.
• Stage III (up to 3 days): tachycardia, nausea, vomiting, hypertension, diarrhea, fever, chills, tremors, seizures, muscle spasms.

Heroin

• Heroin is derived from opium poppies and used recreationally.
• It comes as white or brown powder, or black tar.
• It is highly addictive
• Heroin is stronger, cheaper, and easier to obtain than prescription pills, but is also more dangerous due to unknown contaminants.
• Methods of use include injection (most common and dangerous), snorting, and smoking.

Kratom (Mitragyna speciosa)

• Kratom is a tropical tree native to Southeast Asia, traditionally used to combat fatigue.
• Consumption at low doses has stimulant effects. At higher doses, it has opioid-like effects.
• Kratom can cause dependence and psychological/physiological issues.
• Kratom contains psychoactive ingredients like mitragynines.
• Mitragynine is a kappa-opioid receptor agonist and 13x more potent than morphine.

Kratom Effects in Humans

• Effects are dose dependent; low doses have stimulant qualities similar to amphetamines, while high doses have sedative-narcotic, pain-reducing qualities resembling opioids.
• Regular kratom use may lead to addiction.
• Kratom withdrawal symptoms may occur.

Kratom Composition & Usage

• More than 20 alkaloids have been identified in kratom leaves.
• Mitragynine and 7-hydroxymitragynine are major psychoactive ingredients.
• Kratom is usually consumed as capsules, pills, extracts, or smoked leaves.

Kratom's Effects on the Body

• Kratom's effects can include nausea, itching, sweating, dry mouth, constipation, increased urination, tachycardia, vomiting, drowsiness, appetite loss, anorexia, weight loss, insomnia, hepatotoxicity, seizures, and hallucinations.
• Psychotic episodes have been reported in some cases.

Fatal Overdoses Involving Kratom

• Fatal overdoses from kratom use have occurred.
• Deaths have sometimes resulted from adulterated kratom or mixing it with other potent substances.
• Caution: these kratom overdose numbers may underestimate the actual risk.