Pediatrics in Review
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 Vol. 18 No. 4, April 1997
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Right arrow Substance Abuse

(Pediatrics in Review. 1997;18:122-126.)
© 1997 American Academy of Pediatrics

Opiates

Elizabeth M. Alderman, MD*
* Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Division of Adolescent Medicine, Montefiore Medical Center, Bronx, NY.


   IMPORTANT POINTS
 

  1. Heroin and opiates are not commonly abused by adolescents, but the minority who do use these substances are considered high-risk.
  2. Opiate overdose is readily treatable with attention to the ABCs and administration of naloxone.
  3. Physiologic signs not only are related to the specific drug but also to the mode of administration and lifestyle of the substance user.
  4. Neonatal opiate withdrawal is characterized by a readily recognizable set of symptoms and may be treated with phenobarbital.
  5. Opiate withdrawal should be undertaken in conjunction with treatment with methadone and behavioral therapy.


   Definitions
 
Opiates are a diverse set of drugs that include both illicit substances of abuse and prescription medications. Heroin is the prototype of the opiate class. It is produced as a white crystal but may be adulterated with lactose or procaine to achieve a concentration of 1 to 20 mg per dose. Heroin is short-acting and highly addictive because of its rapid clearance by the liver and usual mode of use, that is, by injection. Heroin is excreted in urine as morphine.

Prescription opiates include morphine, meperidine, codeine, oxycodone, and hydromorphone. Morphine and codeine are derived from opium. Oxycodone and hydromorphone are semisynthetic opiates. Meperidine and methadone are fully synthetic.

"Designer" opiates are synthetic derivatives of opiates created in makeshift laboratories that include 3-methylfentanyl (meperidine and fentanyl) and MPTP (1, methyl, 4 phenyl 1,2,3,6 tetrahydropyridine). The substances in this group of opiates are always changing, not only because of variation in laboratories, but also to evade law enforcement.


   Epidemiology
 
The use of opiates by American high school and college students has decreased since peaking in the early 1970s, when lifetime prevalence of heroin use in 12th graders was greater than 2% and other opiates was 9%. In 1992, 1.2% of all high school seniors had ever used heroin and 6% had used other . . . [Full Text of this Article]






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Copyright © 1997 by the American Academy of Pediatrics.