OTC Abuse Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University
Opiates Abuse
Opioids are a group of natural, partially synthetic, or synthetic drugs derived from the poppy plant or chemically synthesized in laboratory settings. This class of drugs includes: 1. Legally prescribed: opioids include morphine, codeine, and oxycodone. 2. Illegal opioids: 3. include heroin.
Opioids are used to help individuals cope with pain. They bind to natural opioid receptors in the brain, mimicking specific chemicals that are related to sensations of pain relief, pleasure, and reward. When used as prescribed, legal opioids are one of the most effective forms of pain relief, especially when the pain is severe or other attempts to relieve the pain have proven unsuccessful.
However, since opioids have both pain relieving properties and positive psychological properties, they are among the most abused types of substances currently available. When opioids are abused or when illegal opioids, which have a significantly higher potency, are taken usually, the route of administration is altered.
Often pills are ground and the powdered form is snorted, smoked, or mixed with water and injected. These methods of using the substance increase the speed of absorption, leading to a rush, a fast acting strong effect of positive sensations. Even when taken as prescribed however, the potential for abuse and addiction is high and treatment may be required. Repeated use can lead to physical dependence within 4-6 weeks, however psychological addiction can result in as little as two days.
Causes of Opioid Addiction: There is no direct evidence supporting an individual cause to explain any specific substance abuse disorder. However, research has supported links between certain factors and the subsequent development of substance related problems. 1. Genetic Factors: Family studies have shown that when an individual has a first degree relative with an opioid addiction they are more likely to develop the disorder than those who don t have a similar family history.
2. Indirect Genetic Influences: It appears that some potential causes may function through genetic influences. For example, temperamental qualities, such as novelty seeking and impulsivity, believed to be inborn, have been linked to an increased risk for opioid addiction. Additionally, our nature influences what types of people we choose to be around. Thus, while peers can influence our choices as far as beginning and continuing to use a substance, we decide which peer groups to which we want to belong. Factors such as these are thought to result from an interaction between heredity and environment.
3- Coping Factors: For individuals who have difficulty tolerating negative mood states, due to the failure to learn effective coping mechanisms in childhood and adolescence, when distressed the search for relief may lead to substance use of opioids in particular, due to the pleasant effects that can counteract their negative mood. The resulting surge of euphoria can lead quickly to addiction.
4- Pleasure Experienced in thebrain: Everyone enjoys the experience of pleasure. It is important enough to our well-being that there is a pleasure and reward center located in our brains and specific chemicals responsible for neural communication are strongly related to our ability to experience pleasure, happiness, joy, and excitement. When we take opioids, the resulting sudden rush of pleasure we experience is stronger than what we may normally experience on a daily basis.
Co-occurring Disorders: There are a number of disorders that cooccur with opioids addiction. The most commonly co-occurring disorder with any substance abuse disorder is another substance abuse disorder. Disorders that are co-morbid to opioid addiction include:
1. Tobacco use 2. Alcohol abuse 3. Cannabis abuse 4. Stimulant abuse 5. Benzodiazepine abuse 6. Depression 7. Dysthymia 8. Anxiety 9. Insomnia 10. Antisocial Personality Disorder 11. Post-traumatic Stress Disorder 12. History of conduct disorder in childhood or adolescence
Signs and Symptoms of Opioid Abuse: Mood/Psychological symptoms: 1. Increased general anxiety 2. Anxiety attacks 3. Euphoria 4. Psychosis 5. Improved self-esteem 6. Depression 7. Irritability 8. Lowered motivation
Behavioral symptoms: 1. Opioids are used for longer or at a greater amount than intended 2. Unsuccessful attempts to decrease the amount taken 3. Large amount of time spent obtaining, using, or recovering from the drug 4. Abandonment of important activities
Physical symptoms: 1. Improved alertness 2. Increased sensitivity to sensory stimuli 3. Constricted blood vessels 4. Increased heart rate 5. High blood pressure 6. Increased energy 7. Decreased appetite 8. Increased sexual arousal 9. Physical agitation 10. Difficulty sleeping 11. Over arousal and hyper-vigilance
Effects of Opioid Abuse: 1. Fatigue 2. Constipation 3. Breathlessness 4. A sense of elation 5. Bronchospasm 6. Physical and psychological dependence 7. Nausea 8. Confusion 9. Depressed respiration and difficulty breathing 10. Death (often due to use of more than one substance) 11. Chest pain
Withdrawal Effects of Opioid Abuse: 1. Physical and psychological cravings 2. Nausea 3. Stomach pain 4. Cold sweat 5. Chills 6. Vomiting 7. Diarrhea 8. Agitation 9. Anxiety 10. Muscle tension 11. Shaking or quivering 12. Trouble sleeping 13. Enlarged pupils 14. Pain in the bones
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