Research Paper: Prescription Opioids & Heroin

Natasha Wilson

HLTH1050

December 2, 2017
 An epidemic that we have all seen go on the rise has been the abuse of prescription

opioids and heroin abuse. The abuse of opioids such as morphine, heroin, and prescription drugs

has become a serious problem globally that effects the health, social and economical welfare of

all societies (Levinthal, n.d.). Between 26.4 million and 36 million people abuse opioids

worldwide, with 2.1 million being addicted to prescription opioids and 467,000 abusing heroin in

the United States (Opioids, n.d.). It is being argued that there is a growing relationship between

non-medical opioid analgesics and heroin abuse here in the U.S.. Nearly 80 percent of

Americans abusing heroin reported misuse of opioids first (Levinthal, n.d.). Non-medical use of

opioid pain medications have increased dramatically in the recent years, with estimates in 2011

that approximately 7.6 million adults from ages eighteen to twenty-five reported using opioid

drugs for non medical reasons (Levinthal, n.d.). Overdoses and deaths from opioids are

continually increasing here in the United States, so much so that it is being recognized as an

epidemic.

Opioids are psychoactive drugs that have the ability to take away great amounts of pain

while at the same time, potentially suppressing our mind (Opioids, n.d.). Opioid drugs have also

been to referred to as narcotics, because of the dream-like effect they have on the user and the

potential to induce sleep when taking high doses (Levinthal, n.d.). Opioids can be divided into

four categories of drugs- the first comprises three natural compounds that are extracted from

opium itself: morphine, codeine and thebaine. All derivatives of opioids origin from these

compounds. The second category consists of derivative compounds that are created by making

define changes in the chemical composition of morphine (Levinthal, n.d.). Heroin,

hydromorphone, and oxymorphone are all examples of this change in chemical composition. The

third category consists of derivative compounds that are created by making precise changes in
the chemical composition of codeine or thebaine (Levinthal, n.d.). Examples of this category are

oxycodonem and hydrocodone. The fourth, and last, category constitutes drugs that are not

related chemically to any of the natural extracts of opium, but are synthesized completely in the

laboratory; for example, methadone, meperidine, propoxyphene, LAAM, and buprenorphine

(Levinthal, n.d.).

The harvest of raw opium has not changed much in the past three thousand or so years. It

is found in in countries where the weather is hot and the labor is cheap, for example, Thailand,

Colombia, Peru and Laos (Levinthal, n.d.). The source of opium comes from the opium poppy,

which is an annual plant that grows about three to four feet high. Its flowers are large and can be

white, pink, red, or purple. This type of the only kind that produces opium (Levinthal, n.d.).

When the petals fall off the opium poppy, but the seed capsule is not yet completely ripe,

laborers make small, shallow cuts into the capsules. The cuts into the capsules allow a white

milky juice to ooze out during the night (Levinthal, n.d.). The next day the milky juice would

have oxidized and hardened by air contact. With time, the opium turns reddish brown and has the

consistency of heavy syrup, then it will darken more and form into small squishy balls

(Levinthal, n.d.).

The level of response intensity of heroin changes as a objective of the quantity and purity,

the route through which it is administered, the time since last dose of, and the degree of tolerance

the user has to heroin (Levinthal, n.d.). Along with psychological, there is a number of

physiological changes that also happen in the body. A sudden release of histamine in the

bloodstream often produces intense itching all over the body and the reddening of eyes. Heroin

can also cause papillary constrictions, which result in pinpoint pupils- a characteristic that is

greatly used as a diagnostic sign for narcotic abuse (Levinthal, n.d.). Along with other sedative-
hypnotic drugs, heroin also reduces the sensitivity of respiratory centers in the medulla, which

result in a depression in breathing. At high doses, respiratory depression can cause death. Along

with respiratory depression, blood pressure is also depressed due to heroin intake (Levinthal,

n.d.). Heroin enters the brain quickly and binds to opioid receptors on cells located in several

areas, especially those involved with feelings of pain, pleasure, controlling heart rate, sleeping

and breathing (Opioids, n.d.). Since the 1970s we have known that the effects of opioid related

drugs are the result of activation of opioid-sensitive receptors located in the brain (Levinthal,

n.d.). Interestingly enough, The brain has its own ability to produce opioid substances, known

as endorphins, and contains a specific group of receptors to receive them. By surprise, the opium

poppy has a similarly shaped chemical that fits into these receptors, thus producing comparable

physiological and psychological effects. Some short term effects include a rush of pleasure, dry

mouth, clouded mental functioning, and going on the nod (a back and forth state of being

conscious and semiconscious) (Levinthal, n.d.). Long term effects include insomnia, infection of

the heart lining and valves, constipation and stomach cramping, liver and kidney disease, sexual

dysfunction for men, irregular menstrual cycles for women, collapsed veins for people who

inject the drug, and damaged nose tissue for people who sniff/snort it (Levinthal, n.d.).

Widespread abuse of opioid medications in instances which the drug is use in for non-medical

purposes has become on the rise. Opioids that have been particularly problematic have been

oxycodone (oxycontin), hyrocodone with acetaminophen, oxycodone with acetaminophen, and

oxymorphone (Levinthal, n.d.). They have all been classified as Schedule II controlled

substances. Oxycontin was first thought to be relatively safe from potential abuse and more

acceptable to the public because it didnt have the social stigma that comes along with morphine.

It is supposed to be taken orally then absorbed slowly within a period of time, which then kills
the pain but does not induce a feeling of euphoria (Levinthal, n.d.). Although, when Oxycontin is

crushed and then either swallowed or injected it can have similar effects to that of heroin- even

the withdrawal symptoms are similar to heroins. Vicodin and Percocet also have a long record of

abuse and dependence (Levinthal, n.d.). An additional problem to those is that they have been

often paired with acetaminophen, which is particularly dangerous because high doses can

increase the risk of liver toxicity and even death. It is important to note that prescription opioid

pain medicines such as oxycontin and Vicodin have very similar effects to heroin; when

misused, they can be nearly just as dangerous.

Although, this essay is focused on the epidemic these drugs have caused, it is important

to recognize the beneficial effects that they may have in a medical setting- with of course

excluding heroin because it is a schedule 1 controlled substance. The most relevant use of

opioids today is for the treatment of pain. Morphine is the traditional drug of choice with patients

who suffer severe pain following surgery, burns or cancer (Levinthal, n.d.). Another medical use

of opioids is to slow down peristaltic contractions in the intestines that occur as part of the

digestive process. The reasoning for use is directed towards people with bacterial infections of

the lower intestinal tract, causing pain and severe diarrhea (Levinthal, n.d.). Because of the

slowing down of digestive processes, chronic opioid and heroin abusers frequently come across

constipation. A different application focuses on how these drugs suppress the cough reflex center

in the medulla. In cases which an antitussive drug is needed, codeine is often prescribed

(Levinthal, n.d.).

Treatments for heroin abuse comes with two primary difficulties, short-term effects of

heroin withdrawal and long-term effects of heroin craving (Heroin, n.d.). Long term solutions to

heroin abuse must find a solution to both withdrawal and cravings (Levinthal, n.d.). It has been
made possible to make detoxification (process of drug withdrawal which the body is allowed to

rid itself of the chemical effects of the drug in the bloodstream) less distressing to the abuser by

slowly reducing heroin levels under supervision rather than withdrawing cold turkey

(Levinthal, n.d.). Opioid drugs such as propoxyphene, meperidine, or methadone are

administered in medical settings to replace heroin- doses are decreased over a period of two or so

weeks. Once successfully withdrawing the abuser from heroin, the long-term cravings come into

focus. One treatment approach from the 1960s is the methadone maintenance (Levinthal, n.d.).

The methadone maintenance is a treatment program for heroin abusers where heroin is replaced

by long-term methadone intake to relieve heroin cravings. The theory behind this approach is

that if a legal and controllable opioid drug was available to heroin abusers on a regular basis the

craving for heroin would be eliminated- thus, their drug-taking lifestyle would no longer be in

use (Levinthal, n.d.). 71% of former heroin abusers who have participated in methadone

maintenance for a year or more have completely stopped vein taking drugs- reducing the risk of

aids.

With opioid and heroin abuse being an epidemic here in the United States, one might ask

how we can help end it. Safe storage and disposal of opioid drugs is an important task in

reducing/decreasing opioid misuse. One way, which I find to be extremely important, is to help

shape how everyone sees addiction by talking and treating it as a chronic illness, not a moral

failing. When addiction to any substance has become bad enough to effect your well being and

cause you to have body parts working incorrectly it should be seen as a disease, not just a

personal problem. Supporting each other, and ending the stigma, I find to be just as important.

Addiction is not easy, we must not see addicts as bad people. Support, love and encouragement

can be the first step in helping an addict come clean.

References

Abuse, N. I. (2017, July). Heroin. Retrieved December 05, 2017, from https://

www.drugabuse.gov/publications/drugfacts/heroin
Abuse, N. I. (n.d.). Opioids. Retrieved December 05, 2017, from https://www.drugabuse.gov/

drugs-abuse/opioids

Levinthal, C. F. (n.d.). (Eighth ed.). Pearson Eduction Inc.