Lecture on Opioid Epidemic and Fentanyl

Introduction

• Annual opioid-related overdose deaths: ~70,000.
• Oxycodone was the main culprit in the early 2000s, known as Oxycontin.
• In 2013, fentanyl surpassed both Oxycontin and heroin in opioid epidemic.
• Contributing factors:
  • Pharmaceutical greed and malpractice.
  • Overprescription by healthcare providers.
  • Illicit fentanyl production from China, Mexico, and India.

Fentanyl Crisis

• Fentanyl is disguised as legitimate medications and smuggled.
• People may think they’re getting Xanax or Adderall, but actually receive fentanyl.
• Fentanyl is 50x more powerful than heroin, 100x more powerful than morphine.
• 2mg of fentanyl is often a fatal dose.

Opiates vs. Opioids

• Opiates: Natural compounds from poppy (e.g., morphine, codeine).
• Opioids: Broad term for compounds affecting opioid receptors, includes opiates, semi-synthetic (e.g., heroin), and synthetic (e.g., fentanyl).

Endogenous Opioids

• Body produces its own opioids: endorphins, encephalins, etc.
• Bind to opioid receptors in the body and modulate pain.

Pain Processing

• Pain signals travel from injury site to the brain.
• Primary areas involved: Thalamus, Primary Somatosensory Cortex, Amygdala.
• Descending pain modulation occurs via endogenous opioids to reduce pain perception.

Neurotransmitters and Receptors

• Important neurotransmitters: Glutamate (excitatory), GABA (inhibitory).
• Opioid Receptors: Mu, Delta, Kappa (focus on Mu due to fentanyl's preference).
• Mu receptors are found throughout the body, affecting digestion, nervous system, and brain functions.

Addiction and Dopamine

• Opioids affect the mesolimbic pathway crucial for dopamine release.
• Addiction involves increasing doses to achieve dopamine highs.

Legitimate Uses of Fentanyl

• Administered in controlled settings for extreme pain (e.g., cancer, surgery).
• Controlled usage by anesthesiologists.

Overdose and Withdrawal

• Overdose often results from respiratory depression due to opioid impact on the brain stem.
• Naloxone (Narcan) can reverse overdose by binding to opioid receptors.
• Withdrawals are extremely painful due to sudden sensitivity in pain pathways.

Conclusion

• Education on opioids critical to avoid misuse.
• Opioid epidemic remains a major public health issue.

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