pharmacology -opiates and benzos

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Dr. Dawn-Elise Snipes PhD, LPC-MHSP, NCC


Examine the following for both opiates and benzodiazepines◦ Types of drugs in each category

◦ The short and long term effect on the person

◦ Symptoms of intoxication and withdrawal

◦ Detoxification issues

◦ Current state of abuse

◦ Recommended treatments


Method of administration greatly effects the intensity and duration of onset for various drugs◦ Oral (slowest)◦ Inhalation/Snorting◦ Inhalation/Smoking◦ Injection◦ Rectal suppository◦ Skin patches


Class of Drugs: Analgesic (pain killer); CNS Depressant

Types of Drugs◦ Natural

◦ Synthetic

◦ semi-synthetic.


Types of Drugs


• Natural• Opium• Morphine• Codeine

• Synthetic• Methadone• Fentanyl

• Semi-Synthetic• Demerol• Heroin• Dilaudid• Oxycodone (Percocet)• Hydrocodone

(Vicodin)

Short term impact (up to 5 hours)

◦ Depends heavily on the dose of morphine or heroin, the

route of administration, and previous exposure

◦ Including

Psychological: Euphoria, feeling of well-being, relaxation,

drowsiness, sedation, disconnectedness, delirium.

Physiological: Analgesia, depressed heart rate and

respiration depression, constipation, flushing of the skin,

sweating, pupils fixed and constricted, diminished reflexes


Complications and Side Effects

◦ Medical complications among abusers arise

primarily from adulterants and in non-sterile

injecting practices

◦ Include skin, lung and brain abscesses, collapsed

veins, endocarditis, hepatitis and HIV/AIDS.


Complications and Side Effects

◦ Alcohol or depressants such as benzodiazepines,

hypnotics, and antihistamines increase the CNS

effects of opiates such as:

Sedation/drowsiness

Decreased motor skills.

Respiratory depression, hypotension


Long term impact◦ Vein collapse

◦ Depression

◦ Brain changes/damage

◦ Reduction of the production of natural pain killers


Symptoms of intoxication◦ Constricted pupils

◦ Sleepiness or extreme relaxation

◦ Agitation

◦ Scratching and picking


Symptoms of withdrawal◦ Begin within 6-12 hours; last 5-10 days; peak

between 48-72 hours

◦ Yawning

◦ Drug Craving

◦ Irritability/dysphoria/depression

◦ Flu like Symptoms: Runny nose, sweating. vomiting, chills, abdominal cramps, body aches, muscle and bone pain, muscle spasms, insomnia.


Detoxification Issues◦ Tolerance decreases rapidly, so overdosing during

relapse is easy

◦ Biggest focus during opiate withdrawal is to provide palliative care

◦ In general, opiate withdrawal is not life threatening


Current state of Use/Abuse◦ Fentanyl is 30-50x stronger than heroin. Overdose

rates are extremely high.

◦ Difficulty getting prescription opioids has led to increases in demand for heroin and fentanyl

◦ Nearly 6% of 12th graders report using narcotics other than heroin for recreational purposes


Recommended Treatment/Interventions◦ Methadone—long acting synthetic opiate agonist

◦ Buprenorphine—Partial agonist/ceiling effect

◦ Suboxone– Burprenorphine+Naloxone to prevent injection

◦ Naloxone—Antagonist

◦ Therapy


Class of Drugs: Antianxiety/Depressant

Types of Drugs◦ Short acting

◦ Long Acting



Duration Onset Peak Half-Life

Librium Long 30m 3hr 30hr

Valium Long 15m 1hr 50hr

Xanax Medium 30m 1hr 20hr

Ativan Medium 30m 1hr 20hr

Restoril Medium 1hr 1hr 20hr

Halcion Short 30m 1hr 5hr

http://www.vhpharmsci.com/vhformulary/tools/benzodiazepines-comparison.htm

Short term impact◦ Drowsiness◦ Blurred vision◦ Poor coordination◦ Amnesia◦ Hostility/Irritability◦ Disturbing dreams◦ Reduced inhibition◦ Impaired judgment


Short term impact in the elderly◦ Confusion

◦ The appearance of dementia

◦ Benzodiazepine overdose

Combining with other depressants has an exponential additive effect

Rohypnol is a benzodiazepine


Long term impact◦ Impairment in several cognitive domains, such as

visuospatial ability, speed of processing, and verbal learning J Clin Psychiatry. 2005;66 Suppl 2:9-13.

◦ Benzodiazepine use for 3 months or more was associated with an increased risk of Alzheimer's disease of up to 51%. Benzodiazepine use and risk of Alzheimer’s disease:

case-control study BMJ 2014; 349


http://www.ncbi.nlm.nih.gov/pubmed/15762814

Long term impact◦ Despite benzodiazepines being added to the

American Geriatrics Society's list of inappropriate drugs for older adults in 2012, almost 50% of older adults continue to use them


Symptoms of withdrawal◦ Sleep disturbance◦ Increased tension and anxiety; irritability, panic

attacks, palpitations, hand tremor◦ Difficulty in concentration◦ Flu-Like symptoms: Dry heaves and nausea;

headache; muscular pain and stiffness; sweating◦ Seizures◦ Psychotic reaction


Detoxification Issues◦ Symptoms appear around the end of the half-life

period

◦ Rebound anxiety and insomnia peak within a couple of days

◦ Withdrawal symptoms can last for 2-4 weeks depending on the drug


Detoxification Issues◦ Protracted withdrawal is not uncommon in heavy

and/or long-term users.

◦ A grand mal seizure may occur in 20-30 percent of individuals undergoing untreated withdrawal from benzos. Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.


Recommended Treatment/Interventions◦ SSRIs

Paxil: sedating

Lexapro: FDA approved for GAD

Zoloft: FDA approved for panic, PTSD, social phobia, OCD

◦ Buspar: Non-benzo anxiolytic


Current state of Use/Abuse

Most frequently used class of drugs for anxiety disorders. An estimated past year prevalence of use in the USA has been reported at 12.9% Archives of Clinical Neuropsychology Volume 19, Issue 3,

April 2004, Pages 437–454


http://www.sciencedirect.com/science/journal/08876177

http://www.sciencedirect.com/science/journal/08876177/19/3

Opiates and benzodiazepines are both system depressants

Detoxification from benzodiazepines can be fatal

One clue to opiate intoxication is constricted, minimally responsive pupils

Combining opiates or benzos with each other or other system depressants can lead to fatal CNS depression


Tolerance to opiates disappears relatively quickly, making it easy to overdose during a relapse.

Fentanyl is ◦ 30x more powerful than morphine

◦ cheaper to produce

◦ Used to cut/bulk heroin


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pharmacology -opiates and benzos

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