CAS RN: 56030-54-7

Key Info


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.
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.

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