Heroin AddictionHeroin Addiction

What is heroin?What is heroin?

Heroin is an opioid, derived from the opium Heroin is an opioid, derived from the opium poppypoppy الخشخاشالخشخاش

Morphine is the active ingredient in opiumMorphine is the active ingredient in opium

Effects of heroinEffects of heroin ““Positive” effects (the reasons for use)Positive” effects (the reasons for use)

Heroin's main effect is a sudden rush sense of euphoria Heroin's main effect is a sudden rush sense of euphoria with dreamy state of complete relaxation for several with dreamy state of complete relaxation for several hourshours

Also, flushing of the skin and heavy extremitiesAlso, flushing of the skin and heavy extremities The onset of these effects differs based on the method The onset of these effects differs based on the method

of administrationof administration Smoked/snorted = 10-15 minSmoked/snorted = 10-15 min Injected = 7-10 secondsInjected = 7-10 seconds

Negative effectsNegative effects

Negative effects on CNS:Negative effects on CNS: Drowsiness, and mental cloudiness Drowsiness, and mental cloudiness change in mood with difficult concentrationchange in mood with difficult concentration Anxiety or fearAnxiety or fear The user may become sleepy and in large doses it may The user may become sleepy and in large doses it may

cause deep sleepcause deep sleep Slowed breathing and cardiac function: breathing is slowed Slowed breathing and cardiac function: breathing is slowed

down. If in large amount death may occur cardiorespiratory down. If in large amount death may occur cardiorespiratory failure.failure.

Negative effects on digestive System:Negative effects on digestive System: Stomach digestive juices become scanty in amountStomach digestive juices become scanty in amount Contraction of Stomach muscles and intestines is Contraction of Stomach muscles and intestines is

slowed down, so digestion of food is slowed downslowed down, so digestion of food is slowed down Constipation takes placeConstipation takes place Nausea and vomiting, or upset StomachNausea and vomiting, or upset Stomach Loss of appetite which leads to undernourishment Loss of appetite which leads to undernourishment

and anemia and anemia

Other effects and health problemsOther effects and health problems Hepatitis from injection with dirty needleHepatitis from injection with dirty needle Skin problems, Itchy skinSkin problems, Itchy skin Much sweating Much sweating Constipation Constipation Narrowing of pupilsNarrowing of pupils Urgency or urinary retentionUrgency or urinary retention HypotensionHypotension The blood vessels of the skin are dilated especially The blood vessels of the skin are dilated especially

face& neck with feeling of warmthface& neck with feeling of warmth

Long-Term EffectsLong-Term Effects::

■ ■ AddictionAddiction

■ ■ Infectious diseases, for example, HIV/AIDS Infectious diseases, for example, HIV/AIDS and hepatitis B and Cand hepatitis B and C

■ ■ Collapsed veinsCollapsed veins

■ ■ Bacterial infectionsBacterial infections

■ ■ AbscessesAbscesses

■ ■ Infection of heart lining and valvesInfection of heart lining and valves

■ ■ Arthritis and other rheumatologic problemsArthritis and other rheumatologic problems

What are the medical What are the medical complicationscomplications of of chronic heroin use?chronic heroin use?

Medical consequences of chronic heroin injection use include:Medical consequences of chronic heroin injection use include:1-scarred and/or collapsed veins1-scarred and/or collapsed veins,,2-bacterial infections2-bacterial infections of the blood vessels and heart valves, of the blood vessels and heart valves,

abscesses abscesses (boils) and other soft-tissue infections, (boils) and other soft-tissue infections,3- 3- liver or kidney diseaseliver or kidney disease..4-Lung complications4-Lung complications (including various types of pneumonia (including various types of pneumonia

and tuberculosis) may result from the poor health condition and tuberculosis) may result from the poor health condition of the abuser as well as from heroin’s depressing effects on of the abuser as well as from heroin’s depressing effects on respiration. Many of the additives in street heroin may respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.small patches of cells in vital organs.

What are the medical What are the medical complicationscomplications of of chronic heroin use?chronic heroin use?

5-Immune reactions5-Immune reactions to these or other contaminants to these or other contaminants can cause arthritis or other rheumatologic can cause arthritis or other rheumatologic problems.problems.

6-Of course, sharing of injection equipment or fluids 6-Of course, sharing of injection equipment or fluids can leadcan lead

to some of the most severe consequences of heroin to some of the most severe consequences of heroin abuse—abuse—

infections with infections with hepatitis B and C, HIVhepatitis B and C, HIV, and a host , and a host of other blood borne viruses, which drug abusers of other blood borne viruses, which drug abusers can then pass on to their sexual partners and can then pass on to their sexual partners and children. children.

How does heroin abuse affect How does heroin abuse affect pregnant pregnant womenwomen??

Heroin abuse can cause serious complications Heroin abuse can cause serious complications during pregnancy, including during pregnancy, including miscarriagemiscarriage and and premature deliverypremature delivery..

Children born to addicted mothers are at Children born to addicted mothers are at greater risk of sudden infant death syndrome greater risk of sudden infant death syndrome (S(SIDS).IDS).

How heroin worksHow heroin works Heroin cross the blood-brain barrier with much Heroin cross the blood-brain barrier with much

greater efficiencygreater efficiency Once in the brain, heroin is converted to Once in the brain, heroin is converted to

morphine, and becomes “trapped”morphine, and becomes “trapped” by the barrierby the barrier The morphine interacts with receptors and The morphine interacts with receptors and

causes the effects. causes the effects.

How heroin worksHow heroin works

Receptors located non-uniformly throughout Receptors located non-uniformly throughout Central Nervous SystemCentral Nervous System Cerebral cortex has mostCerebral cortex has most Spinal cord has significantly lessSpinal cord has significantly less

How users become addictedHow users become addicted

The body cannot completely eradicate The body cannot completely eradicate drugs. It metabolizes them, and the drugs. It metabolizes them, and the metabolites get stored in fatty tissue. metabolites get stored in fatty tissue. When the fatty tissue is broken down, the When the fatty tissue is broken down, the metabolites are released and act on the metabolites are released and act on the brain again, causing a craving.brain again, causing a craving.

Opioid ToleranceOpioid Tolerance Tolerance develops to Opioids in remarkable Tolerance develops to Opioids in remarkable

degree, more thandegree, more than to general sedatives such as to general sedatives such as

barbiturates and alcohol.barbiturates and alcohol.

Cross-tolerance can be developed for drugs Cross-tolerance can be developed for drugs

within the opoid class.within the opoid class.

Opioid WithdrawalOpioid Withdrawal It can be a severe process. It can be a severe process. Symptoms depend on degree of tolerance and the Symptoms depend on degree of tolerance and the

severity of the dependence.severity of the dependence. develops within 4-12 hours of cessation of the drug. develops within 4-12 hours of cessation of the drug.

The symptoms and signs reach their peak by the end The symptoms and signs reach their peak by the end of the second day and are mostly resolved within 3-of the second day and are mostly resolved within 3-4 days.4 days.

Opioid WithdrawalOpioid Withdrawal minutes to days:minutes to days:

Unhappy mood (Irritability and depression)Unhappy mood (Irritability and depression) Twitching of Muscle, tremors of tongue and aching pain Twitching of Muscle, tremors of tongue and aching pain

in aches Muscles, bone and joints. in aches Muscles, bone and joints. Runny nose with sniffing, itching of nose and paroxysm Runny nose with sniffing, itching of nose and paroxysm

of sneezingof sneezing Pupillary dilation/TearingPupillary dilation/Tearing Subjective feeling of hot or cold occur, marked feeling of Subjective feeling of hot or cold occur, marked feeling of

coldness with contraction of muscles attached to hair, so coldness with contraction of muscles attached to hair, so hair will erect (Goose bumps-cold turkey) or sweatinghair will erect (Goose bumps-cold turkey) or sweating

Opioid WithdrawalOpioid Withdrawal Nausea/VomitingNausea/Vomiting Abdominal cramping and Diarrhea – Abdominal cramping and Diarrhea – Fever , increase in breathing rate and blood pressure Fever , increase in breathing rate and blood pressure Yawning becomes frequent and deepYawning becomes frequent and deep Nervousness and restlessnessNervousness and restlessness Increased salivationIncreased salivation Anorexia, loss of food intake and loss of weightAnorexia, loss of food intake and loss of weight Feeling of desperation Feeling of desperation with obsessivewith obsessive desire to secure desire to secure

more of the drugmore of the drug

Opioid OverdoseOpioid Overdose Life threatening they depress the brain Life threatening they depress the brain

(breathing control part of the brain) which (breathing control part of the brain) which results in respiratory failure, coma and deathresults in respiratory failure, coma and death

Constricted pupilsConstricted pupils DrowsinessDrowsiness or comaor coma Slurred Slurred speechspeech Poor attention and memoryPoor attention and memory

DiagnosisDiagnosis Lab testsLab tests

Urine, blood, othersUrine, blood, others 12-36 hrs after use12-36 hrs after use

Acute InterventionAcute Intervention OverdoseOverdose

EmergencyEmergency Support vital signsSupport vital signs Naloxone: 0.4 Naloxone: 0.4 mgmg q 2-3 min. q 2-3 min. SC/IVSC/IV

WithdrawalWithdrawal Opioid substitution with gradual ↓Opioid substitution with gradual ↓ Symptomatic treatmentSymptomatic treatment

Pharmacological TreatmentPharmacological Treatment1.1. Methadone Methadone

Once/day dosedOnce/day dosed 40-60 mg/d: sufficient to block withdrawal sx.40-60 mg/d: sufficient to block withdrawal sx.

2.2. Buprenorphine/NaloxoneBuprenorphine/Naloxone 12-16 mg/d12-16 mg/d

Psychosocial TreatmentPsychosocial Treatment Specialized programsSpecialized programs Cognitive behavioral therapyCognitive behavioral therapy Group and Family therapyGroup and Family therapy

MethadoneMethadone

How it worksHow it works Methadone is broken down in the liver and storedMethadone is broken down in the liver and stored When the brain opiate receptors are ready, When the brain opiate receptors are ready,

methadone is mobilized and fills the receptorsmethadone is mobilized and fills the receptors Methadone is an agonist, so it works similar to Methadone is an agonist, so it works similar to

heroin, but does not produce the extreme heroin, but does not produce the extreme highs highs and lowsand lows

NaltrexoneNaltrexone Used mainly for alcoholism treatmentUsed mainly for alcoholism treatment New method in other countries, currently New method in other countries, currently

being researched in the United Statesbeing researched in the United States Opioid antagonist – blocks effect of opioids by Opioid antagonist – blocks effect of opioids by

blocking receptorsblocking receptors Non-addictiveNon-addictive

NaltrexoneNaltrexone How it worksHow it works

Naltrexone is attached to the opioid receptors, Naltrexone is attached to the opioid receptors, competitively inhibiting the attachment of opioids to competitively inhibiting the attachment of opioids to the receptorsthe receptors

Completely blocks euphoria feeling, but some still Completely blocks euphoria feeling, but some still feel nauseousfeel nauseous

NaltrexoneNaltrexone Problems and QuestionsProblems and Questions Not used in pregnant womenNot used in pregnant women High relapse numbersHigh relapse numbers