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.

 For more information see Addictive substances.

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.

References

• BENEŠ, Jiří. Studijní materiály [online]. [cit. 2010]. <http://jirben.wz.cz>.