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

◦ 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

◦ 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

◦ 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

◦ 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

 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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