Tema 8-9 dificil

Opioid Addiction

• Definition and Basic Concepts:
  • Papaver somniferum (opium poppy) is the source of opium, used as an analgesic since ancient Egypt and smoked since the 16th century.
  • Morphine, a derivative of opium, was isolated in 1804 and used medicinally. Also addictive, especially among healthcare workers.
  • Codeine and heroin are semi-synthetic opioids derived from morphine.
  • Tramadol and Fentanyl are synthetic opioids, with fentanyl being significantly more potent than morphine (50-100x). Fentanyl is now found in many illicit drugs, including heroin (NIDA report, 2018).
• Administration & Potency:
  • Opium use includes ingestion, oral intake or smoking.
  • Morphine can be ingested, injected, or applied transdermally.
  • Codeine and Tramadol have primarily oral or injected administrations.
  • Heroin can be consumed orally, injected, smoked, or absorbed transdermally.
  • Fentanyl is primarily administered orally, injected, or using transdermal patches.
• Course and Effects:
  • Heroin rapidly converts to morphine in the brain, leading to a “rush.”
  • Opioids work by occupying mu-opioid receptors (MORs), affecting pain perception and well-being.
  • This process in the CNS activates dopamine release in the reward center (accumbens-ventral tegmental area).
  • Chronic opioid use reduces noradrenergic firing rates, leading to tolerance and withdrawal symptoms.
  • Naloxone and naltrexone are opioid antagonists used to reverse CNS depression from overdose.
  • Clonidine, an α2-adrenergic agonist, treats acute withdrawal symptoms.
  • Methadone is a preferred mu-opioid agonist used for substitution therapy without euphoric effects or significant adverse toxicity to help prevent opioid use.
  • Heroin dependence is highly detrimental, impacting all aspects of life.
• Complications:
  • Chronic opioid use can lead to various complications, including chronic insomnia, intestinal issues, respiratory depression, and problems with organs like the lungs, liver, cardiovascular system, and more.
  • Injection routes can lead to infections and vascular damage, potentially causing serious health problems.
  • Sharing needles can contribute to the spread of infectious diseases like HIV and hepatitis.
  • Substance abuse often leads to marginalization and increased criminal activity.

Substance Use Disorders Associated with Opioids

• Substance Use Disorder (SUD): Ongoing problems due to the use and abuse of opioids.
• Opioid Intoxication: Symptoms include initial euphoria followed by apathy, disphoria, agitation, or slowed movement, altered judgment, and problems interacting with others. Symptoms are not caused by other medical or mental conditions.
• Opiate Withdrawal Syndrome: Symptoms include severe craving, intense anxiety, pupillary dilation, high blood pressure, fever-like face, restlessness, piloerection (goosebumps), tachycardia, vomiting, irritability, tremors, hyperthermia, diarrhea, yawning, coldness/heat sensations, weight loss, tearing in eyes, muscle/joint pain.

Treatment Considerations

• Withdrawal Reversal: Buprenorphine (Suboxone) minimizes withdrawal symptoms with antagonist dosages to prevent reinforcement, and controls symptoms even with use. Methadone is another opioid agonist with long-acting effects, known for its therapeutic safety and use in maintenance programs.
• Multidisciplinary Treatment: Acute withdrawal often necessitating short-term hospitalizations and transition to more controlled settings, such as residential or intensive outpatient treatment.
• Epidemic of Prescription Opioid Use: Trends show a large increase in addiction rates from 2002 to 2016 in the USA, with prescription painkillers (oxycodone, Vicodin, fentanyl) and heroin being strong contributors.

Cocaine and Stimulant Addiction

• Types of Personalities:

  • Individuals with cocaine use disorder show varied personality traits, dependent on the type of personality tool utilized. Common types relate to the cluster B traits.
  • Studies connect various personality disorders (Borderline Personality Disorder, Antisocial Personality Disorder) and stimulant use.

• Stimulant Use:

  • Cocaine use may involve "speedballing" (mixing cocaine with heroin), "crack" (a more potent form), or other preparation methods.
  • Other stimulants include methamphetamines, amphetamines, and others.

• Assessment and Treatment:

  • Steps for evaluation include a complete history, analysis of problem behaviors and maintaining factors, use of specific assessment tools like the EuropASI, various psychological tests to assess potential co-occurring mental health issues, and functional analyses to gain insight into specific behaviors and motivators.

• Stimulant Abuse:

  • Acute stimulation of the sympathetic nervous system results in euphoria, increased energy and alertness, heightened mental acuity, increased blood pressure, heart rate and bodily functions such as sweating, dilated pupils, dry mouth, nausea, and high body temperature, followed potentially by breathing difficulties (potential respiratory arrest).
  • Overheating is a potential danger during stimulant use.
  • Chronic usage can lead to various mental and physical health complications, including significant mood changes, sleep/sexual issues, cardiovascular problems (risk of heart attacks, cardiomyopathy, and sudden death), kidney failure, and pulmonary edema.
  • Various methods of treatment, including both pharmacological and psychological approaches are available for the management of stimulant use disorders.

Treatment Programs/Approaches/Therapy

• Programs often support either complete abstinence or harm reduction.
• Techniques involve reducing the intensity, frequency and duration of relapses.
• Programs also look to reduce illegal activities related to the substance.
• Treatment programs have varied methodologies and philosophies but often target the underlying issues leading to dependence to help patients return to a healthier life.

Este cuestionario explora la adicción a los opioides, incluyendo sus definiciones, conceptos básicos y diversas formas de administración. Aprenderás sobre la historia y la evolución de los principales opioides como la morfina, la codeína, el heroína y el fentanilo, así como su potencia y los métodos de uso. Conocimientos vitales para tomar conciencia sobre este problema de salud pública.