Talk:Opioid/Archive 2

Archive 1

Archive 2

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 23:27, 7 August 2007 (UTC)

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)

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 Carlson^Talk 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)

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)

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)

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)

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)

Different opioids and affinity to different opioid receptors / areas of receptors or types of signaling pathways.

There is some scientific literature out there which describes the different ways in which opiates can bind to the opioid receptors (binding to different proteins on one particular kind of opioid receptor - either mu or kappa or delta, etc.). The multiple types of intracellular functional agonism that opioids can display on the second-messenger level, and the extent of that knowledge should be touched on a bit in this article, and the individual articles of the opioids so covered. We have so many other articles that go in depth & to such levels about such science topics and the opioid subject should be priority in that regard due to the pertinent use of such substances in the world.

Also besides the separate conformations of signaling actions that one opioid molecule/compound can have on a single receptor, the action and interplay of two types of opioid receptors from the same molecule should be touched on (i.e. what type of opioid, and in what way, they create synergy between for example μ- & κ- receptors, or μ- & δ- receptors, etc., and how one influences the action of the other by means of the particular exogenous opioid involved) someone with more knowledge may be able to extrapolate something useful in the encyclopedic sense from links such as these on that topic: opioid receptor homo- and heterodimerization in living cells & targeting opioid receptor heterodimers Nagelfar (talk) 17:04, 20 November 2008 (UTC)

Definition of opioid as "morphine-like"

In the definition of opioid it says: "An opioid is a chemical substance that has a morphine-like action in the body." However, the article also says: "The pharmacodynamic response to an opioid depends on [...] whether the opioid is an agonist or an antagonist." Is it really correct to say that an antagonist opioid has a morphine-like action in the body? Wouldn't it be better to define an opioid as a substance that influence opiate receptors? (Source: http://medical-dictionary.thefreedictionary.com/Opioid) Lova Falk (talk) 11:30, 6 December 2008 (UTC)

Opioid definition (not an opiate!)

Free Merriam-Webster Dictionary: opioid: possessing some properties characteristic of opiate narcotics but not derived from opium

TheFreeDictionary: opioid: any synthetic narcotic that has opiate-like activities but is not derived from opium

Stedman's Medical Dictionary: opioid: denoting synthetic narcotics that resemble opiates in action but are not derived from opium

 Rbaselt (talk)  —Preceding undated comment added 23:50, 21 June 2010 (UTC). 

Addiction vs. Dependence

This page uses outdated explanations of the terms Addiction and Dependence, and is cross-linked on many other articles about specific opioids. It would be highly beneficial to update this section of the article. As I understand it, in current professional usage, addiction is a psychological condition characterized by behaviors, with much debate as to whether the underlying cause is physical or mental, and dependence is a state in which the body has become accustomed to a chemical being in the system and reacts badly when that chemical is removed (i.e., withdrawal symptoms). While dependence and tolerance do both tend to develop over time, they are not inherently linked- it is possible to become physically dependent on a substance long before any significant tolerance is built up, particularly as indicated by need to increase dosage in order to maintain analgesic effect. Overall, this is an excellently maintained article, and I am currently not up to the challenge of finding references specific to opiates in order to update this section, so I feel it is sufficient to request an update here. Perhaps a cross-link to the Addiction entry is in order? Nightsmaiden (talk) 10:11, 30 July 2010 (UTC)

Phenylmorphans

Although there aren't any opioids in medical use of this class, a large volume of research on them including several highly active compounds (circa 500-1000 morphine) has been carried out. Would it be appropriate to include them as they do give further insight as to QSAR of both agonist & antagonist activity? — Preceding unsigned comment added by 86.30.243.179 (talk) 06:34, 26 July 2011 (UTC)

Opioid itching is not responsive to histamine blockade

Pruritus associated with opioids is a centrally mediated phenomenon. It does not respond to H1 antihistamines. Current (U.S.) palliative medicine practice would suggest use of emollient lotion, as well as consideration of rotating to a different opioid (e.g. from morphine to hydromorphone or fentanyl). There is reasonably good evidence for ondansetron and some for mirtazepine and paroxetine. Centrally-acting opioid antagonists relieve the itch, but also antagonize analgesia. Skipbidder (talk) 16:06, 26 July 2011 (UTC)

Skipbidder - How would mirtazepine come into play to relieve pruritus? One might consider the histamine effects of mirtazepine as playing a role, if indeed it reduces it. Sydnicans (talk) —Preceding undated comment added 05:30, 4 August 2011 (UTC).

Articles derived

If anyone would be interested in collaborating on creating a List of morphinans page (in similar style to the List of phenyltropanes page), using the morphinan table here as a pooled resource and including activity profile, binding & solubility etc., information. Please contact me (or start it and I will contribute how I can). Nagelfar (talk) 07:48, 6 November 2011 (UTC)

Definition Confusing?

Hello. I admit I have no background in pharmacology, and very little in molec biology. But in trying to research opiods and opiod receptors on wiki, opiods are defined as substances that bind to opiod receptors. I think, OK, so what are opiod receptors? But opiod receptors are defined as G-protein receptors that have opiods as ligands! ??? Am I just missing something here? Can someone with expertise please clarify, and help to give some insight into the classification of these compounds/receptors that do not resort to circular definitions? Thanks.78.100.89.89 (talk) 13:12, 4 May 2013 (UTC)

opioid definition changed

The definition of opioid used to mean things made from opium. Opioid receptors were misnamed at their discovery and now it seems the definition of opioid is being changed to match the receptors misnaming. It was a misnaming because it referred to an external substance. — Preceding unsigned comment added by 156.34.204.160 (talk) 12:53, 31 March 2012 (UTC)

Opioid physiological basis

It would be good if the physiological action of opioid drugs was included in this article. 61.245.168.46 (talk) 10:23, 4 June 2012 (UTC)

Clarification needed re Tramadol

The article states that Tramadol is a semi-synthetic opioid the goes on to say that it is not an opioid. Can somebody clarify this please? 79.79.251.183 (talk) 08:58, 14 August 2012 (UTC)

Half life of fentanyl is orders of magnitude off the chart

The given half life of active metabolites of fentanyl (0.04 hours) is orders of magnitude off the chart. The real value is about 3-5 hours. Perhaps someone mixed it up with remifentanil. Surely no one injects new fentanyl every couple of minutes. — Preceding unsigned comment added by 193.175.73.206 (talk) 05:35, 7 February 2013 (UTC)

Contradictory info on tramadol?

The article currently classes tramadol as a fully synthetic opiod, but also states: "There are also drugs such as tramadol... that are chemically not of the opioid class, but do have agonist actions at the μ-opioid receptor." 24.227.162.10 (talk) 03:01, 5 June 2013 (UTC)

Rearrangement of article

I just moved a lot of content in the article around. I am reading a layman document published by my employer, which I cite throughout this article. Since it is a layman document I try to complement it with review articles which comply with WP:MEDRS; I think I did this everywhere. The bias and perspective which I bring to this article is that I want it to be understandable by an average person who is taking an opioid but who does not know much about medicine. I wanted to emphasize the adverse effects which a patient should know, so I put the existing list into sections so that they would appear on the table of contents. I tried to make the article conform better to WP:MEDMOS. If anyone wants clarification about anything I did then ping me. I do not think that I deleted any significant content in all my changes. Blue Rasberry (talk) 21:27, 16 January 2014 (UTC)

Classification section

Right now a large part of the table of contents is occupied by the "classification" section, which has 8 sections, one of which has 7 subsections. In the body of the article all of this information accounts for little text. It seems to me that this section should not be so represented in the table of contents.

The arrangement of this text is done with section headings, and it is a good arrangement. I am not sure that section headings are best for sorting this, though. Another option could be to use a definition list with the semicolon and colon markdown.

No action needs to be taken at this time, but perhaps if this article were more developed then this section could be reconsidered. Blue Rasberry (talk) 18:12, 17 January 2014 (UTC)

Primary sources storage

I just removed some content which reports medical claims made by primary sources. Per WP:MEDRS this kind of content is not preferred over better sources, and better sources do exist for this.

Extended content

In the UK two studies have shown that double doses of bedtime morphine did not increase overnight deaths, and that sedative dose increases were not associated with shortened survival (n=237). Another UK study showed that the respiratory rate was not changed by morphine given for breathlessness to patients with poor respiratory function (n=15). In Australia, no link was found between doses of opioids, benzodiazepines or haloperidol and survival. In Taiwan, a study showed that giving morphine to treat breathlessness on admission and in the last 48 hours did not affect survival. The survival of Japanese patients on high dose opioids and sedatives in the last 48 hours was the same as those not on such drugs. In U.S. patients whose ventilators were being withdrawn, opioids did not speed death, while benzodiazepines resulted in longer survival (n=75). Morphine given to elderly patients in Switzerland for breathlessness showed no effect on respiratory function (n=9, randomised controlled trial). Injections of morphine given subcutaneously to Canadian patients with restrictive respiratory failure did not change their respiratory rate, respiratory effort, arterial oxygen level, or end-tidal carbon dioxide levels. Even when opioids are given intravenously, respiratory depression is not seen.

I am storing it here in case it inspires anyone to look more deeply into existing research and see if there are better sources for sharing similar information. Blue Rasberry (talk) 19:16, 17 January 2014 (UTC)

Opioids for pain relief

Hypnosis should be added to this list, e.g., "Opioids for pain relief are also used when nondrug pain treatment options including cognitive behavioral therapy, exercise, spinal manipulation, and physical medicine and rehabilitation programs are insufficient to meet therapy goals. Hypnosis, an efficacious, non-pharmacologic treatment for pain with few or no side effects, tends to be synergistic with opioids, often reducing doseages needed for pain control, sometimes to the extent of replacing opioids completely."

Further comment: Hypnosis has a long, well-documented and well-researched history (including its use as a primary or sole anesthetic for major surgeries)in the treatment of chronic and acute pain of all origins. It can be very effective with essentially no side effects (possible rare exception: relaxation induced anxiety).

Citations: For clinical uses and approaches, see, e.g.,

For a representative meta-analysis of efficacy, see, e.g., Davidarapkin (talk) 04:46, 30 April 2014 (UTC)

Opioids for pain relief

Re adding mention of hypnosis: Hmmm. Not sure I did this correctly. Here are the references I attempted to insert in case they don't appear properly: For clinical approaches and methods (citation 1): Hammond, D. C. (1990). Hypnosis in pain management. In D. C. Hammond (Ed.), Handbook of hypnotic suggestions and metaphors (First ed., pp. 45-83). New York: W.W. Norton.

For a meta-analysis of efficacy studies (citation 2): Elkins, G., Jensen, M. P., & Patterson, D. R. (2007). Hypnotherapy for the Management of Chronic Pain. International Journal of Clinical and Experimental Hypnosis, 55(3), 275-287. doi: 10.1080/00207140701338621

Davidarapkin (talk) 04:53, 30 April 2014 (UTC)

Edits of 9/20/14

I would like to know why you and another Wikipedia editor undid almost all of my edits (all factual, all with citations) on the opioids article. Right now, this article is very high level, reads like it is written by a pharmacist or someone involved in some way with pharmaceuticals (and the composition thereof). I was trying to add -- in a balanced fashion -- the many concerns with over-prescription of opioids and accidental addiction. Both the governments of Canada and the U.S. have declared opioid addiction a public health crisis -- why was this removed from the article? This is not an opinion, but a fact. I was careful to leave up all the discussions of how useful the drug can be, etc., but the public health information should be included here as well otherwise it is not a balanced article.

Also, this article is not plain language. I was trying (a first attempt) to do much more to make this article accessible to those who are not doctors, pharmacists, in chemistry, etc. It is a terrificly meaty article, but needs a plain language intervention.  : )

So, my question: how can I proceed to include all the information I know well on the issue if you and the fellow editor take it all down? What's the process? I've not had that happen to the numerous other edits I've undertaken over the years on Wikipedia.

I can see if what I was adding was controversial -- but it's not. It was all factual.

I can see one paragraph was left (of my edits), which I'm happy to see. But frankly, this article still reads like a pro-opioids piece, and there are many issues that are not adequately raised. (I'm not anti-opioids for the record).

So, again, I'd like to know the process for making edits to this page. Who is 'in charge,' so to speak.

Thanks if you can help.

kathleen5454

Kathleen5454 15:03, 20 September 2014 (UTC) — Preceding unsigned comment added by Kathleen5454 (talk • contribs)

(talk page stalker) this discussion belongs on the article Talk page. i would be happy to join there. Jytdog (talk) 15:19, 20 September 2014 (UTC)

Hi @Kathleen5454:,

Sorry if I made you feel unwelcome.

I largely agree that your edits did not say anything controversial, and frankly, I generally agreed with the content (though I felt that at one or two points you drifted slightly into WP:OR. The real issue here was sourcing.

On medical articles we have a more stringent (or at least a different) set of rules for sourcing called WP:MEDRS. Its fairly detailed, but in essence it calls for the use of peer reviewed review articles and meta analyses as sources for any statement about human health related issues. No primary research papers, no newspaper articles, no magazines, etc, at least not as a source for statements about drug benefits or risks. I'm personally a big fan of Consumer Reports, but what is needed is to go to http://www.ncbi.nlm.nih.gov/pubmed/, select "Reviews" in the left hand column, and search for citations that back up your material. Consumer Reports can't really be used for that, though its a great publication, because we get in too many arguments here about which non-peer reviewed magazines and publications are acceptable if we don't have well defined boundaries.

Also, while this article is not really even close, I was trying nudge it in the direction of the style guide for medical articles, found here: https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs.2C_medications_and_devices. It should start with an Intro, move into Medical Uses, then Contraindications, Side Effects, etc., and then move down into a discussion of societal issues. I may be splitting hairs, but the discussion of an abuse epidemic really seems to me to belong in society and culture, and not Adverse Effects, though the latter section should of course include some content about the risk of addiction. Also, in the Society and Culture section, the MEDRS limits on sourcing do not apply to the same degree.

Hope this is helpful. Let me know if you need help finding suitable peer-reviewed review articles and the like.

Formerly 98 (talk) 16:53, 20 September 2014 (UTC)

As the other editor who got a message like this, I agree with everything Formerly 98 said here, and I also want to point to my own reply at User talk:Tryptofish. I think it is also important to point out that we really did not delete what Kathleen5454 had written, so much as relocate it to Opioid#Overuse and call for regulation. --Tryptofish (talk) 20:42, 20 September 2014 (UTC)

Much appreciated response. I clearly have more learning to do, re: the technical side of things since I've clearly misread a few things. Apologies -- and I'll try to remedy this before I edit further. I've edited dozens of smaller articles or created new ones, but nothing so technical with so many players. I may bug you for some help as I progress, but I'll read up on the guidelines further first when I get a moment. I'm hoping to edit a variety of health policy pages where I have expertise. Thx again.

Kathleen5454

Kathleen5454 16:32, 24 September 2014 (UTC) — Preceding unsigned comment added by Kathleen5454 (talk • contribs)

@Kathleen5454:, glad there are no hard feelings. If you think you can run through the article and adjust the language to make it more accessible, I'm all for that. And it wouldn't really require any new references to do so, so why not take a run at it? Formerly 98 (talk) 20:23, 24 September 2014 (UTC)

I'm not sure that Consumer Reports is not a WP:MEDRS. They are peer-reviewed, and they go through more layers of editing and fact-checking than many journals on PubMed -- as least as much as the NEJM Perspectives, for example. And the NEJM (like other journals) often assigns review articles to doctors who are consultants to the companies that manufacture the same drugs they're recommending. (In their smoking cessation review article, for example.) Consumer Reports doesn't have those financial conflicts of interest.

In their Using Opioids to Treat: Chronic Pain they say:

http://consumerhealthchoices.org/wp-content/uploads/2012/08/BBD-Opioids-Full.pdf

Our evaluation is based on an independent scientific review of the evidence on the effectiveness, safety, and adverse effects of opioids. A team of physicians and researchers at the Oregon Health & Science University Evidence-based Practice Center conducted the analysis as part of the Drug Effectiveness Review Project, or DERP. DERP is a first-of-its-kind multistate initiative to evaluate the comparative effectiveness and safety of hundreds of prescription drugs.

As for the slippery-slope argument of people wanting to use non-peer-reviewed publications, the answer to that is that the Consumer Reports medical recommendations are peer reviewed and independent. If you can find another publication that meets Consumer Reports' editorial processes, I would accept it.

The reason I'm defending Consumer Reports here is that they are clearly written and easy to understand, even though they sometimes have to explain some essential but technical ideas. It would be difficult for a typical Wikipedia editor (even a medical professional) to read the review articles in major journals, understand them completely, rewrite them into language that the ordinary reader can understand, and get everything right. I'm not sure I could. Could you? Consumer Reports has done that for us.

It also gives our reader the ability to verify the article, since it's written in plain English and free access.--Nbauman (talk) 23:38, 29 November 2014 (UTC)

Right now it not listed in MEDRS, and the list of acceptable sources is pretty narrow. I certainly have no objections if you want to take it up on the MEDRS talk page. Formerly 98 (talk) 01:11, 30 November 2014 (UTC)

That paper may be good as an external link. The "choosing wisely" campaign produces statements from major medical organizations and thus I am of the opinion that they satisfy MEDRS. We should use more authoritative sources as references otherwise though.

When one clicks on the report it is based on a dead page comes up [1] Doc James (talk · contribs · email) 05:50, 30 November 2014 (UTC)

Formerly 98, I'm not aware of any "list of acceptable sources" in WP:MEDRS. As far as I know, they describe acceptable sources in general terms.

This page in a nutshell: Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published secondary sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies.

...

For example, popular science magazines such as New Scientist and Scientific American are not peer reviewed, but sometimes feature articles that explain medical subjects in plain English.

I would think that Consumers Union is among the "reliable, third-party, published secondary sources". I also think they're among the "nationally or internationally recognized expert bodies." I also think — and this is the most important reason — that they explain medical subjects in plan English.

I think that Consumers Union is more reliable than, for example, the Society for Women's Health Research Talk:Society for Women's Health Research. --Nbauman (talk) 07:15, 30 November 2014 (UTC)

I assume we are looking at these edits [2]. Some of it was already supported by better refs and thus this one was not really needed. This may be a good discussion to have at WT:MEDRS Doc James (talk · contribs · email) 07:55, 30 November 2014 (UTC)

Well, I appreciate the effort Formerly 98 went to in replacing the Consumer Reports source with a Cochrane source, rather than just deleting the whole text. However, Cochrane doesn't say the same thing. Consumer Reports was about non-cancer pain, and Cochrane is about cancer pain.

The main benefit of the Consumer Reports article is that if a layman -- the target audience for Wikipedia -- wanted to follow up the sources, they could do that for the Consumer Reports link, and get a full explanation in layman's language. If they looked up the Cochrane report, they would only get the short abstract (and layman's summary), but not the full report. In this case, the Consumer Reports link is both useful to the layman and reliable. I would use both citations. There's a benefit, and I don't see the harm.

Let's face it, the Consumer Reports piece explains this subject better than we are likely to do on Wikipedia. They have professional medical writers and editors who know how to write for both laymen and medical professionals, and they work closely with some of the top medical content experts. I would also use it as an external link.

The Okie article is a NEJM Perspective. Is that a WP:RS? --Nbauman (talk) 09:03, 30 November 2014 (UTC)

This looks like a pretty readable and highly MEDRS compliant source: http://www.ncbi.nlm.nih.gov/pubmed/22084455 Formerly 98 (talk) 10:21, 30 November 2014 (UTC)

Agree. There is even a part two [3] Doc James (talk · contribs · email) 10:27, 30 November 2014 (UTC)

(←) My main problem with the Consumer Reports article is that there is no evidence of academic peer review, and the names of the authors are not visible. This could have been written by an opinionated loner using CR as a platform. I'd much prefer the Canadian guideline. The CR report could be mentioned under "Further reading". JFW | T@lk 14:42, 30 November 2014 (UTC)

I get the Medical Letter, which I believe was founded by people who originally worked for Consumers Union. The individual contributors to each report aren't identified; there is only a list of contributing editors in the back.

The strength of the Medical Letter is that (like Consumers Union) it rigorously avoids financial support from the drug companies. Other review articles and guidelines are often written by authors or panel members who are consultants to the companies whose products they're evaluating. (That includes NEJM.) But Consumer Reports, like the Medical Letter, issues reports that don't identify the authors. The idea is that the authority is the organization, not the individual author.

So whose advice do I follow -- a guideline written by identified doctors who are paid consultants to the companies whose drugs they're evaluating, or a guideline written by unidentified doctors, who have no financial relationship to the drug companies? I would take each guideline on its own merits.

In the last year or 2, I've had occasion to review opioid guidelines a few times. 2 things caught my attention: (1) There are several guidelines, and they often had different conclusions (2) Many of their recommendations weren't based on high-quality evidence.

One of the problems with that Canadian Family Physician citation is that they don't give the levels of evidence. They cite a 2006 CME http://www.cfp.ca/content/52/9/1091.full.pdf+html but most of their recommendations aren't supported by Level I (or II or III) evidence. (I couldn't find the financial disclosures either.) And things have changed since 2006.

For example, many doctors use a "treatment agreement" like the one here, but I was surprised to find that there was no evidence supporting these treatment agreements. An editorial in (I think) the NEJM argued that they amounted to unethical abandonment. Nor is there any evidence supporting drug abuse testing. These seem to be recommendations by lawyers to protect doctors at the expense of their patients.

(This agreement requires the patient to agree not to seek opioid medications from another doctor. Jane Brody, the veteran NYT health reporter, wrote a series of articles about her knee replacements. She said that her orthopedic surgeon gave her an inadequate dose of morphine that left her in pain all day (and unable to participate in physical rehabilitation). So she asked her internist to give her an adequate dose. By this agreement, Brody would be a doctor-shopping opioid abuser and would be denied any opioid drugs at all. But since she was a celebrity patient, these rules didn't apply to her.)

To summarize: The Consumers Union report seems to be a useful summary for laymen (Wikipedia's primary audience), and it seems to be reliable. Putting it in a "Further reading" or "External links" section is a reasonable compromise (although there are some editors who routinely delete them). Canadian Family Physician is a nice journal and it's open access, so you might put it in (although 2006 is pretty old), but if I wanted a good review article, I'd start with the major journals, like Annals of Internal Medicine doi: 10.7326/0003-4819-160-1-201401070-00732 although they're usually paywalled. Then you have to compare the different guidelines and recommendations to see how they differ for WP:NPOV. It will be a big job. --Nbauman (talk) 02:20, 1 December 2014 (UTC)

Yes I agree with the importance of highlighting some sources that do not have a financial conflict of interest. Have started some discussion here [4] Doc James (talk · contribs · email) 05:44, 1 December 2014 (UTC)

all of this loose talk about funding is a) and most importantly, without basis for all of the sources under discussion as nobody has cited any actual funding/financing - and we don't even know who the authors of the Consumer Union report are for pete's sake; b) therefore a bunch of ugly WP:SOAPBOXING. If there were disclosed financial COI for authors of any of these sources, the source could be challenged per [{WP:INDY]] but with regard to funding of the review itself, MEDRS specifically says "Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." please keep the discussion within WP:TPG and base it on policies and guidelines. Jytdog (talk) 09:16, 1 December 2014 (UTC)

off-topic violation of WP:TPG
The following discussion has been closed. Please do not modify it.
Jytdog, we have been over this before. You said that you thought NEJM, Lancet, BMJ, Marcia Angell, Richard Horton and Richard Lehman were WP:FRINGE, and not WP:MEDRS, simply because of your personal objections to their statements about drug marketing, and you deleted them. You also accused me of being FRINGE POV, misquoted me and accused me of believing things that I don't believe and never said. I told you that you were violating WP:CIVILITY and WP:NPA, and when you continued, I said that I would have nothing more to do with you. I'm making an exception now just to put this on the record. If anyone is tempted to get into a discussion with you, I recommend they first follow that link to my talk page and see what they would be getting into. --Nbauman (talk) 02:58, 2 December 2014 (UTC) this is just more off-topic violation of WP:TPG. responding briefly: we discussed particular generalzations, and i said that the generalizations themselves were FRINGE and your application of them was POV-pushing: i said nothing about entire journals nor about anyone in general (including you) Jytdog (talk) 21:00, 2 December 2014 (UTC)

Conflicting definitions of opioid.

Has anyone commented on the conflicting definitions of opioid here and in the opiate article? Here opioids are exclusive of opiates; there opioids include opiates. Here morphine isn't an opioid; there morphine is an opioid. Different sources give one or the other definition, so it isn't a matter of who is right or wrong. Rather Wikipedia needs to settle on a consistent definition. I learned the inclusive definition but the exclusive definition reduces ambiguity. Nonetheless I believe the most common accepted use needs to be considered.

I sense the editors here and there may be as different as the definitions. This central issue needs to be discussed and here and at the opiate article talk page and resolved by a common consensus. To use a bad pun, you need to get on the same page. Box73 (talk) 11:27, 4 October 2015 (UTC)

Actually Wikipedia doesn't need to settle on a consistent definition. At a practical level the inclusive definition is more convenient, but if authoritative sources use both definitions, we should give both of them and explain the range of usage: that's the function of a neutral encyclopedia. Looie496 (talk) 11:45, 4 October 2015 (UTC)

I agree that both should be given—which isn't the case now in either article itself—however Wikipedia does need to settle on a consistent primary definition. It is the definition that will be used in related articles. The secondary definition(s) will be mentioned—and as appropriate discussed—but not be used generally except in special cases (eg, dealing with a quote which uses the secondary definition). Otherwise, should every use of opioid or opiate include an explanation? This is unrealistic yet imagine part of the opioid article being transcluded in the opiate article or the reverse.

One function of a neutral encyclopedia is mentioning alternative accepted definitions; another function is not confounding their audience (across related articles). Box73 (talk) 17:25, 8 October 2015 (UTC)

Concerning the definition

Opioids are medications that are similar to opiates but made rather than found naturally -- I acknowledge that the source meets MEDRS, but unfortunately the source is wrong. Opioids are defined as substances that bind with high affinity to opioid receptors; opioid receptors are molecular receptors that are bound to with high affinity by opiates; opiates are various derivatives of opium that have narcotic effects. The definition in the source does not allow for endogenous opioids such as endorphins and dynorphins. As discussed above there is disagreement about whether opiates should count as opioids, but nobody as far as I know declines to classify endorphins as opioids. Our opioid peptide article also gives other examples of substances that are called opioids that aren't medications and aren't manufactured. Looie496 (talk) 15:06, 11 October 2015 (UTC)

Yes good point. It appears people use this term in a few different ways. Doc James (talk · contribs · email) 17:07, 11 October 2015 (UTC)

Although I'm not a reliable source, I long taught the subject at the university level, and I actually treated it as the complete opposite of that source. Opioids certainly include the opioid peptides (no reliable source calls them opiate peptides), whereas the opiates are the compounds found in opium as well as their close synthetic analogs (phenanthrenes and phenylpiperidines). Opiates are a subset of opioids. --Tryptofish (talk) 17:19, 11 October 2015 (UTC)

I just spent a couple of hours tracking this down, and wrote a short section about the definition, with references. I'll leave a little time for discussion here before changing the definition in the lead, though. Looie496 (talk) 13:19, 12 October 2015 (UTC)

Thanks! I support revising the lead accordingly. --Tryptofish (talk) 21:06, 12 October 2015 (UTC)

I've now rewritten the definition in the lead; please feel free to modify it. Looie496 (talk) 11:52, 13 October 2015 (UTC)

I believe the lead should be rewritten to reflect what Tryptofish said: "Opiates are a subset of opioids". I recommend a read of this page at The National Alliance of Advocates for Buprenorphine Treatment for insight; it says, "[a]n opioid is any agent that binds to opioid receptors". (I believe this organization/site should qualify as a reliable source.) Indeed in a medical context the term opioid is generally used for opiates. Here are other relevant quotes from several reliable sources:

Morphine, the prototypical opioid agonist, has long been known to relieve severe pain with remarkable efficacy.... It remains the standard against which all drugs that have strong analgesic action are compared. These drugs are collectively known as opioid analgesics and include not only the natural and semisynthetic alkaloid derivatives from opium but also synthetic surrogates, other opioid-like drugs whose actions are blocked by the nonselective antagonist naloxone, plus several endogenous peptides that interact with the different subtypes of opioid receptors. ...(continued)...
Opioid drugs include full agonists, partial agonists, and antagonists. Morphine is a full agonist at the l (mu)-opioid receptor, the major analgesic opioid receptor. — "Opioid Analgesics & Antagonists" in Basic and Clinical Pharmacology

The term opioid was coined to include the opiates, which are the naturally occurring drugs derived from opium (morphine and codeine), the semisynthetic drugs produced from opium derivatives, and a wider range of totally synthetic agents bearing little chemical resemblance to morphine. — "Opioid-Related Disorders" in Kaplan and Sadock's Comprehensive Textbook of Psychiatry

The term opioid refers broadly to all compounds related to opium, a natural product derived from the poppy. Opiates are drugs derived from opium and include the natural products morphine, codeine, and thebaine, and many semisynthetic derivatives. Endogenous opioid peptides, or endorphins, are the naturally occurring ligands for opioid receptors. — "Opioid Analgesics" in Goodman & Gilman's Manual of Pharmacology & Theraputics

This definition would bring the lead in line with opiates and the opioid "Classification" section. Accepting this, would opioid antagonists (eg, naloxone) be considered opioids as the first source professes? It hinges on whether the substance simply binds to opioid receptors or has agonist properties. Opinions? (I do not mean to discount endogenous opioids.)

Being new to the article, I might offer my version for the lead here for consideration. Maybe something like:

Opioids are a family of substances that act on opioid receptors; as drugs they are primarily used [or best known] for relief of pain. Opioids include opiates such a morphine, synthetic and semi-synthetic drugs, as well as endogneous substances that naturally act on opioid receptors....

— Box73 (talk) 03:14, 14 October 2015 (UTC) / Box73 (talk) 22:07, 14 October 2015 (UTC)

References

Revised lead for review

I want to offer this for review before posting. This grew from revising the lead paragraph. I placed the modern definition of opioid at the beginning while noting opiate in that definition. It simply isn't appropriate to not place the primary there. Even sources such as D'Arcy call morphine an opioid in the cited sources. After review of multiple reliable sources I made this more comprehensive and repositioned existing sentences more logically. This is also cited heavily which will serve the review but can be moved or removed in the article space.

The citations may not yet follow the date style in the article, if one exists.

I can't imagine any major issues with this. The lead follows minus the layout markers:

(signed here and at bottom) Box73 (talk) 11:41, 13 February 2016 (UTC)

Opioids are substances that act on opioid receptors to produce morphine-like effects. Opioids include opiates, an older term that refers to such drugs derived from opium, including morphine itself. Other opioids are semi-synthetic and synthetic drugs such as hydrocodone, oxycodone and fentanyl; antagonist drugs such as naloxone and endogenous peptides such as the endorphins. Opioid drugs are predominantly central nervous system agents, most often used medically to relieve pain.

The side effects of opioids may include pruritus, sedation, nausea, respiratory depression, constipation, and euphoria. Tolerance and dependence will develop with continuous use, requiring increasing doses and leading to a withdrawal syndrome with upon abrupt discontinuation. The profound euphoria attracts recreational use; frequent and escalating recreational use of opioids typically results in addiction. Accidental overdose or concurrent use with other depressant drugs commonly results in death from respiratory depression. Because of opioid drugs' reputation for addiction and fatal overdose, most are highly controlled substances.

Primarily used for pain relief, including anesthesia, opioids are also approved to suppress cough, suppress diarrhea, treat addiction, reverse opioid overdose, and suppress opioid induced constipation,. Extremely potent opioids are used to only approved for veterinary use such as immobilize immobilizing large mammals. Opioids act by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract. These receptors mediate both the psychoactive and the somatic effects of opioids. Opioid drugs include partial agonists and antagonists, which produce moderate or no effect (respectively) but displace other opioids from binding in those receptors.

Opioids are among the world's oldest known drugs. The medical use of the opium poppy predates recorded history; recreational and religious use likewise precedes the common era. In the 19th century morphine was isolated and marketed, and the hypodermic needle invented, introducing rapid, metered administration of the primary active compound. Synthetic opioids were invented, and biological mechanisms discovered in the 20th century. Illicit production, smuggling, and addiction to opioids, prompted treaties, laws and policing which have realized limited success. In 2013 between 28 and 38 million people used opioids recreationally (0.6% to 0.8% of the global population between the ages of 15 and 65). In 2011 an estimated 4 million people the United States used opioids recreationally or were dependent on them. Current recreational use and addiction are attributed to over-prescription of opioid medications and inexpensive illicit heroin. Conversely, fears about over-prescribing, exaggerated side effects and addiction from opioids are similarly blamed for under-treatment of pain.

The terms opiate and narcotic are sometimes encountered as synonyms for opioid. Opiate is properly limited to the natural alkaloids found in the resin of the Papaver somniferum (opium poppy) although some authorities include semi-synthetic derivatives. Narcotic, derived from numbness or sleep, is now a legal term that refers to cocaine and opioids, and their source materials; it is also loosely applied to any illegal or controlled psychoactive drug. The term has pejorative connotations and its use is generally discouraged.

(sign is repeated from above revised lead) — Box73 (talk) 11:41, 13 February 2016 (UTC)

minor revisions to above lead — Box73 (talk) 12:12, 13 February 2016 (UTC)

Changes needed due to new guidelines?

Content on the new CDC guidelines was added only to the lead in this dif, and i moved that to the appropriate part of the body in this dif. I don't think this rises to the importance of being included in the lead of this article. Others may differ of course.

bigger question - do these new guidelines need to be incorporated elsewhere in the article? I kind of don't think so, as they are more about how to prescribe them, and we follow WP:NOTHOWTO. But am interested in what others think. Jytdog (talk) 18:52, 18 March 2016 (UTC)

Please, refine first para in lede

Tolgraven made some good faith edits to the lede's first paragraph which seemed reasonable but suffered from too many prepositional phrases. I pruned them for readability while attempting to keep his changes. I also moved the opioid drugs are CNS pain agents sentence to 2nd place which might benefit from fine tuning. The "American legal term" isn't quite right, but the thing gets choppy with many prepositional phrases. My time and energy are short so I'd appreciate someone helping tweak things. Thanks. — Box73 (talk) 11:45, 12 April 2016 (UTC)

re revert:

1. The lead would make one believe opioids are utilized equally for CNS, PNS and GI effects. There is a reason morphine is C-II and Imodium is OTC, most opioids are given for pain, and recreational use involves reward.
2. Since morphine is called strong and fentanyl very strong, etorphine etal need more emphasis, hence extremely potent.

I do appreciate the campaign of simplification but oversimplification cuts essential information and breeds confusion. If such info is cut it should reappear elsewhere in the lead or the ideas somehow preserved. Now I did request tweaking for readability but respectfully, I think our audience can grasp material/complexity a bit above the level of My Weekly Reader. — Box73 (talk) 11:00, 15 April 2016 (UTC)

What does this mean "reverse opioid overdose, and suppress opioid induced constipation" Opioids are not used for opioid overdoses or to treat constipation. Ref does not have a page number. Doc James (talk · contribs · email) 15:43, 15 April 2016 (UTC)

Re my last post... First, the CNS inclusion comes down to the lede later saying CNS, PNS and GI. Opioid drugs (desired actions) are predominantly central. This issue is also important because opioids are also endogenous, not simply drugs, and these are distributed in those areas+. Second, the drug sufentanil is described as very potent but vet only opioids are much stronger/more potent than this very strong/potent, which should qualify as extremely potent. Sufentanil is approved for medical (human) use. — Box73 (talk) 16:18, 15 April 2016 (UTC)

Doc: Respectfully, based on a current definition of opioid, I am not wrong. An antagonist is used to reverse an agonist overdose; a peripheral antagonist is used to suppress peripheral effects (constipation) of an agonist permitting central effects. Opioids are agonists, partial & mixed agonists and antagonists. This is ref'd in lede. Give me a few minutes to look at the ref in question. — Box73 (talk) 16:18, 15 April 2016 (UTC)

@Doc James: First, re opioids including antagonists, see Hemmings, "Opioid, a more modern term, is used to designate all substances, both natural and synthetic, that bind to opioid receptors (including antagonists)." and Freye, "...the term opioid refers to opioid agonists, opioid antagonists, opioid peptides, and opioid receptors." Since these are cited you should revert those changes. Second, what reference above are you talking about? Third, would you prefer to talk about changes or instigate warring? You're putting me in a position where I am forced into warring. Should we seek an outside opinion? — Box73 (talk) 16:36, 15 April 2016 (UTC) fix typos above. Box73 (talk) 16:44, 15 April 2016 (UTC)

Yes agree you are correct and have returned the other uses to the lead. We should keep discussion of the mechanism in the second paragraph though IMO. We have "Opioids act by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract." in the next paragraph so not convinced we need to mention CNS effects in the paragraph above.

This ref is missing a page number "Stromgaard, Kristian; Krogsgaard-Larsen, Povl; Madsen, Ulf (2009). Textbook of Drug Design and Discovery, Fourth Edition. CRC Press. ISBN 9781439882405." Doc James (talk · contribs · email) 17:16, 15 April 2016 (UTC)

• If we are going to include antagonists here the first sentence is now wrong. the article was formerly limited to opioids with agonist effects. my sense is that we should have this article focus on opioids with agonist-like effects as we have Opioid antagonist already and opioid agonist redirects here. Jytdog (talk) 17:45, 15 April 2016 (UTC)

Yes I do not typically consider opioid antagonists to be opioids. I think common usage is for opioids to mean agonists. But do agree that some sources support that this is the case. Doc James (talk · contribs · email) 18:48, 15 April 2016 (UTC)

Editors decide the scope of Wikipedia articles; they do need to be a reasonable fit with the literature and common use and the limitation to opioid agonist-like compounds was and is both, regardless of whether some sources use the term more broadly. Jytdog (talk) 18:54, 15 April 2016 (UTC)

I guess the question is do we redirect opioid to opioid agonist. Than have an opioid (disambig) page that mentioned the wider meaning and links to opioid antagonist. So we result in this article being split into two. Doc James (talk · contribs · email) 19:22, 15 April 2016 (UTC)

1. We certainly don't need to do that. (If so then we should separate endogenous opioids from opioid drugs.) I'm cool with excluding antagonists and this issue can be simply noted in the first section for clarity. What follows was already written...
2. Common use and medical literature also generally limits opioids to drugs yet inclusion of antagonists is not limited to two sources (for example, see: Opioid Guidelines in the Management of Chronic Non-Cancer Pain and also Mehdi B (2008). "Opioid analgesics and antagonists". In Seth SD, Seth V. Textbook Of Pharmacology.). Having said that, excluding antagonists is a reasonable compromise and remaining wording easily tweaked. IMO the distribution of receptors is appropriate and well written. Yet it misses the fact that opioids' utility is by CNS action.
3. re the missing page number: I don't know the page offhand but this refers to naloxegol.
4. This has bothered me: Does the 5th and 6th paras under addiction belong there?
5. Doc James, I appreciate your efforts to simplify as too many articles make readers trudge through technical details to get to the meat and also benefit from common language. Thank you and Jytdog for responding here. — Box73 (talk) 22:18, 15 April 2016 (UTC)

Great, so we can resolve the dispute with which this section began and all move on. thx for compromosing, box73 Jytdog (talk) 03:53, 16 April 2016 (UTC)

Removed content - consumer information

I work for Consumer Reports, and I am paid to add my organization's health information to Wikipedia. Paid editing is a touchy subject on Wikipedia. If anyone wants to comment on what I am doing, WikiProject Medicine would one of the appropriate forums to discuss paid editing in medicine with others.

I do not have any question or request here. I just wanted to talk through an experience in this article so that I can reflect on it and state the issue.

I couple of years ago I added the below information to this article, and the article looked this way in June 2014. Mostly I cited this report.

• Consumer Reports Health Best Buy Drugs (21 August 2012), "Using Opioids to Treat: Chronic Pain - Comparing Effectiveness, Safety, and Price" (PDF), Opioids, Yonkers, New York: Consumer Reports, retrieved 28 October 2013

A user removed a lot of what I added, saying "Consumer's reports is not a reliable source for medical information, see WP:MEDRS". That user since left Wikipedia. I agree with them, though - the report that I cited is not the kind of medical source which Wikipedia usually accepts, because it is not peer reviewed academic literature. Still, I feel that the report is an expert response to the academic literature and written in a way that presents evidence-based medicine to a layman audience, along with insights for that demographic, and is a good source for the information it presents.

Here is most of the text I originally added, and which was either removed or kept but with the citation to Consumer Reports replaced with academic sources. A lot of this is still in the article, and I am glad for that. It stayed in the article because I used multiple citations, so the citation to my organization's layman source was deleted while the academic sources remained.

Extended content

Opioids for pain relief are also used when nondrug pain treatment options including cognitive behavioral therapy, exercise, spinal manipulation, and physical medicine and rehabilitation programs are insufficient to meet therapy goals. Patients taking opioids talk with their health care provider to develop a personal health plan which includes a combination of therapies, perhaps including drug and nondrug treatments, to relieve pain. In treating chronic pain, opioids are an option to be tried after other less risky pain relievers have been considered, including paracetamol/acetaminophen or NSAIDs like ibuprofen or naproxen. Some types of chronic pain, including the pain caused by fibromyalgia or migraine, are preferentially treated with drugs other than opioids. The efficacy of using opioids to lessen chronic neuropathic pain is uncertain. There are gaps in available research describing the safe use of opioids long-term or comparing the relative safety of the long-term use of various opioids to each other. The research also does not have information about the extent to which opioids differ in terms of the risk they bring for causing addiction. Research suggests that when methadone is used long-term use it can build-up unpredictably in the body and lead to potentially deadly slowed breathing. Regular physician monitoring reduces the likelihood of problems. When prescribing an opioid, physicians have a process to recommend the correct one, find the right dosage for the patient, and then minimize the side effects. People who take opioids long term have increased likelihood of being unemployed. Taking opioids further disrupts the patient's life and the adverse effects of opioids themselves can become a significant barrier to patients having an active life, gaining employment, and sustaining a career. 'from bluerasberry in this case, the Consumer Reports citation was removed, but the sentence was left without a citation. I do not think this information is of greater value when it is presented without a citation.

Some information was removed and not re-added in any form. Here is that information -

1. Opioids for pain relief are also used when nondrug pain treatment options including cognitive behavioral therapy, exercise, spinal manipulation, and physical medicine and rehabilitation programs are insufficient to meet therapy goals. Patients taking opioids talk with their health care provider to develop a personal health plan which includes a combination of therapies, perhaps including drug and nondrug treatments, to relieve pain.
2. There are gaps in available research describing the safe use of opioids long-term or comparing the relative safety of the long-term use of various opioids to each other. The research also does not have information about the extent to which opioids differ in terms of the risk they bring for causing addiction.
3. When prescribing an opioid, physicians have a process to recommend the correct one, find the right dosage for the patient, and then minimize the side effects.
4. For this statement, the information was kept, but left without any citation at all:

Taking opioids further disrupts the patient's life and the adverse effects of opioids themselves can become a significant barrier to patients having an active life, gaining employment, and sustaining a career.

As an organization, Consumer Reports advocates that patients consider treatments with fewer side effects whenever such treatments are backed by evidence based medicine. Biases that Consumer Reports has include favoring evidence-based medicine (just like Wikipedia) and then within evidence-based medicine, encouraging health care providers and patients to consider safer treatment options when possible. I do not think the information above is heavy science, but rather, it a social perspective of the field of consumer studies derived from the original academic papers.

I think that I might be able to find academic sources which say all of the above things, but I doubt that I would find any academic source which emphasizes drug safety in the way that a nonprofit advocacy group would. I do not know whether this information has a place in the article, because I do not know if it is worthwhile to seek academic sources for consumer issues. I am also biased because this is from my organization, and I am encouraged to share whatever content I like from my organization. I do not think that I want to think this through right now, but in the future, I do hope that more nonprofit educational groups with special interests can come to Wikipedia and share expert interpretations of health information. Social issues are never likely to be covered well in academic articles presenting reviews of drugs. Not every social issue has a place in Wikipedia's medical content, and I am not sure where to seek a balance.

Blue Rasberry (talk) 16:17, 20 May 2016 (UTC)

reference to Opioid Wikipedia

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.

Sagharmolazade (talk) 00:56, 20 June 2017 (UTC)

Lead

The lead currently talks about opioid use to induce euphoria but it doesn't say anything about opioid use to prevent withdrawal, which as I understand is also a major motivation for use. Would something like the following be appropriate?

Opioids are most often used medically to relieve pain. Opioids are also frequently used by people with opioid use disorder for their euphoric effects or to prevent withdrawal.

or perhaps more succinctly

Opioids are most often used medically to relieve pain. Opioids are also frequently used for their euphoric effects or to prevent withdrawal.

as some amount of people may use opioids as euphoriants but not do so frequently enough to develop addiction or dependence. Sizeofint (talk) 16:57, 18 July 2017 (UTC)

I think the 2nd option is better. But, prevention of withdrawal is medical treatment, and methodone type treatment is really to prevent relapse, not just withdrawal.

How about, 'Opioids are also used medically to relieve pain and to prevent relapse for opioid addicted patients. Opioids provide users with a sensation of euphoria and are highly addictive, and are frequently abused.'

Other comments on lead:

1. First sentence 'morphine-like effects' to describe opiates is a circular definition. Maybe psychoactive effects?
2. There should be more emphasis on the opioid epidemic in the lead, and a section in the body.
3. Lead first paragraph doesn't mention that opoids are highly addictive.
4. The sentences in the first paragraph comparing the terms opiate and narcotic should be moved to the text body (and are poorly written).

Teretylac (talk) 18:31, 19 July 2017 (UTC)

I think the 2nd is better. Some addicts use it to prevent withdrawal outside of treatment.Doc James (talk · contribs · email) 19:50, 19 July 2017 (UTC)

Agree with your middle two points. To your first point, morphine is generally considered the prototypical opioid so in some ways the similarity of a drug to morphine determines if it is an opioid. I don't consider the information on opiates and narcotics too poorly written. I think the content is positioned there because readers frequently conflate the terms. I'm not opposed to moving it if there is a better spot. Sizeofint (talk) 21:14, 19 July 2017 (UTC)

I've moved it out of the lead to its own section before medical uses. My thought is this placement can let the reader know what the article is about early on without sacrificing space in the lead for etymology. Sizeofint (talk) 22:17, 19 July 2017 (UTC)

References

Table of opioids, morphinan, heroin as Bayer brand name?

It keeps getting reverted to such, and the wikification link removed. I am changing it once more but it needs discussion now. Nagelfar (talk) 17:21, 16 October 2017 (UTC)

Updated charts. May need to refresh your cache to see 2015 column

http://refreshyourcache.com/en/cache

Windows: ctrl + F5
Mac/Apple: Apple + R or command + R
Linux: F5

--Timeshifter (talk) 14:51, 29 October 2017 (UTC)

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)