9: Management of opiate misuse

Question 1

What is diamorphine also known as?

Answer 1

Heroin

Question 2

How does heroin affect your mood initially?

Answer 2

Euphoria

Sedation

Question 3

What properties of heroin make it highly addictive?

Answer 3

Short onset of action

Short half life (provokes cravings)

Question 4

Which plant does opium come from?

Answer 4

Poppy

Question 5

What are the two main constituents of opium?

Answer 5

Morphine

Codeine

Question 6

How is morphine, from opium, changed into diamorphine?

Answer 6

Addition of 2 acetyl groups

Question 7

What are the two most common routes of administration of heroin?

Why?

Answer 7

IV

INH

fastest absorption into bloodstream

Question 8

IV and INH heroin bypass ___ ___ ___.

Answer 8

first pass metabolism

Question 9

What is diamorphine metabolised into?

Answer 9

Morphine

which is the active metabolite

Question 10

What is the most common opioid receptor?

Answer 10

Mu receptor

Question 11

Heroin and codeine are both broken down into morphine.

How do you tell what a patient has used in a drug screen?

Answer 11

Heroin has a unique intermediate which sticks around for 6h

Question 12

What are the

a) desired
b) side effects

of heroin?

Answer 12

a) Euphoria, analgesia

b) Constipation, N&V, sedation, respiratory depression, hypotension and bradycardia

Question 13

What is a sign, seen in the eyes, that someone has used an opioid?

Answer 13

Pupillary constriction

Question 14

What process occurs with repeated use of opioids?

Answer 14

Tolerance

Question 15

Patients using opioids may report that their teeth are rotting.

What causes this?

Answer 15

Analgesia - patient unaware of dental problems e.g abscess

Vomiting - breakdown by stomach acid

Question 16

What are some symptoms of opioid withdrawal?

Answer 16

Opioid cravings

GI symptoms - N&V, diarrhoea

Cardio symptoms - tachycardia, hypertension

Joint pain

Rhinorrhoea

Watery eyes

Question 17

In patients tolerant to opioids, how long without the drug does it take for withdrawal to start?

Answer 17

6 - 8 hours

Question 18

Opioid withdrawal effects overlap with ___ symptoms.

Why?

Answer 18

sympathetic

locus caeruleus releases loads of NA

Question 19

___ is a common complication of IV heroin use.

Answer 19

Infection

local, distant (e.g infective endocarditis) or systemic

Question 20

As IV heroin use requires vascular access and damage to the endothelium, what vascular complication can occur?

Answer 20

Thrombosis

Embolism

Question 21

What is naloxone?

Answer 21

Opioid receptor antagonist

used to reverse opioid overdose

Question 22

What state does opioid overdose mimic?

Answer 22

Sleep

Question 23

Which atypical analgesics have a street value and are often used at the same time as opioids?

Answer 23

Gabapentin

Pregabalin

Question 24

Which commonly prescribed sedative drugs can be abused alongside opioids?

Answer 24

Benzodiazepines e.g lorazepam

Question 25

Which **psychiatric disorders** are you more at risk of when using heroin?

Answer 25

**Anxiety** **Depression**

Question 26

Does **opioid withdrawal** cause **psychosis** or **delirium?**

Answer 26

**NO** trainspotting isn't accurate

Question 27

What is **opiate substitution therapy?**

Answer 27

**Substitution of a SHORT-ACTING opioid with a LONG-ACTING one**

Question 28

What are **long-acting opioids** used in substitution therapy?

Answer 28

**Buprenorphine** **Methadone**

Question 29

How is **opiate substitution therapy** carried out?

Answer 29

**Administration of ORAL buprenorphine or methadone** **Once daily** **Under direct supervision**

Question 30

**Opiate substitution therapy** removes the risks of ___ administration.

Answer 30

**IV administration** infection, embolism

Question 31

**Opiate substitution therapy** allows users to live a more ___ life.

Answer 31

**normal** family, employment, criminal activity

Question 32

**Initially**, patients on **opiate substitution therapy** have to visit the chemist how often?

Answer 32

**Every day** Eventually relaxed if they're complying with treatment

Question 33

Why is **methadone** only prescribed as a **liquid**?

Answer 33

**Tablets can be hidden and sold on**

Question 34

What are the two opioids prescribed as part of **opiate substitution therapy**?

Answer 34

**Methadone** **Buprenorphine**

Question 35

What is the more ambitious therapy for opioid addiction?

Answer 35

**Detox**

Question 36

What does **opioid detox** involve?

Answer 36

**Gradually tapering opioid dose until patient is drug free**

Question 37

**Opioid detox** therapy hugely increases a patient's risk of ___ in the next year.

Answer 37

**dying**

Question 38

Patients who successfully complete **opioid detox** are only ___ detoxified.

Answer 38

**physically** they are still psychologically dependent and therefore at huge risk of relapse \> overdose

Question 39

Patients who complete **opioid detox** are most likely to die due to **overdose.** Why?

Answer 39

**Physical dependence gone but psychological dependence remains** Patient then takes the huge dose they took before And dies from overdose

Question 40

What management allows patient who would otherwise abuse heroin to be monitored safely?

Answer 40

**Prescription of heroin and supervised use of it**