Talk:Opioid analgesic

Questions

I'd call this family of drugs "opiates". I understand "analgesic" but have never seen "opioid" before. Am I just hopelessly out of touch?

"narcotic" has one meaning in medicine & pharmacology, sometimes another in law. Cannabis may be legally a "narcotic" in some jurisdictions. Since narcotic redirects here, shouldn't we say something about that?

What about apomorphine? My understanding is it is neither analgesic nor addictive, but it does have some therapeutic uses. William Burroughs claimed it was the only treatment for morphine/heroin addiction that actually worked. He claimed to have tried all the others except electro-shock. That article was originally in Lancet, was included as an appendix in the edition of "Naked Lunch" I had. Sandy Harris 12:46, 1 June 2010 (UTC)

Let me answer generally, and we can work some of this into the article.

There is a specific class of cellular opioid receptors, on which opioid drugs have effects: agonist (stimulate or up-regulate), antagonist (depress or down-regulate), and, at the subclass (or perhaps particular site) level, agonist-antagonists or partial agonists. Some opioids have multiple effects on multiple receptors and sub-receptors

• Mu-receptors are generally analgesic, euphoriant, respiratory depressant
• Kappa-receptors tend to be dysphoric, act more in the spinal cord than brain, but are analgesic
• Delta-receptors have less clear effects.

Naloxone is a pure antagonist used as an antidote. Buprenorphine is a mixed agonist-antagonist, which, as opposed to morphine, is an analgesic in cats -- morphine is not an effective analgesic but instead makes them wildly excited. Buprenorphine, however, will induce withdrawal in a human opioid addict.

Burroughs is out of date. Addiction treatment is complex, but tends to use long-acting mu agonists that produce minimal sedation and euphoria, such as methadone and l-alpha-acetylmethadone. Other, non-opioid drugs, such as alpha-adrenergic antagonists such as clonidine, help with withdrawal for both opioids and nicotine. Apomorphine is now rarely used to produce vomiting.

So, yes, "narcotic" is essentially legal. Opioid analgesic is a subset of opioids that has agonist effects on analgesic receptors. Not all opioids are analgesic. Howard C. Berkowitz 13:24, 1 June 2010 (UTC)

Pure opioid comparison versus opioid and adjuvant

I see a statement that opioids may not be as effective as tricyclic antidepressants. This, I think, is misleading, because it is quite routine, in chronic pain management, to combine opioids with adjuvants from several families, and get a synergistic result. I'm assisting with research in a couple of case, right now, where this sort of thing will be done.

For example, one patient is on heavy doses of baseline oxycontin with breakthrough hydromorphone, but, on doing a detailed pain history, much of his pain seems to be soft tissue rather than due to his back surgery -- his spine doesn't hurt, but everyone has been assuming that. He doesn't have the trigger points of fibromyalgia, and stopped taking cyclobenzaprine (closely related to tricyclics) due to anticholinergic side effects, wise since he has kidney stones. I suspect we will go with a second-generation or atypical serotonigenic antidepressant with evidence for pain effects, probably venlafaxine. Also, he has said NSAIDs have a dramatic effect although naproxen has stopped working -- he describes a classic autonomic prostaglandin local release. I am recommending, to the treating physician, trying some different NSAID families, as with diclofenac. He has been on baclofen for several years, but no one is sure why. Consultation with rheumatologu is probably appropriate.

So, the two-drug comparisons simply to not represent best practices in complex pain management. Howard C. Berkowitz 17:53, 27 December 2010 (UTC)

Broken reference

There is a broken citation in this article and I can't work out how to fix it. David Finn 15:54, 9 May 2011 (CDT)