How is pain defined in relation to tissue damage?
An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in those terms.
What does analgesia relieve?
Pain.
What does anesthesia abolish?
All sensation.
What substance is obtained by dehydrating poppy juice?
Opium.
How do opiates differ from opioids in origin and structure?
Opiates derive from opium; opioids are synthetic or endogenous molecules with structures very different from morphine.
What does dependence mean in the WHO definition?
A powerful or compulsive desire to use a psychoactive substance.
Which source is given for the definition of dependence?
OMS.
What activities can the concept of dependence also include?
Gambling, video games, or sex.
What does impaired control over substance use affect?
Starting, stopping, or regulating use.
What physiological indicator can signal dependence?
Withdrawal.
How far back do archaeological traces of opium use date?
About 7,000 years.
What opium-related remains have been found in European Neolithic settlements dating to 5000 BC?
Poppy seeds and capsules.
What does the 2000 BC Sumerian cylinder seal associated with Urlugaledinna record?
The first therapeutic use of opium at Sumer.
How was pain understood in medieval Christianity?
It was divinely willed and expiatory.
What punishment could physicians face for using opium in medieval Christianity?
Excommunication.
In the Buddhist view, which kind of pain offers little scope for action?
Physical pain.
In the Buddhist view, which kind of pain can be acted upon and transcended?
Mental pain.
Before which century was analgesia not accepted for surgery?
Before the 19th century.
Before which century was analgesia not accepted for obstetrics?
Before the 20th century.
Where was the first general anesthetic administered in 1846?
Boston.
What began with the first general anesthetic in Boston in 1846?
A contentious and gradual adoption of anesthesia.
What does morphine production isolate from opium?
Morphine, opium’s principal and most powerful analgesic substance.
When did Sertürner identify morphine?
Between 1805 and 1817.
Which name did Sertürner give morphine?
Principium somniferum.
What response does an opioid agonist trigger after binding to opioid receptors?
A biological response.
What are the three opioid receptor types identified in 1973?
Mu, delta, and kappa.
What structure do opioid receptors have?
G-protein-coupled receptors with seven transmembrane domains.
What did the 1911–1912 Hague Convention initiate controls over?
The production, trade, and use of opium, morphine, and cocaine.
What did the French law of 12 July 1916 criminalize?
Social use, trade, and fraudulent possession of poisonous substances.
What is opioid substitution?
Treatment with longer-acting medicines such as methadone or buprenorphine to reduce intoxication and physiological withdrawal effects.
According to the CDC reference, how many US prescription-painkiller overdose deaths were reported in 2009, 2015, and 2018?
15,500 in 2009, 33,000 in 2015, and 65,000 in 2018.
Which source is cited for US prescription-painkiller overdose figures?
CDC, prescription painkiller overdoses, 1990 jusqu’à nos.
How do opioid consumption and dependence relate to trafficking and disease, respectively?
Consumption is not itself trafficking, and dependence is a disease.
Which treatment factors can increase dependence, overdose, and mortality risks?
High doses, long treatments, powerful medicines, and short half-lives.
What does anesthesia enable during painful invasive procedures?
It enables those procedures to be performed.
Which three components comprise anesthesia?
Narcosis, analgesia, and muscle relaxation.
What is an alkaloid?
A chemically pure, pharmacologically active substance extracted from plants or living organisms.
What is withdrawal?
A physiological syndrome of unpleasant effects after stopping substance use.
What is tolerance?
The need to increase the substance quantity at each renewed use to obtain the desired effect.
What were two uses of opium in ancient Egypt?
As an analgesic and sedative.
Which work describes opium harvesting by incising poppy capsules?
Théophraste, Historia Plantarum.
How did Theophrastus describe harvesting opium from poppy capsules?
By making incisions to extract the latex.
Which remedies did Hippocrates recommend for uterine illnesses?
Poppy juice.
What question does the Jewish approach raise about divinely willed illness?
Whether people may intervene to relieve it.
What treatment does the Jewish approach emphasize in practice?
Treatment through prayer.
Which thinker considered pain inseparable from pleasure?
Platon, 428-348 av J.-C.
How did Blaise Pascal regard illness?
As the Christian's natural state.
Who declared avoiding pain artificially an impossible chimera in 1840?
Velpeau.
In which year did Velpeau call artificial pain avoidance an impossible chimera?
1840.
Which author argued against loss of consciousness in 1847?
Magendie.
What did Magendie say a courageous person should not tolerate?
Loss of consciousness.
Which author described morphine salts in Formulaire de Magendie?
Magendie.
In which year did Formulaire de Magendie describe morphine salts?
1822.
Who discovered codeine, and in which year?
Robiquet discovered codeine in 1832.
Who discovered papaverine, and in which year?
Merck discovered papaverine in 1848.
How active is heroin compared with morphine?
Ten times more active.
How active is fentanyl compared with morphine?
One hundred times more active.
Which compounds belong to the exogenous opioid system?
Morphine, codeine, methadone, and heroin.
Which work describes Thomas de Quincey’s opium use?
The Confessions of an English Opium-Eater.
Which author wrote Les Paradis Artificiels?
Baudelaire.
Which drug did Sherlock Holmes use in The Adventures of Sherlock Holmes?
Drugs.
When did heroin addiction increase sharply in the United States?
Between 1900 and 1912.
How was heroin successively classified as a medicine?
Useless, dangerous, and proscribed.
On what date did the Harrison Law prohibit nonmedical drug use?
17 December 1914.
Which three tables did the 1948 decree establish?
Poisonous substances, narcotics, and dangerous substances.
What prescription system did France adopt in 1999?
Secure prescriptions replaced narcotics prescription books.
How did France regulate prescription duration in 1999?
According to the substance.
What happened to Saint Christopher Hospital’s morphine solution in France in 1976?
It entered France.
Which source and year are associated with the pain scale regulating analgesic use by pain intensity?
OMS, 1987.
Which routes can be used to administer morphine?
Orally, by injection, or transdermally through patches.
How can patients manage some injected morphine administration?
Through patient-managed pumps.
What happened to heroin-overdose deaths in France from 1995 to 2005 after substitution medicines were introduced?
They fell sharply.
In the course's account of US overdose deaths, what percentage involved methadone?
30%.
What share of US overdose deaths involved prescribed medicines?
More than half.
What was the most common source of analgesics obtained for nonmedical use, and what share did it represent?
A relative or friend, at 55%.
In what year did Wright discover heroin?
1874.
Which work describes opium as calming anger and making pain forgotten?
Homer’s Odyssey.
Who changed Sertürner’s name “morphium” to “morphine”?
Gay-Lussac.
Answer 16 questions on History of Opioid Medicine.
1. Which statements correctly describe milestones in French opioid regulation and medical use?
2. Which statements correctly distinguish the exogenous and endogenous opioid systems?
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