Chapter 203: Narcotic Abuse
Narcotics, or opioids, are primarily used for pain management, but due to ease of availability individuals procure and misuse these drugs, with dire consequences including opioid use disorder and overdose. Nearly 4 million individuals in the United States are current misusers of pain relievers, and globally opioid misuse causes the greatest global burden of morbidity and mortality; disease transmission; increased health care, crime, and law enforcement costs; and less tangible costs of family distress and lost productivity.
Opioids bind to specific opioid receptors in the CNS and elsewhere in the body. These receptors mediate the opiate effects of analgesia, euphoria, respiratory depression, and constipation. Endogenous opiate peptides (enkephalins and endorphins) are natural ligands for the opioid receptors and play a role in analgesia, memory, learning, reward, mood regulation, and stress tolerance.
The prototypic opiates, morphine and codeine, are derived from the juice of the opium poppy. The semisynthetic drugs produced from morphine include hydromorphone (Dilaudid), diacetylmorphine (heroin), and oxycodone (Oxy-Contin). The purely synthetic opioids and their cousins include meperidine, propoxyphene, diphenoxylate, fentanyl, buprenorphine, tramadol, methadone, and pentazocine. All produce analgesia and euphoria as well as physical dependence when taken in high enough doses for prolonged periods of time.
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Citation
Kasper, Dennis L., et al., editors. "Chapter 203: Narcotic Abuse." Harrison's Manual of Medicine, 20th ed., McGraw Hill Inc., 2020. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623127/0/Chapter_203:_Narcotic_Abuse.
Chapter 203: Narcotic Abuse. In: Kasper DLD, Fauci ASA, Hauser SLS, et al, eds. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623127/0/Chapter_203:_Narcotic_Abuse. Accessed December 2, 2024.
Chapter 203: Narcotic Abuse. (2020). In Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (Eds.), Harrison's Manual of Medicine (20th ed.). McGraw Hill Inc.. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623127/0/Chapter_203:_Narcotic_Abuse
Chapter 203: Narcotic Abuse [Internet]. In: Kasper DLD, Fauci ASA, Hauser SLS, Longo DLD, Jameson JLJ, Loscalzo JJ, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. [cited 2024 December 02]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623127/0/Chapter_203:_Narcotic_Abuse.
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