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Harrison's Principles of Internal Medicine, 18e
| Part 17. Neurologic Disorders > Section 6. Alcoholism and Drug Dependency > |
Chapter 393. Opioid Drug Abuse and Dependence
Sections: Introduction, Neurobiology, Pharmacology, Prevention, Further Readings.
Topics Discussed: drug abuse; opioid abuse; opioid dependence; opioids; substance-related disorders: overview and depressants, stimulants, and hallucinogens.
Excerpt:"Opiate analgesics are some of the oldest and most common medications in clinical practice, but have also been abused 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 endogenous opioid peptides were discovered in 1995. Two of the most important adverse effects of all these agents are overdose and dependence. The 0.14% annual prevalence of heroin dependence in the United States is only about one-third the rate of prescription opiate abuse and is substantially lower than the 2% rate of morphine dependence in Southeast and Southwest Asia. While these rates are low relative to other abused substances, their disease burden is substantial, with high rates of morbidity and mortality; disease transmission; increased health care, crime, and law enforcement costs; and less tangible costs of family distress and lost productivity...."
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