Opiate misuse Flashcards
Why is heroin addictive?
rapid onset of action
short half life
easy avaliability
Are heroin and morphine the same thing?
YES
How is morphine made?
extracted from opium
diacetylmorphine -> 6-mono-acetyl morphine -> morphine
What is the effect of heroin on the body?
euphoria analgesia respiratory depression constipation hypotension bradycardia reduced concious level pupillary constriction
When do heroin withdrawal symptoms present?
within 6-8 hours
What are the heroin withdrawal symptoms?
dysphoria and cravings agitation tachycardia and hypertension piloerection - goosebumps diarrhoea, nausea and vomiting dilated pupils joint pain yawning, runny nose and watery eyes
What are the complications of IV use?
Infections - Hep B, Hep C, HIV, cellulitis, abscesses, necrotising fasciitis, thromboplebitis, infective endocarditis
Thrombo/embolic - DVT, PTE, ischaemic limb
What are the clinical treatment options?
Opiate susbtitution therapy
Opiate detoxification
Heroin assisted treatment
What is opiate substitution therapy?
replacement of taking a short acting opiate with a long acting one eg Buprenorphine or Methadone
What is the pro of opiate substitution therapy?
reduced mortality of 1/3rd
What are the cons of opiate substitution therapy?
methadone stigma
daily visits to the chemist
What is Buprenorphine?
long acting partial agonist
What is Methadone?
long acting full agonist
What is opiate detoxification?
use a long acting opiate to achieve complete abstinence
What are the cons of opiate detoxification?
4x more likely to die from an overdose
70-80% will relapse within the year
