Management of Opiate Misuse Flashcards
what is opium?
mixture of alkaloids (esp codeine and morphine)
what is morphine?
morphine extracted though often codeine contaminants remain
what is diamorphine?
addition of 2 acetyl rings to produce diacetylmophine (diamorphine)
what is the different ways you can take heroin?
IV smoking suppository insufflation ingestion
what is the basic early metabolic pathway of heroin?
diacetylmorphine -> 6-mono-acetylmorphine -> morphine
what effects does heroin have on body?
euphoria analgesia respiratory depression constipation reduced conscious level hypotension and badycardia pupillary constriction tolerance develops with repeated use
how long after taking heroin does withdrawal usually occur?
6-8 hours
what are the symptoms of heroin withdrawal?
dysphoria and cravings agitation tachycardia and hypertension piloerection diarrhoea, nausea and vomiting dilated pupils joint pains yawning rhinorrhea and lacrimation
what are the complications of IV use heroin?
local infection - cellulitis, abscess, thrombophlebitis, necrotising fasciitis
distant - infective endocarditis
systemic - hep B, HIV, hep C
thrombotic / embolic - DVT, PTE, ischaemic limb
what effect do gabapentin and pregabalin have on opioids?
enhance effects
what is etizolam?
benzo type novel psychoactive substance - twice as likely as diazepam to be implicated in deaths where it was found present
what are the social and psychiatric consequences of heroin use?
social - unemployment, neglect of family / children, alternative interests, criminality, risk of violence, prostitution
psychiatric - depression, anxiety
does heroin cause psychosis or delirium?
no
what is opiate substitution therapy (OST)?
replacement of short acting opiate with long acting opiate eg buprenorphine or methadone
once daily dosing, taken under supervision (initially)
what are the pros of OST?
reduced mortality rate
reduce HIV risk
prevents new HCV infection
what are the cons of OST?
daily visit to chemist (initially)
stigma (esp of methadone)
side effects
ongoing cost
how is methadone administered?
long acting full agonist taken in tablet or liquid form (usually liquid)
how is buprenorphine administered?
long acting partial agonist given as tablet (depot in future?)
different preparations have different dissolution rates
what drug can be used to help with symptoms of opioid withdrawal?
lofexidine
why are those who have undergone detoxification four times as likely to die from overdose as those who failed to complete?
tolerance is lower but they still take same dose
what % of detoxification completers will relapse within 1 year?
70-80%
what psychosocial interventions can be used for substance misuse?
contingency management - rewarding positive behaviours
behavioural couples therapy
CBT and psychodynamic therapy (not for drug misuse but is appropriate for comorbid anxiety and depression)
what treatment results in greater improvements in most other outcomes such as crime and psychosocial functioning?
heroin-based treatment
oral methadone + injectable methadone or heroin
however, not necessarily improves health
