(OPIATES & OPIOID)
The opiates are found in a gummy substance extracted from the seed pod of the Asian poppy, Papaver somniferum. Opium is produced from this substance, and codeine and morphine are derived from opium.
Other drugs, such as heroin, are processed from morphine or codeine. Opiate-related synthetic drugs, such as meperidine and methadone, are called opioids.
Forms and Appearance
Opium appears either as dark brown chunks or in powder form, and is generally eaten or smoked. Heroin usually appears as a white or brownish powder, which is dissolved in water for injection. Most street preparations of heroin contain only a small percentage of the drug, as they are diluted with sugar, quinine, or other drugs and substances. Other opiate analgesics appear in a variety of forms, such as capsules, tablets, syrups, elixirs, solutions, and suppositories.
Medical and Other Uses
Opiates and their synthetic counterparts (opioids) are used in modern medicine to relieve acute pain suffered as a result of disease, surgery, or injury; in the treatment of some forms of acute heart failure; and in the control of moderate to severe coughs or diarrhoea. They are not the desired treatment for the relief of chronic pain, because their long-term and repeated use can result in drug dependence and side effects (such as constipation and mood swings). They are, however, of particular value in control of pain in the later stages of terminal illness, where the possibility of dependence is not a significant issue.
A small proportion of people for whom the drugs have been medically prescribed become dependent; they are referred to as ‘medical addicts’. Even use of non-prescription codeine products, if continued inappropriately, may get out of control. Medical advice should be sought, since withdrawal symptoms may result from abruptly stopping use after physical dependence has been established. Because members of the medical and allied health professions have ready access to the drugs, some become dependent.
The Federal Narcotic Control Act regulates the possession and distribution of all opiates and opioids. The act permits individual physicians, dentists, pharmacists, and veterinarians, as well as hospitals, to keep supplies of certain drugs. Members of the general public must obtain these drugs from such authorised sources. Although the act also permits the prescribing of methadone in the treatment of heroin dependence, permission is given only to specially licensed physicians, and use is governed by specific guidelines.
Opiates have been used both medically and non-medically for centuries. A tincture of opium called laudanum has been widely used since the 16th century as a remedy for ‘nerves’ or to stop coughing and diarrhoea.
By the early 19th century, morphine had been extracted in a pure form suitable for solution. With the introduction of the hypodermic needle in the mid-19th century, injection of the solution became the common method of administration.
Heroin (diacetylmorphine) was introduced in 1898 and was heralded as a remedy for morphine addiction. Although heroin proved to be a more potent painkiller (analgesic) and cough suppressant than morphine, it was also more likely to produce dependence.
Of the 20 alkaloids contained in opium, only codeine and morphine are still in widespread clinical use today. In this century, many synthetic drugs (opioids) have been developed with essentially the same effects as the natural opium alkaloids. These opiate-related synthetic drugs, such as meperidine (Demerol) and methadone, were first developed to provide an analgesic that would not produce drug dependence. Unfortunately, all opiates and opioids, while effective as analgesics, can also produce dependence. Modern research has led, however, to the development of other families of drugs. The narcotic antagonists (e.g. naloxone hydrochloride) – one of these groups – are used not as painkillers but to reverse the effects of opiate overdose.
(Note that where a drug name is capitalized, it is a registered trade name of the manufacturer.)
Another group of drugs has both morphine-like and naloxone-like properties (e.g. pentazocine, or Talwin) and these are sometimes used for pain relief because they are less likely to be abused and to cause addiction. Nevertheless, abuse of pentazocine in combination with the antihistamine tripelennamine (Pyribenzamine) was widely reported in the 1980s, particularly in several large cities in the United States. This combination became known on the street as “Ts and blues.” The reformulation of Talwin, however, with the narcotic antagonist naloxone has reportedly reduced the incidence of Ts and blues use.
Methods of Use
Street users usually inject opiate solutions under the skin (‘skin popping’) or directly into a vein or muscle, but the drugs may also be ‘snorted’ into the nose or taken orally or rectally.
Effects of Use
The effects of any drug depend on several factors:
the amount taken at one time; the user’s past drug experience; the manner in which the drug is taken; and the circumstances under which the drug is taken (the place, the user’s psychological and emotional stability, the presence of other people, simultaneous use of alcohol or other drugs, etc.).
These appear soon after a single dose and disappear in a few hours or days. Opiates and opioids briefly stimulate the higher centres of the brain but then depress activity of the central nervous system. Immediately after injection into a vein, the user feels a surge of pleasure or a ‘rush’. This gives way to a state of gratification – hunger, pain, and sexual urges rarely intrude.
The dose required to produce these effects may at first cause restlessness, nausea, and vomiting. With moderately high doses, however, the body feels warm, the extremities heavy, and the mouth dry. Soon, the user goes ‘on the nod’, an alternately wakeful and drowsy state during which the world is forgotten.
As the dose is increased, breathing becomes gradually slower. With very large doses, the user cannot be roused; the pupils contract to pinpoints; the skin is cold, moist, and bluish; and profound respiratory depression resulting in death may occur.
These appear after repeated use over a long period. Chronic opiate users may develop endocarditis, an infection of the heart lining and valves as a result of non-sterile injection techniques.
Drug users who share needles are also at a high risk of acquiring AIDS (acquired immune deficiency syndrome) and HIV infection (human immunodeficiency virus). Non-sterile injection techniques can also cause abscesses, cellulitis, liver disease, and even brain damage. Among users with a long history of subcutaneous injection, tetanus is common. Pulmonary complications, including various types of pneumonia, may also result from the unhealthy lifestyle of the user, as well as from the depressant effect of opiates on respiration.
Women dependent on opiates and opioids are likely to experience complications during pregnancy and childbirth. Among their most common medical problems are anaemia, cardiac disease, diabetes, pneumonia, and hepatitis. They also have an abnormally high rate of spontaneous abortion, breech delivery, caesarean section, and premature birth. Withdrawal from the drugs has also been linked to a high incidence of stillbirths.
Infants born to heroin-dependent mothers are smaller than average and frequently show evidence of acute infection. Most exhibit withdrawal symptoms of varying degrees and duration. The death rate among these infants is higher than normal.
If tried by summary conviction, a first offence for opiate or opioid possession carries a maximum penalty of a $1,000 fine and six months imprisonment. For subsequent offences, the maximum penalty is a $2,000 fine and 12 months imprisonment. If tried by indictment, opiate or opioid possession carries a maximum penalty of seven years imprisonment.
Importing, exporting, trafficking, and possession for the purposes of trafficking are all indictable offences and carry a maximum penalty of life imprisonment. Cultivation of opium is also an indictable offence and carries a maximum penalty of seven years imprisonment.
It is illegal to obtain a prescription for opiates, opioids or any other ‘narcotic’ from health care professionals without notifying them that you have obtained a similar prescription through another practitioner within the last 30 days.
Tolerance and Dependence
With regular use, tolerance develops to many of the desired effects of the drugs. This means the user must use more of the drug to achieve the same intensity of effect.
Long-term users may also become psychologically and physically dependent.
Psychological dependence exists when a drug is so central to a person’s thoughts, emotions, and activities that the need to continue its use becomes a craving or compulsion. With physical dependence, the body has adapted to the presence of the drug, and withdrawal symptoms occur if use of the drug is reduced or stopped abruptly. Some users take heroin on an occasional basis, thus avoiding physical dependence.
Withdrawal may occur in regular users as early as a few hours after the last administration. It produces:
- abdominal cramps
- goose bumps
- runny nose
These symptoms are accompanied by a craving for the drug. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after a week. Some bodily functions, however, do not return to normal levels for as long as six months. Sudden withdrawal by heavily dependent users who are in poor health has occasionally been fatal. Opiate and opioid withdrawal, however, is much less dangerous to life than alcohol and barbiturate withdrawal.
Overdose is a particular risk on the street, where the amount of drug contained in a ‘hit’ cannot be accurately gauged.