Talk:Opioid

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[edit] Categorization of synthetics

I just changed the size of the heading "Piperanilides" to match the other headings. Due to the fact that "Morphinan derivatives", "Others", etc. were subheadings of it, and they don't seem to be related to piperidines, I think it was just a mistake made by the anon who added the subhead a couple months ago. If possible, I'd like someone who knows more about the chemistry to confirm this for me, as I can't find anything on Google for "piperanilide" but WP mirrors. What relation do piperanilides have with phenylpiperidines (as fentanyl is definitely also classed as the latter... I believe)? Oy. Thanks in advance... --Galaxiaad 08:17, 19 January 2007 (UTC)

They are actually called "anilidopiperidines" or "anilinopiperidines". Fentanyl is no way a phenylpiperidine derivative, since it is an 4-anilidopiperidine (so N-phenylamino-piperidine) derivative.

The relation between 4-phenylpiperidines (e.g. meperidine/pethidine) and 4-anilidopiperidines (e.g. fentanyl) is that, both groups have certain structural similarity, namely the base of their molecular sceleton is the 1-alkylated, 4- substitued-piperidine. In the case of 4-phenylpiperidines, the 4-substituent is a phenyl or substitued phenyl cycle (e.g. 3-hydroxyphenyl in ketobemidone), whereas 4-anilidopiperidines have a N-phenylN-acylamido group as their 4-substituent (Ph-N(-CO-R)-), mostly N-phenyl-N-propionamido group (Ph-N(-CO-CH2-CH3)-). In general, anilidopiperidines are more potent opioids than phenylpiperidines.--84.163.87.92 21:27, 19 January 2007 (UTC)

[edit] Chemical categorisation of fully synthetic opioids.

I have removed the link to ketobemidone from the sub-category "Piperoanilidines (or anilidopiperidines), because it is chemically a phenylpiperidine derivative (4-(3-hydroxyphenyl-1-methyl-4-(1-oxopropyl)-piperidine). I further suggest to fuse the sub-categories of "Phenylheptylamines" and "Diphenylpropylamine derivatives", under "Diphenylpropylamine derivatives", since both methadone and LAAM are chemically derivatives of 3,3-dipheylpropylamine (methadone can be described as (R,S)-1-methyl-3,3-diphenyl-3-(1-oxopropyl-)propyl-N,N-dimethylamine, however it is an homologue of diphenylpropylamine, namely (R,S)-2-N,N-dimethylamino-4,4,-diphenylheptan-5-one; same can be applied for levacetylmethadol/LAAM). Discussion is wellcomed, if nobody has objections, I will do so in few days.--84.163.87.92 21:19, 19 January 2007 (UTC)

[edit] I will begin to try to improve the style of writing.

I think this article is quite good, but at present somewhat inaccessible for an untrained person. I will try to rewrite the point-wise sections as prose, and begin improving citations (as per WP:CITE and WP:CITET template). I will try not to change the content and meaning, but as always, criticism from others is important, especially as I am not a pro writer. I will post sections as I complete them. --Seejyb 23:50, 19 January 2007 (UTC)

Should all the long paper or book citation details within the text not be converted into footnotes ? If people agree, I can help markup as footnotes and use the relevant citation template to standardise the styling. :-) The information in the article is detailsed and good but overall it reads like lecture-notes points rather than flowing prose. David Ruben Talk 01:57, 23 January 2007 (UTC)

[edit] Summary of changes of January 24th, 2007; Section: synthetic opioids

The sub-categories "Diphenylheptylamines" (Methadone and LAAM) and "Diphenylpropylamine der." were fused under "Diphenylpropylamine derivatives"; for reason see my argumentation of January 19th. Further, "Piperoanilines" were renamed to "Anilidopiperidines", since this is the mostly used name for this subcategory of synthetic opioids in english literature (fentanyl derivatives); the opioid Etorphine was moved into subcategory "Oripavines", since it is an oripavine derivative. Opioids Loperamide and Diphenoxylate were moved into subcategory "Diphenylpropylamine derivatives", because they are both derivatives of this class (structurally akin to the opioid Piritramide). Spelling of the titles of subcategories "Benzomorphan derivatives" and "Morphinan derivatives" were corrected to "Benzomorphane" and "Morphinane" derivatives, respectivelly (see IUPAC organic nomenclature, english). For every change, a standard source cited is: ISBN 3-527-30403-7 ; Buschmann et al.: Analgesics. From Chemistry and Pharmacology to Clinical Apllication. Wiley-VCH, 2002.--84.163.91.142 03:12, 24 January 2007 (UTC)

[edit] Summary of changes to opioids Jan 2007

Over the past two months I have been working steadily to add the clinical use of opioids for people with palliative care needs. I realise that opioids are used and abused for many other reasons, but feel that some of these are subjects for other sections, particularly the recreational use of the naturally occuring agents.

There is so much misinformation about this group of chemicals that many people who need opioids for the relief of symptoms such as pain or breathlessness, are frightened by the fear of addiction, tolerance or intolerable adverse effects. Ocasionally patients will believe pain is preferable.

I realise that some will find these changes more 'clinical', but I have tried to make the academic aspects readable. As far as possible I have tried to reference the experience of palliative care and attempted to make clear the diference between safe and unsafe use of opioids.

Being relatively new to Wikipedia, I am still learning the rules, and apologise that I have not previously written a comment to explain my actions and encourage debate. I am happy to do so now.

--Claud Regnard 23:22, 4 February 2007 (UTC)


Dear Claud, I agree with you, but I think that half of this Wiki voice shoud be erased and the title changed. It's not a voice about opioids but something else , like Pain management or palliative care.

Albert0, alt.drug.hard poster, 23/07/2007


Dear Albert, I accept there is a balance to be struck between the scientific (chemical, pharmacological, medical), pragmatic (practical use and abuse) and social. However, it is not possible to isolate any one part without creating a knowledge gap in the information. Opioids bring both relief and harm to millions around the world. Understanding the aspects of both are crucial in offering a section that is useful and informative. --Claud Regnard 22:43, 21 August 2007 (UTC)

[edit] No title

A citation is DEFINITELY needed for the claim that people taking opioids for medicinal purposes rarely get addicted.

-Jessica 71.246.71.26 12:30, 3 May 2007 (UTC)

Quite right, although it is true that addiction is rare. After 30 years practice using opioids in palliaitve care I have never known a patient develop a craving or drug-seeking behaviour for their opioid. There are many references for this, but currently the best text is the Oxford Textbook of Palliatve Medicine. --Claud regnard 23:34, 9 May 2007 (UTC)

I have merged the previous text for opiate into this expanded entry for opioid, and created a redirect from opiate.

As the article says, the word "opioid" is now the preferred general medical and scientific term for any drug, natural or synthetic, that behaves like opium on the central nervous system. "Opiate" is a more restrictive term that applies only to natural and semi-synthetic opioids, so I thought it made sense to perform this restructuring.

User: karn


I have now also merged in the contents of opioid analgesic, added some text, and created a redirect. The list of opioids is not complete, and the various classifications need checking.

User: karn

I am not particularly happy with the opening sentence referring to opium. I think this is a little unfortunate to imply all drugs listed below are opium derivates or opioid receptors are in any way sensitive to opium. It'd be better to mention opium later on in the article. Kpjas

How would you reword it? The definition of "opioid" *is* in fact any drug that mimics the effects of opium in the body, whether or not the drug is actually made from opium. Perhaps it would be better to say that an opioid is any drug that mimics the effects of *morphine*, the primary alkaloid in natural opium? User:Karn

The moderator was not happy with the style of the 'dangerous opioids or dangerous prescribers section, so I have changed this into a more suitable style (I hope).
--Claud regnard 23:48, 9 May 2007 (UTC)

--- The mention of Harold Shipman is quite bizarre, almost suggesting that he was a victim of juducial anti-opioid prejudice. He was convicted of fifteen counts of murder, not simply of knowingly administering overdoses. It was decided by an inquest that Shipman had murdered at least two hundred and fifteen of his patients, having caused them to include him as a beneficiary in his will. There were two hundred more suspicious deaths associated with him. On that basis, I deleted it.

You're quite right, although there have been two cases of UK doctors who were not convicted despite giving similar or higher doses. They used double-effect as their defence. --Claud regnard 00:58, 6 June 2007 (UTC)

The "dangerous opioids or dangerous prescribers" section still seems biased, written inappropriately, and possibly off-topic.68.127.88.58 01:57, 10 July 2007 (UTC)

There definitley needs to be something done about the article stating that people using opiates for painkillers rarely get addicted, as this is completely wrong. people taking prescription opiates are at a huge risk for addiction and many of them are addicted. by having their doctors up their dose and being on a lifelong regime, this defines addiction, particularly due to the fact that they cannot stop taking said opiates without withdrawal symptoms, and require more of said opiates for the pain relief and allevation from the withdrawal. --User:kmac20 23:34, 23 May 2007 (ETC)

kmac20, No, you are mistaken. Addiction is defined to be a "drug seeking behaviour" where an individual actively seeks a drug despite it not being therapeutic, despite any adverse criminal, social or economic circumstances, and with no regard to the consequences. What you are describing is Drug Tolerance (where the body requires a larger dose to get the same effect) and drug dependance (where a drug user's body requires the presense of a drug for "normal" function - compare to a diabetic being "dependent" on insulin). I believe the main article clearly delineates these differences, as does the article on drug addiction. For the record, I've been taking opioid based medications (Tramadol, Morphine and Oxycodone) for over a decade now on a twice daily basis, and I've never been inclined to seek any beyond the dosages prescribed by my Pain Specialist. My doses are larger than they were, and the drugs I take are stronger, but that is due to tolerance and the fact that my condition is deteriorating. Yes, if I stop taking them I have unbearable pain, but that's as much due to massive nerve damage as to dependence. Patients who are dependent on opioids will get a regime to reduce their dose when (and if) the underlying cause is cured, thus managing the withdrawal and eventual cessation of the drug. I believe that many people don't talk to their doctors about weaning off the meds once they're better due to a stigma of "addiction" caused by basic misunderstanding much like yours. Given that taking these drugs for pain doesn't seem to provide any euphoria, but does provide chronic constipation and the real risk of not noticing other injuries, most pain patients would love to be able to live without narcotics. Myself, I've only 30 or 40 years of living like this left to go <sigh>... Johnpf 09:09, 24 May 2007 (UTC)

It does seem odd to claim that addiction is rarely seen in clinical practice in patients taking opioids for pain relief. And yet, that is the reality, with extensive literature to support that observation. Johnpf gives one definition of addiction, but a more recent view is that addiction is a craving for a chemical or behaviour (relieved when the pleasure centre of the brain is stimulated by that chemical or behaviour) and that this occurs within a specific social context. For a patient in pain, the social context is to relieve the pain, and the use of opioids for pain relief does not create a craving for the opioid. Patients whose pain is relieved by other means can reduce and stop their opioid without being left with a craving. --Claud regnard 00:20, 6 June 2007 (UTC)

Johnpf, the drug users would seek the drug and attempt to obtain it illegally due to their tolerance, if their prescription was revoked. just because they are given the drug with reason does not make them any less addicted due to the addictive nature of the drug to begin with. they must be addicted, and this is why it is so dangerous to take them off of the drug, they will then just become addicts without a license. kmac20

Kmac, please take the time to check the articles on Addiction, Tolerance and Dependence. Learn a little about the difference between the terms. You are describing Addiction. Tolerance is a completely different thing, being a reduction of affects on the body. It is not usual for someone who has been using opioids appropriately to respond to medically guided cessation of these painkillers by developing an addiction. It could be the case in places where it is easy to get strong opioids (like oxycontin in the USA) that people could be self- medicating, and over-medicating, and then developing addiction. Addiction is usually (though not always) associated with abusing drugs. You also have to be aware that to people like myself, who have another 30 or so years of pain ahead of them, properly supervised medical treatment with opioids is such an important contributor to quality of life that addiction is really a non-issue - no more than a diabetic's dependence on insulin, as both are cases where medicine dramatically increases lifespan. Johnpf 11:36, 2 July 2007 (UTC)


The quality of this article is poor, because it gives some ggod datas but is heavily biased and with rhetoric argumentation

Some quotes: Contrary to popular belief, high doses.../ In the U.S., doctors virtually never prescribe opioids for psychological relief , despite their extensively reported psychological benefits/ 33% of UK doctors believe .. etc[about belief on opioid or about opioid?]/ Before the twentieth century, institutional approval was often higher, even in Europe and America [also for war was the same]] In some cultures, approval of opioids was significantly higher than approval of alcohol / With exceptions such as Shipman, UK doctors are very cautious about shortening life (??!!)/ There is a parallel here with power tools which are inherently safe unless they are used in a negligent or malicious way. Why blame the tool—morphine—and ignore bad prescribers? [some more sermon?]/ For patients taking opioids for pain relief, this can occur in some (but not all), but it is not a clinical problem[citation needed: yes it is]/ Abuse is the misuse of opioids in the context of addiction [circolar definition, that imply no pssible problem in medical use]/ Prevention of tolerance [in the future there will be no problem, so stop worring *now*]/ Occasionally, *people who are addicted* to opioids on the street develop a painful condition which requires strong opioids. [...] they *do not run the risk of addiction* It's enough?

Albert0 from ADH 23/07/2007

Albert, I can see why you find some parts of this article difficult, although the truth can be surprising! You are right that more statements need referencing, but it is not clear from your comments exactly what are your difficulties with the sections you quote. In relation the sections I'm most familiar with:
...UK doctors are very cautious about shortening life... This is true and comes from a recent study which is cited.
...Why blame the tool... This is a comment rather than a sermon and refers to the tendency to blame opioids for problems, when the problem is invariably incorrect, ignorant or malicious use.
...people who are addicted... There is increasing experience of patients with pain who were previously (or even currently) opioid-addicted, having no difficulties managing with opioids. In the past such patients had opioids withheld for fear this would worsen or rekindle their addiction.
Perhaps you could help us with more specific comments on the sections you quote. --Claud Regnard 22:22, 21 August 2007 (UTC)

[edit] Updating references

I have added references where asked to do so by the moderator. However, in some sections (eg. adverse effects) there are so many references that could be added and I have taken the short cut of referencing to larger texts and online resources, and I'll wait to see if this is acceptable. --Claud Regnard 01:02, 6 June 2007 (UTC)

[edit] Heroin -- Diamorphine -- semisynthetic opioid

heroin (diamorphine) is an OPIATE. it's neither an alkaloid nor is it semi synthetic - it's a form of morphine.. an ultra prodrug that is essentially non-existent

Well, I'm sorry to dissapoint you, Thegoodson, but Heroin/Diamorphine is not an opiate, according to contemporary classification of these. Opiates are alkaloids, naturally occuring in opium; these are: morphine, codeine, thebaine and oripavine (others, like papaverine aren't opioids). That's it. Heroin isn't a native opium alkaloid, it is semisynthetic, since it is a man-made morphine-acetic acid-ester (hence diamorphine or diacetylmorphine). Much the same like oxycodone, oxymorphone, hydromorphone, hydrocodone or even etorphine. All of the mentioned are made by chemical processing of natural opiates such as morphine, codeine or thebaine; as is heroin. If you want to argue, do as you wish. Or even better, go ask an organic chemist, expert in the field of alcaloid chemistry. I revert therefore your changes; and I ask you, if you are really concerned to make sensefull contributions in this article, to discuss it here. Thank you in advance.--84.163.115.138 04:25, 1 August 2007 (UTC)

Hi there. This topic has been brought to my attention by Spiperon (talk · contribs), and I'd like to say that the most damaging aspects of this issue are the escalation into a content dispute and the lack of real discussion.
Regarding the actual issue—heroin as opiate or opioid—I must say that, personally, when I hear "opiate" I specifically think "natural alkaloid". However, this distinction is AFAIK not that widely held, and both terms are used interchangeably when referring to heroin, even in the literature (as a quick PubMed search will attest). Perhaps it is a historically established use? I've also come across a definition of "opiate" as any opioid preserving the core structure of the a natural opium alkaloid. However, I haven't got a reference for this and am not entirely convinced of its accuracy or how established a definition it is. I would welcome further input on this matter and discussion before any further edits are made. Fvasconcellos (t·c) 22:51, 4 August 2007 (UTC)

An opiate is an "opioid of the poppy" or " a drug who acts on opioid/opiate receptor", opioid " a drug who acts on opioid/opiate receptor". In scientific literature opioid is used more often, 5:1 ratio in Pub Med where 1:1 in Google( but who really cares if the drug is or is not in the poppy? It's more a mere linguistic iusse). By the way, no doubt that in papaverum there is not any acetyl-morphine, so I have rearranged "heroin" in opiate voice. ( more: by IV Heroin is not a prodrug , MAM has an half-life of 40minutes) Albert0, 07 August 2007

[edit] Paradoxical beliefs about opioids

When reading this article, I ran across the bullet point stating paradoxical beliefs about opiods: "33% of UK doctors believe they had possibly shortened life during alleviation of symptoms. and yet UK doctors are particularly cautious about shortening life."

When I first read it, I thought, "Don't doctors do this regardless of where they live?" I vote for removal of the last sentence - "and yet..." - because the first sentence in itself points out the paradox.

Also, the title of the sub category doesn't really seem to fit. It could probably go into the sub category below it, "How safe are opioids? A world view" —Preceding unsigned comment added by 198.16.3.247 (talk) 19:17, 12 September 2007 (UTC)

I agree that the bullet point is not clear. The second part of the first bullet point refers to a second, follow-up study and I have altered the text to make this clearer. I also agree that the section heading is unhelpful and, as you suggest, I have moved the text into the next section.

--Claud Regnard 23:58, 19 September 2007 (UTC)

[edit] Narcotic vs. Opiod

Narcotic duplicates a lot of information from this article. I think this article should contain all the pharmacological information about opiods, and the narcotic article should be confined to discussing the various uses of that very inprecise term. Steve CarlsonTalk 08:40, 14 September 2007 (UTC)

I agree with Steve. The term 'narcotic' has too many associations with the illegal supply or recreational use of opioids. --Claud Regnard 00:01, 20 September 2007 (UTC)

Also some more pharmacological and scientific facts regarding opiates would better suit this article, as opposed to narcotics as well. Potency for example is one that comes to mind, as opiates are somewhat unique in their wide range of analogues and relational equipotencies. Other facts as well, if you can think of any.-70.74.122.87 03:31, 23 October 2007 (UTC)

[edit] The Sheer Idiocy of It

IS THIS ARTICLE A JOKE?! The only fact-laden area here was the discussion of what was an opiod and what was an opiate. The *medical* side is neglecting fact on a criminal level. Gods forbid some young doctor reads this and decides to experiment on some poor patient... Oh, and making docs legally answerable for administering high doses to those that further die? You have heard of *tolerance*, right? A cancer patient or a street drug user might have a daily dose that would be enough to kill a bus-load of patients without tolerance. Increasing death rates? Oh, please... Only if it's through horrid malpractice. Pure opiates in proper dosages, administered by proper doctors, are about as toxic as vitamins. As to the decrease in pain, stress, and panic (also, fatigue due to those), that's a lifesaver - the psychological state of the patient is always the flip-area that makes it go either way, life or death. The chemical, medical, and pharmacological points in this article are laughable. I wouldn't dream of writing something so crucially important and I surely know much more on the topic than the articles author. Here's hoping someone QUALIFIED will re-write it. 128.195.186.78 11:11, 27 September 2007 (UTC)Adieu

Dear Anonymous: I'm sad that you believe that so many referenced facts are laughable. Opioids are no different to many drugs in that they are usually safe if used correctly. This does not mean they are always safe, nor that they are always dangerous- even the vitamins that you quote can have serious adverse effects when taken in excess. Many folks contributing to this article are qualified and experienced in the use of opioids and trying hard to create a balanced consensus. Are there any specific facts that you can demonstrate with reputable references to be untrue, unsafe or imbalanced? --Claud Regnard 22:24, 4 October 2007 (UTC)

Dear Claud: You seem like a robot. You typed up most of this page as though it was an essay, and your profile says that you are trying to keep yourself sane... wtf? —Preceding unsigned comment added by 24.6.5.15 (talk) 09:09, 15 October 2007 (UTC)

Oh dear 24.6.5.15- I wish there was something I could write that would correct your view of me as an idiot robot essayist trying to stay sane! However, I'm certainly responsible for a few (but by no means all) sections, so once again, if there are specific facts you can demonstrate with references to be untrue, unsafe or imbalanced, please let us know. --Claud Regnard 14:21, 1 November 2007 (UTC)

Thanks for your edits, 24.6.5.15. I will agree that the page needs a great deal of encyclopedi-fication from its current state, but I would suggest you look at Claud's list of scholarly publications before judging him so harshly. There is a need for both experts and editors here, and I hope that you continue to help in whatever capacity suits you. St3vo 16:18, 15 October 2007 (UTC)

Thank you St3vo --Claud Regnard 14:21, 1 November 2007 (UTC)

[edit] natural opioid consensus?

I have never encountered such a debate over opiate/opioid terminology in the literature, although that doesn't mean we shouldn't have it here. Bear in mind, however, that Wikipedia shouldn't be defining words, merely reflecting their use by expert sources (as per WP:NOR).

Can we agree, then, that "natural opioids" (call them opiates if you prefer) are the [phenanthrene] alkaloids directly derived from opium that act at opioid receptors? In this system, thebaine and oripavine are natural opioids despite the fact that they have little intrinsic therapeutic value (except as precursors to semisynthetics), while papaverine - albeit an alkaloid found in opium - is not an opioid at all. Heroin is, by all accounts, semisynthetic. St3vo 21:07, 2 October 2007 (UTC)

[edit] endogenous opioids

nociceptin is not an endogenous opioid and so I have moved the section from here to the nociceptin page. —Preceding unsigned comment added by Blahfooblahfooblah356 (talk • contribs) 12:27, 1 November 2007 (UTC)

[edit] Opiates, opioids, Thegoodson and again, and again, and again, and...

...I'll submit a protected-status demand on this article, since this is plain vandalism and it's impossible for me to assume good faith (see lack of any discussion..). Okay?--Spiperon (talk) 03:51, 13 February 2008 (UTC)