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Psychiatry > Heroin/Opioid misuse > Flashcards

Heroin/Opioid misuse Flashcards

1
Q

Definition of opioid abuse?

A

Continuous opioid use despite physical, psychological or social harm to the user

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2
Q

What are examples of opioids?

A

Heroin, morphine, methadone, buprenorphine

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3
Q

What are the main effects of opioid?

A 
Analgesia
Euphoric effect (the main reason why it is abused)
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4
Q

By which routes can opioids be taken?

A

IV, SC, intranasally, smoked

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5
Q

What are characteristic features of opioid dependence?

A
  • Drug craving / compulsion to take substance
  • Maladaptive behaviour focused on obtaining opioids at any cost
  • Difficulty in controlling use
  • Physiological withdrawal state
  • Tolerance (need increased dose for same effect)
  • Neglect of alternative pleasures and interests
  • Persistence of use despite harm to themselves or others
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6
Q

What are the three major symptoms of opioid overdose?

A
  • pinpoint pupils
  • unconsciousness
  • respiratory depression
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7
Q

What are symptoms of acute opioid withdrawal?

A
  • Sweating
  • Watering eyes
  • Rhinorrhoea and coughing
  • Yawning
  • Feeling hot/cold
  • Anorexia
  • Abdominal cramps
  • Nausea, vomiting and diarrhoea
  • Tremor
  • Goosebumps
  • Tachycardia and HTN
  • Insomnia, restlessness, anxiety and irritability
  • Generalised aches and pains
  • Dilated pupils
  • Increased bowel sounds
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8
Q

How soon can acute heroin withdrawal symptoms start to improve?

A

after 5 days

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9
Q

How soon can methadone withdrawal symptoms start to ease?

A

10-12 days

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10
Q

How long can opioid cravings last for after withdrawal?

A

Up to 6 months

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11
Q

What health complications are there with opioid dependence?

A
  • Death  overdose, suicide accidents, health-related complications
  • Skin infection at injection sites (can be serious e.g. necrotising fasciitis)
  • Sepsis
  • Infective endocarditis
  • HIV infection
  • Hepatitis A, B, C infection
  • TB
  • Venous and arterial thromboses (due to poor injecting techniques)
  • Poor nutrition and dental disease
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12
Q

What social complications can occur with opioid dependence?

A
  • Crime
  • Relationship problems
  • Child protection issues
  • Homelessness and deprivation
  • Working in sex industry
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13
Q

What psychological complication scan occur with opioid dependence?

A
  • Craving
  • Guilt
  • Anxiety
  • Cognitive impairment and memory loss
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14
Q

How may opioid dependence present in primary care?

A
  • Direct request for help with their dependence
  • Medical complication due to their dependence
  • Clinical signs of opioid intoxication or withdrawal
  • Social problems including forensic history
  • Disclosing their opioid abuse whilst presenting for another problem
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15
Q

How would you assess for current opioid drug use?

A

Drug testing:

  • Screening test - immunoassay and dipstick (these are quick, easy and cheap)
  • confirmatory tests - gas or liquid chromatography and mass spectrometry
  • oral fluid testing ( however, this only detects drug use in past 24-48 hours)
  • hair testing - can detect drug use over past few months ( but can’t tell between continuous and sporadic use)
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16
Q

Which risks need to be assessed in opioid drug users?

A 
Overdose risk
Polydrug and alcohol misuse
Unsafe injecting practices
Unsafe sexual practices
Risk of self harm or harm to others
Risk to dependent children
17
Q

What needs to be looked at in order to assess social functioning?

A
  • partners, family, support
  • housing
  • education/employment
  • domestic violence
  • Benefits and financial problems
  • childcare issues - pregnancy, parenting and child protection
18
Q

What should be assessed in opioid users?

A 
current drug use
risk ( to self and others)
Social functioning
criminal involvement and offending
physical and psychological health
19
Q

What is the treatment of opioid intoxication?

A

1) ABCDE
2) Naloxone (is. pure opioid antagonist to reverse opioid intoxication) (route: IV best, IM or SC if venous access difficult)
3) supportive measures - maintain airway, ventilation, IV fluids

20
Q

What is the treatment of opioid dependence?

A

detoxification

induction and maintenance substitute prescribing

21
Q

How long does it take to lose tolerance to methadone?

A

3 days

22
Q

If someone stopped taking methadone and wanted to restart it after 3 or more days what would you do?

A

Prescribe them a lower dose than before to reduce risk of overdose

23
Q

what are the two main treatment options for heroin detox?

A

Methadone

Buprenoprhine

24
Q

What else should be delivered alongside the medication during detox?

A

Psychological interventions - CBT

keyworker support

25
Q

When an opioid user asks for detox, what has to be considered when assessing suitability?

A
  • Patient COMMITTED and fully informed??
  • Does patient understand the physical and psychological aspects of withdrawal and how they can be managed?
  • Understand increased risk of overdose and death if use illicit drug whilst on detox medication
  • High risk of relapse been explained?
  • Adequate social support available post detox??
26
Q

What are the aims of pharmacological treatment for opioid detoxification?

A
  • Reduce or prevent withdrawal symptoms
  • Provide opportunity to stabilise drug intake whilst breaking with illicit drug use and associated unhealthy risk behaviours
27
Q

Which medication is first line for opioid detox (despite them both appearing to be equally effective)?

A

methadone

28
Q

What does treatment with a. drug substitute help protect against?

A

Risk of overdose
Bloods-borne infection
Risk of offending

29
Q

With methadone - when is the risk highest for overdose?

A

On induction and during the first 2 weeks of treatment

30
Q

What increases the risk of overdose when on methadone for detoxification?

A 
o	Low opioid tolerance
o	Other CNS Depressants e.g. alcohol, benzos
o	Initial dose is too high
o	Slow methadone clearance
o	Polysubstance abuse
31
Q

How do you reduce the risk of toxicity with methadone?

A
  • Identifying high-risk patients
  • Avoid starting the patient on too a low a dose
  • avoid rapid increases of dose
  • explain and educate patients and careers on the early signs of overdose
32
Q

Why does buprenorphine have reduced risk of overdose during induction of the medication for detoxification?

A

As it has mixed agonist and antagonist properties at opioid receptors, so an increased dose does not produce more intense opioid effects

33
Q

What are downsides with using buprenorphine for opioid detox?

A
  • May interact with any HIV medications

- More risk of misuse than methadone

34
Q

What pharmacological medications can be used to treat any withdrawal symptoms that may be experienced?

A
  • Antidiarrhoeals (Loperamide) for diarrhoea
  • Metoclopramide, Prochlorperazine for nausea, vomiting and stomach cramps
  • Mebeverine for stomach cramps
  • Diazepam or Zopiclone for agitation, anxiety and insomnia
  • Paracetamol and NSAIDs for muscle pains and headaches
35
Q

What medication can be prescribed to prevent replaces of opioid use?

A

Naloxone

Psychiatry (40 decks)

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