Opioid dependence Flashcards
What is the primary social problem with opioid use?
Opiate experience in the real world is highly variable, difficult to predict in usual dose-response terms
What are the primary issues in tolerance with opioid use?
- Some individuals can behave as though quite affected by small opiate dosages, despite regular usage experience
- Some overdoses do not appear to involve dosages beyond the individual’s tolerance
What are problematic issues with opioid withdrawal?
- Users may take short-acting opiates 1-2 times daily, yet not experience withdrawal in between
- Physical withdrawal from minimal dosage
- Some stop high doses with little or no symptoms
- Triggering of physical withdrawal symptoms after extended abstinence
How is the mechanism of opioid withdrawal/tolerance different than other drugs?
Opioids have conditioned tolerance and withdrawal
- Physical symptoms either induced or alleviated by the organism’s expectations of opiate dose/effect
What plays the largest role in overdose in human and animal models on opioids?
Inability to expect and predict the situation where opioid use will occur, INCREASES risk of overdose/death
Explain how opioid conditioning occurs.
1) With regular opiate usage, various cues become associated with dose and effect
2) Using such cues, the brain attempts to “predict” the amount of excess opioid about to enter the system
3) Based on that prediction, brain readjusts the opioid system to offset the dose, maintain homeostasis
Explain how a lower dosage can lead to a lethal outcome despite tolerance.
Overdose vulnerability:
With high-dose usage, if the brain doesn’t get all the cues, dosage normally tolerated may become lethal
Explain opiate withdrawal despite abstinence.
- Physical withdrawal symptoms may be provoked by cues, regardless of length of abstinence
- Major relapse implications
- Addict’s brain perceives the withdrawal as an emergency, experiences opiate use as necessary “treatment” for a dangerous condition.
