Opioids: An appendix for readers

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Note for readers: The conversations around the opioid epidemic are often peppered with technical terms and names. We’ve compiled this appendix of terms and will continue to build it as the series continues.

 

Buprenorphine – Sold as Subutex in the US, buprenorphine might best be described as a “semi-opioid.” The drug is derived from thebaine, a chemical found in opium poppies that is similar to morphine, but which acts as a stimulant rather than a depressant. Buprenorphine has some opioid characteristics and can be used – and abused – as a painkiller. However, because it has a limited effect on the respiratory system, it has a lower risk of overdose compared to methadone, and it often used in titration, or “step-down” detox and rehab situations.

Heroin – The original brand name given to diamorphine by Bayer Pharmaceuticals in 1898. Diamorphine is a semi-synthetic made from morphine, becoming four to five times stronger than the naturally occurring opioid.

Hydrocodone – A semi-synthetic that is 10 times stronger than codeine and about the same strength as morphine, and frequently used to treat mild to moderate pain.

Methadone – A lab-created opioid that is nearly as strong a heroin, methadone is harder to break down and stays active in the body longer. Though the high it produces is less intense than heroin (in part because it is often take orally instead of injected), rates of methadone abuse are considerable. Because lower doses of methadone can “hold off” withdrawal symptoms for long periods of time, methadone is still used to titrate – or step down – people from high-level opioid use (“methadone clinic” has become synonymous with the use of a wide range of opioids used to ease people out of chemical addiction). There is debate over the safety of methadone, and some clinics are switching to buprenorphine.

Morphine – A naturally occurring opioid found in the poppy plant, morphine was one of the first ‘active ingredients’ isolated from a plant. Used for two hundred years for as a painkiller, morphine is still used in hospitals worldwide. Morphine is also the basis for equianalgesic charts (i.e. comparing the relative strength of painkillers).

Naloxone – A semi-synthetic drug that blocks that action of opioids. Naloxone, like buprenorphine, is derived from thebaine but, unlike buprenorphine, it has no opioid characteristics. By itself, naloxone has very little effect. Naloxone can reverse the fatal effects of high doses of opioids.

Naltrexone – Related but distinct from naloxone, naltrexone is a long term prescription that blocks the activity. Naltrexone does not block cravings, but can prevent a user from getting high. The weakness is that, by skipping a dose of naltrexone, a user can then use an opioid to get high.

Narcan – The trade name for naloxone. Several pharmaceutical companies have been accused of price gouging on versions of Narcan. Evzio increased the cost of their auto-injector (which provides prerecorded instructions) from $490 to $4,500 last year. Other versions manufactured by Hospira and Amphastar doubled in price in 2012 and 2014, respectively.

Oxycodone – One of the most common prescription opioids, oxycodone has numerous trade names – including OxyContin (which is time released) and Roxicdone (a fast release version). The drug is 50 percent more powerful than morphine, equal in strength to street heroin (which is cut), giving it the occasional nickname “prescription heroin.” Oxycodone’s role in issues of addiction, law enforcement and legal action against pharmaceutical companies (including manufacturing Purdue), has led to the occasional use of “Oxycodone” to refer to prescription opioids in general.

Opiates – Naturally occurring psychoactive chemicals that occur in nature, including in the human body (where they are called endorphins, for endogenous morphine). The opium poppy is the primary source for refined opiates.

Opioids – The broader class of substances that act on the opiate pathways in the human body. These include naturally occurring opiates, refined or “semi-synthetic” chemicals and purely lab-created.

Opium Poppy – Papaver somniferum, the opium poppy, naturally contains codeine and morphine, as well as other opiates, from which other drugs are synthesized. The poppy is cultivated legally in India, Turkey and Australia for the pharmaceutical industry. Illegal production is centered in Afghanistan; about two-thirds of the world’s illicit supply is grown there, according to the 2016 UN World Drug Report. Opium product also occurs in and Columbia.

Percocet – Brand name for oxycodone with acetaminophen.

Vicodin – Brand name for hydrocodone, a semi-synthetic used almost exclusively in the United States (also sold as Lorcet and Lortab).

Titrate/titration  – The gradual adjustment of a dosage until the desired effect is achieved. This can refer to users increasing their doses to account for habituation to the effects of opioids; it can also refer to the gradual reduction in doses, ‘stepping down’ or weaning a user off of the drug completely.

Part I – The epidemic, by the numbers

Part III – The many changing faces of opioid addiction

Part II – Opioids: from heroin to prescription pills to and ‘psycho synthetics’

Part III – The many changing faces of opioid addiction

Part IV – Mental health and opioid abuse