Category:Opioids: Difference between revisions

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The '''third wave''', from around 2013, has been driven by illicitly manufactured synthetic opioids, above all [[fentanyl]], which is far more potent by weight than [[morphine]] and is frequently mixed into other illicit drugs, often without the user's knowledge.<ref name="cdc"/> Some analysts describe a '''fourth wave''' marked by combined use of [[fentanyl]] with stimulants such as [[methamphetamine]] or [[cocaine]].<ref name="feinberg">Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine. What is the opioid epidemic? A public health explainer.</ref>

The progression from [[opium]] to [[heroin]] to [[fentanyl]], each successive material more potent by weight than the last, has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986~~; and "Iron law of prohibition", Wikipedia~~.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>

The progression from [[opium]] to [[heroin]] to [[fentanyl]], each successive material more potent by weight than the last, has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>

== Harm reduction ==

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== Mechanisms ==

Opioids bind opioid receptors, especially the µ-opioid receptor, with additional activity at the κ and δ receptors, found in the nervous system and elsewhere in the body. Binding at the µ-opioid receptor is associated with the analgesic effects of opioids, with their euphoric effects, and with respiratory depression, the mechanism by which opioid overdose causes death.<ref name="chemviews"/> As with medicines generally, that opioids bind these receptors is well established; the fuller relationship between receptor binding and the range of clinical effects, including the development of tolerance and of dependence, is more complex and remains a subject of research, and should not be regarded as a closed question.

~~== Members ==~~

The opioids include compounds of natural origin such as [[morphine]] and [[codeine]]; semi-synthetic compounds such as [[heroin]] ([[diacetylmorphine]]), [[oxycodone]], [[hydrocodone]], and [[buprenorphine]]; and synthetic compounds such as [[fentanyl]], [[methadone]], and [[tramadol]]. [[Naloxone]] and [[naltrexone]] are opioid antagonists, they block opioid receptors rather than activating them. The list is not exhaustive.

== Safety ==

The central acute danger of opioids is respiratory depression: at sufficient dose, opioids slow and can stop breathing, and this is the mechanism of fatal overdose. Risk is substantially increased when opioids are combined with other central nervous system depressants, including alcohol and benzodiazepines, and when potency is unknown, the particular hazard of illicitly manufactured [[fentanyl]]. Repeated use is associated with tolerance and with physical dependence, and a withdrawal syndrome on stopping. Figures for these risks in the literature are population estimates that vary between studies, and individual response varies considerably between people.

== Opioids indexed ==

The opioids are grouped by origin, the route by which each reached use: the natural alkaloids of the [[opium]] poppy, the semi-synthetic compounds derived from them, and the wholly synthetic agents, together with the receptor antagonists and a small group of related botanical materials.

* '''Natural opium alkaloids''': [[opium]] itself and the alkaloids of the poppy, [[morphine]], [[codeine]], [[thebaine]], [[papaverine]], and [[ethylmorphine]].

* '''Semi-synthetic opioids''', made by chemical modification of the natural alkaloids: [[diacetylmorphine]] (heroin), [[oxycodone]], [[hydrocodone]], [[hydromorphone]], [[oxymorphone]], [[buprenorphine]], [[dihydrocodeine]], [[desomorphine]], [[nalbuphine]], and [[butorphanol]].

* '''Synthetic opioids''': [[fentanyl]] with its analogs [[alfentanil]], [[sufentanil]], [[remifentanil]], [[carfentanil]], and [[acetylfentanyl]]; [[methadone]], [[meperidine]], [[levorphanol]], [[pentazocine]], and [[dextropropoxyphene]]; the dual-acting [[tramadol]] with its active metabolite [[O-Desmethyltramadol]], and [[tapentadol]]; and the illicit synthetic [[U-47700]].

* '''Opioid antagonists''', which occupy the opioid receptors without activating them: [[naloxone]], [[naltrexone]], and [[nalmefene]].

* '''Kratom and its alkaloids''': [[kratom]], the leaf of a Southeast Asian tree long used in traditional medicine, and its alkaloids [[mitragynine]] and [[7-Hydroxymitragynine]].

The atypical antidepressant [[tianeptine]], which carries unexpected activity at the µ-opioid receptor, is also indexed here.

== Notes on scope ==

This category indexes the opioids: the medicines and related materials whose actions are mediated by the opioid receptors, chiefly the µ-opioid receptor. Membership runs from the natural alkaloids of the [[opium]] poppy through the semi-synthetic and fully synthetic agents to the receptor antagonists, which are indexed here because they act at the same receptors, even though they block those receptors rather than activate them.

The opioids are a class that spans both medicine origins. The poppy alkaloids reached medicine through a long traditional relationship with the plant, while heroin, the fully synthetic agents, and most modern opioids were creations of the laboratory; for that reason this category sits under both [[:Category:Plant|Plant]] and [[:Category:Pharmaceutical|Pharmaceutical]]. [[Kratom]] and its alkaloids, a botanical opioid material, are indexed here for their opioid-receptor activity. Following the wiki's multi-membership convention, a medicine is indexed wherever its pharmacology warrants.

== About these pages ==

Each opioid indexed here has its own page, built on the wiki's standard structure for a medicine: a history-first account, then pharmacology, indications, adverse effects, and interactions. Alongside the origin grouping above, the wiki maintains receptor-based subcategories, among them mu-opioid receptor agonists, partial mu-opioid agonists, kappa-opioid receptor agonists, mixed agonist-antagonists, and opioid antagonists, which sort the members by how they act at the opioid receptors.

This is one of the wiki's MedCategory class-overview pages. It carries the [[:Category:MedCategory|MedCategory]] and [[:Category:MedCategoryFull|MedCategoryFull]] marker tags; the second suppresses the member list that MediaWiki would otherwise generate automatically, leaving the curated index above as the only one the reader sees. Because the class spans both origins, the category sits beneath [[:Category:Plant|Plant]] and [[:Category:Pharmaceutical|Pharmaceutical]] alike, and beneath [[:Category:Medicines|Medicines]].

== References ==

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[[Category:MedCategory]]

[[Category:MedCategoryFull]]

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[[Category:Pharmaceutical]]

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