All You Need to Know About Opioids
Opioids are psychoactive chemicals that relieve pain by binding into some opioids receptors in the brain. They are considered to be one of the oldest drugs that encompass analgesic effects which when taken by people, will immediately control the emotion and diminish the effect of painful stimulus.
Opioids come from the plant Opium Poppy, which is botanically known as Papaver somniferum. The plant was first cultivated around 3400 B.C. This plant is also found in Europe, North America, South America, and Asia and is referred to as the "common garden poppy". The opium poppy grows up 1.2 meters with flowers that have various attractive colors like white, pink, red, and purple. Their seeds also vary in color from white to blue.
Today, opioids can be found as contents in several painkillers like morphine, heroin, thebaine, codeine, papaverine and noscapine. To detect the presents of opioids in the body, a drug testing may be administered through the opiates drug test kit.
The opium poppy first got its name "opius", a Greek word for "little juice", where the word "opioids" basically has coined its name from. Back then, Opioids were used by Romans and Greeks to induce sleep and produce constipation. Two prominent Greek physicians, Hippocrates and Galen make use of the opium poppy to relieve headache, coughing, asthma, and to alleviate the feeling of sadness and cause euphoria.
In 1805, a German chemist Friedrich Serturner discovered the medicine morphine by isolating the opium poppy. By 1853, Alexander Wood invented the hypodermic syringe and developed the intravenous route of administration for morphine which was commonly administered to the wounded soldiers during the civil war.
However, people later on discovered the addictive effects of opioids. Most of the soldiers began craving for the drug and the instance was referred to as the Soldier's Disease.
Most people have known opiates to be a synonym of opioids, however; the two basically differ from each other. Opiates refer to the drugs that are derived from the opium poppy plant while opioids refer to the drugs that are created to mimic the effect of opium. Opioids are synthetic opiates. Although they resemble the same effect to humans, they are chemically different.
Today, the term "opioids" is used to call the entire family of opiates including natural, synthetic, and semi-synthetic.
The opium alkaloid refers to the dried latex that comes from the opium poppy plant. It is obtain by scratching the immature seed to obtain the white sap that firstly leaks out the seed. This later on dries into a sticky yellowish residue that is scraped from the fruit and is used to make a variety of pain killers.
- Morphine - This is the most common and abundant opium alkaloid found in the opium poppy plant. It consist 12 to 17 percent of the weight of the dried sap of opium poppy. Morphine is basically administered intravenously, subcutaneously, or via intramuscular to treat chronic pain. Its analgesic effects can last from 3 to 4 hours. However, while morphine is habit forming, most people who used the drug basically end up being dependent to it which is why morphine belongs to the group of the most commonly abused prescription drugs. A person who is medically treated by morphine may get positive drug testing. Longer association with morphine can cause several adverse effects which include constipation, gastric pains, and damage to coronary arteries which may even cause asphyxia and death. Quitting morphine in an instant will also cause severe withdrawal symptoms.
- Codeine - This drug is an isomer of mythelated morphine, also known as 3- methylmorphine. Codeine is the second most abundant opium alkaloid consisting 2 percent of the dried sap. Compared to morphine, codeine is more prevalent in the Iranian Poppy and is determined for its antidiarrheal usage. It is also use to treat mild and severe pain and is commonly found as content in some cough medicines. However, because of its addictive effects, this drug is one of the most commonly abused prescription drugs by teenagers. At first, codeine create the feeling of happiness and contentment from pain, but longer association may cause various side effects such as itching, nausea, vomiting, drowsiness, dry mouth, urinary irritation, constipation, and frequent mood swings.
- Thebaine - Thebaine is basically a minor constituent of opium. It got its name from the ancient city of Egypt called Thebai. However, unlike the others, this drug is not used medically but is used to create more effective opiate narcotics such as Oxycodone, Buprenorphine, and Naloxone. In the United Kingdom, Thebaine is considered to be a Class A drug, a group of the most dangerous yet largely abused drugs such as cannabis and cocaine. This drug is also labeled as Schedule II in the United States.
- Papaverine - Papaverine is another opium alkaloid but unlike the others, this drug is not used to treat pain but is basically used as a relaxant after surgeries. Thebaine is also used to treat spasms especially those that occurs inside the gastrointestinal tract, bile ducts, and urethra as well as a remedy to erectile dysfunction. By this, thebaine is directly applied or injected to penile tissues which immediately relax muscle tissues, thus; resulting to erection. Longer association with thebaine can be dangerous to health though. Its adverse effect can start from simple constipation, severe sweating, and loss of appetite to contagious hepatitis and even aggravated circumstance of cerebral vasospasm.
Classification of Opioids
Opioids are classified into four: naturally occurring opioids, endogenous opioids, synthetic opioids, and the semi-synthetic opioids. Their names were coined based on how they are derived and are used in a variety of situations.
- Naturally Occurring Opioids
Naturally occurring opiates are those that primarily come from the dries sap of the opium poppy plant. This includes the opium alkaloids such as morphine and codeine which are used to treat mild to severe pain, and thebaine which is converted industrially to make up more effective analgesics like Oxycodone. Most of the drugs that are made from the naturally occurring opiates such as Astramorph PF morphine are prescription drugs or drugs that cannot be taken out without any prescription. Longer association of the naturally occurring opioids can actually be addictive which is why some patients become dependent to it. Some teenagers, however; simply use the drug for recreational purposes.
- Endogenous Opioids
These are the types of opioids that are produced in the body such as endorphins, enkephalins, dynorphines, and endomorphins. Endorphins are produced in the pituitary glands during strenuous activity and orgasm but they also produced analgesic effects same to that of the naturally occurring opioids. Enkephalins are produced in the body in response to painful circumstance. Dynorphines are produced from the precursor prodynorphin which arise during the proprotein process. Endomorphins, on the other hand, have the highest affinity in the opioids receptors. There are two types of endomorphins, the first is Endomorphin 1 which is commonly produced in the brain and the other is Endomorphin 2, which is more common in the spinal cord.
- Synthetic Opioids
Synthetic opioids refer to opiates that are only made in laboratories emulating the effects of real opiates. These false opiates are considered to be less addictive and are often prescribed by doctors to treat pain than the real ones. Unlike the naturally occurring opiates, these do not immediately draw positive opiate drug test result. Some examples of the synthetic opioids include fentanyl, pethidine, methadone, tramadol, and dextroprpoxyphene. The most common one is fentanyl which is actually sold in pharmacies under different brand names such as Sublimaze, Actiq, Duragesic, Fentora, Onsolis, and Instanyl. These drugs are commonly prescribed by doctors to treat pains caused by cancer treatment.
- Semi-synthetic Opioids
These drugs are basically created from various chemical manipulations of the sap extracted from the opium poppy plant. These are the substances that have already undergone certain processes in order to create more effective medicines that resemble the same effects such that of the naturally occurring opiates. Two most common examples of semi-synthetic opioids include hydrocodone and oxycodone. Both resembles a morphine-like effect which are usually prescribed to patients suffering from severe pain; however, because of their highly addictive characteristic that lured many teenagers to abuse the drugs, both the hydrocodone and oxycodone are now labeled as Schedule II drugs which belong to the most dangerous yet commonly abused prescription drugs among teenagers. Some other examples of semi-synthetic opioids include heroin, oxymorphone, desomorphine, nicomorphine, dipropanoylmorphine, benzylmorphine, and ethylmorphine.
Medical Usage of Opioids
The pure opium poppy plant has been greatly used as remedy to pain even long before the discovery of morphine. With the advent of medical machineries, today the dried sap of the opium poppy plant has been converted into a variety of prescription medicines used to relieve pain such as paracetamols and analgesics.
Opioids are basically contained in some medicines and are prescribed by doctors to treat mild to severe pain. Their main function is to bind with the opioids receptor in the brain and prevent the body from feeling the throbbing of muscle tissues.
The hydrocodone and oxycodone are most commonly used to treat pain after a surgery or to remedy the pains of excruciating cancer treatments as well as dental and injury-related pain. Codeine, however; is only to treat mild pains and is also used to relieve coughs and diarrhea.
The discovery of opioids' addictive effects has actually marked a significant change on opioids usage. Although modern technology has converted the drug into useful medicines such as codeine and morphine, their addictive nature has lured people to abuse the drugs.
Nowadays, opioids are still prescribed by doctors in order to treat mild to severe pain, however; at the same time used by teens and adults for recreational use.This is the reason why many countries have joined together to promulgate the U.N. Commission of Narcotic Drugs which actually put opioids into a few of the prohibited drugs. With this, any person who is caught using the drug, unless it is prescribed by doctors, will face some criminal liabilities.
Furthermore, in some other countries like South America, the opium poppy plants are used as decorations. In some parts of the country, the opium poppy is cultivated even without legal controls while the seeds, despite containing morphine, codeine, and many other alkaloids, are made into colorful house decorations. In some cases, opioids are also topped into bread and cookies to add flavor or boiled in order to make a bitter tea.
According to research, teens are very prone to opiate drug addiction, especially during high schools and college years when they begin to separate from their parents.
In a survey conducted by the National Substance Use Drug Health, drugs are commonly smuggled at school and are easily obtainable from friends and colleagues. According to data, more than 2500 teenagers between 12 to 17 years old abuse opioids for the first time each day. And since 1992, the number of children abusing opioids has tripled in number.
The two most commonly abused forms of opioids are prescription pain killers and heroin. However, prescription painkillers have shown to be the favorite of most children. In a survey done in 2006, more than 2.1 millions kids with age between 12 20 13 years old were found to be abusing prescription killers. In fact, they abused more than they abuse cocaine, heroin, and methamphetamine combined.
- Perilous Pastries
The availability of perilous pastries has also lured teens to abuse opioids without being caught.
In truth, some bakeries make use of the poppy seeds as flavorings to their breads and cakes. Bakers usually topped one gram of poppy seeds which actually contain 33 micrograms of morphine and 14 micrograms of codeine. In North America, they make used of the poppy seed oil to bake rusk, bagels, and cakes. In Europe, bakers sprinkle poppy seeds on top of their white bread pastries to create the popular bun known as Cozonac which is actually traditional Romanian sweet bread.
These baked goodies are sometimes used as medicines, but in some places, they are simply sold naturally like any other ordinary bread. However, their availability has actually added more reasons for youth to abuse opioids. What is even more appalling is the prevalent act of neglecting its forthcoming dangers.
According to research, eating two rolls of opium poppy bread can cause positive opiate drug testing since one roll already contains 0.76 grams of poppy seeds. Likewise, a slice of cake which contains 5 grams of poppy seeds can also positive opioids drug testing within 24 hours. Frequent eating of the perilous pastries, can actually make a person more addicted to opioids.
- Cheese, fentanyl, syrup and soda
The cheese made from heroin is actually another type of opioids, created by a combination of heroin and cold medication drugs like Tylenol and the antihistamine diphenhydramine which is an active ingredient in Benadryl. In Dallas, Texas the widespread of cheese samples have actually cause severe addiction to the youth as well as great tragedy in schools where a number of students died from its withdrawal symptoms. Cheese has a very strong potency that appears from 6 to 24 hours. This is also the reason why it is termed by the many as "starter heroin."
Fentanyl is actually one of the most common medicines for pain derived from the original opium poppy plant which is four times more potent than morphine. It is used to treat pains caused by cancer treatment but is commonly abused by many people to calm and soothe emotions. The lollipop fentanyl or Actyq lollipop is actually known to be mostly eaten by children.
In 1990, heroin sodas and syrups were made popular by the hip hop community especially in Houston Texas. Back then, codeine and promethazine is mixed into soft drinks like sprite, mountain dew, coke, and sprite to make up opiate sodas. Today, these types of drinks are known as Purple Drink, Sizzurp, or lean.
Whether a person use opioids for medical or recreational reasons, opioids always bring varying effects to both physical and psychological aspects of a person. Medical effects of opioids are good. When they are medically used, they alter the person's perception with pain and relieve the muscles and tissues from feeling the ache.
However, while opioids are highly addictive drugs, taking opioids for longer medications may cause physical addiction. This is clearly manifested in a person who cannot go through such pain without taking opioids. This physical addiction may also lead to a series of psychological effects which are considered as negative.
Symptoms of Opioids Abuse
There are many ways to detect whether or not a person is using opioids for recreational purposes. These symptoms may also occur when a person is going under opiate medication but some may also lead to a suspicious opiate abuse which can become strong grounds for opiate drug testing.
The following are symptoms of opiate abuse and addiction:
- Taking longer larger doses of opioids in order to get the desired effects
- Spending a lot of time focusing on drug such as taking it over and over again even without the feeling of pain
- Hiding large doses of medicines and buying it without doctor's prescription
- Weight loss as a result from loss of appetite
- Nausea / vomiting even without eating meals
- Untidy physical appearance
- Having dark sunken or reddish eyes
- Becoming stubborn and paranoid
- Suicidal thoughts
- Altered social activities
- Social problems such as withdrawal from family and friends
- Significant problems at work
- Poor decision making
- Becoming irresponsible and dishonest
Adverse effects of Opioids to Health
Abusing opioids can reflect in the eyes of the abuser. Unlike cocaine which makes the person's eyes alert and highly suspicious, opiates make the person's pupil to look extremely constricted to pin points in the eye. This is the reason why people who abused opiates are termed as "pinned" wherein their pupils looked almost invisible due to their small size.
However, what abusers have actually neglected behind its euphoric effect are the dangers opiates can cause to the central nervous system. Since prescription medications like Oxycontin and Vicodin suppresses the central nervous system causing the function of the brain and the body to slow, taking larger dosage of the drugs can be very dangerous to the health.
The following are the adverse effects of opiates to health:
- Elevated body temperature
- Increased heart rate and blood pressure
- Decreased appetite
- Chest pain
- Difficulty breathing
- Heart attack and stroke
Drug testing on opiates can be done in three ways: saliva drug testing, urine drug testing, and hair follicle test.
Using the drug test kits, drug testing on opiates basically detect for opiate metabolites. During a urine drug test, a urine sample is obtained from the subject. The sample undergoes an initial test known as immunoassay. If the urine sample is positive during the initial test, another sample will be taken from the subject to perform the confirmatory test known as gas chromatography- mass spectrometry.
On the other hand, the saliva drug testing is performed through the use of a swab which is similar to that of an ordinary toothbrush. The swab is placed in the lower cheek and gum to gather the saliva for two minutes until it gets wet before it is brought to the laboratory for the detection of opiate metabolites.
Lastly, the hair follicle test detects for opiate metabolites through the piece of hair, particularly 1.5 inch closest to the scalp. According to studies, when a person abuse drugs, it actually goes through the bloodstream and is absorbed by the hair when they grow. The hair follicle test detects for any drug history within 90 days while detection period can last up to 5 days.
What will cause positive opiates?
Opiate medication can cause positive opiates when a person undergoes opiate drug test, however; this positive result is referred to as false positive. In this case, a person may not face any liabilities. In this case, sspeople who are into opioids medication must inform authorities about their condition before any drug test to be able to come up with unbiased result.
Medicines like OxyCodone, Codeine, Hydrocodone, Fentanyl, Tylenol #3, Norco, Vicodin, ENdocet, Percocet, Percodan, Codeine Sulfate, Acetaminophen with Propoxyphene, Fentanyl (aka Actiq), MS Contin, Oramorph SR, OxyContin, and Morphine can actually cause positive opiates. A person may also result into positive codeine when taking cough suppressants like Robitussin A-C and Robitussin DAC as well as head ache analgesics like Fiorinal, Fioricet and Butalbital.
Detection of Drug Metabolite 6-AM
The 6-acetylmorphine or 6- AM is the drug metabolite of heroin which can be detected through the opiate drug test kits in a person who use heroin for recreational purposes. 6 -AM basically serves as confirmatory for heroin abuse in order to prevent false positive results. Drug testing detects for the drug metabolite within 2 to 4 days while 6 -AM itself is already detectable 3 to 5 minutes after injection. The metabolite has a short half-life of 36 minutes which can be detected in urine after 8 hours of heroin usage. It is important to note that 6-Am is not a metabolite of morphine and codeine but complications can occur when heroin is mixed with codeine and morphine.
New Federal Cut- off Level
To avoid false positive result, the Substance Abuse and Mental Health Services Administration (SAMHSA) has mandated a specific cut -off level of drugs for every drug testing methods. This is the minimum residue of drugs that must be confirmed in the sample in order for a person to be labeled as positive. By then, a person may be required to explain the drug positivity or face some liabilities.
Previously, the SAMHSA mandated that all drug screening laboratories to use 300 ng/ml cut off level of drug metabolites in urine samples. However, due to frequent false positive results and the increasing number of teens abusing drugs as well as the existence of the different detox methods, it was later on revised in October 10.
The new federal cut-off level for 6 -AM is now at 10 ng/ml. Confirmatory test cut-off is more than 2, 000 ng/ml. For opiate in general, the new federal cut- off is 300 ng/ml for the initial test and 2000 ng/ml for the confirmatory test. For codeine and morphine, initial test cut-off level is 120 ng/ml while the confirmatory should be 2000 ng/ml.