Lecture 4: Opioids Flashcards
Naturally occurring, semi synthetic, or synthetic
Opium = plant = (Morphine)
Semi Synthetic Opioid = anything that acts like morphine (Heroin,Oxycodone)
Opiate = synthetic (Methadone, Fentanyl)
Opioid Prevalence
Opioid - 1% - roughly 0.37%
Men = 0.49%
Female = 0.26%
Opioids | Heroin | Cocaine
_________ are implicated in more deaths than ______ and _____ combined
Men | women | 5
More _____ die from opioid overdose but from 1999-2010 rate among ____ increased by ___ times
Opioids
Most commonly implicated drug in unintentional overdose Fatalities, usually in combination with other substances
93% | 44% | 80%
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
Rushing and snorting pills | Response to negative emotions or interpersonal stress
Men are more likely to _____ and ____ their Opioids. Women are more likely to use them in response to ______ _______or ______ ________.
Heroin
Synthesized from morphine. When it enters the brain it converts back to morphine and binds to MU opioid receptors
Symptoms of heroin abuse
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
Naloxone
Discovered in 1960
- An opioid antagonist use for a complete or partial reversal of opioid overdose and respiratory depression.
Endogenous Opioids
Produced within the brain and are active regulators of an immune response i.e endorphins
Opioid Receptors
Mu, Kappa & Delta receptors
Adaptation
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?
Clinical Description
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
Treatment
20-30% cure after first treatment
70-80% relapse after first attempt
Magic # 5 - 5 years of being sober
Clinical Assessment
systematic evaluation of biological, psychological and social factors
BIO: Naloxone challenge test
PSYCHO: SCID assessment, diagnosis, severity and comorbidity
SOC: peers, legal, support
Lifespan Development Equfinality
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
Canada’s current substance ranking
- Alcohol
- Tobacco
- Cannabis
- Opioids
- Other
11 criteria for SUD
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)
Stimulant Related Disorder
Stimulant Use Disorder, Stimulant Intoxication, Stimulant Withdrawl, Stimulant Induced Disorders
Stimulant Use Disorder
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
Stimulant Intoxication
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
Stimulant Withdrawal
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
Dose-response curve
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.
