Narcotics

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Replacement Therapies for Heroin

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Methadone, and Buprenorphine, LAAM

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Natural Narcotics

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Opium (produces M&C)

Morphine Codeine

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What is a Narcotic

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Naturally occurring psychoactive substances derived from the opium poppy

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Morphine

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Extracted from opium, a gummy black or dark brown substance produced when the pods of the poppy are incised at a certain time of the year.

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Raw Opium

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Easily produced into Morphine and Codeine.

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The Major differences between Narcotics

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1. Potency.

2. The speed at which their effects are produced.

3.Effective when taken orally.

4. The duration of action.

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Narcotics not used in US medical practice

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1. MPTP

2. MPPP

3. Heroin

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Medical uses for Narcotics

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1. Reduce pain

2. Reduce anxiety and depression

3. Decrease respiration

4.Suppress cough

5. Control Diarrhea

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Short Term physical effects

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Bobbing Head

Flushed skin

Itching

Vomiting

Reduction of respiratory functions

Sedation

Nausea

Constricted pin point pupils

Inability to urinate

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Short Term psychological effects

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1. Lethargy

2. Euphoria

3. Mental Clouding

4. Impaired Judgement

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Narcotic Tolerance

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Develops rapidly to the euphoric effects and requires higher dosages to achieve the same desired effect

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Narcotic Dependence

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All Narcotics have a very high risk to developing dependence. Physical dependence usually develops very rapidly.

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Narcotic Withdrawal

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Withdrawal from narcotics produces uncomfortable symptoms that are generally the opposite of the psychoactive substances during intoxication but are not fatal.

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What is Heroin?

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1. The most common,y used street narcotic usually white powder if pure.

2. Schedule I drug

3. Made from Morphine

4. Has extremely rapid effects if taken intravenously.

5. Increases them risk of HIV/AIDS and infections due to needle sharing.

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Heroin Method of Administration

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1. Intravenously/ Shooting

2. Subcutaneously/ Skin Popping

3. Intramuscularly

4. Smoked

5. Snorted

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Heroin Mechanism of Action

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Heroin activates natural opioid receptors in the limbic system thus releasing dopamine allowing the individual to feel pleasure.

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Short Term Physical effects of Heroin

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Elimination of pain

Inability to urinate

Bobbing head

Flushing if skin

Vomiting

Itching

Sedation

Reduction of respiratory functions

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Short Term Psychological effects of Heroin

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Lethargy

Euphoria

Mental Clouding

Impaired Judgement

Decreased anxiety

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Long term Psychological effects of Heroin

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1. Effects from pharmacological properties of heroin.

2. Effects resulting from route of administration

3. Effects due to other aduletrants added to heroin.

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Chronic Heroin use physical effects

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Decreased immune response

irregular levels of sex hormones

erectile dysfunction

risk of pneumonia

fetal damage, low birth wgt, small head size

liver disease

severe skeletal-muscle cell breakdown

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Long Term Psychological effects

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Neuron Damage

Death

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Toxicity level and risk of overdose of Heroin

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Potency of heroin or cuts with other substances to increase sell amount can result in severe respiratory depression an death. Often abused with alcohol and barbiturates.

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Tolerance of Heroin

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Develops quickly to the euphoric effects of heroin but not the side effects. Usually takes 2-3 weeks of frequent use to surface in which the process beings with the first hit.

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Dependence properties of Heroin

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Highly addictive due to the intense and euphoric effects, the degree of dependence to heroin depends on dose, length of time substance was taken, and biology of individual.Maintaining a constant supply of heroin begins to be the most important activity to an individual dependent on heroin, replacing family, work, and even food.

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Needle Freaks

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The occasions where individuals are not physically dependent and only psychologically dependent on heroin. Individuals feel like they need heroin to feel normal but do not inject enough to develop physical dependence.

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Detoxification of Heroin

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The most common approach is the substitution of a longer-acting opioid, such as methadone or buprenorphine which blocks symptoms of withdrawal and cravings.

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Withdrawal from Heroin

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Symptoms are very uncomfortable to endure. Effects are felt around 6-8 hours after last dose with symptoms peaking between 12 and 48 hours after last fose

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Residual Withdrawal/Protracted Abstinence Syndrome

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Withdrawal symptoms that me be present for as long as 8-12 months after initial effects of withdrawal have ceased for extremely heavy heroin users.

Sx. inability to tolerate stress, discomfort, tiredness, weakness, and decreased pain threshold.

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Symptoms of heroin withdrawal

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1.Gooseflesh

2. Cravings

3. Irratibility

4. Anxiety

5. Bone aches

6. Muscle spasams

7. Hot/cold flashes

8. Increased BP, HR and temp

9. Abdominal cramps

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Methadone

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Synthetic narcotic used to stabalize opioid depend clients during withdrawal by acting as an antagonist.

Administered daily in pill form and suppresses withdrawal sx for 24-36 hrs.

Prevents individuals from getting high from heroin and other opioids.

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LAAM

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Developed to eliminate the need for take home prescriptions. Reacts for a longer period of time lasting up to 72 hrs. Administered 3x per week.

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Buprenorphine

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Produces a partial agonist/antagonist effect adn blocks the effects of other opioids taken simultaneously. Does not produce feelings of euphoria

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Narcotic antagonists

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Naltrexone ( Depade/ReVia)

Nalexone ( Narcan) or (Vivitrol)

Proven to maintain sobriety with individuals dependent on heroin and can be used to reverse the effects of overdose. Administered 3x per week.

Naltrexone ( Vivitrol) administered 1x montly

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Setbacks to using narcotic antagonist

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1. Do not delay the onset of withdrawal sx

2. Only block the effects of consuming other narcotics.

3. Individuals will still endure withdrawal sx but can be used with clonidine to reduce sx of withdrawal.

2. Individual must be detoxed before using.

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Therapeutic communities

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Synanon and NA Are used to allow former dependents to share their experience

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Drug Interaction

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Mostly combined with alcohol and cocaine. often smoke a mixture of heroine and cocaine called "speedballing".