Opium is obtained from juice of the opium poppy, papaver somniferum. About 20 distinct opiod alkaloids are derived from opium the best known of which is morphine. Other opiod alkaloids occur naturally or can be synthesized from morphine including heroin.
Opioids exert their effect by binding to specific sites in the brain that have been identified as opioid receptors. The medicine Naltrexone, blocks opioid binding sites & reverses or blocks opioid effect. Heroin is more potent than morphine; it crosses the blood brain barrier in lesser time & produces a more rapid onset of action .After absorption, it is transferred to some degree into morphine & binds to the same neuroanatomical sites. Synthetic bind to the opioids recepters. Morphin reduced brain glucose utilization approximately 10 %.
These are possible but not definitive warning signs among children who may turn to drugs in later years. These high risk signs are
Early health problems,
Behavioral problems at mealtime & in school,
Conduct disorder, lack of self confidence,
Self centered philosophy of life, anti-authoritarian views,
Parents themselves are often involved in using drugs & alcohol,
Family�s attitude of inconsistency & Self centeredness.
Environmental Factors:
In recent years there is steady increase in the number of middle-class addicts from privileged homes. There is a drop in the average age of heroin users. The imitation of heroin use reaches a peak at age 16 to 17. The age of initiation has been dropping steadily. Some 10 and 11 years old children are now experimenting with opioids.
Certain consistent behavior patterns seem especially pronounced in adolescent addicts. These patterns have been called the heroin behavior syndrome:
* underlying depression, often of an agitated type and frequently accompanied by anxiety symptoms;
impulsiveness expressed by a passive-aggressive orientation
heroin as an ant anxiety agent to mask feeling of low self-esteem, hopelessness, and aggression,
limited copings strategies & low frustration tolerance, accompanied by the need for immediate gratification,
sensitivity to drug contingencies, with a keen awareness of the relation between good feelings and the act of drug taking,
feelings of behavioral impotence counteracted by momentary control over the life situation by means of drugs,
disturbances in social and interpersonal relations with peers maintained by mutual drug experiences,
Drug abuse as a form of identification and engagement.
More than 50 percent of urban heroin users belong to single-parent or divorced families; alcoholism and drug abuse are common among the families of drug abusers. Neonatal addiction is a significant problem; approximately three-fourths of infants born to addicted mothers experience the withdrawal syndrome. Close to 90 percent of opioid addicts have diagnosed psychiatric disorder, most often depression. Alcoholism, antisocial personality, and anxiety are the next most common disorders. Suicidal ideation is frequent, in one study, 13 percent of heroin addicts had made at least one suicide attempt.
CLINICAL EFFECTS
Heroin, pharmacologically similar to morphine, induces analgesia, drowsiness, and changes in mood. The pleasurable and euphoric actions of heroin are about twice as potent as those of morphine. Although the manufacture, sale, and possession of heroin are illegal attempts have been made to make heroin available to pain-ridden terminal cancer patients because of its excellent analgesic and euphoric effects. Tolerance to opioids develops in terminally ill patients, who may require 200 to 300 mg of morphine a day to manage pain. Tolerance to the respiratory depressant effects does not develop, however, which place such patients at risk if their needs for opiates are met. Many patients suffer unnecessary pain before they die because physicians are unwilling to prescribe such large doses or because of restrictive legislation.
INTOXICATION AND OVERDOSE:
Opioid intoxication occurs after the recurrent use of an opioid and is characterized by altered mood, psychomotor retardation, drowsiness, slurred speech, and impaired memory or attention. An overdose is life threatening and is characterized by marked unresponsiveness, coma, slow respiration, decreased body temperature, low blood pressure.
Treatment of Overdose:
Opioid overdose is a medical emergency. The Patient�s respiration is severely depressed, and he or she may be semi comatose or comatose or in shock. The first task is to ensure that there is an open airway and that vital signs are maintained. Naloxone is administered, 0.4 mg intravenously, that dose can be repeated four to five times within the first 30 to 45 minutes.
WITHDRAWAL:
Withdrawal means the symptoms experienced by an addict after he gives up regular consumption of the drug. Morphine and heroin addicts may take hundreds of milligrams of heroin, as much as 5,000 mg of morphine has been taken by tolerant addicts. In nontolerant person death from overdose may occur with 60 mg of morphine. The morphine and heroin withdrawal syndrome begins in six to eight hours after the last dose, usually after a one to two week period of continuous use or the administration of a narcotic antagonist. The withdrawal syndrome reaches its peak intensity during the second or third day and subsides during the next 7 to 10 days. However, some symptoms may persist for six months or longer.
TREATMENT OF WITHDRAWAL:
Methadone is a synthetic opioid that substitutes for heroin and can be taken orally. It is given to addicts in place of their usual drug of abuse and suppresses withdrawal symptoms. The action of methadone is such that 20 to 80 mg a day (although doses up to 120 mg a day have been used) is sufficient to stabilize the patient. It has duration of action exceeding 24 hours. Methadone maintenance is continued until the patient can be withdrawn from methadone, which is itself addicting. Patients are detoxified from methadone more easily than from heroin, although a similar abstinence syndrome occurs with methadone. Usually clonidine (0.1to0.3 mg, three to four times a day) is given during the detoxification period.
LAMM is a longer acting opioid than methadone. In contrast to the daily methadone treatment. LAMM can be administered in dosage of 30 to 80 mg thrice a week. Methadone maintenance has several advantages, it frees the addict from dependence on injectable heroin; it is legal; it causes minimal euphoria & rarely causes drowsiness or depression when taken chronically; and it allows the person to engage in gainful employment; instead of criminal activity. The disadvantage is that the patient remains addicted to the narcotic.
Although opioid withdrawal is almost never fatal for the otherwise healthy adult, opioid withdrawal is hazardous to the fetus & can lead to miscarriage or fetal death. Maintaining the pregnant woman addict on low dose of methadone (10 to 40 mg daily) may be the less hazardous course. At this dosage, neonatal withdrawal is usually mild & can be managed. If the pregnancy begins while the patient is on high dosage of methadone, the dosage should be reduced slowly (1 mg every 3 days) & fetal movement should be monitored. If withdrawal is necessary or desired, it is accomplished during the second trimester.
The major risk for the fetus of an opioid-addicted woman is AIDS. Pregnant woman can pass the causative agent of the AIDS, the human immunodeficiency virus to the fetus through placental circulation. The HIV infected mother can also pass the HIV to the infant through the breast feeding.
Opioid antagonists block or antagonize the effect of opiod, preventing them from acting. Unlik methadone, they do not in themselves exert narcotic effect, nor are they addicting. The antagonists include the following drugs; Naloxone, which is used in the treatment of opioid overdose because it reverses the effect of narcotics, & Naltrexone which is the longer acting (72 Hours) antagonist. The theory behind the use of antagonist for opioid addiction is the blocking of drug effect, particularly euphoria, discourages addict from drug seeking behavior & thus deconditions them to opioids. The major weakness of the antagonist model is the lack of any mechanism compelling addicts to continue to take the antagonist.
The therapeutic community is a residence composed of members who all have the same problem of drug abuse. Abstinence is the rule, &, in order to be admitted to such community, the person requires a high level of motivation. The goals are to affect a complete change of life style, including abstinence from drug; the development of personal honesty, responsibility & useful social skills; elimination of antisocial attitudes & criminal behavior.
The staff of the most therapeutic communities is made up of the former addicts, who often put the prospective candidate through a rigorous screening process to the test motivation. Self help through the use of confrontational group & isolation from the outside world & from friends associated with the drug life are emphasized.
