Opioids & Kratom Lecture Notes PDF

OPIOIDS & KRATOM NFNF3512 Lecture Objectives At the end of this lecture, students should be able to: › Describe different classes of opioids › Explain the effects of opioids and their withdrawal symptoms › Describe the effects of kratom in humans › Explain on issues concerning the misuse of kratom...

OPIOIDS & KRATOM NFNF3512 Lecture Objectives At the end of this lecture, students should be able to: › Describe different classes of opioids › Explain the effects of opioids and their withdrawal symptoms › Describe the effects of kratom in humans › Explain on issues concerning the misuse of kratom Classification of Opioids 1. Morphine analogs- 2. Synthetic derivatives structure closely related to morphine › Hydromorphone (dihydromorphinone) › Morphine › Pethidine › Diamorphine › Fentanyl (heroin) › Methadone › Codeine › Dextropropoxyphene › Nalorphine › Pentazocine › Levallorphan › Naloxone › Buprenorphine › Etorphine › Loperamide Common Prescription Opioids Hydrocodone, Oxycodone Commonly prescribed for a variety of painful conditions, including dental and injury-related pain Morphine Often used before and after surgical procedures to alleviate severe pain Codeine Often prescribed for mild pain; Can also be used to relieve coughs and severe diarrhea How do opioids act? Opioids act through specific G-protein coupled receptors which then alter the state of ion channels to increase or decrease neuronal activities mediated by neurotransmitters What are the effects opioids? › Reduce and relieve pain › Can sometimes create a sense of euphoria › HIGHLY habit-forming and addictive  Increased efficacy is usually associated with an increase in addiction liability of an opioid What are the side effects opioids? › Drowsiness and sedation › Mental confusion › Nausea and vomiting › Constipation › Pinpoint (constricted) pupils › Slowed or depressed vital signs › Body temperature, blood pressure, pulse and respiration rates › Overdose and death Opioid Misuse/Dependence : Signs & Symptoms Physical Signs Behavioral Signs Change in appetite Change in personality/attitude Pupil size Change in friends Small: opioid intoxication Change in activities, sports, hobbies Large: opioid withdrawal Poor attendance / grades Nausea Increased isolation; secrecy Vomiting Wearing long sleeved shirts Sweating Moody, irritable, nervous, giddy, or Shaking nodding off Stealing Opioids Withdrawal Symptoms A little bit about heroin › Heroin comes from the opium poppy flower and used recreationally to achieve effects similar to those caused by prescription opioids › It can look like a white or brown powder, or black tar › HEROIN IS HIGHLY ADDICTIVE – tolerance develops quickly › Heroin is stronger, cheaper, and easier to get than prescription pills. Also more dangerous – you never know what it is cut/mixed with How heroin is used? › Inject (most common and most dangerous), snort, or smoke it › No matter how you use it, it gets to the brain quickly Kratom (Mitragyna speciosa) › Kratom or locally known as ‘ketum’ is a tropical tree native to Southeast Asia › used traditionally to combat fatigue and improve work productivity among farm populations in Southeast Asia › Consumption of its leaves produces both stimulant effects (in low doses) and has an opioid-like effects (in high doses), and can lead to psychotic symptoms, and psychological and physiological dependence. › Concerns: affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence Kratom Extract Composition › More than 20 alkaloids in kratom have been identified in the laboratory › Kratom leaves contain two major psychoactive ingredients (mitragynine and 7-hydroxymitragynine) › Mitragynine is classified as a kappa- opioid receptor agonist and is roughly 13 times more potent than morphine › Mitragynine/OH-mitragynine thought to be responsible for the opioid-like effects How kratom is used › Capsules › Pills › Extract › Leaves – Chewed – Brewed as tea – Smoked What are the effects of kratom in humans? The effects of kratom in humans are dose-dependent: › Small doses produce stimulatory effects resembling the stimulant effect of drugs such as cocaine or amphetamines. › Larger doses associated with sedative-narcotic, pain reducing effects that resemble drugs such as opiates. › Regular kratom use is associated with addictive disorders, as evidenced by craving and compulsive use. Opioid withdrawal symptoms upon cessation have been reported. What does it do to the body? › Kratom’s effects on the body include nausea, itching, sweating, dry mouth, constipation, increased urination, tachycardia, vomiting, drowsiness, and loss of appetite. › Users of kratom have also experienced anorexia, weight loss, insomnia, hepatotoxicity, seizure, and hallucinations. › Several cases of psychosis resulting from use of kratom have been reported, where individuals addicted to kratom exhibited psychotic symptoms, including hallucinations, delusion, and confusion. Fatal Overdoses Involving Kratom From July 2016 to June 2017, 25 fatal overdoses involving kratom in the US States ME NH NM OH PA RI WV WI Total Opioid overdose 301 402 322 4,534 3,231 265 844 825 10,724 deaths Deaths involving 4 2 1 3 8 1 5 1 25 kratom Percent involving 1.3% 0.5% 0.3% 0.07% 0.25% 0.4% 0.6% 0.1% 0.23% kratom Caution: testing of kratom is not Most kratom associated deaths appeared to uniform thus these numbers are have resulted from adulterated products or underestimates. Source: CDC SUDORS Overdose Death Data taking kratom along with other potent substances