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Control of Postoperative Pain by Self-Administered Opioids
Published in Robert B. Northrop, Endogenous and Exogenous Regulation and Control of Physiological Systems, 2020
The analgesic effects of the juice of the poppy (Papaver somaniferum) were known before the third century B.C. The concentrated juice of this poppy is a brown, gummy substance known as opium. Opium contains at least 20 distinct alkaloids (opiates) that have significant pharmacological action. The first opiate isolated was morphine in 1806; codeine was discovered in 1832, and papaverine was described in 1848. These three natural opiates have clinical usefulness as analgesics. Morphine, codeine, and thebaine belong to a class of opiate molecule called phenanthrenes.61 The morphine molecule is shown in Figure 9.2. The natural opiates, papaverine and noscapine belong to the benzylisoquinolines. Many semisynthetic opiate derivatives are made by simple chemical modification of terminal groups on the morphine or thebaine molecules. For example, heroin (diacetylmorphine) is made from morphine by acetylation of the 3 and 6 positions (see Figure 9.2). (Goodman and Gilman61 give a table in which 14 opiates related to morphine are described.)
Pulmonary complications of illicit drug use
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
The most common street drug associated with non-cardiogenic pulmonary oedema (NCPE) is heroin. It is a fairly infrequent complication of heroin overdose: the incidence was reported to be 2.1 per cent in a recent case series by Sporer and Dorn.7 NCPE related to heroin overdose usually presents as a combination of persistent hypoxia after resolution of opiate respiratory depression along with frothy pink-tinged pulmonary secretions and a characteristic radiographic pattern of fluffy diffuse pulmonary infiltrates.7 The mechanism of heroin-induced pulmonary oedema (HIPE) has been debated. Haemodynamic studies performed in patients with HIPE show elevated pulmonary artery pressures and normal pulmonary capillary wedge pressures.8 It was suggested that hypoxia-related pulmonary hypertension resulted in oedema formation. Bronchoalveolar lavage (BAL) studies performed by Katz and colleagues showed that HIPE fluid had protein levels that were nearly similar to serum levels, considerably higher than levels found in cardiogenic pulmonary oedema. Therefore, increased capillary permeability was suggested as a possible mechanism for this.9 However, later studies by Dettmeyer and colleagues found no difference in the number of IgE positive cells or in alveolar staining for collagen or lamin in lung tissue for patients who died of heroin intoxication compared to patients who had sudden cardiovascular death.10 Other theories suggested include histamine mediated capillary leak.11,12 The central nervous system depression that accompanies opiate use suggests that neurogenic pulmonary oedema may also contribute to opiate-induced acute lung injury. Acute lung injury manifests as bilateral, perihilar areas of increased opacity or attenuation, usually without pleural effusion or cardiomegaly. High-resolution CT may show multifocal ground-glass attenuation associated with septal thickening.13
Evaluating drugged driving: Effects of exemplar pain and anxiety medications
Published in Traffic Injury Prevention, 2018
Timothy L. Brown, Gary Milavetz, Gary Gaffney, Andrew Spurgin
Prescription drug use and abuse continues to be a significant challenge in the United States (Maurer 2016). Benzodiazepines (BZDZ) and opiates are among the most commonly used and abused psychoactive medication available (Jones et al. 2012). BZDZ reduce anxiety and have been shown to limit short-term memory (Lader 2014). Opiates are powerful pain relievers that act via a central opiate receptor in the CNS (Basbaum and Fields 1978). Both medications have abuse potential and are controlled substances by the Drug Enforcement Administration. These drugs are one of the most commonly prescribed therapeutic combinations for pain relief related to acute and chronic pain in the United States.