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Opioids and Opiates (Narcotics) 9, 10
Opioids are a synthetic form of opiates and include Darvocet, Vicodin, Dilaudid, Demerol, Percocet, Oxycontin, and Fentanyl. Opioids are commonly prescribed for relief of dental pain because of their effective analgesic, or pain relieving, properties. Studies have shown that properly managed medical and dental use of opioid analgesic compounds is safe and rarely causes addiction. Taken exactly as prescribed, opioids can be used to manage pain effectively.
Hydrocodone is one of the most abused prescription drugs. Our patients who are abuse or are addicted to opioids may feign dental pain in order to get a prescription. This is one example of drug seeking behavior.
Fentanyl is a potent opioid drug 80-100 times more potent than morphine. This drug is commonly used during surgery and has lead to addiction and death of health care workers who have access to this to it. Fentanyl has been formulated into a "lolli-pop," intended for use by chronic pain patients. Several narcotics are now available in transdermal patches again intended for management chronic pain. Abuse of both patches and "lolli-pops" by both teens and adults is increasing at alarming rates.
The opiate class includes such drugs as opium, codeine, morphine, and heroin. Opium, codeine and morphine can be extracted directly from the opium plant. Heroin is the most addictive opiate because it penetrates the brain the fastest. There is no therapeutic use for heroin. There has been an increase in the use of heroin in the past few years. The increase is due to modification of heroin into a more pure form that can be smoked or ingested rather than injected intravenously a practice that became popular as the public learned that IV drug use was responsible for spread of infectious diseases such as HIV and/or hepatitis.
Table 8: Opiates & Opioids (Narcotics) , |
Action & Use
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These drugs (along with amphetamines and cocaine) offer the most powerful activation of the drug reward system. Activation of opiate receptors in the brain produces sensations of pleasure (reward) and pain relief (analgesic). Opiates may also be used as antidiarrheal and antitussive agents.
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Method(s) of
Administration |
- Oral (ingested and transmucosal)
- Snorted
- Smoked
- Injected (increased risk of hepatitis, HIV and blood poisoning)
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| Effects |
- Vomiting
- Drowsiness
- Depressed respiration
- Constricted (pinpoint) pupils
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| Prolonged Use/Abuse |
- Physical and psychological dependence
- Constipation
- Congested lungs
- Peptic and duodenal ulcers
- Diabetes
- Liver disease*
- Death
*narcotics pain relievers are commonly made with acetaminophen; abuse of these drugs expose the user to prolonged doses of acetaminophen
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Withdrawal Symptoms
A careful review of opiate withdrawal symptoms is important for dental professionals. Persons seeking drugs in the dental office often present with these clinical manifestations. |
(Usually begin within 24 hours after the last use and may last up to 10 days)
- Yawning
- Diarrhea
- Runny, itchy nose
- Uneasiness
- Weight loss
- Abdominal cramps
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DMX (dextromethorphan) 9, 10 Recent news reports have addressed the abuse of DMX found in over the counter (OTC) cough depressants taken in extremely high doses. At the doses recommended for treating coughs (1/6 to 1/3 ounce of medication, containing 15 mg to 30 mg dextromethorphan), the drug is safe and effective. At much higher doses (4 or more ounces), dextromethorphan produces dissociative effects similar to those of PCP and ketamine. One slang term for use is "skittling" since pills resemble Skittles candy.
"Robo shaking" describes a behavior that involves drinking large amounts of DMX containing cough syrup. Once the syrup is consumed vomiting is immediately induced making most of the DMX absorb into the stomach lining. The purpose is to enhance DMX effects and expel unwanted ingredients. (National Clearinghouse on Drug Abuse, 2001)
Continue on to
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Depressants
