Office of National Drug Control Policy

Established by Act of the US. Congress in 1988 and is organized within the Executive Office of the President. ONDCP is authorized to develop and coordinate the policies, goals, and objectives of the Nation's drug control program for reducing the use of illicit drugs. ONDCP engages in activities that both meet the requirements of its authorization and represent the values and commitments of the President and its Director. Officinal 1. Readily available in pharmacies■; not requiring special preparation. 2. Recognized by a pharmacopoeia: an officinal herb. French, from Medieval Latin officinalis, of a storeroom or workshop, from Latin officina, workshop, alteration of opi-ficina, from opifex, opific-, workman : opus, work + facere, to do. Ofium Opium.

OGD Observatoire géopolitique des drogues. Oglan Turkish colloquial term for heroin. Ogoy Turkish colloquial term for heroin. Ogyline Zipeprol.

Ohio bag Colloquial term for a packet of 100 grams of marijuana.

Ohmefentanyl Beta-hydroxy 3-methylfentanyl.

Ohton Dimethylthiambutene or Dimethyl-

thiambutene hydrochloride.

Ohuetagi Brugmansia suaveolens.

Oicadil Cloxazolam.

Oil Colloquial term for hashish oil.

Oil based Cocaine which is purified using kerosene process, and is thought to be more potent.

Oil burner Colloquial term for a drug addict. Oil burning habit Colloquial term for drug addiction.

Oiled Colloquial term for being high on drugs.

Oiler Colloquial term for a person who uses hashish oil.

Oili Finnish colloquial term for hashish oil. Oinker Colloquial term for a drug police agent.

OJ 1. Colloquial term for marijuana and opium. 2. Colloquial term for opium. Oja Nigerian colloquial term for marijuana. Ojitos de picho Rhynchosiapyramidalis. Ojo de cangrejo Rhynchosia pyramidalis. Ojo de chanate Rhynchosia pyramidalis. Ojo de culebra Rhynchosia pyramidalis. Ojo de pajarito Rhynchosia pyramidalis. Ojo de zanate Rhynchosia pyramidalis. Okay scene Colloquial term for a party with plenty of drugs available. Okodon Pemoline. Okolehao Oke.

OK 1. Colloquial term for heroin. 2. Colloquial term for heroin. Oksazepam Oxazepam. Oksikon Oxycodone. Oksydihydrokodeinon Oxycodone. Oksykon Oxycodone. Oksymorfon Oxymorphone. Oktedrin Amfetamine sulfate. Okulcocugu Turkish colloquial term for codeine.

Okun, Herbert S. Member of UN:s International Narcotics Control Board, INCB. International executive and ambassador. Oke Alcoholic beverage made of sugar molasses from rhizome from Colocasia antiquorum. The rhizome is called kalo or taro. The fermentation process is made by the yeast fungus preparation koori which is obtained by cultivating mould fungus on boiled rice. Oke kan matures in charcoaled oak barrels and get a taste similar to whiskey. Made mainly in Hawaii.

Ol meraa Colloquial term for khat. Old E Rap (hip hop) term for beer, presumably from Old English beer. Old Lady White Colloquial term for drugs in powder form.

Old Steve Colloquial term for drugs in powder form.

Old swill Colloquial term for Old Milwaukee beer.

Old timers 12 Step group- term for a persons who have been in the 12 Step program for long periods of time, have been regular in attendance throughout that time, and tend to be very rigid about following the suggested steps exactly as written because of previous repeated failures at trying to accomplish the same goals using other methods. Old woman's broom Turnera diffusa. Olfaricur Amfetamine sulfate. Oliban Boswellia sacra. Olibanum Boswellia sacra. Olibanumbaum Boswellia sacra. Olivenstein, Claude (b. 1933), French psychiatrist and leading drug expert who have written several books on drug abuse. he is critical to the "pharmaceutical pub" that the Western world according to him has developed into. He has also tried to explain the cultural differences between drug abuse in different countries. 1971 he founded a drug treatment program Hopital Marmottan. Olja Swedish colloquial term for hashish oil. Olla paukilla Finnish colloquial term for smoking hashish.

Olla pilvessa Finnish colloquial term for being high on hashish.

Olle Swedish colloquial term for smoking heroin.

Olle Bris Swedish colloquial term for hashish.

Ololiuhqui Turbina corymbosa. See: Olo-liugui.

Ololiuqui Turbina corymbosa. See: Olo-liugui.

Ololuiqui Seeds from the liana Turbina co-rymbosa, also called Rivea corymbosa, grows in the tropical parts of South America. The long stems have heart-formed leaves and white flowers with green stripes, the fruit is round and contains a seed, 3 mm. Ololuiqui was one of the most important drugs in the az-tecan religion and is still used among the ma-zateques, mixteques and zapoteques. The fruits are blessed and then ritually crushed with a stone and made into a fine powder that is put into water and filtered. The drug is taken nightly in a covered solitary place where the appointed makes his trip to the goods. The alkaloid are similar to the ergot alkaloids and the intoxication is similar to LSD. Olquadil Cloxazolam.

Om sultone compositum Drug containing more than one substance under international control: Amobarbital. Om-hidantoine-C Phenobarbital.

Om-kwan Colloquial term for smoking heroin from a aluminum foil where it is heated with a lighter and then the smoke is sucked through a drinking straw. Compare: Chasing the dragon.

Omahenmilch Opium. Omca Drug containing more than one substance whereof one under international control: Pentobarbital. Omca-Nacht Pentobarbital. Omen Colloquial term for low to medium grade PCP

Omequelite Piper auritum. Omequilit-dos quelite Piper auritum. OMF Beta-hydroxy-3-methylfentanyl. Ommbarb Phenobarbital. Omnalio Chlordiazepoxide or Chlordiazepoxide hydrochloride. Omnibel Drug containing more than one substance whereof one under international control: Pentobarbital or Phenobarbital. Omnibex Phentermine resinate. Omnipotence One having unlimited power or authority. Feelings of omnipotence is a common effect of the use of stimulants like amfetamine and cocaine. Middle English, from Old French, from Latin om-nipotens, omnipotent- : omni-, omni- + potens, present participle of posse, to be able.

Omnised Pentobarbital sodium. Omnisedan Drug containing more than one substance whereof one under international control: Meprobamate or Methaqualone or Methaqualone resinate. Omnisedan duplex Drug containing more than one substance whereof one under international control: Meprobamate. Omnopon, -e, -um Opium, mixed alkaloids of.

Omnyl Methaqualone or Methaqualone resinate.

Omo ile Colloquial term for marijuana. Omturnen Dutch colloquial term for turn someone on to drugs.

On Colloquial term for being under the influence of drugs.

On a mission Colloquial term for searching for crack.

On a trip Colloquial term for being under the influence of drugs.

On blotter Colloquial term for LSD on paper.

On edge Colloquial term for being irritated and nervous as the drug effect wears off. On fire Colloquial term for a very good drug effect, especially. from heroin. On happy medicine Colloquial term for being addicted to morphine. On ice Colloquial term for being in jail or staying away from observation.

On one's back Colloquial term for being in dire need of drugs.

On stuff Colloquial term for being addicted. On tape Colloquial term for knowing by heart, for example telephone numbers and addresses which are not recorded for safety reasons.

On the Nickel Film released in 1980. Director: Ralph Waite; Robert Waite. This sentimental drama is set upon Los Angeles' notorious Fifth Avenue and tells the sad tales of some of the skid-row bums who live there. The tale centers on one man who managed to escape the boozy haze of derelict life and make good. Unfortunately, when his best friend gets into trouble, he finds himself having to return. The tale was written and directed by recovered alcoholic Ralph. Tom Waits composed the score.

On the beam Colloquial term for being high on drugs.

On the bricks Colloquial term for walking the streets.

On the capital H Colloquial term for being addicted to heroin.

On the go 1. Colloquial term for being addicted. 2. Colloquial term for being high on drugs.

On the ground Colloquial term for being released from prison.

On the horse Colloquial term for being addicted to heroin.

On the house Colloquial term for beverages being provided by the drinking establishment, sometimes done for good will, sometimes to begin the festivities with an expectation of significant return.

On the junk Colloquial term for being addicted to heroin.

On the lam Colloquial term for running away from trouble or law enforcement personnel.

On the natch 1. Colloquial term for being drug-free. 2. Colloquial term for involuntary, sudden withdrawal.

On the needle Colloquial term for injecting drugs.

On the nod Colloquial term for being under the influence of narcotics or depressants. On the nog Colloquial term for the sleepy condition following the use of drugs, especially heroin or large quantity of methadone. On the perch Colloquial term for being high on drugs.

On the pine Colloquial term for freebasing cocaine.

On the pipe 1. Colloquial term for being addicted to opium. 2. Colloquial term for smoker offree base cocaine.

On the prod Colloquial term for being addicted to drugs.

On the spike Colloquial term for being addicted to drugs.

On the stem Colloquial term for a smoker of crack.

On the street 1. Colloquial term for being released from prison. 2. Colloquial term for the drug scene. 3. Colloquial term for using drugs. 4. Colloquial term for being in action. On the stuff Colloquial term for being addicted to drugs.

On the tar Colloquial term for being addicted to opium.

On the wagon Colloquial term for avoidance of alcoholic beverages. On the water wagon Colloquial term for avoidance of alcoholic beverages. On tour Colloquial term for looking for drugs.

Ona-mast Phentermine or Phentermine hydrochloride.

Onadox-118 Drug containing more than one substance whereof one under international control: Dihydrocodeine bitartrate. Oncidium cebolleta Cebolleta. Onda (en) To be high. Ondasil Glutethimide.

ONDCP Acronym for Office of National

Drug Control Policy. Executive Office of the

US president and the main presidental advisor on drug abuse issues.

One 1. Colloquial term for amfetamines.

2. Colloquial term for hashish oil.

One and one Colloquial term for snorting cocaine.

One box tissue Colloquial term for one ounce of crack.

One day at a time [AA and other 12 Step group slogan] ceasing to consume substances on a daily basis - it may be impossible to stop doing anything on a "forever" basis, but stopping for just one day (today) is a reasonable possibility.

One dollar Colloquial term for 100 gram of a drug.

One fifty one (151) 151 rum, so named because it is 151 proof, indicating that the rum is 75.5% alcohol -sufficient to kill bacteria. One for the road Colloquial term for a parting drink.

One grain Colloquial term for standard measurement for a syringe, contains half a grain (0.0324 grams).

One hitter quiter Colloquial term for marijuana that takes one hit to obtain a high. One kartoo Colloquial term for a roll of marijuana.

One panchak Colloquial term for 1 drop of opium for oral use.

One straw Colloquial term for heroin in a plastic straw.

One thou Colloquial term for 1,000 (money or grams).

One tinne Colloquial term for the amount of opium needed to fill 2 pipes.

One way 1. Colloquial term for LSD.

2. Colloquial term for heroin.

One way ticket Colloquial term for a lethal overdose.

One way trip Colloquial term for a bad trip. One young Colloquial term for 40 grams of raw opium.

One, the Colloquial term for hashish oil. One-fifty-one Colloquial term for crack. One-hit grass Colloquial term for DMT. One-seven-five-one Colloquial term for being in possession of barbiturates. One-seven-four-seven Colloquial term for wrongful possession of a large quantity of drugs presumed to be not for personal use. One-toke weed Colloquial term for marijuana.

ONeill, Eugene Gladstone (1888-1953) American dramatist, Nobel laureate, winner of four Pulitzer Prizes, who attempted to define fundamental human problems in his works. He is considered the most important writer in the American theater. His most famous play A Long Day's Journey into Night is an autobiographical play about a family where the mother is addicted to morphine and other family members has alcohol problems. From 1934 until his death O'Neill suffered from a crippling nervous disorder similar to Parkinson's disease. During this entire period he worked intermittently on a long cycle of plays concerning the history of an American family but completed only A Touch of the Poet (produced 1958) and More Stately Mansions (United States production 1967). After 1939 he wrote three other plays unrelated to the cycle: The Iceman Cometh (1946), which portrays a group of social misfits unable to live without illusions, and two tragedies dealing with his family, Long Day's Journey into Night (produced 1956, Pulitzer Prize, 1957) and A Moon for the Misbegotten (produced 1957). O'Neill was awarded the 1936 Nobel Prize for literature. Oneiragon Barbital sodium. Oneiral belladonado Drug containing more than one substance whereof one under international control: Barbital sodium. Onirema 5 Nitrazepam. Onturnen Dutch colloquial term for getting someone to take drugs.

Ook toa Thai colloquial term for drug dealing.

Oo'na-oo Banisteriopsis caapi.

OP Colloquial term for opium.

Opa Finnish colloquial term for opium.

Opalescent Exhibiting a milky iridescence like that of an opal. Absinthe, pernod, pastis ouzo, opalesce when mixed with water.

Opamox Oxazepam.

Ope Colloquial term for opium.

Ope charge Colloquial term for cannabis with opium added.

Opecto Drug containing more than one substance whereof one under international control: Opium, Medical. Opedice Metamfetamine hydrochloride. Operidine Phenoperidine hydrochloride. Opgefokt zijn Dutch colloquial term for being high on drugs. Ophion Opium. Opiaceo Opioid. Opiado Opioid.

Opial, -o, -um Opium, mixed alkaloids of. Opiate One of a group of alkaloids derived from the opium poppy (Papaver somniferum) with the ability to induce analgesia, euphoria, and, in higher doses, stupor, coma, and respiratory depression. The term opiate excludes synthetic opioids. See: Opioids. Opiated hash Colloquial term for hashish with opium added. Opij Opium.

Opio Colloquial term for opium. Opio crudo Raw opium. Opio do pobre Cannabis. OPIOIDS

Introduction History

Effects, tolerance, withdrawal and overdose Opioid Dependence Syndrome OPIOIDS - Introduction Opioids consists of three main groups:

1. Endorphines the substances produced in the human body who effectivally decrease the feeling of pain in the brain.

2. Opiates substances directly derived from the opium poppy like morpine and codein.

3. Opiate-related synthetic drugs, such as me-peridine and methadone.

The opioids are unrivaled in their ability to relieve pain. Opium is the dried milky gummy-like exudate from the unripe seed pods of the poppy plant Papaver somniferum, which grows naturally throughout most of Asia Minor. Of the 20 or more alkaloids found in opium, only a few are pharmacologically active. The important constituents of opium are morphine (10 percent), papaverine (1 percent), codeine (0.5 percent), and thebaine (0.2 percent).

Opium appears either as dark brown chunks or in powder form, and is generally eaten or smoked. Heroin usually appears as a white or brownish powder, which is dissolved in water for injection. Most street preparations of heroin contain only a small percentage of the drug, as they are diluted with sugar, quinine, or other drugs and substances. Other opiate analgesics appear in a variety of forms, such as capsules, tablets, syrups, elixirs, solutions, and suppositories. Street users usually inject opiate solutions under the skin ("skin popping") or directly into a vein or muscle, but the drugs may also be "snorted" into the nose or taken orally or rectally.

Tolerance is developed rapidly and completely in the more important members of the group, morphine and heroin, and they are highly addictive. In addition, they produce respiratory depression and frequently cause nausea and emesis. As a result, there has been a constant search for synthetic substitutes: meperidine, first synthesized in Germany in 1939, is a significant addition to the group of analgesics, being one-tenth as potent as morphine; al-phaprodine is one-fifth as potent as morphine but is rapid-acting; methadone, synthesized in Germany during World War II, is comparable to morphine in potency but has a much longer action-tome; levorphanol is an important synthetic with five times the potency of morphine. These synthetics exhibit a more favourable tolerance factor than the more potent of the opiates, but in being addictive they fall short of an ideal analgesic. Of this entire series, codeine has the least addiction potential and heroin has the greatest.

Opiates have been used both medically and non-medically for centuries. A tincture of opium called laudanum has been widely used since the 16th century as a remedy for "nerves" or to stop coughing and diarrhea. By the early 19th century, morphine had been extracted in a pure form suitable for solution. With the introduction of the hypodermic needle in the mid-19th century, injection of the solution became the common method of administration.

Heroin (diacetylmorphine) was introduced in 1898 and was heralded as a remedy for morphine addiction. Although heroin proved to be a more potent painkiller (analgesic) and cough suppressant than morphine, it was also more likely to produce dependence. Of the 20 alkaloids contained in opium, only codeine and morphine are still in widespread clinical use today. In this century, many synthetic drugs have been developed with essentially the same effects as the natural opium alkaloids.

Opiate-related synthetic drugs, such as me-peridine (Demerol) and methadone, were first developed to provide an analgesic that would would not produce drug dependence. Unfortunately, all opioids (including naturally occurring opiate derivatives and synthetic opiate-related drugs), while effective as analgesics, can also produce dependence. (Note that where a drug name is capitalized, it is a registered trade name of the manufacturer.) Modern research has led, however, to the development of other families of drugs. The narcotic antagonists (e.g. naloxone hydrochlo-ride) - one of these groups - are used not as painkillers but to reverse the effects of opiate overdose.

Another group of drugs possesses both morphine-like and naloxone-like properties (e.g. pentazocine, or Talwin) and are sometimes used for pain relief because they are less likely to be abused and to cause addiction. Nevertheless, abuse of pentazocine in combination with the antihistamine tripelennamine (Pyriben-zamine) was widely reported in the 1980s, particularly in several large cities in the United States. This combination became known on the street as "Ts and blues." The reformulation of Talwin, however, with the narcotic antagonist naloxone has reportedly reduced the incidence of Ts and blues use. OPIOIDS - History The narcotic and sleep-producing qualities of the poppy have been known to humankind throughout recorded history. Sumerian records from the time of Mesopotamia (5000 to 4000 BC) refer to the poppy, and medicinal reference to opium is contained in Assyrian medical tablets. Homer's writings indicate Greek usage of the substance at least by 900 BC; Hippocrates (c. 400 BC) made extensive use of medicinal herbs including opium. The Romans probably learned of opium during their conquest of the eastern Mediterranean; Galen (AD 130-200) was an enthusiastic advocate of the virtues of opium, and his books became the supreme authority on the subject for hundreds of years. The art of medicinals was preserved by the Islamic civilization following the decline of the Roman Empire; opium was introduced by the Arabs to Persia, China, and India. Paracelsus (1493-1541), professor at the University of Basel, introduced laudanum, the modern tincture of opium. Le Mort, a professor of chemistry at the University of Leyden (1702-18), discovered paregoric, useful for the control of diarrhea, by combining camphor with tincture of opium.

Smoking of opium was introduced in Europe and Asia in the late 1500s when it was found that opium like the newly discovered tobacco was possible to smoke. In the 1600s there was reports over opium dens and opium smoking as a social problem in China. The European had few attractive things to trade with the Chinese and exported opium from India to China and in short time established an opium epidemic in China. When the Chinese government stopped this it led to the Opium Wars Because there were few alternative therapeutics or painkillers until the 19th century, opium was somewhat of a medical panacea. Thus, although at least one account in 1701, by a London physician named Jones, spoke of an excessive use of opium, there appears to have been no real history of concern until recent times, and opiates were easily available in the West in the 19th century, for instance, in a variety of patent medicines. Physicians prescribed them freely, they were easy to obtain without prescription, and they were used by all social classes. At one time, the extensive use of these medicines for various gynecological difficulties probably accounted for the high addiction rate among women (three times the rate among men).

In 1803 a young German apothecary's assistant named Sertürner isolated crystalline morphine as the active analgesic principle of opium. Codeine is considerably less potent (1/6) and is obtained from morphine. Diace-tylmorphine-or heroin-was developed from morphine by the Bayer Company of Germany in 1898 and is five to 10 times as potent as morphine itself. The invention of the hypodermic needle in 1856, and its subsequent use to administer opiates during wartime produced large numbers of addicted soldiers (about 400,000 during the U.S. Civil War alone); it was thought mistakenly that if opiates were administered by vein, no dependence or addiction would develop, since the narcotic did not reach the stomach. Toward the end of the 19th century, various the use of opiates, and narcotics became identified more with the so-called criminal element than with medical therapy.

By the turn of the 20th century, narcotic use had become a worldwide problem, and various national and international regulatory bodies sought to control traffic in opium from the Near and Far East. In modern times various synthetical opioids has been developed. OPIOIDS - Effects, tolerance, withdrawal and overdose The effects of any drug depend on several factors: The doses, how the drug is adulterated, how potent the active substances are, if the drug is taken with food or other drugs, the body weight of the user and the users past drug experiences, the psychological and emotional status of the user, the manner in which the drug is taken, the circumstances under which the drug is taken, the interaction with other people and the environ ment.

Short-term effects of opioids appear soon after a single dose and disappear in a few hours or days. Opioids briefly stimulate the higher centers of the brain but then depress activity of the central nervous system. Immediately after injection of an opioid into a vein, the user feels a surge of pleasure or a "rush." This gives way to a state of gratification; hunger, pain, and sexual urges rarely intrude. The dose required to produce this effect may at first cause restlessness, nausea, and vomiting. With moderately high doses, however, the body feels warm, the extremities heavy, and the mouth dry. Soon, the user goes "on the nod," an alternately wakeful and drowsy state during which the world is forgotten. as the dose is increased, breathing becomes gradually slower. With very large doses, the user cannot be roused; the pupils contract to pinpoints; the skin is cold, moist, and bluish; and profound respiratory depression resulting in death may occur. overdose is a particular risk on the street, where the amount of drug contained in a "hit" cannot be accurately gauged. In a treatment setting, the effects of a usual dose of morphine last three to four hours. Although pain may still be felt, the reaction to it is reduced, and the patient feels content because of the emotional detachment induced by the drug.

The most long-lasting and conspicuous physiological responses are obtained from the central nervous system and the smooth muscle of the gastrointestinal tract. These effects, while restricted, are complex and vary with the dosage and the route of administration (intravenous, subcutaneous, oral). Both depressant and stimulant effects are elicited. The depressant action involves the cerebral cortex, with a consequent narcosis, general depression, and reduction in pain perception; it also involves the hypothalamus and brain stem, inducing sedation, the medulla, with associated effects on respiration, the cough reflex, and the vomiting center (late effect). The stimulant action involves the spinal cord and its reflexes, the vomiting center (early effect), the tenth cranial nerve with a consequent slowing of the heart, and the third cranial nerve resulting in pupil constriction. Associated effects of these various actions include nausea, vomiting, constipation, itchiness of the facial region, yawning, sweating, flushing of skin, a warm sensation in the stomach, fall in body temperature, diminished respiration, and heaviness in the limbs.

The most outstanding effect of the opiates is one of analgesia. All types of pain perception are affected, but the best analgesic response is obtained in relieving dull pain. The analgesic effects increase with increasing doses until a limit is reached beyond which no further improvement is obtained. This point may fall just short of complete relief.

Depression of cortical function results in a euphoric response involving a reduction of fear and apprehension, a lessening of inhibitions, an expansion of ego, and an elevation of mood that combine to enhance the general sense of well-being. Occasionally in pain-free individuals, the opposite effect, dysphoria, occurs and there is anxiety, fear, and some depression. In addition to analgesia and associated euphoria, there is drowsiness, mental and physical impairment, a clouding of consciousness, poor concentration and attention, reduced hunger or sex drives, and sometimes apathy.

Apart from their addiction liability, respiratory depression leading to respiratory failure and death is the chief hazard of these drugs. All of the more potent opiates and synthetics produce rapid tolerance, and tolerance to one member of this group always is associated with tolerance to the other members of the group (cross-tolerance). The more potent members of the group have a very great addiction liability with the associated physical dependence and abstinence syndrome.

Long-term effects appear after repeated use over a long period. Chronic opiate users may develop endocarditis, an infection of the heart lining and valves as a result of unsterile injection techniques. drug users who share needles are also at a high risk of acquiring HIV and AIDS. Unsterile injection techniques can also cause abscesses, cellulitis, liver disease, and even brain damage. Among users with a long history of subcutaneous injection, tetanus is common. Pulmonary complications, including various types of pneumonia, may also result from the unhealthy lifestyle of the user, as well as from the depressant effect of opiates on respiration.

Opioid-dependent women are likely to experience complications during pregnancy and childbirth. Among their most common medical problems are anemia, cardiac disease, diabetes, pneumonia, and hepatitis. They also have an abnormally high rate of spontaneous abortion, breech delivery, caesarean section, and premature birth. Opioid withdrawal has also been linked to a high incidence of stillbirths. infants born to heroin-dependent mothers are smaller than average and frequently show evidence of acute infection. Most exhibit withdrawal symptoms of varying degrees and duration. The mortality rate among these infants is higher than normal. the various opiates and related synthetics all produce about the same physiological effects. All are qualitatively similar to morphine in action and differ from each other mainly in degree. Tolerance and dependence With regular use, tolerance develops to many of the desired effects of the opioids. This means the user must use more of the drug to achieve the same intensity of effect. chronic users may also become psychologically and physically dependent on opioids. Psychological dependence exists when a drug is so central to a person's thoughts, emotions, and activities that the need to continue its use becomes a craving or compulsion. With physical dependence, the body has adapted to the presence of the drug, and withdrawal symptoms occur if use of the drug is reduced or stopped abruptly. Some users take heroin on an occasional basis, thus avoiding physical dependence.

Withdrawal from opioids, which in regular users may occur as early as a few hours after the last administration, produces uneasiness, yawning, tears, diarrhea, abdominal cramps, goose bumps, and runny nose. These symptoms are accompanied by a craving for the drug. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after a week. Some bodily functions, however, do not return to normal levels for as long as six months. Sudden withdrawal by heavily dependent users who are in poor health has occasionally been fatal. Opioid withdrawal, however, is much less dangerous to life than alcohol and barbiturate withdrawal.

OPIOIDS - Opioid Dependence Syndrome In the World Health Organization ICD-10 Classification of Mental and Behavioural Disorders defined as: F11. 2 Opioid Dependence Syndrome A cluster of physiological, behavioural, and cognitive phenomena in which the use of opi-oid takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take opioid (which may or may not have been medically prescribed). There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals. Diagnostic Guidelines

A definite diagnosis of dependence should usually be made only if three or more of the following:

have been experienced or exhibited at some time during the previous year:

(a) a strong desire or sense of compulsion to take opioid;

(b) difficulties in controlling opioid-taking behaviour in terms of its onset, termination, or levels of use;

(c) a physiological withdrawal state when opioid use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for opioid; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;

(d) evidence of tolerance, such that increased doses of opioid are required in order to achieve effects originally produced by lower doses (clear examples of this are found in opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);

(e) progressive neglect of alternative pleasures or interests because of opioid use, increased amount of time necessary to obtain or take the substance or to recover from its effects;

(f) persisting with opioid use despite clear evidence of overtly harmful consequences, such as depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm. Narrowing of the personal repertoire of patterns of opioid use has also been described as a characteristic feature.

It is an essential characteristic of the dependence syndrome that either opioid taking or a desire to take opioid should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use. This diagnostic requirement would exclude, for instance, surgical patients given opioid drugs for the relief of pain, who may show signs of an opioid withdrawal state when drugs are not given but who have no desire to continue taking drugs. In the USA a slightly different diagnosis tradition exists mainly organised after DSMIV: Diagnostic Criteria

A.Opioid abuse: A destructive pattern of opioid use, leading to significant social, occupational, or medical impairment.

B.Must have three (or more) of the following, occurring when the opioid use was at its worst:

1. Opioid tolerance:

Either need for markedly increased amounts of opioid to achieve intoxication, or markedly diminished effect with continued use of the same amount of opioid. 2. Opioid withdrawal symptoms:

(a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged opioid use: sweating or rapid pulse increased hand tremor insomnia nausea or vomiting physical agitation anxiety transient visual, tactile, or auditory hallucinations or illusions grand mal seizures

(b) Opioid is taken to relieve or avoid withdrawal symptoms. 3. Greater use of opioid than intended:

Opioid was often taken in larger amounts or over a longer period than was intended 4.Unsuccessful efforts to cut down or control opioid use:

Persistent desire or unsuccessful efforts to cut down or control opioid use 5.Great deal of time spent in using opioid, or recovering from hangovers 6.Opioid caused reduction in social, occupational or recreational activities: Important social, occupational, or recreational activities given up or reduced because of opi-oid use. 7.Continued using opioid despite knowing it caused significant problems: Continued opioid use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by opioid Associated Features Learning Problem Dysarthria/Involuntary Movement Hypoactivity Euphoric Mood Depressed Mood Somatic/Sexual Dysfunction Addiction

Sexually Deviant Behavior Dramatic/Erratic/Antisocial Personality

Differential Diagnosis

Nonpathologic opioid use for recreational or medical purposes; repeated episodes of Opioid Intoxication.

Opioid, endogenous Any one of the naturally occurring brain neuropeptides, which include at least two major groups, the enkepha-lins and the endorphins. Both can interact with opiate-binding sites (receptors) and may thus modulate the perception of pain; endorphins, in addition, appear to modulate mood and responses to stressful stimuli. See also: Opioids.

Opiomano Colloquial term for opium addict. Opiopan Opium, mixed alkaloids of. Opiophage German colloquial term for an opium user.

Opiototal Opium, mixed alkaloids of. Opistin Pethidine hydrochloride. Opiu Opium.

Opium C21H23NO5. Natural product defined as "The coagulated juice of the opium poppy", under international control according to the UN Single Convention 1961 and its amendments, Schedule I.

A bitter, yellowish-brown, strongly addictive narcotic drug prepared from the dried juice of unripe pods of the opium poppy and containing alkaloids such as morphine, codeine, and papaverine.

The legitimate uses of opium are medical and include the extraction of purified opium alkaloids (e.g., morphine, codeine; qq.v.) and the manufacture of alkaloid derivatives (e.g., dihydromorphinone, dihydrocodeinone). Opium, either raw or purified as alkaloids and their derivatives (such as heroin), is also used illicitly.

In the 1st century AD, Dioscorides, whose De Materia Medica was the leading text on pharmacology for centuries, described opium. Assyrian herb lists and medical texts refer to both the opium poppy plant and opium. The growth of poppies for their opium content spread slowly eastward from Greece and Mesopotamia. Apparently opium was unknown in either India or China in ancient times, and its widespread cultivation in these countries is a comparatively recent development. Knowledge of the opium poppy first reached China about the 7th century AD, but Japan probably did not begin cultivating it until the 15 th century. Opium smoking did not begin until after the discovery of America, where the practice of pipe smoking originated. It was reported as a problem in China about the middle of the 17th century. Between World Wars I and II the illicit cultivation of the poppy for opium became established in the mountains of western Mexico. Later, it was begun to some extent in Peru and Ecuador.

Middle English, from Latin, from Greek opion, diminutive of opos, vegetable juice. See: Opioids.

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