Opiate addiction Flashcards
What is the chemical name for heroin?
Diacetylmorphine (Diamorphine)
Describe the production of heroin
Opium is extracted from opium poppies
This contains a mix of alkaloids, mainly codeine and morphine
Morphine is extracted and 2 acetyl rings are added to produce diacetylmorphine (Heroin)
What are some of the ways that heroin is taken?
- IV
- Smoking (Most common)
- Suppository
- Snorting
- Ingestion
What happens to heroin in the body?
It is broken down into 6-mono-acetylmorphine and then into morphine to produce effects
What are some of the effects of heroin on the body?
- Euphoria
- Analgesia
- Respiratory depression
- Constipation
- Reduced conscious levels
- Hypotension and bradycardia
- Pupillary constriction
- Tolerance with repeated use
How quickly do withdrawal symptoms occur after heroin use?
6-8 hours
What are some of the withdrawal symptoms of heroin?
- Insomnia
- Dysphoria and cravings
- Agitation
- Tachycardia and hypertension
- Piloerection and shivering
- Diarrhoea, nausea and vomiting
- Dilated pupils
- Joint pains
- Yawning
- Rhinorrhoea and lacrimation
What are some possible complications of IV heroin use?
Infections (Local, Distant, systemic)
Thromboses
What are some local infections that can occur in IV heroin use?
Cellulitis
Abscess
Thrombophlebitis
Necrotising fasciitis
What is a distant infection that can occur in IV heroin use?
Infective endocarditis
What are some systemic infections that can occur with IV heroin use?
Hep B
Hep C
HIV
How does Scotland’s drug death compare with the rest of the UK and Europe
It was 3.5x that of the UK was the highest in Europe
What are some social consequences of heroin use?
- Unemployment
- Neglect of family or children
- Criminality
- Risk from violence and prostitution
What are some psychiatric consequences of heroin use?
- Depression
- Anxiety
What are some of the clinical treatment options for heroin use?
Opiate substitution therapy (OST)
Heroin assisted treatment
Psychological therapy
What is opiate substitution therapy?
This is the replacement of a short acting opiate with a long acting opiate
What are some examples of long-acting opiates used in OST?
Buprenorphine (Partial agonist)
Methadone (Full agonist)
What are some positives of OST?
- Reduced mortality rate
- Reduced HIV risk by approx. 50%
- Reduces criminality
- Promotes pro-social activities
- Promotes family life
- Promotes employment
What are some negatives of OST?
- Daily visits to the chemist
- Stigma (Esp. methadone)
- Side effects
What is heroin assisted treatment?
Treatment that involves the use of prescribed, carefully monitored heroin
What are the advantages of heroin assisted treatment?
Heroin based treatment results in greater improvements in most other outcomes such as criminality and psychosocial function
What are some psychosocial interventions that can be used in opiate addiction?
Contingency management (Reward positive behaviour - Vouchers, etc)
Behavioural couples therapy
CBT and psychodynamic therapy
What is opiate detoxification?
This is the achievement of complete abstinence from ALL opiates
What are some of the advantages of opiate detoxification?
There is the potential to realise a lot of social, physical and psychiatric benefits
What are some negatives of opiate detoxification?
increases the risk of OD in the case of relapse, as their tolerance is greatly decreased
10% of people in a study of 137 patients who underwent opiate detoxification were dead within 4 months
70-80% of detoxification completers will relapse within 1 year
