Transcript Drugs For The Treatment Of Heroin Addiction

Heroin Addiction
What is heroin?
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Heroin is an opioid, derived from the opium
poppy ‫الخشخاش‬
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Morphine is the active ingredient in opium
Effects of heroin
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“Positive” effects (the reasons for use)
 Heroin's main effect is a sudden rush sense of euphoria
with dreamy state of complete relaxation for several
hours
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Also, flushing of the skin and heavy extremities
 The onset of these effects differs based on the method
of administration
 Smoked/snorted = 10-15 min
 Injected = 7-10 seconds
Negative effects
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Negative effects on CNS:
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Drowsiness, and mental cloudiness
change in mood with difficult concentration
Anxiety or fear
The user may become sleepy and in large doses it may
cause deep sleep
Slowed breathing and cardiac function: breathing is slowed
down. If in large amount death may occur cardiorespiratory
failure.
Negative effects on digestive System:
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Stomach digestive juices become scanty in amount
Contraction of Stomach muscles and intestines is
slowed down, so digestion of food is slowed down
Constipation takes place
Nausea and vomiting, or upset Stomach
Loss of appetite which leads to undernourishment
and anemia
Other effects and health problems
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Hepatitis from injection with dirty needle
Skin problems, Itchy skin
Much sweating
Constipation
Narrowing of pupils
Urgency or urinary retention
Hypotension
The blood vessels of the skin are dilated especially
face& neck with feeling of warmth
Long-Term Effects:
■ Addiction
■ Infectious diseases, for example, HIV/AIDS
and hepatitis B and C
■ Collapsed veins
■ Bacterial infections
■ Abscesses
■ Infection of heart lining and valves
■ Arthritis and other rheumatologic problems
What are the medical complications of
chronic heroin use?
Medical consequences of chronic heroin injection use include:
1-scarred and/or collapsed veins,
2-bacterial infections of the blood vessels and heart valves,
abscesses (boils) and other soft-tissue infections,
3- liver or kidney disease.
4-Lung complications (including various types of pneumonia
and tuberculosis) may result from the poor health condition
of the abuser as well as from heroin’s depressing effects on
respiration. Many of the additives in street heroin may
include substances that do not readily dissolve and result in
clogging the blood vessels that lead to the lungs, liver,
kidneys, or brain. This can cause infection or even death of
small patches of cells in vital organs.
What are the medical complications of
chronic heroin use?
5-Immune reactions to these or other contaminants
can cause arthritis or other rheumatologic
problems.
6-Of course, sharing of injection equipment or fluids
can lead
to some of the most severe consequences of heroin
abuse—
infections with hepatitis B and C, HIV, and a host
of other blood borne viruses, which drug abusers
can then pass on to their sexual partners and
children.
How does heroin abuse affect pregnant
women?
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Heroin abuse can cause serious complications
during pregnancy, including miscarriage and
premature delivery.
Children born to addicted mothers are at
greater risk of sudden infant death syndrome
(SIDS).
How heroin works
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Heroin cross the blood-brain barrier with much
greater efficiency
Once in the brain, heroin is converted to
morphine, and becomes “trapped” by the barrier
The morphine interacts with receptors and
causes the effects.
How heroin works
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Receptors located non-uniformly throughout
Central Nervous System
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Cerebral cortex has most
Spinal cord has significantly less
How users become addicted
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The body cannot completely eradicate
drugs. It metabolizes them, and the
metabolites get stored in fatty tissue.
When the fatty tissue is broken down, the
metabolites are released and act on the
brain again, causing a craving.
Opioid Tolerance
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Tolerance develops to Opioids in remarkable
degree, more than to general sedatives such as
barbiturates and alcohol.
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Cross-tolerance can be developed for drugs
within the opoid class.
Opioid Withdrawal
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It can be a severe process.
Symptoms depend on degree of tolerance and the
severity of the dependence.
develops within 4-12 hours of cessation of the drug.
The symptoms and signs reach their peak by the end
of the second day and are mostly resolved within 3-4
days.
Opioid Withdrawal
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minutes to days:
 Unhappy mood (Irritability and depression)
 Twitching of Muscle, tremors of tongue and aching pain
in aches Muscles, bone and joints.
 Runny nose with sniffing, itching of nose and paroxysm
of sneezing
 Pupillary dilation/Tearing
 Subjective feeling of hot or cold occur, marked feeling of
coldness with contraction of muscles attached to hair, so
hair will erect (Goose bumps-cold turkey) or sweating
Opioid Withdrawal
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Nausea/Vomiting
Abdominal cramping and Diarrhea –
Fever , increase in breathing rate and blood pressure
Yawning becomes frequent and deep
Nervousness and restlessness
Increased salivation
Anorexia, loss of food intake and loss of weight
Feeling of desperation with obsessive desire to secure
more of the drug
Opioid Overdose
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Life threatening they depress the brain
(breathing control part of the brain) which
results in respiratory failure, coma and death
Constricted pupils
Drowsiness or coma
Slurred speech
Poor attention and memory
Diagnosis
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Lab tests
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Urine, blood, others
12-36 hrs after use
Acute Intervention
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Overdose
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Emergency
Support vital signs
Naloxone: 0.4 mg q 2-3 min. SC/IV
Withdrawal
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Opioid substitution with gradual ↓
Symptomatic treatment
Pharmacological Treatment
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2.
Methadone
 Once/day dosed
 40-60 mg/d: sufficient to block withdrawal sx.
Buprenorphine/Naloxone
 12-16 mg/d
Psychosocial Treatment
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Specialized programs
Cognitive behavioral therapy
Group and Family therapy
Methadone
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How it works
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Methadone is broken down in the liver and stored
When the brain opiate receptors are ready,
methadone is mobilized and fills the receptors
Methadone is an agonist, so it works similar to
heroin, but does not produce the extreme highs
and lows
Naltrexone
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Used mainly for alcoholism treatment
New method in other countries, currently
being researched in the United States
Opioid antagonist – blocks effect of opioids by
blocking receptors
Non-addictive
Naltrexone
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How it works
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Naltrexone is attached to the opioid receptors,
competitively inhibiting the attachment of opioids to
the receptors
Completely blocks euphoria feeling, but some still
feel nauseous
Naltrexone
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Problems and Questions
Not used in pregnant women
High relapse numbers