Heroin Addiction What is heroin n n Heroin

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Heroin Addiction

Heroin Addiction

What is heroin? n n Heroin is an opioid, derived from the opium poppy

What is heroin? n n Heroin is an opioid, derived from the opium poppy ﺍﻟﺨﺸﺨﺎﺵ Morphine is the active ingredient in opium

Effects of heroin n “Positive” effects (the reasons for use) n Heroin's main effect

Effects of heroin n “Positive” effects (the reasons for use) n Heroin's main effect is a sudden rush sense of euphoria with dreamy state of complete relaxation for several hours n Also, flushing of the skin and heavy extremities n The onset of these effects differs based on the method of administration n Smoked/snorted = 10 -15 min n Injected = 7 -10 seconds

Negative effects n Negative effects on CNS: n n n Drowsiness, and mental cloudiness

Negative effects n Negative effects on CNS: n n n 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: n n n Stomach digestive juices become scanty in

Negative effects on digestive System: n n n 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 n n n n Hepatitis from injection with dirty

Other effects and health problems n n n n 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

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

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

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? n n Heroin abuse can cause serious

How does heroin abuse affect pregnant women? n n 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 n n n Heroin cross the blood-brain barrier with much greater

How heroin works n n n 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 n Receptors located non-uniformly throughout Central Nervous System n n Cerebral

How heroin works n Receptors located non-uniformly throughout Central Nervous System n n Cerebral cortex has most Spinal cord has significantly less

How users become addicted n The body cannot completely eradicate drugs. It metabolizes them,

How users become addicted n 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 n Tolerance develops to Opioids in remarkable degree, more than to general

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

Opioid Withdrawal n n n It can be a severe process. Symptoms depend on

Opioid Withdrawal n n n 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 n minutes to days: n Unhappy mood (Irritability and depression) n Twitching

Opioid Withdrawal n minutes to days: n Unhappy mood (Irritability and depression) n Twitching of Muscle, tremors of tongue and aching pain in aches Muscles, bone and joints. n Runny nose with sniffing, itching of nose and paroxysm of sneezing n Pupillary dilation/Tearing n 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 § § § § Nausea/Vomiting Abdominal cramping and Diarrhea – Fever ,

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

Opioid Overdose n n n Life threatening they depress the brain (breathing control part

Opioid Overdose n n n 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 n Lab tests n n Urine, blood, others 12 -36 hrs after use

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

Acute Intervention n Overdose n n Emergency Support vital signs Naloxone: 0. 4 mg

Acute Intervention n Overdose n n Emergency Support vital signs Naloxone: 0. 4 mg q 2 -3 min. SC/IV Withdrawal n n Opioid substitution with gradual ↓ Symptomatic treatment

Pharmacological Treatment 1. 2. Methadone § Once/day dosed § 40 -60 mg/d: sufficient to

Pharmacological Treatment 1. 2. Methadone § Once/day dosed § 40 -60 mg/d: sufficient to block withdrawal sx. Buprenorphine/Naloxone § 12 -16 mg/d

Psychosocial Treatment n n n Specialized programs Cognitive behavioral therapy Group and Family therapy

Psychosocial Treatment n n n Specialized programs Cognitive behavioral therapy Group and Family therapy

Methadone n How it works n n n Methadone is broken down in the

Methadone n How it works n n n 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 n n Used mainly for alcoholism treatment New method in other countries, currently

Naltrexone n n 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 n How it works n n Naltrexone is attached to the opioid receptors,

Naltrexone n How it works n n 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 n n n Problems and Questions Not used in pregnant women High relapse

Naltrexone n n n Problems and Questions Not used in pregnant women High relapse numbers