Management of opiate misuse Flashcards
What contributes to the addictiveness of heroin?
Rapidity of onset of action
Short half-life
Availability
how many stages to heroin production?
3
Opium
Morphine
Diamorphine
Opium stage?
Mixture of alkaloids (especially codeine and morphine)
Morphine stage?
Morphine is extracted though codeine contaminants often remain
Diamorphine stage?
Addition of 2 acetyl rings to produce diacetylmorphine (diamorphine).
How is heroin taken?
(In order of popularity)
- Intravenous
- Smoking
- Suppository
- Insufflation (blowing into a body cavity)
- Ingestion
Metabolic pathway of morphine?
diacetylmorphine to 6-mono-acetylmorphine to morphine
Effects of heroin (and other opiates)?
euphoria
analgesia
reduced conscious level
constipation
tolerance develops due to repeated use
constricted pupils
If substance, such as heroin, has been injected, there may be evidence of needle mark abscesses or vein collapse at injection sites.
Time frame for withdrawal symptoms for heroin?
typically occurs within 6-8 hours
Withdrawal symptoms of heroin?
Dysphoria and cravings
Diarrhoea, nausea and vomiting
Joint pains
Yawning
Tachycardia and hypotension
Agitation
Anxiety
Dilated pupils
“Goose bump skin”
complications of IV use?
Infections
Local: cellulitis, abscess, thrombophlebitis, necrotising fasciitis
Distant: eg. infective endocarditis,
Systemic: Hep B, HIV, Hep C
Thrombotic/embolic
DVT, PTE, ischaemic limb
other consequences of heroin use?
Social – unemployment, neglect of family/children, alternative interests, criminality, risk of violence, prostitution.
Psychiatric – depression, anxiety.
Heroin use can cause delirium or psychosis. true/false?
false
Does NOT cause psychosis or delirium.
What is opiate substitution therapy?
Replacement of short acting opiate with a long acting opiate
Buprenorphine or methadone
Long acting depot (buvidol)
Once daily dosing and taken under supervision (initially)
Pros of OST?
Reduced mortality rate of less than 1/3 compared to those without therapy.
Reduces HIV infection by ~50%
There is evidence that OST is effective in preventing HCV (hep C) infections