TY - CHAP M1 - Book, Section TI - Opioid-Related Disorders A1 - Kosten, Thomas R. A1 - Haile, Colin N. A2 - Jameson, J. Larry A2 - Fauci, Anthony S. A2 - Kasper, Dennis L. A2 - Hauser, Stephen L. A2 - Longo, Dan L. A2 - Loscalzo, Joseph PY - 2018 T2 - Harrison's Principles of Internal Medicine, 20e AB - Opioid analgesics have been used since at least 300 B.C. Nepenthe (Greek “free from sorrow”) helped the hero of the Odyssey, but widespread opium smoking in China and the Near East has caused harm for centuries. Since the first chemical isolation of opium and codeine 200 years ago, a wide range of synthetic opioids have been developed, and opioid receptors were cloned in the 1990s. Two of the most important adverse effects of all these agents are the development of opioid use disorder and overdose. Prescription opioids are primarily used for pain management, but due to ease of availability individuals procure and misuse these drugs with dire consequences. In 2015, for example, 3.8 million individuals in the United States were current misusers of pain relievers. More concerning, during 2015 >20,000 overdose deaths involved opioids with an additional 12,990 overdose deaths related to heroin alone. These numbers continue to increase and have accelerated due to mixing high potency fentanyl derivatives with heroin. The accelerating death rates are partially because reversal of fentanyl overdoses can require several-fold larger doses of naloxone than the doses in the intranasal devices used for nonmedical street resuscitations. Indeed, according to the most recent World Drug Report, opioid misuse causes the greatest global burden of morbidity and mortality; disease transmission; increased health care, crime, and law enforcement costs; and less tangible costs of family distress and lost productivity. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1156510515 ER -