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Psychology of Addiction > Final Exam Opioids > Flashcards

Final Exam Opioids Flashcards

1
Q

opiates:

A

drugs derived directly from the opium poppy

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2
Q

How is opium made?

A

the resin (gum) that seeps from cuts in unripe poppy pods is scraped and dried to make opium

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3
Q

opium poppies have been cultivated for use since at least ___ in ___

A

3400 BC

Southwest Asia

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4
Q

opium use in the U.S. contributed to the ____, which outlawed the production, use, possession, and distribution of opiate and coca products, except for medical purposes

A

Harrison Narcotics Tax Act in 1914

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5
Q

Today, about 90% of the world’s supply comes from __

A

Afghanistan

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6
Q

morphine was first isolated from dried opium poppy resin by Friedrich W. Serturner in the early 1800s–he named it after ___, the Greek god of dreams

A

Morpheus

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7
Q

Making Herion #1

  1. opium is boiled in water, producing a clear brown liquid
  2. impurities are scraped from the top, and lime is added, producing ___
  3. the solution is filtered to remove impurities
  4. ___ is added and the solution is reheated
  5. morphine collects as a solid at the bottom
A

morphine alkaloid

ammonia

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8
Q

heroin #1, comprises only 10% of ___

A

raw opium

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9
Q

heroin (diacetylmorphine) is obtained by converting ____ and is sometimes called ___

A

morphine to heroin base

heroin #2

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10
Q

diacetylmorphine is also known as

A

heroin

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11
Q

heroin #2 is made by

  1. morphine base is mixed with ___ and heated to __ degrees Celsius for two hours
  2. morphine dissolves
  3. upon cooling, morphine and ___ bond chemically to form heroin
  4. the heroin is dissolved in water and ___ is added, producing heroin base
A

acetic acid, 85
acetic acid
sodium bicarbonate

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12
Q

heroin #2 can be snorted but not ___

A

smoked

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13
Q

heroin base must be purified further to produce ___, which is smokable

A

heroin #3

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14
Q

Heroin #3 is made by

  1. heroin #2 is mixed with ___ and stirred until it dries
  2. the dried past is crushed to form ___
A

hydrochloric acid

“brown sugar”

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15
Q

heroin #3 is only ___ pure, and is therefore not suitable for injection

A

20-30%

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16
Q

heroin #4 is ___ pure and injectable

A

80-90%

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17
Q

Heroin #4 is made by

  1. hydrochloric acid and __ are added to heroin base (heroin #2)
  2. the product is filtered and dried to form a white powder
  3. this powder is compressed into bricks with a heroin press
A

ether

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18
Q

opioids:

A

semi- and fully-synthetic opiates that are manufactured chemically

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19
Q

both opiates and opioids are now often referred to as ___

A

opioids

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20
Q

opiates are very effective pain relievers but their addictive properties led pharmaceutical companies to seek ___ (Koob’s highly charitable interpretation)

A

synthetic, opioid alternatives

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21
Q

___ (brand name Demerol) and ___ (brand name Dolophine) were developed by German scientists in the 1930s to pursue Hitler’s goal of German independence on foreign markets

A

pethidine/meperidine

methadone

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22
Q

Many other synthetic opiates (opioids) have been developed and they have similar ___

A

chemical structures

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23
Q

Name 2 natural and one semisynthetic type of opioids

A

Natural: morphine (e.g., Dilaudid), codeine (e.g., Vicodin)
Semisynthetic: buprenorphine (e.g., Suboxone, Subutex, etc.)

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24
Q

opioids vary widely in strength, and many are metabolized into ___

A

other opioids

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25
Q

endogenous opioids:

A

neuropeptides produced by the body that have “morphine-like” actions

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26
Q

3 endogenous opioids:

A

enkephalins
dynorphins
endorphins

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27
Q

these endogenous opioids bind to the ___ as opioid drugs of abuse, just not as ___

A

same receptors

powerfully

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28
Q

What is the Dilemma of Exogenous Opioids?

A

that nothing relieves pain as well, but nothing is more addictive

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29
Q

The probability of abuse/dependence given ANY use in the past year is highest for __ with about a __% chance

A

Heroin, close to 70%

30
Q

The prevalence of prescription opiate addiction is ___

A

increasing rapidly

31
Q

use often begins with prescriptions for pain; to which ___ individuals become addicted

A

genetically vulnerable

32
Q

drug deaths from prescription opioids increased nearly ___ from 1999-2014, and ___ are increasingly involved

A 
six-fold (six times as great or as numerous)
synthetic narcotics (e.g., fentanyl)
33
Q

many of those who become addicted eventually turn to ___ because it’s cheaper and easier to get

A

heroin

34
Q

heroin deaths are up almost ___ since 1999 and ___ are increasingly involved

A 
eight-fold
synthetic narcotics (e.g., fentanyl)
35
Q

True or false? heroin purity is unpredictable, and much stronger opiates (e.g., fentanyl, carfentanil) are sometimes cut in

A

true

36
Q

Medical Uses for opioids:

A

anti-diarrhea properties–used to save lives during dysentery epidemics in the 19th Century
pain relief:
a therapeutic dose of morphine relieves pain for 3-4 hours
much larger effect on dull, aching pain than acute sharp pain (good for survival)
blunted affective reaction to pain
poor at relieving neuropathic pain

37
Q

analgesia

A

(pain relief)

38
Q

What is balanced anesthesia?

A

use of different opioids before and during surgery to induce analgesia (pain relief), amnesia, muscle relaxation, and abolition of reflexes (e.g., fentanyl, alfentanil, remifentanil)

39
Q

Pharmacokinetics: blood levels of smoked heroin peak in ___ and decline rapidly to minimum limits of detection within __

A

1-5 min

30 min

40
Q

What does it mean that heroin is a prodrug?

A

it has no pharmacological activity, but it’s active metabolites do

41
Q

Koob et al. (2014) describe opioids as ___ drugs of addiction

A

“classic”

42
Q

a few people ___are able to maintain quasi-controlled use patterns–>this is playing with fire because __

A

“chippers”

it often precedes (come before something in time) compulsive use

43
Q

early outcome data suggested that heroin addiction is a ___, and that __ of addicts die

A

lifelong condition

half

44
Q

In the 1960s compulsory drug treatment centers predominantly use ___ for treatment

A

methadone maintenance

45
Q

Methadone maintenance was replaced with ___ because ___

A

suboxone

methadone itself is an addictive opioid (marketed originally as a pain killer by Eli Lilly)

46
Q

True or False? Although data are hard to collect, opioid addicts do recover in self-help groups such as Narcotics Anonymous without maintenance therapy

A

True

47
Q

Treu or False? there may be a need for maintenance therapy for some, but abstinence is possible and should not be ruled out

A

true

48
Q

opioid intoxication following injection or smoking of 1-3mg heroin or 3-15mg morphine is described in four stages by Koob et al. (2014):

A
  • Rush (45s) intense pleasure/euphoria
  • Nod (15-20min) escape from reality detached
  • High (several hours) state follows rush general feeling of wellbeing
  • Being straight (up to 8h) is not experiencing the 3 states but also not experiencing the withdrawl
49
Q

In the opioid intoxication stages, the ___ is resistant to tolerance but the __ and __ are not

A

rush

nod, high

50
Q

opioid tolerance: tolerance to the sedative, euphoric, and analgesic properties of opioids builds ___

A

rapidly

51
Q

opioid tolerance: those who are addicted can inject doses up to __ times the lethal dose for a drug-naive individual

A

70

52
Q

opioid tolerance: tolerance also shortens the duration of ___

A

drug action

53
Q

True or false? opioid tolerance: cross-tolerance also develops (e.g., switching from codeine to morphine)

A

True

54
Q

tolerance occurs for two reasons:

A
  1. neuro-adaptive down-regulation of the opioid system

2. conditioning to place of use and associated compensatory body reactions in the opposite direction of opioid effects

55
Q

opioid withdrawal: like other drugs of abuse, early use is driven by ___ and after tolerance develops, ___ drives use

A 
positive reinforcement (feeling of elation and euphoria)
negative reinforcement (avoiding withdrawal)
56
Q

opioid withdrawal symptoms peak at

A

48-72 hours

57
Q

many of those who are addicted will go to great lengths to avoid __

A

acute withdrawal

58
Q

True or false? Many treatment providers believe acute withdrawal should be prevented, hence maintenance therapy with methadone, suboxone, etc.

A

True

59
Q

notably, methadone and suboxone withdrawal are more ___ than heroin withdrawal

A

protracted (lasting for a long time or longer than expected or usual.)

60
Q

why the different approach with opioids vs. other drugs?

A

notably, in contrast to some drugs of abuse (alcohol, benzodiazepines), opioid withdrawal is not life-threatening

61
Q

some withdrawal symptoms, including increased pain and stress sensitivity, dysphoria, and certain metabolic changes can persist for about 5 months, a phenomenon known as ___

A

post-acute withdrawal

62
Q

since opioids cross the ___, infants born to opioid-addicted mothers suffer withdrawal

A

placental barrier

63
Q

endogenous opioids were not discovered until the __

A

1970s

64
Q

it was quickly discovered that opioids have ___, and that animals will self-administer when delivered directly into the brain

A

analgesic properties (they relieve pain. Unlike medications used for anesthesia during surgery, analgesics don’t turn off nerves, change the ability to sense your surroundings, or alter consciousness. They are sometimes called painkillers or pain relievers)

65
Q

analgesia occurs through direct injection into various sites (4):

A

rahpe nuclei
periaqueductal gray
certain medullary nuclei
spinal cord

66
Q

animals will also self-inject into the ventral tegmental area and the nucleus accumbens (the mesolimbic reward system). Given that opioids are not ___, this was (and is) perplexing

A

dopamine agonists

67
Q

one possibility as to why animals will also self-inject into the ventral tegmental area and the nucleus accumbens (the mesolimbic reward system) even tho opioids are not dopamine agonists is that ___

A

μ opioid agonists disinhibit inhibitory GABA interneurons, raising midbrain DA levels indirectly

68
Q

the μ opioid receptor is most important for the ___

δ and κ receptors are implicated in ___

A

addictive properties of opioids

tolerance and dysphoria

69
Q

analgesic properties are caused by ____ in both the brain and spinal cord

A

direct inhibition of nociceptive activity

70
Q

nociception:

A

sensory nervous system response to harmful or potentially harmful stimuli

71
Q

True or false: intoxication results from blocking the affective component of pain (brain only)

A

True

Psychology of Addiction (7 decks)

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