So let's go to slide two and give you a little background on the opiates. As we can see here all the opiates come from the opium poppy or are synthetic copies of the opiates. Opiates have a wide variety of uses. They are used for pain relief; they are used to cause sleep, to reduce sensation, and also used for pleasure.

Historically, as we see in slide three, the opiates have been around for a long time. They are also mentioned in recorded history, approximately 6000 B.C. The drug has been used by the Egyptians, Greeks, Arabs, Chinese, Europeans, etc. All were used by 4000 B.C. Primarily these drugs were used in medicine. However, about 1500 B.C. it began to be used for pleasure in India. And, because it is so widely addictive, it became an extremely important point for commerce. The drug entered the United States in about 1800 and was used in all sorts of over-the-counter medications including Coca Cola. In 1874, Wright synthesizes the drug Heroin from opium and it was used to treat opium and morphine addiction. Also, as we know, heroin has its own effects and consequently heroin use began to increase. Ultimately, the United States began to ban opium and the Harrison Narcotics Acts made it illegal to purchase opium related products. Consequently, it had to be purchased on the black market.

Many products contain opium in one way or another and as we can see in slide four there is a wide variety of different products that contain opium.

There are also many drugs that contain opium as shown on slide five. For example, it is used in cough medicines, it is used to relieve withdrawal symptoms, and there is a drug, Naloxone, which is used for narcotic overdoses.

Opium, as we see in slide six, is a brownish tar-like substance. It is commonly smoked or orally ingested. It is not commonly used today.

Codeine, on the other hand, is combined with all sorts of other compounds. As we can see in slide seven, when you combine it with Aspirin you get Darvon or with Tylenol you get Darvocet. These drugs are used primarily for pain control. It is also used in higher end cough syrups which you have to get from your pharmacist; however, you do not need a prescription. Consequently this is often used by opium addicts or heroin addicts to help them overcome withdrawal symptoms when they are trying to find a hit. This drug is commonly abused and probably needs more controls placed on it.

Morphine, as seen in slide eight, is a derived form of opium. Primarily it is used for pain control in medical settings. It is not used as commonly as a wide variety of the other medical opiates. It is also highly addictive in street form. It is not as addictive for hospital use and this is because of the expectancy effects one gets from the different settings. Morphine is also very had to get and is not as commonly used on the street as a wide variety of other opiates.

Demerol as we see in slide nine is basically just a weaker form of Morphine. It is most commonly used in hospitals and has the same issues as Morphine. It is also seen in pill form.

Heroin, as we see in slide ten is the most commonly obtained and used opiate on the street. It has a white powder substance or a tar-like form commonly called Black Tar and is very common in Idaho. It also comes in a wide variety of different colors and Heroin is smoked, snorted, or injected.

Heroin, as seen in slide eleven, is basically a pure white powder. It is usually diluted with some particular substance. When it is first entering the United States it may be ninety-five percent pure, but by the time it is sold out on the street it may be down to three to five percent. Heroin has a bitter taste and is often cut with a wide variety of different compounds. When you combine it with cocaine you get what is called a speedball which gives you a very intense effect.

Dilaudid, as we see in slide twelve, is basically a Super Morphine. It is a hundred times more potent per dose and it can easily cause an addict to overdose if they were using either Morphine or heroin. Dilaudid comes in pill or liquid form and can even be used as an injection in hospitals. It is usually used in hospitals and hospices for pain control and is not usually found on the street.

Methadone, as we see in slide thirteen, was developed by the Germans for pain control when their access to the Opium fields was cut off. What it is basically is a synthetic form of opium. It works exactly the same for pain but also targets different receptors associated with pleasure. Consequently, it works the same as opium but it does not give you the "hit" that opium, heroin, and other types of drugs do. This drug is often dispensed to help clients get off of heroin and what it basically does is stop the withdrawal symptoms. The drug is also long lasting, goes for approximately seventy-two hours. It can be very addictive; consequently you need to watch your clients very, very well. We will talk more about Methadone when we talk about the treatment section.

Fentanyl or what is also called, China White, is a liquid. It is primarily used in hospitals for pain control and it is also used in anesthesia. It is a hundred times more potent than Morphine and it can even be stronger, it can be up to two thousand times as strong. It has no quality control and can easily kill you. Consequently, it is not as often used as heroin or other substances out on the street.

In general, opiates are used for a variety of things. For medical reasons as seen in slide fifteen, it is primarily used for pain control. It is also used for chronic or severe coughs and can also be used in cases of severe diarrhea. For the street use there is a wide variety of uses but basically it is used for intense pleasure. It is also used to help stop mental pain and to relieve withdrawal symptoms from other drugs and from the opiates themselves. Of course, it is also used for pain control.

Opium products can be taken into the system in a wide variety of ways. Orally, just basically drinking it, inhalation usually through smoking it, or through injection intramuscularly in hospitals primarily, or intraveiniously which is usually used on the street. Both of these techniques if not used in a sterile manner increase the risk for Blood borne pathogens. The drug can also be given rectally. Once in the system it goes throughout the blood stream and is metabolized by the liver, then the byproducts are excreted by the kidneys.

Pharmocokinetically what this drug does, as seen in slide seventeen, is target three major sets of receptors. It targets receptors in the Medulla which shuts down your breathing and your cough. It also shuts down the Pons and the Reticulator Activating System, this results in sleep and decreased arousal. Receptors in the Medial Forebrain Bundle also have an impact. These include structures in the Hippocampus, so it will shut down your memory system which is very important when used with some sort of anesthesia. It also has an impact on the Limbic System which is your pleasure and reward centers. The structure also has impact on the Forebrain, shutting down memory systems and pleasure. Finally, the drugs will have effects in the Spinal Cord resulting in shutting down the pain system.

Opiates also have impacts on other structures. It impacts muscle tissue, it causes pupils to change, and will impact the sympathetic and parasympathetic nervous systems in general.

One of the issues that relates with opiates is what is called tolerance. As we can see in slide nineteen tolerance to the opiates is very, very rapid. It also occurs very rapidly at the receptor level as well and in other systems such as your liver. Opiates also develop rapid cross tolerance to other compounds so consequently it has a variety of effects.

In general, the effects of opiates are varied, as shown in slide twenty, most people take it because it makes you feel good and you do not want to stop using it as a result of that. It is also used medically for respiratory impairment; it also causes constipation, etc.

Withdrawal from opiates is very similar to having a very bad flu. As we can see in slide twenty-one it can usually take one to two weeks. You get shaking, temperature, stomach and muscle cramping, and a wide variety of other symptoms as well. The solution for many people is to go out and get another hit. However, if a person does try to stop using heroin the major symptoms are over in about two to three days.

Now, there is one more issue that needs to be discussed when you talk about opiates and that is shown on slide twenty-two. Opiates are highly correlated with blood borne pathogens especially HIV and hepatitis. Consequently, when you are working with individuals who are injecting you need to be very cognizant of the fact that they may have these diseases. You need to educate them about not sharing their needles or at least clean their works. In the old days we didn't talk or think about blood borne pathogens with the injection drug use. Today, it is not an option any more. You have to be thinking about these types of diseases. I highly recommend that all injection drug users be tested for blood borne pathogens and you can easily and cheaply do that by having them go to the public health service area in your community. It is not an option anymore. Intravenous Drug Users (IDU's) are passing HIV into the heterosexual population and it is causing major problems.

Despite all the issues going along with opiate abuse there is some good news. First of all, as seen in slide twenty-three, with the exception of heroin, opiate use is decreasing. Even then, it is decreasing across the system in some areas. We still have significantly high rates of use in the Hispanic and Black communities and we need to do more work there. However, more people are smoking or snorting heroin than in the past but consequently that is a good sign that injection use is going down a little bit however, we have a long way to go.

That concludes the section on opiates. In our next section with will begin talking about the next major category which is the hallucinogens. Until then we hope you have yourself a great day.

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