Health and Body Care

More than 20 chemically distinct opioid drugs are in clinical use throughout the world. In the developed countries, the opioid drug most frequently associated with abuse and dependence is heroin; a drug that is not approved for therapeutic purposes in the United States. These drugs are all prototypical-opioid receptor agonists and all produce similar subjective effects. The patterns of use and some aspects of opioid toxicity are powerfully influenced, however, by the route of administration and the metabolism of the specific opioid, as well as by the social conditions that determine its price and purity and the sanctions attached to nonmedical use.

Opioids have been used for at least 3,500 years, mostly in the form of crude opium or in alcoholic solutions of opium. Morphine was first isolated in 1806 and codeine in 1832. Over the next century, pure morphine and codeine gradually replaced crude opium for medicinal purposes, although nonmedical use of opium (as for smoking) still persists in some parts of the world.

About 90 percent of persons with opioid dependence have an additional psychiatric disorder. The most common comorbid psychiatric diagnoses are major depressive disorder, alcohol use disorders, antisocial personality disorder, and anxiety disorders. About 15 percent of persons with opioid dependence attempt to commit suicide at least once. The high prevalence of comorbidity with other psychiatric diagnoses highlights the need to develop a broad-based treatment program that also addresses patients’ associated psychiatric disorders.