Opiates are a family of drugs derived from the poppy flower. Morphine is extracted from the poppy. However, over the last several decades, man has synthesized a varierty of opioid drugs from morhphine that have somewhat different properties with regard to potency and half-life (amount of time active in the body). All of these drugs are active on the opiate receptors that are present in nerve cells throughout the central nervous system. The main subtype of receptor responsible for the addictive properties of opiates is the mu receptor.
Opiates include a variety of drugs. The most well known is heroin (diacetylmorphine) which is a particularly lipid soluble form of morphine which quickly crosses the blood-brain barrier to produce a rapid effect. Other well known opiates are codeine, oxycodone (brandnames Oxycontin, Percocet), hydromorphone (Dilaudid), hydrocodone (Vicodin), fentanyl (Duragesic), meperidine (Demerol), buprenorphine (Subutex, Subuxone) and methadone.
All opiates cross the blood braind barrier and effect opiate receptors. When these receptors are stimulated, they not only produce analgesia but also produce euphoria when highly activated. This euphoria activates brain reward centers that make the brain say "I need some more of that". These pathways are also used in to re-enforce normal behavior such as eating, social interaction, exeercise, and sex. However, opiates bypass normal regulation and can lead to problems. Eventually, the addicted individual can become a slave to the brains desire for these drugs.
The addictive power of a drug is measured in research by capture rate. The capture rate is the percent first time users that eventually become dependent on the drug. Opiate drugs have the highest capture rates of any drug known to man. Heroin's capture rate is nearly 29%.
About 1 million americans are addicted to heroin. This does not include Americans addicted to other opioid drugs
Intravenous heroin probably has the highest potential for abuse because of it's rapid onset of action. It is a schedule I item as per the Drug Enforcement Agency and has no approved medical use. However, all opioids have a high potential for abuse. In my practice, Percocet and Oxycontin which are both forms of oxycodone are probably the drugs that patient's have the most problems with besides heroin.
Two of the best markers of physical dependence are tolerance and withdrawal. Tolerance occurs when an individual has to take larger amounts of a substance to get the same effect. Withdrawal occurs when a patient who regularly uses a substance has signs and symptoms opposite the drugs action when they have been without it for sometime.
The two primary signs of psychological addiction are compulsive use and loss of control over use. A patient who is addicted cannot stop using and uses more then they intend to over a given period of time.
Yes. There are highly effective treatments for opiate dependence. Treatments for substance dependence are just as good as for treatments for any other chronic medical disorder such as diabetes or heart disease. Most substance treatment programs rely on a combination of psychological and biological treatments. Psychological treatments include individual substance counseling, group substance counseling, AA/NA, relapse prevention, and motivational interviewing. Biological treatments include naltrexone, buprenorphine, and methadone.
Methadone and buprenoprhine (brandname Suboxone) are both opioid agonist approved by the FDA for treatment of opiate dependence. Methadone is only available in registered methadone maintenance treatment clinics regulated by federal and state governments. Treatment usually involves nearly daily reporting to clinics to pick up the day's dose of methadone. Buprenorphine is available through doctors specially trained and licensed by the DEA. It it can be obtained in the privacy of a physician's office and regulations about it's use are much less strict then for methadone. This allows for greater treatment flexibility for the physician and patient.