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Lecture

Week 8 - Drugs and Behaviour.docx

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Department
Psychology
Course
PS268
Professor
Bruce Mc Kay
Semester
Fall

Description
Cultivation and history of opium Papaver somniferum – poppy that brings sleep Annual flowering Narcotics – stupor or sleep inducing agents *The poppies you grow in your backyard do not produce opium in the same way Opium is produced and available for collection for only a few days of the poppy plant’s life Opium Wars -People ate opium for years, with very few problems... then they started smoking it (thanks Columbus) -1729: Opium smoking outlawed in China, but smuggling was widespread -British East India Company was involved in opium trade, legally in India and illegally in China -Pressure grew and eventually war broke out between the British and Chinese -839-1842; 1856-1860 - Opium wars are fought, China loses, forced to allow opium sales by the British Morphine 1806: active ingredient in opium isolated -10 times as potent as opium -named Morphium after Morpheus, the god of dreams 1832: another alkaloid of opium discovered -named codeine from the Greek word for ‘poppy head’ Medically useful characteristics Pure chemical Known potency Use Spread due to two developments 1853: Hypodermic syringe allowed delivery of morphine directly into the blood Widespread use during war provided relief from pain and dysentery Many veterans were dependent on morphine, and dependence was later called “soldier’s disease’ or ‘army disease’ Morphine allowed detailed surgery for the first time – not just amputation Battlefield surgical kit: bone saw, meat knife, wire cutters Used bullet for you to bite on, 5 or 6 people to hold you down, saw it off So long as opium was used in the proper way “Men drank alcohol in the local [drank laudanum] at home.” Edward Beecher, Licit and illicit drugs (1972) saloon while women took opium After morphine, take their time and do real surgery Morphine stops diarrhea Someone invented syringe 1832 Another alkaloid of opium discovered After the opium wars, saw them smoking tobacco… Heroin -two acetyl groups added to morphine in the laboratory, creating diacetylmorphine given the brand name Heroin placed on the market in 1898 by Bayer -three times as potent as morphine due to increased lipid solubility of the heroin molecule -marketed as a non-habit-forming substitute for codeine later linked to tolerance and dependence basically is morphine, as soon as heroin gets to brain, it is stripped down to morphine Opiod use was not initially viewed as a problem Opium (especially morphine) was used to treat alcoholism – resulted in addictions, but at least the ‘addicts’ weren’t violent -Patent medicines were socially acceptable, and legal -High drugs levels in patent medicines meant that withdrawal symptoms were severe and relieved only by taking more -Opium dependence was viewed as a ‘vice of middle life’ Typical user was … But then it became a problem – a Chinese immigrant problem Opium den in NYC (late 19 century) – offering to vulnerable white girls What are the key differences between the pictures? -One’s real (passed out guys smoking) and one’s a drawing (men giving to women) – probably never happened ...So laws had to be formulated Opium laws in Canada 1885 – Chinese Immigration Act Tax on Chinese to enter Canada 1885: $50 1900: $100 1903: $500 (2 years wages) 1908 – The Opium Act An Act to prohibit the importation, manufacture and sale of opium for other than the medicinal purpose 1911 – The Opium and Narcotic Drug Act An Act to prohibit the improper use of Opium and other Drugs 1923 – Chinese Exclusion Act Chinese immigrants deemed the culprits in the opium trade; except for specific cases (merchant, diplomat, student, etc) banned from immigrating to Canada (Act repealed in 1947) 1996 – Controlled Drugs and Substances Act Why were Chinese citizens ‘emigrating’ to NA? The new laws markedly decrease the supply of opium, so what happens? --Black Market – price goes up Results of the laws - changes in the pattern of opiod use Oral use declined; the primary remaining group users were those who injected morphine or heroin Only sources of drugs were illegal dealers Cost and risk of use increased The 1960s... In Vietnam Heroin use by American troops in Vietnam Rate of use = about 5 percent Heroin was -Inexpensive -About 95 percent pure (compared to 5 percent in the U.S.) -Easy to obtain -Most users smoked or sniffed – or even ate – heroin -Most users stopped when they returned to the U.S. Vietnam experience showed -Under certain conditions, a relatively high percent of individuals will use opioids recreationally -Opioid dependence and compulsive use are not inevitable among occasional users Medical Uses Pain Relief Reduces the emotional response to pain and diminishes the patient‟s awareness of, and response to, the aversive stimulus Typically causes drowsiness Treatment of intestinal disorders Reduce colic and counteracts diarrhea and the resulting dehydration Acts by decreasing the number of peristaltic contractions An opium solution known as paregoric is still available for relief of diarrhea Cough suppressant (antitussive) Codeine has long been used to reduce coughing -it remains available in prescriptions cough meds Nonprescription cough remedies contain the opioid analogue dextromethorphan -it produces hallucinogenic effects at high doses Narcotic analgesic drugs Oxycodone (Percodan) Oxycodone with acetaminophen (Percocet) OxyContin (time-release form of oxycodone) Hydrocodone (Hycodan) Hydrocodone with acetaminophen (Vicodin) OxyNeo (to replace oxycntin) – uncrushable, uninjectable The two sides of oxycontin: powerful analgesic/potential drug of abuse Problem for the physician: “A practicing physician has to be mindful that someone, even if the don‟t come with „addict‟ written all over them, may be one… The physician has to establish a relationship with the patient they‟re taking care of on a long-term basis.” OxyContin – most addictive drug, taken off the shelves Possible adverse effects of opiate treatment Respiratory depression if patient suffers from asthma, emphysema, or pulmonary heart disease Nausea and vomiting (often goes away after a few treatments) IIntestinal spasms due to decreased secretion of hydrochloric acid Undue sleep-inducing effect Medical vs. non-medical doses of morphine Medical – for moderate to severe pain: -optinaml intramuscular dosage is -10mg per 70kg body weight every 4 hours (5-20mg/4hrs depending on severity). -with oral admistration: dose about 4-10mg; severe pain only, analgesic effect is immediate Nonmedical -irregular or intermittent users (who are not substituting the drug for another narcotic analgesic) may start and continue to use doses with the therapeutic range (e.g., up to 20mg) -*Regular users may take several hundred milligrams per day, and perhaps upwards of 4-5 GRAMS (4000 – 5000 mg) per day 2007 – Purdue Pharma pleaded guilty in a U.S. federal court to misleading regulators and an unsuspecting public about risk of addiction to OxyContin. The firm agreed to pay more than 600 million in civil and criminal fines. OxyContin sales in Canada nevertheless rocketed. Percocet Story -Going through hard time + Percocet, severe addiction -just because they‟re prescription doesn‟t mean they won‟t result in dependence -before giving out an opiate prescription, find out what‟s going on in patient‟s personal life OxyNeo --oxycontin was going from pharmaceutical companies to the street --oxycontin disappeared, users switched to heroin Medical use of prescription opiate pain meds among WLU students Past year use: 25% Possible adverse effects of opiate treatment Respiratory depression if patient suffers from asthma, emphysema, or pulmonary heart disease Nausea and vomiting (often goes away after a few treatments) Intestinal spasms due to decreased secretion of hydrochloric acid Undue sleep-inducing effect Dizziness in some patients The two sides of oxycontin: powerful analgesic/potential drug of abuse Problem for the physician: A practicing physician has to be mindful that someone, even if they don‟t come with „addict‟ written all over them, may be one…The physician has to establish a relationship with the patient they‟re taking care of on a LT basis. --How easy is it to get an opiate prescription? Doctors hand this stuff over Non-medical use of opiates Prescription pain relievers (nonmed use): About 20% of Ontario high school seniors report past year (non-medical) use of opiod pain relievers -most are taken orally -dependence and toxicity can occur from misuse of prescription opioids -special problem of Oxycontin; illicit users crush the time-release capsules to obtain a high dose Three days later OxyNeo could be crushed and liquefied Non-medical use of prescription opioid pain medications among WLU students Past year use: about 10% Perception 8%
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