Treatment of heroin addiction
* Opium, poppy (poppy, papaver somniferum) is obtained from the plant and is one of the oldest drugs.
* Used in the ancient Sumerians (BC 4000) and Egypt (2000 BC).
* The main active ingredient of opium is morphine alkaloid. More than 20 alkaloids (10% morphine, 0.5% codeine, 0.2% tebain, papaverine, etc.)
* In order to produce non-addictive analgesic (pain reliever), some semisynthetic drugs produced using morphine, codeine and drugs produced from opium and tebain were produced.
Opioid: A more comprehensive concept. This includes opiates (morphine, codeine, bain) and synthetic substances with morphine-like activity (methadone, fentanyl, meperidine), agonist / antagonists, partial agonists and endogenous opioid peptides.
Endogenous opioid peptides: 1. Endorphins, 2. Enkephalins, 3. Dinorphins
Morphine is the prototype opiate and is the precursor of many opiates: heroin (diacetylmorphine), oxymorphon, hydrocodone, oxycodone, codeine (methylmorphine)
Tebain is the precursor of nalaxone, etorphine and oxycodone.
* Mu: mood regulation, reinforcement mechanisms, respiratory suppression, pain relief (analgesia),
* Delta: Gastrointestinal (gastrointestinal) system, Endocrine system
* Kappa: Endocrine system, pain stimulation (aversive)
* Sigma (?) Opioid receptor is controversial because it is not affected by Nalaxone (opioid antagonist). It stimulates dysphoria and hallucinations when stimulated.
Opioid receptor subtypes and their effects:
mu1: supraspinal analgesic effect
mu2: spinal anesthesia, GI motility (gastrointestinal movement), respiratory
delta2 and kappa1: spinal anesthesia
delta1 and kappa3: supraspinal anesthesia
delta2: anelogic effect in the brain
Opioid receptors are found in the brain, spinal cord, neural plexus of the gastrointestinal tract, in other parts of the autonomic nervous system and in the white blood cells. The effects of opioids are therefore very common.
Agonist: those who bind and activate opioid receptors
Antagonist: Those who bind to but do not activate opioid receptors
Opioids (fentanyl, nalaxone, buprenorphine) differ in their receptor affinities and intrinsic activities
1. Pure agonists
a. Morphinans: Levo-dromoran
b. Phenylpiperidines-piperidines: meperidine, fentanyl
c. Methadone: LAAM (L-alpha-acetylmetadol), Propoxifene
2. Agonist-antagonists: Pentazosin, Nalbufin, Butorphanol, Meptazinol
3. Partial agonists: Buprenorphine
4. Pure antagonist: Naloxone, naltrexone, Nalmefen
Effects of opioids on the central nervous system (from the top of the receptor):
* Analgesia (painkiller)
* Calmness (with the inhibition of locus serelousun)
* Cough reflex suppression
* Nausea, vomiting
* Respiratory suppression
* Myosis (dilation of pupils)
* Changes in temperature regulation
* Decrease in GRH (gonadotropin releasing hormone) ® Reduction of LH & FSH ® Reduction of testosterone and menstrual irregularities
* Decrease in CRF (corticotropin releasing factor) ® Decrease in ACTH ® reduction in cortisol (anticancer effect)
Opioids have different effects on humans:
In addicts, while making euphoria, in some people, confusion makes you dazed.
Ir Flash ad, verici rush ’: this feeling is given to the pleasing feeling of sharp and rapid increase in opioids in the central nervous system. It is likened to orgasm by addicts.
Opioids can reduce depression, anxiety, anger and paranoid thoughts.
The effects of opioids on gastrointestinal system
(over the mu receptor):
The antidiarrheal effect depends on the reduction of bowel movements. There is no tolerance for this effect. In other words, in opioid addicts or methadone users, constipation persists.
Opioid drugs used for this effect:
– Loperamide (does not enter the central nervous system)
Other effects of opioids:
Morphine is antihistamine, vasodilatation and itching (typical nose scratching).
* Increases the sphincter tone in the bladder and suppresses the micturition reflex. This results in urinary retention (inability to urinate).
* Meperiden (Demerol), grand mal can cause epileptic seizures. This effect is important because it can accumulate in the body in renal failure.
* Morphine may cause drowsiness of the Oddi sphincter in the biliary tract, but meperidine (Demerol) does not.
Some clinical features of opioids:
* Morphine is glucosized, its metabolite is active, it is excreted from the kidney. In the kidney failure accumulates in the body.
* Heroin (diacetyl morphine) is a prodrug (prodrug). Its solubility in oil is higher than morphine, it rapidly enters the brain and turns into 6-mono-acetyl-morphine. It is excreted as morphine in urine. Histamine-like effect is less.
Codeine (3-methoxy-morphine) is also prodrug (predominant drug). It is not over-metabolized in the liver when taken orally. It is converted to morphine in the body.
Why add heroin?
1. Repetitive use makes physical dependence and deprivation. Repetitive use makes permanent changes in the endogenous opioid system (naturally occurring opioids in the nervous system). Heroin addicts don't like her, but they want and they can't live without her.
2. The reinforcing effect on the m reward path. In the brain biologically, its gratification makes it psychologically re-use. Heroin does not make euphoria (euphoria) in everyone. This feature (ie, pleasure from the opioid experience) may be related to psychopathology and may be due to lack of endorphins (naturally present opioids in the nervous system).
3. Self-medication: There are also those who start to control their lives, such as depression, anxiety, but then not.
Environmental tips (things that remind us to use) and sadness, anger, distress etc. internal feelings are learned and lead to conditioned craving. For example, seeing a syringe or feeling distress gives a great desire to use heroin.
Symptoms of opioid withdrawal:
(There must be at least 3 of them)
1. dysphoric mood (distressed, sad mood)
2. Nausea or vomiting
3. Muscle aches
4. Tears, nasal flow
5. Pupillary dilatation (enlargement of pupils), piloimulation (erecting hair), sweating
6. Diarrhea (diarrhea)
8. High Fever
9. Insomnia (insomnia)
Subjective (subjective) symptoms of withdrawal begin earlier. These include anxiety, erosion, depression, irritability, muscle cramps, back pain, bone ache, general dysphoria.
Typical deprivation begins after 8-12 hours of end use of morphine and heroin, after 48 hours it reaches the max level, ends in 5-7 days decreasing.
* A single dose of treatment doses (15-30 mg) in a person with no tolerance of morphine, even if a low degree of physical addiction can be and Nalakson (opioid antagonist) deprivation occurs.
* Previously detoxified mice with physical dependence are more easily dependent upon exposure to heroin. This, in turn, supports that those who are dependent on heroin should stay away from it.
* Tolerance develops very quickly in addicts.
Treatment of opioid deprivation:
Antipyretic and analgesics (antipyretic and analgesics)
Benzodiazepines: sedative drugs such as amitriptyline (Laroxyl), etc., may be administered, in particular for sleep.
* Clonidine: Used to reduce noradrenergic discharge. If there is an objective finding, it should be started 4 times a day, 0.2 mg, continued for a few days, and reduced in 2 weeks.
* Methadone: 20-40 mg per day is given. It is cut by reducing in a week or a month. Methadone prolongs detoxification.
* Ultrapure detoxification: Under general anesthesia that lasts for hours under the influence of plenty of liquid and Nalakson to reveal the symptoms of withdrawal and rapid passing is provided. This method, which is popular in the US in recent years, is quite controversial. Because this procedure goes through acute withdrawal symptoms, subacute symptoms continue after a long period of anesthesia. Most importantly, abstinence treatment does not mean the treatment of heroin dependence.
Even after the disappearance of visible and measurable withdrawal symptoms, addicts experience unwanted emotions ranging from sonra non-normal Görün to kal depression Görün. It is important to differentiate this from the underlying psychopathology, such as antisocial personality disorder and depression.
Have you read our article on cannabis addiction?
What are the harms of cannabis addiction cannabis dependence treatment of cannabis dependence
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