SYNTHETIC & OTHER OPIATES

Semi-synthetic narcotics include Heroin, Hydromorphone, Oxycodone, and Hydrocodone. Synthetic narcotics inculde Meperidine, Methadone, Fentanyl, Pentazocine, and many other less potent drugs.

Hydromorphone (Dilaudid) is marketed both in tablet and injectable forms. Its analgesic potency is from two to eight times that of morphine. Much sought after by narcotic addicts, hydromorphone is usually obtained by the abuser through fraudulent prescriptions or theft. The tablets are dissolved and injected as a substitute for heroin.

Oxycodone is synthesized from thebaine. It is similar to codeine, but is more potent and has a higher dependence potential. It is effective orally and is marketed in combination with aspirin (Percodan) or acetaminophen (Percocet) for the relief of pain. Addicts take these tablets orally or dissolve them in water, filter out the insoluble material, and "mainline" the active drug.

Hydrocodone is an orally active analgesic and antitussive Schedule II narcotic which is marketed in multi-ingredient Schedule III products. The therapeutic dose of 5-10 mg is pharmacologically equivalent to 60 mg of oral morphine. Sales and production of this drug have increased significantly in recent years, as have diversion and illicit use. Trade names include Anexsia, Hycodan, Hycomine, Lorcet, Lortab, Tussionex, Tylox and Vicodin. These are available as tablets, capsules and/or syrups.

Meperidine (Demerol) was introduced as a potent analgesic in the 1930s, and produces effects that are similar but not identical to morphine (shorter duration of action and reduced antitussive and antidiarrheal actions). Currently it is used for the relief of moderate to severe pain, particularly in obstetrics and post-operative situations. Meperidine is available in tablets, syrups and injectable forms (Demerol). Several analogues of meperidine have been clandestinely produced. One noteworthy analogue is a preparation with a neurotoxic by-product that has produced irreversible Parkinsonism.

Fentanyl was first synthesized in Belgium in the late 1950s, and was introduced into clinical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze. Thereafter, two other fentanyl analogues were introduced; alfentanil (Alfenta), an ultra-short (5-10 minutes) acting analgesic, and sufentanil (Sufenta), an exceptionally potent analgesic for use in heart surgery. Today, fentalyls are extensively used for anesthesia and analgesia. Illicit use of pharmaceutical fentanlys first appeared in the mid 1970s in the medical community and continues to be a problem in the United States. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentalyls are indistinguishable from those of heroin, with the exception that the fentalyls may be hundreds of times more potent. Fentanyls are most commonly used by intravenous administration, but like heroin, they may also be smoked or snorted. The effort to find an effective analgesic that is less dependence-producing led to the development of Pentazocine (Talwin). Introduced as an algesic in 1967, it was frequently encountered in the illicit trade, usually in combination with tripelennamine and placed into Schedule IV in 1979. An attempt at reducing the abuse of this drug was made with the introduction of Talwin Nx. This product contains a quantity of antagonist sufficient to counteract the morphine-like effects of pentazocine if the tablets are dissolved and injected.

[Abstracted from D.E.A. website q.v.]