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Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the dried latex of the opium poppy; it is mainly used as a recreational drug for its euphoric effects. Heroin is used medically in several countries to relieve pain, such as during childbirth or a heart attack, as well as in opioid replacement therapy. Medical-grade diamorphine is used as a pure hydrochloride salt. Various white and brown powders sold illegally around the world as heroin are routinely diluted with cutting agents. Black tar heroin is a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin.
Morphine, formerly also called morphia, is an opiate that is found naturally in opium, a dark brown resin produced by drying the latex of opium poppies. It is mainly used as an analgesic. There are numerous methods used to administer morphine: oral; sublingual; via inhalation; injection into a muscle, injection under the skin, or injection into the spinal cord area; transdermal; or via rectal suppository. It acts directly on the central nervous system (CNS) to induce analgesia and alter perception and emotional response to pain. Physical and psychological dependence and tolerance may develop with repeated administration. It can be taken for both acute pain and chronic pain and is frequently used for pain from myocardial infarction, kidney stones, and during labor. Its maximum effect is reached after about 20 minutes when administered intravenously and 60 minutes when administered by mouth, while the duration of its effect is 3–7 hours. Long-acting formulations of morphine are available as MS-Contin, Kadian, and other brand names as well as generically.
Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for chronic pain and also for opioid use disorder. It is used to treat chronic pain, and it is also used to treat addiction to heroin or other opioids. Prescribed for daily use, the medicine relieves cravings and removes withdrawal symptoms. Withdrawal management using methadone can be accomplished in less than a month, or it may be done gradually over a longer period of time, or simply maintained for the rest of the patient's life. While a single dose has a rapid effect, maximum effect can take up to five days of use. After long-term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein.
Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.
Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid among others, is a morphinan opioid used to treat moderate to severe pain. Typically, long-term use is only recommended for pain due to cancer. It may be used by mouth or by injection into a vein, muscle, or under the skin. Effects generally begin within half an hour and last for up to five hours. A 2016 Cochrane review found little difference in benefit between hydromorphone and other opioids for cancer pain.
An orphan drug is a pharmaceutical agent that is developed to treat certain rare medical conditions. An orphan drug would not be profitable to produce without government assistance, due to the small population of patients affected by the conditions. The conditions that orphan drugs are used to treat are referred to as orphan diseases. The assignment of orphan status to a disease and to drugs developed to treat it is a matter of public policy that depends on the legislation of the country.
Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.
Opioids are a class of drugs that derive from, or mimic, natural substances found in the opium poppy plant. Opioids work in the brain to produce a variety of effects, including pain relief. As a class of substances, they act on opioid receptors to produce morphine-like effects.
Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.
Buprenorphine, sold under the brand name Subutex among others, is an opioid used to treat opioid use disorder, acute pain, and chronic pain. It can be used under the tongue (sublingual), in the cheek (buccal), by injection, as a skin patch (transdermal), or as an implant. For opioid use disorder, the patient must have moderate opioid withdrawal symptoms before buprenorphine can be administered under direct observation of a health-care provider.
Oxymorphone is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it begins after about 30 minutes, and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high potential to be abused.
A methadone clinic is a medical facility where medications for opioid use disorder (MOUD) are dispensed-—historically and most commonly methadone, although buprenorphine is also increasingly prescribed. Medically assisted drug therapy treatment is indicated in patients who are opioid-dependent or have a history of opioid dependence. Methadone is a schedule II (USA) opioid analgesic, that is also prescribed for pain management. It is a long-acting opioid that can delay the opioid withdrawal symptoms that patients experience from taking short-acting opioids, like heroin, and allow time for withdrawal management. In the United States, by law, patients must receive methadone under the supervision of a physician, and dispensed through the Opioid Treatment Program (OTP) certified by the Substance Abuse and Mental Health Services Administration and registered with the Drug Enforcement Administration.
Lubiprostone, sold under the brand name Amitiza among others, is a medication used in the management of chronic idiopathic constipation, predominantly irritable bowel syndrome-associated constipation in women and opioid-induced constipation. The drug is owned by Mallinckrodt and is marketed by Takeda Pharmaceutical Company.
Thebacon, or dihydrocodeinone enol acetate, is a semisynthetic opioid that is similar to hydrocodone and is most commonly synthesised from thebaine. Thebacon was invented in Germany in 1924, four years after the first synthesis of hydrocodone. Thebacon is a derivative of acetyldihydrocodeine, where only the 6–7 double bond is saturated. Thebacon is marketed as its hydrochloride salt under the trade name Acedicon, and as its bitartrate under Diacodin and other trade names. The hydrochloride salt has a free base conversion ratio of 0.846. Other salts used in research and other settings include thebacon's phosphate, hydrobromide, citrate, hydroiodide, and sulfate.
Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments, and cost reduction or avoidance in other parts of the health care system. Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review evaluate products in this way.
An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics. Equianalgesic charts are used for calculation of an equivalent dose between different analgesics. Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.
An opiate is an alkaloid substance derived from opium. It differs from the similar term opioid in that the latter is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain. Opiates are alkaloid compounds naturally found in the opium poppy plant Papaver somniferum. The psychoactive compounds found in the opium plant include morphine, codeine, and thebaine. Opiates have long been used for a variety of medical conditions, with evidence of opiate trade and use for pain relief as early as the eighth century AD. Most opiates are considered drugs with moderate to high abuse potential and are listed on various "Substance-Control Schedules" under the Uniform Controlled Substances Act of the United States of America.
Intractable pain, also called intractable pain syndrome (IPS), is a severe, constant, relentless, and debilitating pain that is not curable by any known means and which causes a house-bound or bed-bound state and early death if not adequately treated, usually with opioids and/or interventional procedures. It is not relieved by ordinary medical, surgical, nursing, or pharmaceutical measures. Unlike the more common chronic pain, it causes adverse biologic effects on the body's cardiovascular, hormone, and neurologic systems. Patients experience changes in testosterone, estrogen, cortisol, thyroid hormones, and/or pituitary hormones. Both men and women require testosterone, however many doctors neglect to test women for low testosterone. Untreated intractable pain can cause death.
Martin T. Schechter is a Canadian epidemiologist recognized for contributions to research about HIV prevention and treatments, addiction research, and Indigenous health research. He is a professor and was the founding director of the School of Population and Public Health in the Faculty of Medicine at the University of British Columbia (UBC). Schechter received his Order of British Columbia in 1994 alongside BC's first Nobel Prize laureate Michael Smith and noted Indigenous artist Bill Reid. In 2022, Schechter was named as a Member of the Order of Canada.
Buprenorphine/naloxone, sold under the brand name Suboxone among others, is a fixed-dose combination medication that includes buprenorphine and naloxone. It is used to treat opioid use disorder, and reduces the mortality of opioid use disorder by 50%. It relieves cravings to use and withdrawal symptoms. Buprenorphine/naloxone is available for use in two different forms, under the tongue or in the cheek.
References
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- ↑ "Language Movement veteran Dr Col Rokaiya Anis passes away". Daily Sun. Retrieved 2020-11-03.
- ↑ "SPPH Welcomes New Director Dr. Aslam Anis". School of Population and Public Health (SPPH). 2021-03-09. Retrieved 2021-03-15.
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- ↑ Anis, Aslam H.; Wen, Quan (1998-01-01). "Price regulation of pharmaceuticals in Canada". Journal of Health Economics. 17 (1): 21–38. doi:10.1016/S0167-6296(97)00016-7. ISSN 0167-6296. PMID 10176313.
- ↑ "OHE Welcomes Dr. Aslam Anis". www.ohe.org. 2015-01-28. Retrieved 2020-11-03.
- ↑ Anis, Aslam H.; Guh, Daphne; Hogg, Robert S.; Wang, Xiao-Hua; Yip, Benita; Craib, Kevin J. P.; O’Shaughnessy, Michael V.; Schechter, Martin T.; Montaner, Julio S. G. (2000-10-01). "The Cost Effectiveness of Antiretroviral Regimens for the Treatment of HIV/AIDS". PharmacoEconomics. 18 (4): 393–404. doi:10.2165/00019053-200018040-00007. ISSN 1179-2027. PMID 15344307. S2CID 20186375.
- ↑ Luba, Frank. "Why a B.C. doctor says heroin may be better than methadone for addicts". The Province. Retrieved 2020-11-03.
- 1 2 Bansback, Nick; Guh, Daphne; Oviedo-Joekes, Eugenia; Brissette, Suzanne; Harrison, Scott; Janmohamed, Amin; Krausz, Michael; MacDonald, Scott; Marsh, David C.; Schechter, Martin T.; Anis, Aslam H. (2018). "Cost-effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial". Addiction. 113 (7): 1264–1273. doi:10.1111/add.14171. ISSN 1360-0443. PMID 29589873. S2CID 4382466.
- ↑ Oviedo-Joekes, Eugenia; Brissette, Suzanne; Marsh, David C.; Lauzon, Pierre; Guh, Daphne; Anis, Aslam; Schechter, Martin T. (2009-08-20). "Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction". New England Journal of Medicine. 361 (8): 777–786. doi:10.1056/NEJMoa0810635. ISSN 0028-4793. PMC 5127701 . PMID 19692689.
- ↑ Oviedo-Joekes, Eugenia; Guh, Daphne; Brissette, Suzanne; Marchand, Kirsten; MacDonald, Scott; Lock, Kurt; Harrison, Scott; Janmohamed, Amin; Anis, Aslam H.; Krausz, Michael; Marsh, David C. (2016-05-01). "Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence". JAMA Psychiatry. 73 (5): 447–55. doi: 10.1001/jamapsychiatry.2016.0109 . ISSN 2168-622X. PMID 27049826.
- ↑ Mar 26, Kyle Duggan Published on; 2018 9:39am (2018-03-26). "Health Canada speeding up access to prescription heroin, methadone". iPolitics. Retrieved 2020-11-03.
{{cite web}}: CS1 maint: numeric names: authors list (link) - ↑ "CAHS Fellows Directory – Canadian Academy of Health Sciences | Académie canadienne des sciences de la santé" . Retrieved 2020-11-03.