Opioids Research Papers Examples

Introduction

What are Opioids?
Opioids are compounds that adhere to the opiate receptors. The term, however, is often used to describe the alkaloid opioids, which are extracted from the opium poppy. Such alkaloids include codeine and morphine. Moreover, opioids include the drugs that are manufactured from the naturally occurring opiates. Such semi-synthetic opiates include heroin, which is prepared from morphine. Synthetic opioids, however, include methadone, propoxyphene, and fentanyl (Rosenblum, Marsch, Joseph, & Portenoy, 2008).

Mechanism of Action

Opioids act by adhering to the opioid receptor proteins. The receptors are involved in the pain modulation process and occur in both the central and the peripheral nervous systems. In addition, the receptors bind endorphins or endogenous opioid peptides, which modulate pain in the body. Endogenous peptides are valuable in the modulation of mood and stress, as well as the reward and reinforcement mechanisms. In studies involving rats (Raghavendra, Rutkowski, & DeLeo, 2002), the activation of the opioid receptors with Morphine produces effects such as the sensitization of sensory nerves to the noxious stimuli.
Analgesia occurs when an opioid is clinically administered, but may be accompanied by the side effects related to receptor activation. The effects may be mediated by the central or peripheral nervous system, and include reduced peristalsis, pupillary constriction, respiratory depression, and mental clouding. Moreover, the central mechanisms cause the changes associated with opioids’ tolerance and hyperalgesia. The opioid-induced hyperalgesia is clinically-relevant because it increases pain in particular situations (Deleo, Tanga, & Tawfik, 2004). The opioid activation of the other central nervous system pathways often produces mood effects, such as euphoria and dysphoria.

History and Origin

Opioids have been considered for millennia as highly effective drugs for pain alleviation. In advanced medical illnesses, the use of opioids in the management of both chronic and acute pain is the primary standard of care globally (Rosenblum et al., 2008). According to Booth (1996), the Sumerians cultivated the poppy plant approximately 3400 BC and called it Hul Gil or the “joy plant.” Opium also appears in the Egyptian medical scrolls of 1550 B.C. Moreover, the early Greek and Roman physicians utilized it for medical purposes. Later, the expansion of Islam in the 1500s led to the spread of opium from the Middle East to various parts of Asia and Europe. Eventually, the drug spread worldwide through trade.

Manufacture of Opioid Products

In the US, various opioids are commercialized for transdermal, intravenous, and oral administration. The transdermal products, as well as the oral formulations, are administered particularly for pain in the ambulatory setting. The drugs include combination products such as Lorset and Vicodin, which contain acetaminophen and hydrocodone (Rosenblum et al., 2008). Other formulations such as Ultracet contain acetaminophen and tramadol while Percocet contains acetaminophen and oxycodone. Nevertheless, the single entity commercial formulations include hydromorphone-containing Dilaudid, as well as the oxymorphone-containing Opana (Rosenblum et al., 2008). Other opioids in the market include the Kadian and Avinza, which contain morphine.

Periods of Spike in the Use of Opioids

The spikes in the use of opioids began with the cultivation of opium by the Assyrians and Sumerians nearly 6000 years ago. The art of opium poppy-culling was then introduced to the Babylonians who in turn passed the knowledge to the Egyptians. The plant was primarily used to alleviate mood, as well as pain. In 1300 BC, the widespread cultivation of the plant by the Egyptians led to a flourishing opium trade that spread the drug to Greece and other parts of Europe. Opium was then cultivated widely in Europe for trade, as well as smoking, before the practice declined during the Inquisition.
In the 1500s -1600s, Paracelsus reintroduced opium into the European medical literature during the pinnacle of the Reformation. The residents of India and Persia then began drinking and eating opium mixtures for recreational purposes. In 1830, the British reliance on the drug for leisure and medicinal uses reached an all time high as thousands of pounds of opium were imported from India and Turkey. In the early 1900s, the Saint James Society mounted a vigorous campaign to promote the heroin use in the attempt to eliminate morphine addiction. Consequently, heroin addiction rose to alarming rates.

Periods of Rapid Decline

In 1300s, opium disappeared for nearly two hundred years from the European historical record because it had become a taboo subject during the Holy Inquisition (Booth, 1996). In 1729, China’s emperor, Yung Cheng, prohibited opium smoking, as well as its domestic sale. As a result, its use was only allowed for the treatment of various maladies. However, China's emperor, Kia King, eventually banned opium entirely in 1799. The emperor’s decree had an adverse effect on the East India Company, which exported large volumes of opium to China. Moreover, the edict made the cultivation and sale of opium illegal in China. In 1909, the first federal drug prohibition was passed in the US, hence, outlawing opium importation.

Medicinal Uses of Opioids

Opioids are used primarily to provide pain relief. For example, they are used relieve the pain associated with cancer, post-surgery, physical injuries, and various maladies. Various semisynthetic and synthetic and opioids such as hydromorphone and fentanyl are used in anesthesia. Opioids such as codeine suppress coughs, particularly the non-productive coughs. Additionally, drugs such as loperamide help to treat the irritable bowel syndrome.

Side Effects

Positive Effects
In the short term, opioids can relieve the pain caused by temporary injuries, as well as surgery. Some opioids such as fentanyl are used as anesthetics during surgery while others suppress coughs and treat diarrhea. In the long term, opioids are used to relieve pain in chronic illnesses such as cancer.

Adverse Effects

In the short term, opioids may cause slowed breathing, miosis, drowsiness, and constipation. Moreover, they may induce nausea, unconsciousness, and coma. Sometimes, an allergic condition referred to as urticaria may occur, and cause itchy bumps on the skin. In the long term, however, opioids’ use or abuse can cause addiction or physical dependence. Opioid tolerance may also occur, hence, requiring the long-term users to make dosage increases in order to achieve the typical effects.

Effects of Opioids on Men, Children, and Women

Women experience more pain relief from opioids than men because estrogen, which vacillates during menstrual cycles, alters pain responses (Jacobson, 2014). Additionally, men are relatively more likely to become addicted. However, women experience more vigorous withdrawal symptoms than men. Once addicted, women are more likely than men to relapse, especially when the glucose circulating in the brain is low. Such situations occur in the middle of the menstrual cycle because the low glucose levels reduce self-control (Jacobson, 2014). The responses of children and adults to opioids vary because of the differences in pathophysiology, disease variants, and pharmacodynamics. Typically, opioids can alter neural development and cause stunted growth in children. Moreover, the opioid side effects are more pronounced in children than adults. The abuse of opioids among pregnant women may cause preterm labor, fetal growth restriction, and fetal death.

Effect on Behavior

Social Impact
The lifestyle issues linked to illicit drug use promote harmful activities. For example, female addicts engage in theft, prostitution, and violence in order to support their addiction. Such activities also expose them to sexually transmitted infections, as well as legal consequences.

Mental Issues

The correct use of opioids can relieve pain, particularly in terminally ill persons. As a result, it can enhance the individual’s progress at school or workplace. However, opiate abuse can lead to addiction and, consequently, affect the person’s education, work, and relationship with teammates.

Emotional, Psychological, and Physical Issues

Although the clinical administration of opioids can cause psychological and physical relief from ailments, the opiate abuse can cause incessant craving for the drug. Moreover, the withdrawal symptoms often cause psychological and physical distress. The physical effects of opioid abuse include the loss of balance, unconsciousness, coma, and reduced cognitive functions.

Other Useful Information about Opioids

The clinical utilization of the opioid drugs depends on a variety of factors such as the pharmacokinetics. Most opioids, except buprenorphine and methadone, have relatively short half-lives. Consequently, new delivery systems have been designed to prolong the drugs’ effects, as well as the dosing interval. The long-term or short-term use of opioids may result in clinically-relevant tolerance and dependence. Such phenomena vary significantly in the clinical setting and represent the neuro-adaptational processes. In addition, the neurophysiology of physical tolerance and dependence is closely related to the opioid-induced hyperalgesia. According to Rosenblum et al. (2008), the possibility that opioid administration may cause an increased pain has promoted the controversy concerning the opioid therapy for non-cancer pain.

Conclusion

Opioids are highly effective medications for the relief of both moderate and severe pain. Although researchers agree on the drugs’ utility as treatment regimens for chronic cancer pain, their long-term use in the treatment of persistent non-malignant pain is controversial. The contention is primarily based on the incidences of increased pain, which result from the long-term opioid administration. However, various researchers acknowledge the utility of opioid therapy in pain reduction because it has a minimal risk of addiction. The illicit use of opioids, nevertheless, leads to tolerance and addiction, which leads to various psychological, social, and physical issues.

References

Booth, M. (1996). Opium: A history. New York, NY: Simon & Schuster, Ltd.
DeLeo, J. A., Tanga, F.Y., Tawfik, V. L. (2004). Neuroimmune activation and neuroinflammation in chronic pain and opioid tolerance/hyperalgesia. Neuroscientist., 10, 40–52. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14987447
Raghavendra, V., Rutkowski, M. D., & DeLeo, J. A. (2002). The role of spinal neuroimmune activation in morphine tolerance/hyperalgesia in neuropathic and sham-operated rats. Journal of Neuroscience, 22, 9980–9989. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12427855
Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (2008). Opioids and the treatment of chronic pain: controversies, current status, and future directions. Experimental and Clinical Psychopharmacology, 16(5), 405–416. Doi: 10.1037/a0013628
Jacobson, R. (2014). Psychotropic drugs affect men and women differently. Scientific American Mind, 25(4), n. pg. Retrieved from http://www.scientificamerican.com/article/psychotropic-drugs-affect-men-and-women-differently/