Addiction - Opiates

Question 1

What are some factors which are responsible for the addictiveness of heroin?

Answer 1

Rapid onset of action, short half-life, availability

Question 2

What is the relevance of heroin having a short half-life?

Answer 2

Reaches peak plasma levels very quickly, but they also drop very quickly which causes cravings

Question 3

What are the two main constituents of opium?

Answer 3

Codeine and morphine

Question 4

How is diamorphine produced from morphine? What is this known as?

Answer 4

Addition of 2 acetyl rings to form heroin

Question 5

How can heroin be taken?

Answer 5

IV, smoking, suppository, insufflation, ingestion

Question 6

What are the quickest ways of getting heroin into the bloodstream and achieving a quick high?

Answer 6

Smoking or IV

Question 7

Describe the metabolism of diacetylmorphine?

Answer 7

Goes to 6-mono-acetyl morphine and then to morphine

Question 8

How long does 6-mono-acetyl morphine last in the system? If this is detected in a drugs test then the patient has definitely taken what?

Answer 8

6 hours / heroin

Question 9

If morphine is shown up in a drugs test, what could the patient have taken?

Answer 9

Codeine or heroin since these are both metabolised to morphine

Question 10

If a blood test shows up 6-mono-acetyl morphine and codeine, what is the significance of this?

Answer 10

The codeine was probably a contaminant

Question 11

What does taking heroin do to you?

Answer 11

Euphoria, analgesia, respiratory depression, constipation

Question 12

What are some signs of heroin use?

Answer 12

Reduced conscious level, hypotension/bradycardia, pupillary constriction

Question 13

The body sensation of euphoria when taking heroin is more to do with what?

Answer 13

Release of histamine

Question 14

Why do people who take heroin often have very bad dentition?

Answer 14

They receive so much analgesia that they don’t notice when things are wrong / they have reduced saliva production and increased gastric acid production

Question 15

Withdrawal symptoms from heroin usually occur within how long of stopping it? What causes these symptoms?

Answer 15

6-8 hours / overactivity of adrenaline and the sympathetic nervous system

Question 16

What are some infectious complications of IV drug use?

Answer 16

Local e.g. cellulitis, abscess, thrombophlebitis, necrotising fasciitis/ distant e.g. infective endocarditis / systemic e.g. Hep B/C, HIV

Question 17

What are the two main complications of IV use of drugs?

Answer 17

Infections and VTE

Question 18

What are some VTE related complications of IV drug use?

Answer 18

DVT, PE, ischaemia limb

Question 19

Almost all drug related deaths occur after the consumption of what? Give an example.

Answer 19

Multiple substances, especially pregabalin/gabapentin as these increase the effects of opioids and increase people’s tolerance to them

Question 20

What drug is used to reverse the effects of an overdose?

Answer 20

Naloxone

Question 21

What are some psychiatric complications of heroin use? What are some psychiatric features which are NOT seen in heroin use?

Answer 21

Depression and anxiety / psychosis and delirium

Question 22

Is opiate withdrawal dangerous?

Answer 22

No, it is just unpleasant

Question 23

What is opiate substitution therapy?

Answer 23

The act of replacing a short acting opiate with a long acting opiate

Question 24

Give some examples of long acting opiates that can be used for opiate substitution therapy?

Answer 24

Buprenorphine or methadone

Question 25

How are long-acting opiates taken in opiate substitution therapy?

Answer 25

Once daily under supervision (initially)

Question 26

What are the pros of opiate substitution therapy?

Answer 26

Reduces mortality and risk of blood borne virus, also reduces criminality and allows people back to education/work

Question 27

What are the cons of opiate substitution therapy?

Answer 27

Daily visits to the chemist (initially), stigma, side effects

Question 28

Describe the action of methadone and how it is taken?

Answer 28

Long acting full opioid agonist - liquid formulation

Question 29

Describe the action of bupranorphine and how it is taken?

Answer 29

Long acting partial opioid agonist - tablet formulation

Question 30

Can the transition from heroin to long acting opiates cause withdrawal?

Answer 30

Yes

Question 31

What is opiate detoxification and how is this achieved?

Answer 31

Complete abstinence from all opiates - gradually reduce dose until patient is completely drug free

Question 32

What is the big risk of opiate detoxification?

Answer 32

The risk of death from overdose is rapidly increased in the first 4 weeks following detoxification

Question 33

What % of patients who have undergone opiate detoxification will relapse in a year? What is the significance of this?

Answer 33

70% / their tolerance will have decreased but they take the same dose so they overdose and die

Question 34

Overall, which method of treatment for opiate addiction works best?

Answer 34

Opiate substitution tehrapy

Question 35

What is the main psychological treatment for opiate addiction? What does it do?

Answer 35

Contingency management, rewards positive behaviours

Question 36

For who being treated for opiate addiction may behavioural couples therapy be useful?

Answer 36

People in close contact with a non drug abusing partner

Question 37

What are the roles of CBT and psychodynamic therapies in drug misuse?

Answer 37

Not indicated for the treatment of drug misuse, but is indicated for any co-morbid anxiety/depression