Talk:Opioid

Unsourced

No source is actually provided and some of this is dubious. Is opium actually used clinically?? This subsection was in the "Society and culture' section but includes content that should be in the "Medical use" section, if it were sourced.

United States approval

The sole clinical indications for opioids in the United States, according to Drug Facts and Comparisons, 2005, are:

• Moderate to severe pain, i.e., to provide analgesia or, in surgery, to induce and maintain anesthesia, as well as allaying patient apprehension right before the procedure. Fentanyl, oxymorphone, hydromorphone, and morphine are most commonly used for this purpose, in conjunction with other drugs such as scopolamine, short and intermediate-acting barbiturates, and benzodiazepines, especially midazolam which has a rapid onset of action and shorter duration than diazepam (Valium) or similar drugs. The enhancement of the effects of each drug by the others is useful in troublesome procedures like endoscopies, complicated and difficult deliveries (pethidine and its relatives and piritramide where it is used are favoured by many practitioners with morphine and derivatives as the second line), incision & drainage of severe abscesses, intraspinal injections, and minor and moderate-impact surgical procedures in patients unable to have general anesthesia due to allergy to some of the drugs involved or other concerns.
• Cough (codeine, dihydrocodeine, ethylmorphine (dionine), hydromorphone and hydrocodone, with morphine or methadone as a last resort.)
• Diarrhea (generally loperamide, difenoxin or diphenoxylate; but paregoric, powdered opium or laudanum or morphine may be used in some cases of severe diarrheal diseases, e.g. cholera); also diarrhea secondary to Irritable Bowel Syndrome (Codeine, paregoric, diphenoxylate, difenoxin, loperamide, laudanum)
• Anxiety due to shortness of breath (oxymorphone and dihydrocodeine only)
• Opioid dependence (methadone and buprenorphine only)

Evidence supports the use of low dose, regular oral opioids for the safe relief of breathlessness that is not responsive to disease-modifying treatments. This action appears to be a result of the effect on opioid receptors in the limbic system.

Opioids are not used for psychological relief.

Opioids are often used in combination with adjuvant analgesics (drugs which have an indirect effect on the pain). In palliative care, opioids are not recommended for sedation or anxiety because experience has found them to be ineffective agents in these roles. Some opioids are relatively contraindicated in renal failure because of the accumulation of the parent drug or their active metabolites (e.g. codeine and oxycodone). Age (young or old) is not a contraindication to strong opioids. Some synthetic opioids such as pethidine have metabolites which are actually neurotoxic and should therefore be used only in acute situations.

-- Jytdog (talk) 21:00, 31 May 2016 (UTC)

Vardanyan, R.S.; Cain, J.P.; Mowlazadeh Haghighi, S.; Kumirov, V.K.; McIntosh, M.I.; Sandweiss, A.J.; Porreca, F.; Hruby, V.J. (2017). “Synthesis and Investigation of Mixed μ-Opioid and δ-Opioid Agonists as Possible Bivalent Ligands for Treatment of Pain” J. Heterocyclic Chem., 54: 1228-1235. doi: 10.1002/jhet.2696. — Preceding unsigned comment added by Sagharmolazade (talk • contribs) 00:53, 20 June 2017 (UTC)

Speaking of Opium, what relevance does Opium have to opioids? I am not criticizing the mention of Opium here, I am saying that "opioid" seems to indicate Opium and the article should indicate the relevance or lack of relevance. If opioids are derived from Opium then have the drug companies prevented that from being stated here? Sam Tomato (talk) 16:56, 20 April 2018 (UTC)

Opioids are defined by their pharmacology, not by their origin. Most opioids are synthetic (or semi-synthetic) and not obtained from opium. But in any case, there is no reason to think that drug companies control the content of this page. -- Ed (Edgar181) 17:30, 20 April 2018 (UTC)

Hypogonadism

Review doi:10.1210/clinem/dgaa417 JFW | T@lk 21:20, 18 August 2020 (UTC)

Desomorphine

Desomorphine is listed as an ester of morphine, in a wrong way in my opinion. Since is a reduction derivative of codeine, it's better to put it in the section of semi-synthetic derivatives.Fbet1 (talk) 00:11, 3 April 2021 (UTC)

Medical use? Sources?

Is this yet another attempt by WP to interject politics into an encyclopedia? This from the lead paragraph:

Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, suppressing cough,[3] as well as for executions in the United States.

So now putting someone to death is medical treatment for that terminal illness known as life. There is no cure for it.

This appears to be an unsourced assertion rather than fact. Is this even real? More importantly, IMO it is irrelevant and inappropriate for a medical article, without further context. If it were sourced, perhaps it could be included in the "Recreational use" section. Blueistrue (talk) 14:41, 18 January 2022 (UTC)

Hydromorphone was used in the execution of Joseph Wood and the execution of Dennis McGuire, so this appears to be real.

However, lethal injection as part of capital punishment is not a medical use.

I was unsure whether to simply remove this part of the statement or merely correct it, but the potential of opioids to cause death does belong in the lead. IpseCustos (talk) 15:53, 28 May 2022 (UTC)

RL -- OL Usage of opioids and does the topic belong here?

I noted the RLS debate - and the use of opioids in managing R-RLS - while the editor did give a couple of okay cits., there are MANY other citations that either contradict/challenge the usage or totally refute it.

I'm not going to prescribe an opiate in this political climate to an RLS patient casually - FL treatment is not an opioid - perhaps pointing that out is impt.

Off label use by any given US Doc., is not uncommon - but perhaps focusing on primary indications - as in approved - might be more appropriate for a WP article - perhaps this RLS bit belongs in an article about RLS and not in this art. - Just a thought.

Dr. BeingObjective (talk) 20:55, 5 November 2023 (UTC)

Tried a DIPLOMATIC COMPROMISE - very slight mod and ref. "

Restless legs syndrome[edit]

Though not typically a first line of treatment, Opioids, such as oxycodone and methadone, are sometimes used in the treatment of severe and refractory restless legs syndrome." BeingObjective (talk) 23:27, 5 November 2023 (UTC)

Incorrect infographic description

The infographic comparing molecular structures of the opioids under the "Terminology" portion has a false statement. They wrote, "the methyl group is missing from codeine so it is not 100% true". The methyl group is part of the graph, so the comment should be deleted. If they find genuine mistakes on the infographic though it should be removed from the page. Oddchamp (talk) 03:53, 8 October 2024 (UTC)

Terminology

The "Terminology" section includes a graphic showing chemical structures of various opiates and opioids, but there is no obvious similarity at all, to the layman, between the "fully synthetic opioids" and the others, and there is nothing in the text to explain why these would be called "opioids" when they appear, as I say, to the layman, to be chemically completely different. I think a note in the caption to explain this would be very helpful. Thanks. 2A00:23C8:7B0C:9A01:EC5C:91AF:2F47:4551 (talk) 21:34, 29 October 2024 (UTC)