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Key Features

Essentials of Diagnosis

  • Tolerance and withdrawal are major concerns when continued use of opioids occurs

  • Withdrawal causes only moderate morbidity (similar in severity to a bout of "flu")

  • Addicted patients sometimes consider themselves more addicted than they really are and may not require a withdrawal program

General Considerations

  • The terms "opioids" and "narcotics" both refer to a group of drugs with actions that mimic those of morphine

    • The term "opioids" is used when discussing medications prescribed in a controlled manner by a clinician

    • The term "narcotics" is used to connote illicit drug use

  • "Opioids" include a group of drugs with actions that mimic those of morphine

    • Natural derivatives of opium (opiates)

    • Synthetic surrogates (opioids)

    • A number of polypeptides, some of which have been discovered to be natural neurotransmitters

  • The principal opioid of abuse is heroin (metabolized to morphine), which is not used as a legitimate medication

  • Other common opioids are prescription drugs, which differ in milligram potency, duration of action, and agonist and antagonist capabilities (Table 5–8)

  • The incidence of snorting and inhaling heroin ("smoking") is increasing, particularly among cocaine users

Table 5–8.Opioid analgesics.

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