|MadSci Network: Medicine|
Hi Robert, You ask a good question. The short answer is few to none (beside the obvious respiratory depression - and that is a big one!) Opioids (opiate refers to the natural compounds from the poppy, opioid refers to all natural, synthetic, and semi-synthetic compounds) are, perhaps, the most valuable medicinal compounds available today. They have multiple therapeutic uses and are quite efficacious in managing pain, GI disturbances, and coughing (among others). Every medication, natural or synthetic, has desired and undesired (side) effects. Moreover, EVERY drug can produce toxic effects, it just depends on the dose you are examining. Even water can produce nasty side-effects; water intoxication is a syndrome that resembles drug-induced intoxication, but is a result of electrolyte imbalances in the body following excessive water intake - either orally or through some other means like dialysis or iv fluids. Clinically used opioids mimic what our body does on its own. That is, we produce our own natural opioids (endorphins; often talked about with regards to marathon athletes and the runner's high). As such, clinical administration of opioids, like morphine, simply artifically enhances our body's own efforts. Now, you noted that there are plenty of health risks that are indirectly associated with opioid abuse, like HIV & AIDS, hepatitis C, dependence, addiction, and respiratory depression. However there are relatively few risks that are directly associated with opioid use in a clinical, health care setting. One of the classic early studies was done by Bozarth and Wise (see below) and noted the distinct health differences between rats that self-administered cocaine or heroin. There have been a few studies that reported health risks like kidney damage, pulmonary edema, or stroke - but most of these focus on more chronic administration. With regards to short-term administration, opioids have two main risks to my knowledge: 1. Allergic reactions (almost everyone knows someone who had a bad reaction to the codeine the dentist gave them following a root canal or extraction); 2. Suppression of the immune system. This latter one has obvious implications for persons who abuse opioids and are at risk for contracting HIV, however, the suppression over the short-term is minimal is this is more likely a risk factor for chronic opioid users. Finally, an interesting thing to note is that the drug you mention -- heroin (or diacetylmorphine) - is a Schedule I drug in the United States. Schedule I drugs are deemed to have no medical purpose or use (other Class I drugs that you might know are LSD and PCP). Only schedule II-V drugs can be prescribed by a physician/dentist. The justification for this is that the active metabolite of heroin is morphine, which is a schedule II drug and can be prescribed. However, physicians in Great Britain can prescribe heroin for various medical conditions. Just one of the many differences that depend on which side of the pond you call home. Thanks for the good question, Cheers, Josh Rodefer, Ph.D. Harvard Medical School Reference: Bozarth, MA, Wise, RA (1985). Toxicity associated with long-term intravenous heroin and cocaine self-administration in the rat. Journal of the American Medical Association (JAMA), vol 254, pp 81-83.
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