Medicines Opiates

Enkephalins and Endorphins. Morphine (142), an alkaloid found in opium, was first isolated in the early nineteenth century and widely used in patent medicines of that eta. It is pharmacologically potent and includes analgesic and mood altering effects. Endogenous opiates, the enkephalins, endorphins, and dynotphins were identified in the mid-1970s (3,51) (see Opioids, endogenous). Enkephalins and endorphins ate Hsted in Table 9. 

Phyto chemicals can be used to either stimulate or inhibit motility of the GIT. For example, caffeine and other phytochemicals stimulate motility (Lis-Balchim etal, 2001 Boekema et al, 1999), whereas motility is slowed by peppermint oil (Beesley et al, 1996), protease inhibitors (Schwartz et al., 1994) and several other phytochemicals (Abdullahi et al, 2001 Odetola and Acojenu, 2000 Rojas et al, 1999 Amos et al, 1998). Many of the traditional herbal medicines used for treatment of diarrhea are based on aqueous extracts that slow small intestine transit and increase residence time for digesta (Lin et al, 2002). The opiates and derivatives are particularly noteworthy (Williams et al., 1997). 

Does the medicinal value of opiates outweigh their propensity for abuse ... 

Dextromethorphan, contained in many nonprescription cough medicines, will produce a heavy psychedelic trip, but the nausea characteristic of the opiates may constitute a problem. Kosterlitz and Villareal (Eds.) AGONIST AND ANTAGONIST ACTIONS OF NARCOTIC ANALGESIC DRUGS (1972) and Braude et al. (Eds.) NARCOTIC ANTAGONISES (1973) are useful. 

Narcotic analgesics Morphine and many of its homologues, when administered in medicinal doses, relieve pain and produce sleep. In poisonous doses, these produce stupor, coma, convulsions and ultimately death. Morphine narcotics are sometimes referred to as opiates, since they are obtained from the opium poppy. 

In addition to the medicines mentioned above, a number of opiate- and non-opiate-based analgesics, including COX-2 inhibitors, anaesthetics (e.g. propofol, desflurane, sevoflurane, ropivacaine, levobupivacaine and remifentanil), neuromuscular blockers (e.g. rocuronium bromid, zemuron, cisatracuiium, doxacurium. 

Constipation may be caused by slow intestinal transition, pelvic floor dysfunction, bowel dysfunction like irritable Bowel syndrome and tumours, but can also be secondary to other diseases and life conditions. Many medicines cause constipation, for example opiates, calcium channel blockers and drugs with anticholinergic effects, e.g. antidepressants. 

For centuries opium was used for both medicinal and recreational purposes. Derived from the poppy Papaver somniferum, it contains numerous opiates, the primary one of which is morphine. The term opiate has largely been replaced by opioid, which represents all compounds with morphinelike activity and includes morphine, morphine derivatives, and peptides. Opiate is used to refer to morphinelike drugs derived from the plant and structurally similar analogues. These drugs are frequently referred to as narcotics, a Greek term for stupor, which is scientifically obsolete. Even in its early history, opium presented a problem when it was smoked or taken orally. The introduction of the hypodermic needle and syringe, however, drastically enhanced the euphoric properties of opioids and thereby altered their abuse liability. In addition, the synthesis of heroin resulted in an opioid that was more potent than morphine and ideally suited for intravenous administration. 

Opium has been used as a medicine for hundreds of years, inevitably creating countless addicts. Scientists have conducted a never-ending search for effective cures for opium addiction, morphine addiction (morphinism), and heroin addiction. For most of its history, opium addiction was treated as a disease with no cure, and doctors concerned themseives with treating the symptoms of addiction rather than the root cause. As a result, other opiates were used to lessen the effects of withdrawal. The addict is placed on a regimen of opiates that slowly decrease over time, weaning the addict from his or her addiction. This process of treatment is still used today. 

There are many legal medicines that use opiates or opiate-like substances. Most of the opiate-based medicines used today are not made from natural opiates, but are either synthetic or semi-synthetic. Synthetic opiate drugs are not actually opiates at all they are merely different chemicals that act like opiates. Semi-synthetics are those drugs that involve changing the chemical structure of a natural opiate. An example of this is heroin, which is a human-made variation of morphine. Morphine and codeine are the principal natural opiates used as medicines and what follows are descriptions of the other most frequently used opiate-based medicines. 

Modern Opiate-Based Medicines 75 Table 8.1 Common Pharmaceuticals Containing Opiates... 

Harding, Geoffrey. Opiate Addiction, Morality and Medicine. New York St. Martin s Press, 1988. 

Dey P, Roaf E, Collins S, Shaw H, Steele R Donmall M (2002). Randomized controlled trial to assesss the effectiveness of a primary health care liaison worker in promoting shared care for opiate users. Journal of Public Health Medicine, 24, 38-42... 

Farren CK (1997). The use of naltrexone, an opiate antagonist, in the treatment of opiate addiction. Irish Journal of Psychological Medicine, 14, 26-31... 

Naloxone hydrochloride hydrate (Narcan, l-A-allyl-7,8-dihydro-14-hydroxynormorphinone hydrochloride) [51481-60-8] M 399.9, m 200-205°, [aJo -164° (c 2.5, H2O). This opiate antagonist has been recrystd from EtOH + Et2O. or H2O. It is soluble in H2O (5%) and EtOH but insoluble in Et2O. The free base has m 184° (177-178°) after recrystn from EtOAc, [a] -194.5° (c 0.93, CHCI3). [Olofson et al. TET LETT 1567 1977 Gold et al. Medicinal Research Reviews 2 211 7982]. 

By the late Wth century a variety of medicines containing powerful opiates or cocaine were readily available in the United States over-the-counter without a prescription. While conscientious pharmacists might warn customers about the potential dangers of such drugs, there was essentially no regulation of their use. 

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