CAS RN: 71195-58-9

Health Effects

  • A) USES: Opioids are primarily used for the treatment of pain, less often for cough suppression. Opioids are commonly abused for euphoric effects by multiple routes (ie, injection, insufflation, smoking, ingestion and transdermal). The following agents and opioid withdrawal have their own specific managements, please refer to them as indicated: buprenorphine, butorphanol, codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphone, levorphanol, long-acting opioid antagonists (nalmefene, naltrexone, nalmexone), meperidine, methadone, methadone, oxycodone, pentazocine, propoxyphene, tramadol, and naloxegol. Synthetic designer drugs, such as AH-7921, MT-45, and U-47700 (also known as U4), are commonly abused for euphoric effects.
  • B) PHARMACOLOGY: Opioids are a group of chemical substances, naturally occurring and synthetic, that bind at the opiate receptor. Opiates are a group of naturally occurring compounds derived from the poppy, Papaver somniferum.
  • C) TOXICOLOGY: Therapeutic and toxic effects are mediated by different opioid receptors. Mu 1: Supraspinal and peripheral analgesia, sedation and euphoria. Mu 2: Spinal analgesia, respiratory depression, physical dependence, GI dysmotility, bradycardia and pruritus. Kappa 1: Spinal analgesia and miosis. Kappa 2: Dysphoria and psychotomimesis. Kappa 3: Supraspinal analgesia. Chronic opioid users develop tolerance to the analgesic and euphoric effects, but not to the respiratory depression effects.
  • D) EPIDEMIOLOGY: Overdose is common, particularly in patients with chronic opioid abuse, and often life threatening (especially a heroin or methadone overdose).
    • 1) MILD TO MODERATE POISONING: Euphoria, drowsiness, constipation, nausea, vomiting and miosis. Mild bradycardia or hypotension may be present.
    • 2) SEVERE POISONING: Respiratory depression leading to apnea, hypoxia, coma, bradycardia, or acute lung injury. Rarely, seizures may develop from hypoxia. Acute tubular necrosis secondary to rhabdomyolysis and myoglobinuria may develop in patients with prolonged coma or seizures. Death may result from any of these complications. Scleroderma following heroin abuse has been reported and may be linked to talc mixed with heroin. Wound botulism resulting in flaccid paralysis may occur following black tar heroin abuse. Hypoglycemia and leukocytosis have been reported in heroin abusers. Intraarterial injection can cause ischemia.
    • 3) DESOMORPHINE: Severe tissue damage, phlebitis, gangrene, and limb ischemia leading to amputation, and death have been reported following IV or IM injections of "Crocodile" (also known as Krokodil or Russian heroin), a Russian slang term for homemade desomorphine.
    • 1) In severe overdose, hypotension, and respiratory depression are common.
  • A) Most opioids and opioid antagonists are classified as FDA pregnancy category B or C. Fetal physical dependence, withdrawal symptoms and respiratory difficulties may occur in infants born to mothers physically dependent on opioids. Neonatal withdrawal may be seen in the infants of addicted mothers 12 to 72 hours after birth. Infants may be dehydrated, irritable, and experience tremors and cry continually and may have diarrhea. In addition, there have been reports of severe fetal bradycardia, including life-threatening cases, following maternal administration of nalbuphine during pregnancy and/or labor and delivery.
  • A) Bladder carcinomas have been reported in a higher proportion of opium smokers than in cigarette smokers or non-smokers. A case-control study conducted in Iran of 309 cases of gastric adenocarcinoma and 613 matched controls found that opium use was associated with an increased risk of gastric adenocarcinoma.
Find more information on this substance at: PubChem, PubMed