Substance misuse 4 Flashcards
what is opium?
Seedpod is incised with a blade
Milky fluid seeps from cuts in the unripe poppy seed pod
Scraped off and air-dried to produce opium
Dried in open wooden boxes
Resin is placed in bags or rolled into balls for sale
how do you Transform opoium for illicit use
- raw opium
2.Hot water/Ca2+ oxide (lime):
Alkali pH dissolves morphine
3.Ammonium chloride added after
filtration to precipitate morphine
4.Crude morphine powder (~50% morphine)
5.Acetic anhydride/boiling to acetylate
6.Brown heroin
precipitation
7.Hydrochloric acid
Purification: 75%
Diacetyl morphine
6% yield
what are opioid side effects?
Respiratory depression:
reduces sensitivity of respiratory centre; most common cause of death from overdose with street use of opioids
Euphoria:
action on reward pathway in the brain to increase dopamine release
Cough suppression (anti-tussive)
Nausea:
activate the chemoreceptor trigger zone (which in turn activates the vomiting centre)
Aspiration of vomit when unconscious common
Constipation:
due to maintained contraction of smooth muscle
how does the euphoric effect for opiates arise?
Euphoric effects of opiates arise from activation of opioid receptors on GABAergic neurons that inhibit dopaminergic neurons in the ventral tegmental area causing disinhibition and greater dopamine release from VTA presynapses terminating in the nucleus accumbens
what are the side effects of opiate - longterm and short term ?
short term :
Analgesia (feeling no pain)
Sedation
Euphoria (feeling high)
Respiratory depression
Small pupils
Nausea, vomiting
Itching or flushed skin
Constipation
Slurred speech
Confusion or poor judgment
longterm
addiction and tolerance
- ignore pain
-social withdrawel
- overdose
what are withdrawal symptoms of opiates?
Anxiety
Irritability
Craving for the drug
Rapid breathing
Yawning
Runny nose
Salivation
Goosebumps
Nasal stuffiness
Muscle aches
Vomiting
Abdominal cramping
Diarrhoea
Sweating
Confusion
Enlarged pupils
Tremors
Loss of appetite
what is the treatment for acute overdose of opiates?
Assess patient to clear airway.
Provide support ventilation, if needed.
Assess and support cardiac function.
Provide IV fluids.
Frequently monitor the vital signs and cardiopulmonary status until the patient has cleared opioids from the system.
Give IV naloxone if necessary (opioid antagonist)
Administered intravenously or subcutaneously
Rapidly reverses the respiratory depression and sedation caused by heroin intoxication.
Naloxone (Evzio) as an autoinjector dosage form for home
Since 01/10/2015 any worker in a commissioned drug service can provide naloxone without a prescription
what are treatment and rehab options available for opiates?
Detoxification or
Replacement/substitution therapy
Plus behavioural approaches
see substance abuse 1
what is the treatment - drug replacement used for opiote abusers?
Opioid maintenance
Methadone maintenance (longer lasting effects, can be overdosed)
Buprenorphine/naloxone maintenance: 4/1 ratio (naloxone gives withdrawal symptom if used i.v.
Alpha-2 adrenoceptor agonists, such as clonidine and lofexidine
Diacetyl morphine:
Recent trials show better outcome
Societal resistance (see also approval of foil in kits)
Cognitive behavioural, supportive, or analytical-oriented psychotherapies
where can opiote abusers be treated
controlled environment:
Specialized addiction centre
Community clinic
Private sector hospital
Psychiatric hospital
Detoxification Camp
Prison
what is Performance enhancing drugs (PEDs) in sport
Doping: artificially change bodily physiology to enhance performance (most commonly muscle mass or blood oxygenation)
pO2 in blood affects performance
what are the different types of PED?
Stimulants (such as amphetamines)
Anabolic steroids (such as nandrolone)
Diuretics (to help lower body weight)
Blood doping agents (such as EPO)
Many not illiegal to possess
how can you boost oxygen in the blood?
Homologous transfusion
Autologous transfusion
EPO treatment: hormone produced by the kidney enhance oxygen during hypoxia 0 to 19 mU/ml
Artificial blood substitutes (introduced in the list of illegal substances)
what are the side effects and risks of PED?
Proper use of EPO has an enormous therapeutic benefit in the treatment of anaemia related to kidney disease
Misuse can lead to thickening the blood
Heart disease, stroke, and cerebral or pulmonary embolism
May also lead to autoimmune diseases
what is IPED?
examples
The term PED has been expanded to IPED in recent years
Refers to Image and Performance Enhancing Drugs
Several drugs now available which do not necessarily affect performance but improve physical appearance or offset the adverse effects of PEDs
E.g. Melanotan: darkens skin tone (tanning) and improves sexual function
The majority are untested in humans or are being used for off licence effects
