Heroin%20Addiction

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Heroin Addiction
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What is heroin?

• Heroin is an opioid, derived from the opium poppy
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• Morphine is the active ingredient in opium

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Effects of heroin

• 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
• 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

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Negative effects

• Negative effects on CNS
• 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.

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Negative effects on digestive System

• 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

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Other effects and health problems

• 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

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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

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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 heroins 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.

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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.

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How does heroin abuse affect pregnant women?

• 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).

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How heroin works

• 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.

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How heroin works

• Receptors located non-uniformly throughout
  Central Nervous System
• Cerebral cortex has most
• Spinal cord has significantly less

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How users become addicted

• 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.

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Opioid Tolerance

• Tolerance develops to Opioids in remarkable
  degree, more than to general sedatives such as
  barbiturates and alcohol.
• Cross-tolerance can be developed for drugs within
  the opoid class.

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Opioid Withdrawal

• 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.

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Opioid Withdrawal

• 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

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Opioid Withdrawal

• 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

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Opioid Overdose

• 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

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Diagnosis

• Lab tests
• Urine, blood, others
• 12-36 hrs after use

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Acute Intervention

• Overdose
• Emergency
• Support vital signs
• Naloxone 0.4 mg q 2-3 min. SC/IV
• Withdrawal
• Opioid substitution with gradual ?
• Symptomatic treatment

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Pharmacological Treatment

• Methadone
• Once/day dosed
• 40-60 mg/d sufficient to block withdrawal sx.
• Buprenorphine/Naloxone
• 12-16 mg/d

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Psychosocial Treatment

• Specialized programs
• Cognitive behavioral therapy
• Group and Family therapy

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Methadone

• How it works
• 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

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Naltrexone

• 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

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Naltrexone

• How it works
• 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

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Naltrexone

• Problems and Questions
• Not used in pregnant women
• High relapse numbers