Opioid use disorders


 * Opium, morphine, synthetic (codeine, heroin, methadone, buprenorphine, ...),
 * analgesics, antispasmodics, antitussives,
 * the dried juice of unripe poppy seeds has many alkaloids.


 * Soldier sickness – morphine was freely used in wars, soldiers were then addicted (American Civil War 1861-1865, Franco-Prussian War 1870-71).


 * Since the early 1970s – drug mafias, heroin,
 * braun – Czech product, mixture of codeine opiates,
 * the historical shift in application is significant – from smoking, sniffing, to injection.

Symptomatology

 * Dampening, calming, euphoric effect, speed of onset according to application,
 * duration of effect (heroin 3–4 h, morphine 4–5 h, buprenorphine 6–8 h 48 h, methadone 12–24 h).

Acute intoxication

 * Apathy, depression, slowing down of psychomotor skills, disinhibition, deterioration of attention, judgement,
 * numbness, slurred speech, narrowing of the pupils, impaired consciousness ,
 * euphoria, relaxation, pleasant fatigue,
 * there is a risk of depression of the respiratory center, hypotension and hypothermia,
 * decreased GIT motility, constipation, spasms.
 * Harmful use


 * Mainly infections – HIV, hepatitis.
 * Addiction syndrome


 * Very quickly, within weeks, especially with IV administration.

Withdrawal status

 * Very often, in 4-6 hours after the last dose,
 * usually not life-threatening,
 * flu symptoms – nasal discharge, sneezing, lacrimation, pain and muscle spasms, abdominal cramps, nausea, vomiting, diarrhea, dilated pupils, piloerection, chills, tachycardia, hypertension, insomnia.


 * Psychotic disorders


 * They don't call them out.

Course and prognosis

 * It depends on the purity of the substance, often other alkaloids – organotoxicity,
 * disorders of thinking, behavior (anethic states), development of a personality disorder (accentuation of negative traits), libido disorders, amenorrhea, avitaminosis, deterioration of the organism,
 * social problems, problems with the law,
 * resocialization is possible.

Etiopathogenesis

 * There are also people with minor disorders in neurotransmitters – susceptibility, more frequent occurrence of the A1-dopaminergic D2-receptor allele, very rapid habit formation.

Treatment

 * Acute intoxication – naloxone – opiate antagonist, causes withdrawal symptoms in addicts,
 * treatment of withdrawal syndrome - inpatient, substitution treatment - buprenorphine, methadone, symptomatic,
 * withdrawal treatment - long-term comprehensive program, long-term maintenance substitution treatment - methadone, buprenorphine is also starting.