ABSTRACT
Opioids are substances derived from opium (natural opioids). In its raw state, opium is a gummy latex extracted from Papaver somniferum. The use of opioids and their negative health consequences among people who use drugs have been studied. Today, opioids are still the most commonly used and effective analgesic treatments for severe pain, but their use and abuse causes detrimental side effects for health, including addiction, thus impacting the user's quality of life and causing overdose. The mesocorticolimbic dopaminergic circuitry represents the brain circuit mediating both natural rewards and the rewarding aspects of nearly all drugs of abuse, including opioids. Hence, understanding how opioids affect the function of dopaminergic circuitry may be useful for better knowledge of the process and to develop effective therapeutic strategies in addiction. The aim of this review was to summarize the main features of opioids and opioid receptors and focus on the molecular and upcoming epigenetic mechanisms leading to opioid addiction. Since synthetic opioids can be effective for pain management, their ability to induce addiction in athletes, with the risk of incurring doping, is also discussed.
Subject(s)
Analgesics, Opioid , Opioid-Related Disorders , Humans , Analgesics, Opioid/adverse effects , Pain Management/adverse effects , Receptors, Opioid/genetics , Opium , Quality of Life , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/geneticsABSTRACT
BACKGROUND: In recent years, lung cancer (LC) incidence has increased in Iran. The use of opium and its derivatives (O&D) has increased as well. This study aimed to investigate the association between the use of O&D and LC incidence. METHODS: In this case-control study conducted in Kerman, Iran; 140 patients with lung cancer and 280 healthy controls matched by age, sex, and place of residence were included. Data, including O&D use, cigarette smoking, alcohol use, and diet, were collected using a structured questionnaire. The relation between the use of O&D and LC was evaluated using conditional logistic regression adjusted for tobacco smoking, education, daily intake of fruit, vegetables, red meat, and hydrogenated fats. RESULTS: Opium ever-use was associated with an increased risk of LC (Adjusted Odds Ratio (AOR) =5.95, 95% CI: 1.87-18.92). Participants were divided into low and high use groups based on the median of opium use in the control group. A significant dose-response relation was observed between the amount of daily O&D use and LC; and the relation was stronger in high users (AOR low users = 3.81% CI: 1.13-12.77 and OR high users = 9.36, 95% CI: 2.05-42.72). Also, LC was higher among participants starting the use of O&D at younger ages (≤ 41 years old vs never users AOR = 8.64, 95% CI: 1.90-39.18) compared to those who started at an older age (> 41 years old vs never users, AOR = 4.71, 95% CI: 1.38-16.08). The association between opium, and lung cancer among non-smokers was OR: 6.50 (95% CI: 2.89 to 14.64). CONCLUSION: The results of this study show that opium use is probably a dose related risk factor for lung cancer.
Subject(s)
Lung Neoplasms/epidemiology , Opium/adverse effects , Smoking, Non-Tobacco Products/epidemiology , Age Factors , Aged , Alcohol Drinking/adverse effects , Alcohol Drinking/epidemiology , Case-Control Studies , Cigarette Smoking/adverse effects , Cigarette Smoking/epidemiology , Female , Healthy Volunteers , Humans , Iran/epidemiology , Lung Neoplasms/etiology , Male , Middle Aged , Non-Smokers/statistics & numerical data , Registries/statistics & numerical data , Risk Factors , Smokers/statistics & numerical data , Smoking, Non-Tobacco Products/adverse effectsABSTRACT
BACKGROUND: Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES: To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS: Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS: We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p<0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS: Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.
Subject(s)
Allergens/immunology , Analgesics, Opioid/immunology , Anaphylaxis/prevention & control , Immunologic Tests/methods , Opium/immunology , Postoperative Complications/prevention & control , Adult , Anaphylaxis/etiology , Antibodies, Anti-Idiotypic/metabolism , Drug Hypersensitivity/complications , Female , Humans , Immunization , Immunoglobulin E/blood , Male , Middle Aged , Papaver/immunology , Plant Extracts , Predictive Value of Tests , Seeds/immunology , Sensitivity and Specificity , Young AdultABSTRACT
BACKGROUND: Oral cavity cancers (OCCs) are the sixth most prevalent cancers in the world. There are strong evidences showing the risk of the cigarette smoking, alcohol use, poor oral hygiene and some types of diets in OCCs; however, few studies explored the relationship between opium and its derivatives (O&D) use and OCCs incidence. The aim of this study was to investigate the relationship between consumption of O&D and the incidence of OCCs. METHODS: In a case-control; 133 patients with OCCs and 266 healthy controls matched by age, sex, and place of residence were included. Data, including cigarette smoking, O&D, alcohol and others tobacco (Nass, pipe and hookah) use and diet, were collected using a structured questionnaire. The relation between the use of O&D and OCCs was evaluated using conditional logistic regression. RESULTS: Opium ever-use was associated with an increased risk of OCCs (Adjusted Odds Ratio (AOR) =2.36, 95â¯% CI: 1.16-4.78). A dose-response relation was observed between the amount of daily O&D use and OCCs; and the relation was stronger in high users (AOR for low users = 1.38, 95â¯%CI: 0.58-3.24 and AOR for high users = 4.85, 95â¯% CI:1.79-13.11). Those who used opium for more than 18 years were highly at risk of OCCs (AOR= 5.04, 95â¯% CI, 2.00-12.68). Also, OCCs was higher among subjects starting the use of O&D at younger ages (≤ 50 years old vs never users AOR = 3.32, 95â¯% CI: 1.19-9.23). The smoking method of consuming O&D increased the odds of getting OCCs more than twice (AOR= 2.02, 95â¯% CI, 1.03-3.94), and using both smoking and oral consumption simultaneously, increased the odds of getting OCCs more than 8 times (AOR= 8.57, 95â¯% CI, 1.68-43.70). Also, the use of other tobacco products (Nass, pipe and hookah) increases the odds of getting OCCs by 4 times (AOR= 3.90, 95â¯% CI, 1.12-13.57) CONCLUSIONS: The results showed that opium use is probably a dose related risk factor for oral cavity cancers. Therefore, it is necessary to implement preventive policies to control the use of opioids.
Subject(s)
Mouth Neoplasms , Opium , Humans , Case-Control Studies , Male , Female , Iran/epidemiology , Mouth Neoplasms/epidemiology , Mouth Neoplasms/etiology , Middle Aged , Opium/adverse effects , Risk Factors , Opium Dependence/epidemiology , Adult , Aged , IncidenceABSTRACT
In April 2023, the Taliban banned poppy cultivation and the trade of all narcotics. This caused a 95% reduction in opium production. Usually, that would be good news. But there is a substantial worry: synthetic opioids might fill the void left by heroin. This is concerning because these drugs have led to health emergencies in areas where they are prevalent. This paper highlights the limitations of the current drug surveillance system in Europe and proposes improvements. It argues that reliance on secondary data is insufficient. Instead, we need to interview a sentinel group of people who inject drugs and adjust city-level sentinel systems, such as wastewater analysis, to specifically track the spread of synthetic opioids. Without these proactive steps, we risk only noticing a transition from heroin to synthetic opioids after it has occurred, with its harmful impacts already in place.
Subject(s)
Heroin , Papaver , Humans , Narcotics , Opium , Analgesics, OpioidABSTRACT
Opium is defined as the air-dried latex obtained by incision from the unripe capsules of Papaver somniferum L. Opium is a complex mixture that contains approximately 10% morphine and 2% codeine. It is commonly used to prepare opium tinctures for people with chronic diarrhea. Morphine and related opioids are powerful but highly addictive analgesics; designing less addictive opioids is an active area of pharmaceutical research that may lead to significant improvements in chronic pain management. Recently, the International Agency for Research on Cancer (IARC) has classified opium consumption as carcinogenic to humans (Group 1) based on sufficient evidence of carcinogenicity in human studies. However, all human studies analyzed by the IARC Working Group included participants who consumed opium that was mixed, adulterated, and/or contaminated with known and probable human carcinogens (e.g., tarry residues of combusted opium, arsenic, lead, and chromium). The working group considered that these carcinogens were part of the complex mixture that opium is, rather than co-exposure or confounders. No evidence of carcinogenicity was available for pure opium in human, animal, or mechanistic studies. To avoid confusion and concern among health professionals and patients using medicinal opium preparations and in scientists involved in the design and development of new opium derivatives, opium should be classified in Group 3 (not classifiable as to its carcinogenicity to humans). The term 'street opium' could be used to refer to opium that probably contains human carcinogens not present in pure opium and should remain in Group 1 (carcinogenic to humans).
Subject(s)
Neoplasms , Papaver , Analgesics, Opioid , Animals , Carcinogens , Humans , Morphine , Neoplasms/chemically induced , Opium/adverse effects , Opium/chemistry , Papaver/chemistryABSTRACT
In September 2020, the International Agency for Research on Cancer (IARC) announced that opium consumption causes cancer in humans - a conclusion drawn after reviewing data from five decades of research. Given the widespread use of opium and its derivatives by millions of people across the world, the classification of opium consumption as a "Group 1" carcinogen has important public health ramifications. In this mini-review, we offer a short history of opium use in humans and briefly review the body of research that led to the classification of opium consumption as carcinogenic. We also discuss possible mechanisms of opium's carcinogenicity and potential avenues for future research.
Subject(s)
Neoplasms/chemically induced , Opioid-Related Disorders/complications , Opium/history , Biomedical Research/trends , Carcinogenesis , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , HumansABSTRACT
BACKGROUND: A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting. METHODS: The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers (n = 23,619), persistent postoperative opium consumers (n = 3636) and enduring postoperative opium withdrawal (n = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation. RESULTS: After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06-1.54; P = 0.009) and 25% (HR 1.25, 95% CI 1.13-1.40; P < 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16-1.55; P < 0.0001). CONCLUSIONS: The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.
Subject(s)
Coronary Artery Bypass , Coronary Artery Disease/surgery , Opioid-Related Disorders/complications , Opium/adverse effects , Postoperative Complications/etiology , Risk Assessment/methods , Coronary Artery Disease/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Iran/epidemiology , Male , Middle Aged , Narcotics/adverse effects , Postoperative Complications/epidemiology , Retrospective Studies , Time FactorsABSTRACT
Urial K. Mayo (1816-1900) was a successful Boston dentist who was plagued by personal scandal. In 1883 he patented extending the duration of nitrous-oxide anesthesia with an alcoholic tincture of hops and poppies.
Subject(s)
Anesthesia, Dental/history , Anesthetics, Inhalation/history , Nitrous Oxide/history , Opium/history , Anesthetics, Inhalation/chemistry , Ethanol/history , History, 19th Century , Humans , Humulus , Papaver , Solvents/history , United StatesABSTRACT
JUSTIFICATIVA E OBJETIVOS: Devido à finalidade do ambulatório e os fármacos utilizados rotineiramente, o objetivo deste estudo foi rever e atualizar os conhecimentos sobre os receptores opioides e como complemento de estudo após palestra apresentada aos integrantes da equipe. CONTEÚDO: Foram revisados desde os aspectos históricos até os conhecimentos mais recentes sobre receptores opioides, descritos seus subtipos e mecanismos de ação. Para tal, foram consultadas referências indexadas pelo Pubmed. CONCLUSÃO: Com os dados presentes na literatura atual, concluiu-se que ainda existe muito a ser pesquisado sobre o tópico, visando medicações mais seguras e novas técnicas biomoleculares ainda são necessárias.
BACKGROUND AND OBJECTIVES: Due to the objective of the outpatient setting and to routinely used drugs, this study aimed at reviewing and updating the knowledge about opioid receptors and worked as a study complement after a lecture presented to team members. CONTENTS: We have reviewed from historical aspects to most recent developments about opioid receptors, in addition to describing subtypes and action mechanisms. For such, Pubmed-indexed references were queried. CONCLUSION: After reviewing current literature data, we have concluded that there is still a lot to be researched about the topic, aiming at safer drugs, and new biomolecular techniques are still needed.