What Are Opiates

       Strictly speaking, opiates are drugs derived from the poppy plant that have been used over the centuries primarily for pain relief. Also known as narcotics, opiates can be natural or synthetic.  The natural opiates include opium, morphine, and codeine.  Other substances, called opioids, are man-made.  These substances behave like opiates in that they produce the same effects and are most often used to treat chronic or severe pain.  All opiate or opioids are also highly addictive.  Examples of opioids include Dilaudid, Demerol, Oxycodone, Vicodin, Fentanyl, Methadone, and Darvon.  Heroin is an opioid manufactured from morphine.  Heroin is rarely, if ever, used medicinally. Rather, it is used for its ability (initially) to give the user a feeling of euphoria.
      The use of opiates in medical practice has a long history. Reports of opium cultivation and use date back as early as 3400 B.C. by the peoples of Assyria, Babylon, Egypt, and Sumeria.
A number of developments in the use of opiates took place in the nineteenth century. Morphine, named after Morpheus, the Greek god of dreams, was discovered in 1803 by German pharmacist Friedrich Wilhelm Adam Sertürner, and it was first administered by an injection using a syringe in 1843 by Scottish physician Alexander Wood. In 1874, the English scientist C. R. Wright became the first person to synthesize heroin, which began to be sold by The Bayer Company in 1898.
      A user’s reactions and experiences with the opiate are dependent upon several factors including length of time, quantity of use, method of use, and the source of the opiate.  If procured on the street versus the pharmacy, it is usually mixed (“cut”) with numerous other substances, some of which are potentially deadly.   Under a doctor's supervision and used as prescribed for short periods of time (1-2 weeks), opiates are very effective painkillers; however, even appropriate use over the long term can lead to dependence.  When a person becomes dependent, finding and using the drug often becomes the main focus in life. Even if the patient has never had a problem with alcohol or drug abuse, they can technically become and addict.           
      Caught in the vise of dependence, people often "doctor shop,” going to several different physicians complaining of pain and asking for opiates. There are unscrupulous physicians, also known as “dirty doctors” who will supply users with prescriptions at inflated prices of up to $500 per visit. Often, people seek suppliers from the Internet or the streets; these activities are highly dangerous and very illegal.
Signs of opiate use are:

• Lethargy and/or drowsiness
• Constricted pupils and reduced vision
• Shallow breathing
• Needle or track marks on inner arms or other parts of the body from injecting needles
• Redness and raw nostrils from sniffing heroin or pulverized narcotic painkillers
• Use or possession of paraphernalia including syringes, bent spoons, bottle caps, eye droppers, rubber tubing, cotton and needles.

Methods of delivery

      Opiate powders can be swallowed or dissolved in water and injected, particularly into a vein which maximizes the effect. Heroin is sometimes sniffed, or the fumes from the heated powder is inhaled, or “smoked.” Subcutaneous injection ("skin popping") is when a heroin solution is injected into the layers of skin, usually in the arms or thighs. Intravenous injection ("mainlining") is when the heroin is injected into a vein. The effects of injecting heroin are felt within minutes and last three to four hours, depending on the dosage.

      The large majority of heroin is illegally manufactured and imported, which originates largely from the Indian sub-continent. When sold at street level it is likely to have been diluted or cut with a variety of similar powders. The main dilutant is glucose. However, the practice of using other substances such as caffeine, flour and talcum powder is a constant danger to users.

Most man-made opiates are taken orally or are pulverized and then sniffed.

Psychological effects

      Like other depressants, opiates produce a tranquil and euphoric effect. Users who inject an opiate such as heroin may also experience a "rush" as the drug circulates through the body. Some users combine opiates with a stimulant such as cocaine. This is called "speed balling." The stimulant keeps the user from falling asleep; the opiate reduces the hyperactive effects often caused by stimulants.

      Psychological dependence is assured with continued use of opiates. When a user becomes dependent, finding and using the drug becomes the main focus of life. Opiates induce tolerance: the need for more of the drug in order to produce the same effects.

Physical effects

      The physical effects of opiates depend on the opiate used, its source, the dose and the method used. Opiates slow breathing, heart rate and brain activity. Opiates depress appetite, thirst and sexual desire. The body's tolerance to pain is increased.

Regular opiate users who abruptly stop using the drug experience withdrawal symptoms four to six hours following the last dose. Symptoms include uneasiness, diarrhea, abdominal cramps, chills, sweating, nausea, runny nose and eyes, irritability, weakness, tremors and insomnia. The intensity of these symptoms depends on how much of the drug was taken, how often and for how long. These symptoms are usually strongest 24 to 72 hours after onset and can persist for seven to 10 days.

Withdrawal

      Individuals using opiate drugs may become both psychologically and physically addicted to the drugs in as little as two weeks. Individuals withdrawing from an opiate often feel like they have a severe case of the flu. In addition, psychological withdrawal may include mood swings, depression and increased sensitivity to pain.  These withdrawal symptoms are always uncomfortable, sometimes excruciating, but they are not life-threatening.
Treatment
      Like with any addiction, there are many treatment options. Prescription painkiller dependence can be resolved by weaning (or “titrating”) a patient gradually off the drug, usually for a period of two weeks. Prolonged use of heroin, morphine, opium, methadone and suboxone can result in longer periods of withdrawal, accompanied by psychological treatment, group sessions and drug counseling. The best advice, obviously, is not to get started. However, if one must take painkillers for medical reasons, it’s always best to use them for short periods of time and always under the direction of a responsible physician.

What Is Marijuana?

Marijuana is a green or gray mixture of dried, shredded flowers and leaves of the hemp plant Cannabis sativa. It has been around for a long while. Its source, the hemp plant (cannabis sativa), was being cultivated for psychoactive properties more than 2,000 years ago. There are over 200 slang terms for marijuana including "pot," "herb," "weed," "boom," "kush," and countless others. It is usually smoked as a cigarette, in a pipe or bong (a type of water-cooled pipe). Marijuana can also be mixed into foods or brewed into tea.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). This chemical kicks off a series of cellular reactions that produces the high that users experience. Perceived positive effects include euphoria, heightening of the senses, i.e. smell, hearing and taste and an increase in appetite. The short term negative effects of marijuana use may involve problems with memory and learning; distorted perception; difficulty in thinking and problem-solving; loss of coordination; and increased heart rate, anxiety, and, in some instances, panic attacks.

Effects of smoking are generally felt within a few minutes and peak in 10 to 30 minutes. They include dry mouth and throat, increased heart rate, impaired coordination and balance, delayed reaction time, and diminished short-term memory. Moderate doses tend to induce a sense of well-being and a dreamy state of relaxation that encourages fantasies, renders some users highly suggestible, and distorts perception (sometimes making it dangerous to operate machinery, drive a car or boat, or ride a bicycle).

Health Hazards

Effects of Marijuana on the Brain

Researchers have found that THC changes the way in which sensory information gets into and is acted on by the hippocampus. This is a component of the brain's limbic system that is crucial for learning, memory, and the integration of sensory experiences with emotions and motivations. Investigations have shown that neurons in the information processing system of the hippocampus and the activity of the nerve fibers are suppressed by THC. In addition, researchers have discovered that learned behaviors, which depend on the hippocampus, also deteriorate.

Recent research findings also indicate that long-term use of marijuana produces changes in the brain similar to those seen after long-term use of other major drugs of abuse. “Teens using marijuana before age 18 are two to four times more likely to develop psychosis as young adults compared to those who do not.” (http://www.ednewscolorado.org/2012/02/22/33516-research-shows-adverse-effects-of-marijuana-on-teens-as-drug-use-among-students-appears-to-be-rising)

Effects on the Lungs

Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers have. These individuals may have daily cough and phlegm, symptoms of chronic bronchitis, and more frequent chest colds. Continuing to smoke marijuana can lead to abnormal functioning of lung tissue injured or destroyed by marijuana smoke.

Regardless of the THC content, the amount of tar inhaled by marijuana smokers and the level of carbon monoxide absorbed are three to five times greater than among tobacco smokers. This may be due to the marijuana users inhaling more deeply and holding the smoke in the lungs.

“Habitual marijuana use may lead to the following effects on the lung:

• acute and chronic bronchitis;
• extensive microscopic abnormalities in the cells lining the bronchial passages (bronchial epithelium), some of which may be premalignant;
• overexpression of genetic markers of progression to lung cancer in bronchial tissue;
• abnormally increased accumulation of inflammatory cells (alveolar macrophages) in the lung; and
• impairment in the function of these immune-effector cells (reduced ability to kill microorganisms and tumor cells) and in their ability to produce protective inflammatory cytokines.” (http://www.ukcia.org/research/EffectsOfMarijuanaOnLungAndImmuneDefenses.php)

Effects of Heavy Marijuana Use on Learning and Social Behavior

A study of college students has shown that critical skills related to attention, memory, and learning are impaired among people who use marijuana heavily, even after discontinuing its use for at least 24 hours. Researchers compared 65 "heavy users," who had smoked marijuana a median of 29 of the past 30 days, and 64 "light users," who had smoked a median of 1 of the past 30 days. After a closely monitored 19- to 24-hour period of abstinence from marijuana and other illicit drugs and alcohol, the undergraduates were given several standard tests measuring aspects of attention, memory, and learning. Compared to the light users, heavy marijuana users made more errors and had more difficulty sustaining attention, shifting attention to meet the demands of changes in the environment, and in registering, processing, and using information. The findings suggest that the greater impairment among heavy users is likely due to an alteration of brain activity produced by marijuana.

Longitudinal research on marijuana use among young people below college age indicates those who used have lower achievement than the non-users, more acceptance of deviant behavior, more delinquent behavior and aggression, greater rebelliousness, poorer relationships with parents, and more associations with delinquent and drug-using friends.

Research also shows more anger and more regressive behavior (thumb sucking, temper tantrums) in toddlers whose parents use marijuana than among the toddlers of non-using parents.

The Impact on the Body

Chronic marijuana smokers are prey to chest colds, bronchitis, emphysema, and bronchial asthma. Persistent use will damage lungs and airways and raise the risk of cancer. There is just as much exposure to cancer-causing chemicals from smoking one marijuana joint as smoking five tobacco cigarettes. And there is evidence that marijuana may limit the ability of the immune system to fight infection and disease.

Marijuana also affects hormones. Regular use can delay the onset of puberty in young men and reduce sperm production. For women, regular use may disrupt normal monthly menstrual cycles and inhibit ovulation. When pregnant women use marijuana, they run the risk of having smaller babies with lower birth weights, who are more likely than other babies to develop health problems. Some studies have also found indications of developmental delays in children exposed to marijuana before birth.

Marijuana as Medicine

Although U.S. Federal law classifies marijuana as a Schedule I controlled substance (which means it has no acceptable medical use), a number of patients claim that smoking pot has helped them deal with pain or relieved the symptoms of glaucoma, the loss of appetite that accompanies AIDS, or nausea caused by cancer chemotherapy. Numerous states have, in recent years, authorized the medical use of the drug and  this past election, 2012, it was legalized for personal recreational use in the states of Washington and Colorado.

What to Do If A Family Member Won't Go To Rehab

First of all, If you have to talk someone into going to rehab then it probably won’t work. It’s only when they finally say “I’m done….please tell me what to do,” that you know that they are ready.

Few things are more depressing and disturbing than witnessing someone you love willingly hand their life over to addiction. Whether it’s to alcohol, prescription medications like Oxycontin, Vicodin or Xanax or to street drugs like heroin, cocaine and methamphetamines, the long term damage is nearly the same. You know that drug rehab treatment is what they need, but getting them to go may feel like a futile endeavor.

Just because you want to scream out of sheer frustration as you marvel how anyone could be so self-destructive while wondering why they won’t get the help they so desperately need, consider this: A. They can’t feel much of anything anymore, and B. They are caught in the clutches of a disease that wants them dead and neutralizes all sense of reason at the same time.

It is important to recognize that their incessant use isn’t simply a choice on their part. The vast majority of addicts have tried to quit many times – only to pick it up repeatedly. Let’s face it; if an addiction was easy to overcome, most addicts – including your loved one – would have stopped long ago. Unfortunately, the process of becoming clean and staying sober is more complex than that. That’s why any effective program of rehabilitation – whether a 12 Step program by itself or a residential treatment center – is preferable to the status quo – if you can just get them there.

“So how do I do that?”, you say. “How on earth can I convey how much I care and how deeply concerned I am without putting them on the defense?” For years now I’ve watched this person’s life completely deteriorate and no matter how hard I’ve begged, cajoled and even tried to trick them, it’s all been to no avail. …"

First of all, understand and accept that the addict is the only one responsible for his or her addiction – NOT you. Even if you’ve enabled and fed in to their addictive behavior, it’s not your fault. More likely than not they even blamed you for their problem, but whatever you do, remember this: don’t blame yourself!

If you do, the familiar pattern of excuses, denial, and blame will pull you right back in, causing your efforts to fail once again. On top of that, anger, resentment, and a sense of utter hopelessness will interfere with your efforts. Keeping all this in mind, the only viable option at this point is an intervention.

An intervention involves bringing in a group of friends and family members in order to confront the addict. The goal is to break through the addict’s denial, get him or her to finally acknowledge the serious addiction problem, and agree that they need treatment. There are many professional interventionists out there if you choose to hire one. The better ones are trained and certified. Contact the Association of Intervention Specialists (http://www.associationofinterventionspecialists.org/) to locate one in your area. Their fees range from $2500 to $10,000 plus expenses.

If you choose to try it yourself, you must go into it with a clear plan. First, select a program in advance and make sure it’s is a good fit for the addict. Check with the treatment facility to ensure that there’s an opening available. This is important because if the addict agrees to get help, they can be admitted immediately following the intervention.

Another important aspect is to make sure that the people who attend are individuals whom the addict respects and trusts. An intervention can quickly backfire if there’s anyone there who has a lot of anger or other negative feelings towards the addict. This means that if some family members are resentful or are initially unwilling, it’s a bad idea to try and cajole them into participating. Speaking of which, it’s also crucial that every person who participates in the intervention is completely on board with the game plan. They can easily undermine the process and antagonize the addict, which is exactly what you don’t want to happen.

Avoid hurtful comments, playing the blame game or arguing. The atmosphere and mood should be one of genuine caring and concern. The addict has already experienced a lot of guilt, shame, hurt and anger. Be gentle, but straightforward and firm.

Timing is also very important. Morning is generally preferable, while they still have a hangover and/or haven’t had the opportunity to “get well” yet. If there has been a significant upheaval in the addict’s life that’s a direct result of their drinking and using (a relationship breakup or job loss), these events can serve as wake-up calls that it’s time to make a change. They may be more receptive to the intervention and open to treatment under these types of circumstances.

This is also your opportunity to let the addict know that you will no longer cosign the addict’s behavior; that despite the love and concern you have for them, they need to accept this “gift” or you must move away from them. You need to make it crystal clear that none of you will provide any type of help or support, in the form of money, transportation, a place to stay – until he or she agrees to get help. Sometimes this is the turning point that will change the addict’s mind – if not during the intervention then soon after when they ultimately realize how serious you are. This is historically the hardest part for most people, but unless this is done, the pattern will never change.

Naturally, there are no guarantees. This is serious business and people die from it every day. As stated in The Big Book Of Alcoholics Anonymous: “Science may someday find a cure, but it hasn’t done so yet.”