MENTAL DISORDERS DUE TO HEROIN ABUSE

FATIMAH MASYHUR201320401011129

What is opioid?• Opioids are a family of drugs used to relieve pain.• Some opioids, such as morphine and codeine, are made from the

opium poppy plant.• Other opioids are synthetically made from chemicals.• Heroin is a highly addictive, illegal opioid made by adding a chemical

to morphine.• Commonly misused prescription drugs include:

– Oxycodone (Percodan, Percocet, OxyContin)– Hydrocodone (Tussionex)– Codeine (Tynelol 1, Tynelol 3)– Morphine– Hydromorphone (Dilaudid)– Meperidine (Demerol)

Heroin

• An opiate (narcotic) drug processed from morphine. Morphine is a powerful drug, and it naturally occurs in the seedpods of Asian (opium) poppy plants.

• Heroin is a highly addictive drug and the most rapidly acting of the opiates.

Common street names

• Big H• Black Tar• Chiva• Hell Dust• Horse• Negra• Smack

• Thunder• Junk• Caballo (Spanish)• 8-ball (heroin mixed

with crack cocaine)• TNT• Skag

ASIAN HEROIN BLACK TAR HEROIN

HEROIN POWDER

What is its origin?

• Heroin is processed from morphine, a naturally occuring substance extracted from the seed pod of certain varieties of poppy plants grown in:– Southeast Asia (Thailand, Laos, and Myanmar

(Burma)), Southwest Asia (Afghanistan and Pakistan), Mexico, and Colombia.

• It comes in several forms, the main one being “black tar” from Mexico and white heroin from Colombia.

What does it look like?

• Heroin is typically sold as white or brownish powder, or as the black sticky substance.

• Althought purer heroin is becoming more common, most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk, or quinine.

The Fact

• In 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) had used heroin at least once in their lives.

• It is estimated that about 23 percent of individuals who use heroin become dependent on it.

How is it abused?

• InjectedIt can be mixed with water and injected

with a needle.

• Smoked (high purity)• Sniffed/Snorted (high purity)

Heroin can also be smoked or snorted up the nose.

Paraphernalia

NEEDLESyringe used to inject drugs directly into body, such as heroin.

PIPEMade of metal, wooden, acrylic, glass, stone, plastic, ceramic materials, used to smoke marijuana, cocaine and other drugs.

In heroin, used to dissolve drug in water for injection purposes

Short plastic straws, rolled-up paper tubes (dollar bills) are used to snort powdered forms of drugs, such as cocaine or heroin.

• Heroin-dependent patients are at risk for a wide variety of medical, psychiatric, and behavioral health problems.

How does heroin affect the brain

• When it enters the brain, heroin is converted back into morphine, which binds to opioid receptors.– These receptors are located in many areas of the brain,

especially those involved in the perception of pain and in reward.

– Opioid receptors are also located in the brain stem, which controls automatic processes critical for life, such as blood pressure, arousal, and respiration.

• Heroin overdoses frequently involve a suppression of breathing. This can affect the amount of oxygen that reaches the brain and causing hypoxia. Hypoxia have short- and long-term psychological and neurological effects, including coma and permanent brain damage.

• After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by:– dry mouth,– a warm flushing of the skin,– heaviness of the extremities, and– clouded mental functioning.– Following this initial euphoria, the user goes “on the nod,” an

alternately wakeful and drowsy state.• Users who do not inject the drug may not experience the

initial rush, but other effects are the same.• The long-term effects of opioid is brain addiction:

– Brain addiction– Tolerance– Dependence, characterized by the need to continue use of the drug to avoid withdrawal

symptoms.– Deterioration of the brain’s white matter due to heroin use, which may affect:

• decision-making abilities,• the ability to regulate behavior, and• responses to stressful situations.

What is its effect on the mind?

• Because it enters the brain so rapidly, heroin is particularly addictive, both psychologically and physically. Heroin abusers report feeling a surge of euphoria or “rush,” followed by a twilight state of sleep and wakefulness.

How does it affect the body?

• Highly addictive.• Initial surge of euphoria or “rush,” followed by a

twilight state of sleep and wakefulness• Physical symptoms of use include: drowsiness,

respiratory depression, constricted pupils, nausea, a warm flushing of the skin, dry mouth, and heavy extremities.

• Overdose symptoms: slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and possible death.

What Are the Other Health Effects of Heroin?

• Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV.

• Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease.

• Pulmonary complications, including pneumonia.• In addition to the effects of the drug itself, street heroin often contains

toxic contaminants or additives that can clog blood vessels causing permanent damage to vital organs.

• Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal.

Physical symptoms of heroin use:

• Drowsiness• Respiratory depression• Constricted pupils• Nausea• A warm flushing of the skin• Dry mouth• Heavy.

Withdrawal

• One of the most significant effects of heroin use is addiction.

• With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop.

• Users also experience severe craving for the drug during withdrawal, which can precipitate continued abuse and/or relapse.

It can begin as early as a few hours after the last drug administration, can include:

– Cardiovascular system• Tachycardia• Hypertension

– Central nervous system

• Pupillary dilatation• Restlessness• Irritability• Insomnia• Craving

– Gastrointestinal system

• Nausea• Vomiting• Diarrhea

– Skin• Piloerection

– Mucous membranes• Rhinorrhea• Lacrimation

• Symptoms of heroin withdrawal usually begin 4 to 6 hours after last use and may last for 7 to 14 days.

• Withdrawal from heroin is usually managed with initial dosages of methadone in the range of 15 to 30 mg per day.

Symptoms Heroine Overdose• Airways and lungs

– No breathing– Shallow breathing– Slow and difficult breathing

• Eyes, ears, nose, and throat– Dry mouth– Extremely small pupils,

sometimes as small as the head of a pin (“pinpoint pupils”)

– Tongue discoloration• Heart and blood

– Low blood pressure– Weak pulse

• Skin– Blue lips and fingernails– Clammy skin

• Stomach and intestines– Constipation– Spasms of the stomach and

intestinal tract• Nervous system

– Coma– Delirium– Disorientation– Drowsiness– Muscle spasticity– convulsions

Two main treatment options are available:

• Withdrawal management• Subtitution drug therapies using methadone or

buprenorphine.

Psychiatric Comorbidity

• Personality disorders• Depression• Anxiety disorders• Other substance abuse (alcohol, cocaine, and

prescription drugs).• Other behavior-related problems: family

dysfunction, unemployment, and legal problems.

Medication• Methadone (Dolophine® or Methadose®) is a slow-acting

opioid agonist.• Buprenorphine (Subutex®) is a partial opioid agonist.

Suboxone® is a novel formulation of buprenorphine that is taken orally or sublingually and contains naloxone (an opioid antagonist) to prevent attempts to get high by injecting the medication.

• Naltrexone (Depade® or Revia®) is an opioid antagonist.

Naltrexone blocks the action of opioids, is not addictive or sedating, and does not result in physical dependence; however, patients often have trouble complying with the treatment, and this has limited its effectiveness.

Methadone