Opioid Misuse

Question 1

What are the common routes of opioid administration

Answer 1

1. IV
2. smoking
3. suppository
4. Insufflation (snorting)
5. Ingestion (slower absorption, subject to first pass metabolism so least preferred)

Question 2

What is the basic early metabolic pathway

Answer 2

diacetylmorphine (heroin) –>
6-mono-acetylmorphine (if found in drug screening, indicative of heroine use- limited to 6h)–>
morphine (if present, indicate codeine use)

Question 3

What are the effects of opioids?

Answer 3

• euphoria
• analgesia
• resp depression
• constipation (opioid receptors found in bowels)
• reduced consciousness
• hypotension
• bradycardia
• pupillary CONSTRICTION

Question 4

How long does it take to develop withdrawal symptoms?

Answer 4

6-8h

Question 5

What are the withdrawal symptoms?

Answer 5

• dysphoria
• tachycardia
• hypertension
• dysphoria (uneasy and dissatisfaction)
• diarrhea, n&v
• dilated pupils
• joint pains

Question 6

What are the complications of opioid use?

Answer 6

1. Infections
   - local-cellulitis, abscess, thrombophlebitis, necrotising fasciitis
   - distance-infective endocarditis
   - systemic-hep B/C
2. thrombotic/embolic
   - DVT, PE, ischaemic limb

Question 7

What opioids commonly cause drug-related deaths?

Answer 7

• gabapentin & pregabalin
• diazepam
• etizolam, diclazepam(benzodiazepine type NPS)
• mephedrone (stimulant type NPS)

Question 8

Can heroin cause psychosis or delirium?

Answer 8

NO

Question 9

What is opiate substitution therapy?

Answer 9

-Replacement of short acting opiate with long acting opiate

Question 10

What drugs are used for OST?

Answer 10

Buprenorphine
Methadone
lofexidine
**once daily

Question 11

Pros of OST

Answer 11

• reduce risk of HIV infection

- reduce risk of HCV (with needle substitution programme)

Question 12

Cons of OST

Answer 12

• initial daily visits to chemist

- stigma (esp to methadone compared to buprenorphine)

Question 13

what is methadone?

Answer 13

• Used in OST
• long acting full agonist
• table/liquid form (liquid preferred because difficult to hide/divert)

Question 14

What is bupronephrine

Answer 14

• Used in OST
• long acting partial agonist
• sublingual

Question 15

What is at risk of detoxification treatment?

Answer 15

Risk of death is highest right after detoxification treatment because if relapse, they take the dose they used to take before treatment but their tolerance has reduced –> die from overdose

Question 16

What psychosocial interventions can be done?

Answer 16

• contingency management: rewarding abstinence/ encourage methadone maintenance treatment
• Behavioural couples therapy
• CBT (for depression & anxiety)

Question 17

What else can be done for heroin addiction?

Answer 17

Heroine assisted treatment: prescribed heroin+methadone injected under supervision in clinic