Psychiatric disorders induced by the use of opioids and cannabinoids

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
Acute intoxication Harmful use Addiction syndrome Withdrawal status
 * 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).
 * 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.
 * Mainly infections – HIV, hepatitis.
 * Very quickly, within weeks, especially with IV administration.
 * 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.

Therapy

 * 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.

Disorders induced by the use of cannabinoids

 * Cannabinoids are from the Indian hemp Cannabis indica, or from the seeded hemp Cannabis sativa.
 * The key substance in this cannabis is tetrahydrocannabinol (THC).
 * Cannabis contains about 0.5-11% THC in its flowers.
 * Hashish comes from the resinous substance produced by flowers and contains about 5x more THC than marijuana.
 * Smoking or oral use has a longer effect.
 * Excretion of THC takes a long time, t = 30 h, with chronicity it is stored, then it can be released - the so-called flashback.
 * The mechanism of action is complex, there are also specific receptors in the CNS.
 * It has significant anticonvulsant, antiemetic, hypotensive and analgesic effects.
 * Synthetics are used in ophthalmology to reduce pressure in glaucoma.

Acute intoxication

 * dysfunctional behavior, mood changes (euphoria or anxiety ), abnormal perception (hallucinations, slowed perception, ...), deterioration of judgment, attention, depersonalization, sometimes paranoia;
 * inability to concentrate on demanding tasks even several days after ingestion;
 * typical symptoms – injected conjunctivae, increased appetite, tachycardia, dry mouth.

Harmful use

 * chronic inflammation of the lungs, fertility disorders, risk of premature birth;
 * long-term use – anxiety-depressive states, apathetic-abulous syndrome, schizophrenia.

Addiction syndrome

 * psychological, tolerance as an adaptation mechanism of the CNS.

Withdrawal status

 * exceptionally (due to slow excretion), psychomotor restlessness, irritability, nervousness, anxiety, depression.

Source

 * BENEŠ, Jiří. Study materials  [online]. [feeling. 2009]. < http://jirben.wz.cz >.