Lecture 4: Opioids

Question 1

Naturally occurring, semi synthetic, or synthetic

Answer 1

Opium = plant = (Morphine)
Semi Synthetic Opioid = anything that acts like morphine (Heroin,Oxycodone)
Opiate = synthetic (Methadone, Fentanyl)

Question 2

Opioid Prevalence

Answer 2

Opioid - 1% - roughly 0.37%
Men = 0.49%
Female = 0.26%

Question 3

Opioids | Heroin | Cocaine

Answer 3

_________ are implicated in more deaths than ______ and _____ combined

Question 4

Men | women | 5

Answer 4

More _____ die from opioid overdose but from 1999-2010 rate among ____ increased by ___ times

Question 5

Opioids

Answer 5

Most commonly implicated drug in unintentional overdose Fatalities, usually in combination with other substances

Question 6

93% | 44% | 80%

Answer 6

One study found that _____% of decedents had used prescription opioids and only _____ had been prescribed them. In ____ of the decedents multiple substances in addition to opioids contributed

Question 7

Rushing and snorting pills | Response to negative emotions or interpersonal stress

Answer 7

Men are more likely to _____ and ____ their Opioids. Women are more likely to use them in response to ______ _______or ______ ________.

Question 8

Heroin

Answer 8

Synthesized from morphine. When it enters the brain it converts back to morphine and binds to MU opioid receptors

Question 9

Symptoms of heroin abuse

Answer 9

Fatal overdose, spontaneous abortion, infectious diseases like hepatitis and HIV. Chronic user develop collapsed veins, endocarditis, abscesses, constipation/gastrointestinal cramping, and liver or kidney disease

Question 10

Naloxone

Answer 10

Discovered in 1960

- An opioid antagonist use for a complete or partial reversal of opioid overdose and respiratory depression.

Question 11

Endogenous Opioids

Answer 11

Produced within the brain and are active regulators of an immune response i.e endorphins

Question 12

Opioid Receptors

Answer 12

Mu, Kappa & Delta receptors

Question 13

Adaptation

Answer 13

1) Dysfunction - what’s not working? What are the risks?
2) Distress - who or what is being harmed and to what degree?
3) Culture - What social norms or values are being violated?

Question 14

Clinical Description

Answer 14

1) Presenting Problem - what is the reason patient is at the clinic?
2) Clinical Description - patients relevant feelings, thoughts and behaviour
3) Prevalence - the # of cases that exist in a year
4) Incidence - # of new cases in a given year (ex. fentanyl increase)
5) Course = pattern of substance use = chronic - almost always a problem, episodic - recurring problem, time- limit - should fix itself soon
6) Prognosis - prediction of outcome after treatment (good, bad, fair)
7) Etiology - origin of the problem- why or how did this disorder/addiction begin

Question 15

Treatment

Answer 15

20-30% cure after first treatment
70-80% relapse after first attempt
Magic # 5 - 5 years of being sober

Question 16

Clinical Assessment

Answer 16

systematic evaluation of biological, psychological and social factors
BIO: Naloxone challenge test
PSYCHO: SCID assessment, diagnosis, severity and comorbidity
SOC: peers, legal, support

Question 17

Lifespan Development Equfinality

Answer 17

Different paths can result from the interaction of psychological and biological factors during various stages of development; Different paths can end up in the same place

Question 18

Canada’s current substance ranking

Answer 18

1. Alcohol
2. Tobacco
3. Cannabis
4. Opioids
5. Other

Question 19

11 criteria for SUD

Answer 19

2 or more within a 12 month period:
2-3 - MILD
4-5 - MODERATE
6+ = SEVERE
1. Recurrent substance use while failing to fulfil important obligations
2.Recurrent use in physically hazardous situations (i.e.driving)
3. Strong craving or desire for substance
4. Continuing use despite recurrent social and interpersonal problems caused by the effects of the substance
5. Tolerance
- needing to take more of the substance to achieve the desired effect
- Dimish effect with continued use of the same amount
6. WIthdrawal
- characteristic withdrawal syndrome of substance
- Taking the same or closely related substance to relieve avoid withdrawal symptoms
7. Taken in larger amounts for longer period of time than intended
8.Desire or unsuccessful attempts to cut down or control substance use
9. A lot of time is spent in getting substance, using it then recovering from it
10. Recreations, occupational, social activities are reduced
11. Continue substance use despite knowledge of physical or psychological problem caused by substance use (i.e ulcer, liver damage etc)

Question 20

Stimulant Related Disorder

Answer 20

Stimulant Use Disorder, Stimulant Intoxication, Stimulant Withdrawl, Stimulant Induced Disorders

Question 21

Stimulant Use Disorder

Answer 21

A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by two or more of the listed criteria, occurring within a 12 month period.

66% - SMOKE
18% - INJECT
10% - SNORT

Question 22

Stimulant Intoxication

Answer 22

Must meet all FOUR of criteria:
RCPS:

1) Recent Use
2) Clinically significant problematic Behavioural or Physiological changes
3) Physical Symptoms - two or more
4) Signs and symptoms are not attributable to another medical condition or better explained by another mental disorder including intoxication from another substance

Question 23

Stimulant Withdrawal

Answer 23

Must meet all FOUR of criteria:
RDSS:

A) Reduction in prolonged use

B) Dysphoric mood with
Three or more Physiological changes listed developing within a few hours to several days after A

C) Signs and symptoms in B cause clinically significant distress or impairment in social occupational or other important areas of functioning

D) Signs or symptoms not attributable to another medical condition and not better explained by another mental disorder including intoxication or with drawl from another substance

Question 24

Dose-response curve

Answer 24

As the dose is increased, the effects increase but beyond a certain dose threshold, the response curve descends. So, increasing the dose gives less of an effect.