Disruption of opioid use is a medical condition characterized by a problematic pattern of opioid use that causes clinically significant disturbances or distress. This often includes a strong desire to use opioids, increased opioid tolerance, and withdrawal syndrome when opioids are suddenly discontinued. Dependence and dependence are components of substance use disorders and addiction is the most severe form of interference. Opioid dependence can manifest as physical dependence, psychological dependence, or both.
Opioids include substances such as morphine, heroin, codeine, and oxycodone. These can be purchased illegally or determined. The diagnosis of impaired opioid use is often based on criteria by the American Psychiatric Association in DSM-5. This includes preoccupation with the desire to acquire and take opioids, and to use more than is intended despite the social and professional consequences of this behavior.
Disruption of opioid use may be treated with opioid replacement therapy using methadone or buprenorphine. Being in such care reduces the risk of death. In addition, individuals with impaired opioid use may benefit from twelve-step programs, other peer support, and support from mental health professionals such as individual or group therapy. Naltrexone medication may also be useful for preventing recurrence. Naloxone is useful for the treatment of opioid overdose.
By 2013, disruption of opioid use affects about 0.4% of people. By 2015, it is estimated that about 16 million people around the world have been affected at one point in their lives. This resulted in 122,000 deaths worldwide by 2015, up from 18,000 deaths in 1990. In the United States by 2016 there were over 42,000 deaths due to an overdose of opioids, of which over 15,000 were the result of heroin. The majority of heroin users start by using prescription opioids.
Video Opioid use disorder
Signs and symptoms
Signs and symptoms include:
- Drug-seeking behavior
- Improved use over time
- Legal or social ramifications secondary to drug use
- Some recipes from various providers
- Many medical complications from drug use (HIV/AIDS, hospitalization, abscess)
- Cravings opioids
- Withdrawal symptoms
Withdrawal
The onset of withdrawal from the opioid depends on which opioid is used last. With heroin, this usually happens 5 hours after being well used with methadone, probably not going to happen until 2 days later. The length of time the main symptoms occur also depends on the opioid used. For heroin symptoms can last up to two weeks. Less significant symptoms may remain for a longer period, in this case known as protracted abstinent syndrome.
- Agitation
- Anxiety
- Muscle aches
- Increased tear
- Difficulty sleeping
- Nose runny
- Sweating
- Yawning
- Goose geese
- Pupils widen
- Diarrhea
- fast heartbeat
- High blood pressure
- Stomach cramp
- Shake
- Cravings
- Sneeze
opioid intoxication
Signs and symptoms of opioid intoxication include:
- Perception of pain decreased
- Euforia
- Confusion
- The desire to sleep
- Nausea
- Constipation
- Miosis
Overdose opioid
Signs and symptoms of opioid overdose include, but are not limited to:
- Pin-point pupils may occur. Patients who present with enlarged pupils may still suffer from an opioid overdose.
- Heart rate decrease
- Body temperature decreased
- Breath decreases
- The level of consciousness is changing. People may be unresponsive or unconscious.
- Pulmonary edema (accumulation of fluid in the lungs)
- Shock
- Off
Maps Opioid use disorder
Cause
Disruption of opioid use may develop as a result of self-medication, although this is controversial. The scoring system has been lowered to assess the likelihood of opiate addiction in patients with chronic pain.
According to position papers on opioid drug treatment published by the United Nations Office on Drugs and Crime and World Health Organization, treatment providers should not treat opioid use disorders as a result of weak characters or wills. In addition, detoxification alone is not an adequate treatment.
Mechanism
Dependency
Addiction is a brain disorder characterized by the use of compulsive drugs despite adverse consequences. Dependency is a component of substance use disorders and is the most severe form of interference.
The excessive expression of the "FosB" gene transcription factor in nucleus accumbens plays an important role in the development of opioid addiction and other addictive drugs by increasing drug rewards and strengthening compulsive drug-seeking behavior. Like other addictive drugs, excessive use of opioids will increase the expression of Fosb in the nucleus accumbens. Opioids affect dopamine neurotransmission in nucleus accumbens through disinhibition of dopaminergic pathway as a result of inhibition of GABA-based projection to the ventral tegmental area (VTA) of rostromedial tegmental nuclei (RMTg), which negatively modulates dopamine neurotransmission. In other words, opioids inhibit the projection from RMTg to VTA, which in turn inhibits dopaminergic pathways that project from VTA to nucleus accumbens and elsewhere in the brain.
Neuroimaging has shown functional and structural changes in the brain. A 2017 study showed that chronic opioid intake, such as heroin, can cause long-term effects in orbitofrontal areas (OFC), which are important for regulating behaviors related to rewards, emotional responses, and anxiety. In addition, neuroimaging and neuropsychological studies show dysregulated circuits related to emotion, stress and high impulsivity.
Dependency
Drug dependence is an adaptive state associated with a withdrawal syndrome after termination of recurrent exposure to the stimulus (eg, drug intake). Dependency is a component of substance use disorders. Opioid dependence can manifest as physical dependence, psychological dependence, or both.
Increased neurotropic brain factor (BDNF) signals in ventral ventral regions (VTAs) have been shown to mediate opioid-induced break-up symptoms through the downregulation of insulin 2 receptor substrate (IRS2), protein kinase B (AKT), and the mechanistic targets of rapamycin complex 2 (mTORC2 ). As a result of signaling lowered regulation through this protein, opiates cause hyperexcitability of VTA neurons and shrinkage (in particular, the size of neuronal soma is reduced). It has been shown that when naïve people start using opiates in concentrations that cause euphoria, an increase in BDNF signals in the VTA.
Upregulation of cyclic adenosine monophosphate (cAMP) signal transduction pathway by binding cAMP elemental response protein (CREB), gene transcription factor, in nucleus accumbens is a common mechanism of psychological dependence among several classes of drug abuse. The same upregulation of pathways at the coeruleus locus is also a mechanism responsible for certain aspects of opioid-induced opioid dependence.
opioid receptor
The genetic basis for the efficacy of opioids in the treatment of pain has been demonstrated for a number of specific variations; However, the evidence for clinical differences in opioid effects is ambiguous. The pharmacogenomics of opioid receptors and their endogenous ligands have been the subject of intensive activity in association studies. These studies tested extensively for a number of phenotypes, including opioid dependence, cocaine dependence, alcohol dependence, methamphetamine/psychotic dependence, response to naltrexone treatment, personality traits, and so on. Major and minor variants have been reported for each receptor gene and coding ligand in both coding circuits, as well as regulatory areas. The new approach shifts away from specific gene and region analyzes, and is based on an unbiased screen of genes throughout the genome, which has no apparent connection to the phenotype in question. This GWAS study produces a number of genes involved, although many of them encode proteins that appear to be unrelated in processes such as cell adhesion, transcription regulation, cell structure determination, and RNA, DNA, and protein handling/modification.
Currently, there is no recommendation of specific pharmacogenomic doses for opioids because of the lack of clear evidence linking genotypes to drug effects, toxicity, or possible dependence.
118A & gt; G variant
While more than 100 variants have been identified for mu-opioid receptors, the most widely studied mu-receptor variant is the 118A & gt; G non-synonyms, resulting in functional changes to the receptor, including lower binding availability, reduced mRNA levels, altered signal transduction, and increased affinity for beta-endorphin. In theory, all these functional changes will reduce the impact of exogenous opioids, requiring higher doses to achieve the same therapeutic effect. This suggests a greater potential of addictive capacity in individuals requiring higher doses to achieve pain control. However, the evidence connecting 118A & gt; variant G for opioid dependence is mixed, with associations shown in a number of study groups, but negative results in other groups. One explanation for mixed results is the possibility of another variant that is in an imbalance relationship with the G & G variant 118A and thus contributes to a different haplotype pattern more specifically associated with opioid dependence.
Non-opioid receptor gene
Preproenkephalin genes, PENK, encode endogenous opiates that modulate the perception of pain, and engage in rewards and addictions. (CA) repeats in a flanking sequence 3 of the PENK gene is associated with greater opiate dependence in recurrent studies. Variability in the MCR2 gene, encoding the type 2 melanocortin receptor has been associated with protective effects and increased susceptibility to heroin addiction. The CYP2B6 gene from the P450 cytochrome family also mediates opioid disorders and thus can play a role in dependence and overdose.
Diagnosis
The DSM-5 guidelines for the diagnosis of opioid use disorders require that individuals have significant disturbances or stresses associated with opioid use. To make a diagnosis, two or more eleven criteria must exist in a given year:
- More opioids are taken than intended
- Individuals can not reduce the number of opioids used
- A large amount of time is spent trying to get opioids, using opioids, or recovering from taking them
- Individuals crave opioids
- Difficulty fulfilling professional tasks at work or school
- Continue to use opioids that lead to social and interpersonal consequences
- Reduced social or recreational activity
- Use opioids even though the settings are physically harmful
- Continued use even though opioids worsen physical or psychological health (ie depression, constipation)
- Tolerance
- Withdrawals
Prevention
There is an effort to reduce the amount of opioid prescribed in an attempt to reduce the disruption of opioid use and death associated with opioid use.
Naloxone is used for emergency treatment overdose. This can be given by many routes (eg intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts quickly by shifting opioids from opioid receptors and preventing the activation of these receptors by opioids. Kit Nalokson is recommended for laypeople who can watch for opioid overdose, for individuals with large prescriptions for opioids, those who use a substance treatment program, or who have just been released from prison. Since this is a life-saving medicine, many areas of the United States have implemented standing orders for law enforcement to bring and deliver naloxone as needed. In addition, naloxone may be used to challenge the status of a person's opioid abstinence before starting treatment such as naltrexone, which is used in opioid addiction management.
Management
Disruption of opioid use usually requires long-term care and treatment with the goal of reducing risk for the individual, reducing criminal behavior, and improving the person's long-term physical and psychological condition. Most strategies ultimately aim to reduce drug use and cause abstinence. There is no single treatment that works for everybody, so some strategies have been developed including therapy and medicine.
In 2013 in the US, there is a significant increase in abuse of opioid prescription compared to illegal opiates such as heroin. This development also has implications for the prevention, treatment and treatment of opioid dependency. Although treatment reduces the mortality rate, the period during the first four weeks after treatment begins and four weeks after stopping treatment is the time that carries the highest risk for drug-related deaths. This period of increased vulnerability is significant because many of those who leave the treatment program during this critical period.
Drugs
Opioid replacement therapy (ORT), also called opioid substitution therapy or opioid maintenance therapy, involves the replacement of opioids, such as heroin, with longer opioids acting but less euphoria. The drugs commonly used for ORT are methadone or buprenorphine taken under medical supervision. In 2018 buprenorphine/naloxone is preferably recommended.
The driving principle behind ORT is the program's capacity to facilitate the return of stability in the user's life, while the patient's experience reduces symptoms of drug withdrawal and cravings less intense drugs; strong euphoria effects are not experienced as a result of medication treatment. In some countries (not the US, or Australia), the regulation enforces a limited time period for people on ORT programs that end when a stable economic and psychosocial situation is achieved. (People with HIV/AIDS or hepatitis C are usually excluded from this requirement.) In practice, 40-65% of patients maintain abstinence from additional opioids when receiving opioid replacement therapy and 70-95% can significantly reduce their use. Along with this are concurrent elimination or medical abatement (improper dilution, non-sterile injecting equipment), psychosocial (mental health, relationship), and legal issues (arrest and imprisonment) that may arise from the use of illegal opioids. Clonidine or lofexidine may help treat withdrawal symptoms.
Participation in the treatment of methadone and buprenorphine reduces the risk of death from overdose. The commencement of methadone and the time immediately after leaving treatment with both drugs is a period especially the increased risk of death, which must be addressed by public health and clinical strategies. ORT has been proven to be the most effective treatment for improving the health and living conditions of people who experience illegal opiate use or dependence, including reduced mortality and overall social costs, such as economic losses from drug-related crimes and health care expenditures. Opioid Replacement Therapy is supported by the World Health Organization, the United Nations Office on Drugs and Crime and UNAIDS as effective in reducing injection, lowering risks for HIV/AIDS, and promoting adherence to antiretroviral therapy. Currently, 55 countries around the world use methadone replacement therapy, while some countries like Russia do not.
Methadone
Treatment of methadone (MMT), a form of opioid replacement therapy, reduces and/or eliminates the use of illegal opiates, criminality associated with opiate use, and allows patients to improve their health and social productivity. Methadone is an opioid agonist. If the initial dose during initial treatment is too high or in conjunction with the use of illegal opioids, this can lead to an increased risk of death from an overdose. In addition, enrollment in methadone maintenance has the potential to reduce transmission of communicable diseases associated with opiate injection, such as hepatitis and HIV. The main effects of methadone maintenance are to reduce the desire of narcotics, suppress abstinence syndrome, and block the effects of euphoria associated with opiates. Methadone maintenance has been found to be medically safe and non-soothing. This is also indicated for opiate pregnant women addicted. Methadone treatment treatments are given to individuals who are addicted who feel they can not go far and get clean. For individuals who want to really get away from drugs, they can start a methadone reduction program. A methadone reduction program is where a person is prescribed a number of methadone which increases until the breaking-off phenomenon, after a period of stability, the dose will then be gradually reduced until the individual is free of methadone requirement or at a level that allows switching to different opiates with a more withdrawal profile easy, like suboxone. Methadone toxicity has been shown to be associated with the specific phenotype of CYP2B6.
Some disorders in cognition have been demonstrated in those who use methadone.
Buprenorphine
Treatment with buprenorphine may be associated with reduced mortality. Buprenorphine under the tongue is often used to manage opioid dependence. Preparations were approved for this use in the United States in 2002. Some buprenorphine formulations incorporate naloxone opio antagonists during the production of a pill form to prevent people from destroying tablets and injecting them, rather than using sublingual (under tongue) administration lines.
diamorphine
In Switzerland, Germany, the Netherlands and the UK, long-term injecting drug users who do not benefit from methadone and other treatment options are treated with pure injectable diamorphine administered under the supervision of medical staff. For this group of patients, diamorphine treatment has been shown to be superior in improving their social and health situation.
Dihydrocodeine
Dihydrocodeine both in the form of long release and immediate release are also sometimes used for maintenance treatments as an alternative to methadone or buprenorphine in some European countries.
Heroin-assisted treatment
Heroin-assisted medications (HAT, heroin medical prescriptions) have been available in Switzerland since 1994. A 2001 study found a high rate of treatment retention and a significant increase in health, social situations and the possibility of leaving illegal drug sites in participants who registered. The study found that the most common reason for outgoing is the beginning of abstinent treatment or methadone treatment. The study also found that heroin-assisted treatment benefits the cost at the community level because it reduces crime and improves overall participants' health.
A heroin-assisted treatment program was introduced in Switzerland to combat the increased use of heroin in the 1980s and 1990s and was written into the 2010 legislation as a pillar of a four pillar strategy using oppression, prevention, treatment, and risk reduction. Typically, only a small proportion of patients receive heroin and must meet a number of criteria. Since then, the HAT program has been adopted in the Netherlands, Britain, Germany, Spain, Denmark, Belgium, Canada, and Luxembourg. Naltrexone
Naltrexone is used for the treatment of opioid addiction. It works by blocking physiological effects, euphoria, and strengthening opioids. Noncompliance with naltrexone therapy is a concern with oral formulation because of its daily dose, and although alternative intramuscular (IM) injections have better adherence due to monthly doses, attempts to rule out blocking effects with higher doses and stronger drugs have been proven. dangerous. Monthly IM Injections Naltrexone received FDA approval in 2010 for the treatment of opioid dependence on abstinent opioid users.
Behavioral therapy
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT), a form of psychosocial intervention used to improve mental health, may not be as effective as other forms of treatment. CBT primarily focuses on individual coping strategies to help change their cognition, behavior, and emotions about the problem. These interventions have shown success in many psychiatric conditions (eg, depression) and substance use disorders (eg, tobacco). However, the use of CBT alone in opioid dependence has declined due to lack of efficacy and many are relying on drug therapy or drug therapy with CBT because it is found to be more efficacious than CBT alone.
The twelve step program
While medical treatment can help with early symptoms of withdrawal of opioids, after the first phase of withdrawal is done, the method for long-term preventive care is the presence in a 12-step group such as Anonymous Narcotics. Some evidence supports the use of these programs in adolescents as well.
The 12 step program is a form of adaptation of the Alcoholics Anonymous program. The program seeks to help create behavioral change by fostering peer support and self-help programs. Models help affirm gravity addiction by upholding the idea that addicts have to give in to the fact that they are addicted and able to recognize the problem. It also helps maintain self-control and restraint to help promote one's ability.
Epidemiology
Globally, the number of people with opioid dependence increased from 10.4 million in 1990 to 15.5 million in 2010. Disruption of opioid use resulted in 122,000 deaths worldwide by 2015, up from 18,000 deaths in 1990. Death of all the cause increased from 47.5 million in 1990 to 55.8 million in 2013.
United States
The current epidemic of opioid abuse is the deadliest drug epidemic in American history. According to the CDC in 2017, in the US, "age-adjusted drug-related death rates involving opioid analgesics increased from 1.4 to 5.4 deaths per 100,000 population between 1999 and 2010, dropping to 5.1 in 2012 and 2013, then increased to 5.9 in 2014, and up to 7.0 in 2015. The age-adjusted dose of drug-related toxicity involving heroin doubled from 0.7 to 1.4 deaths per 100,000 inhabitants between 1999 and 2011 and then continues to increase to 4.1 by 2015. "
In 2012 it is estimated that 9.2 percent of the population over the age of 12 years had been using illicit drugs in the previous month. By 2015, an estimated 20.5 million Americans have substance use disorders. Of these 20.5 million, two million use prescribed pain medications (most of them opioids) and one-half million using heroin.
By 2015, in the US there are 33,000 deaths due to drug overdose involving the use of opioids. Of these, about 15,000 are from prescribed opioids and 13,000 are derived from the use of heroin.
Non-medical opioid consumption peaked around 2010 and then began to decline between 2011 and 2013.
Among adults, the rate of hospitalization in fixed hospitals in the United States associated with overuse of opioids increased by an average of 5% per year from 1993-2012. The percentage of inpatients persisted due to overuse of opioids received from the emergency department increased from 43% in 1993 to 64% in 2005, but has remained relatively constant since 2005.
The prevalence of opioid use and opioid or opiate dependence depends on age and sex, among many other factors. Males are at higher risk for opioid use and dependence than women, and men are also responsible for more opioid overdose than women, although this gap closes. Women are more likely to be prescribed pain relievers, given higher doses, use them for longer periods of time, and can become dependent on them more quickly.
Deaths due to opioid use also tend to tilt at older age than deaths due to the use of other illegal drugs. This does not reflect the overall use of opioids, which include individuals in a younger age demographic. Overdose of opioids is the highest among individuals between the ages of 40 and 50, in contrast to heroin overdose, the highest among individuals aged between 20 and 30. Ages 21 to 35 years represent 77% of individuals who enter treatment for opioid use disorders , however, the average age of first-time use of prescription painkillers is 21.2 years in 2013. Among the middle class means obtaining funds has included financial misuse of Elder through the vulnerability of financial transactions from the sale of goods and the international dealers are aware of the lack of enforcement within scams of their deals throughout the Caribbean.
History
Opiate abuse has been noted since at least 300 BC. Greek mythology describes Nepenthe (Greek "free from sadness") and how it is used by the heroes of the Odyssey. Opioids have been used in the Near East for centuries. Purification and isolation of opiates occurred at the beginning of the 19th century.
Levacetylmethadol was previously used to treat opioid dependence. In 2003 drug manufacturers stopped production. No generic version available. LAAM produces long-term effects, allowing people receiving treatment to visit the clinic only three times per week, compared to daily such as with methadone. In 2001, levacetylmethadol was removed from the European market due to reports of life-threatening rhythmic rhythm disturbances. In 2003, Roxane Laboratories, Inc. stop Orlaam in the US.
See also
- Benzodiazepine withdrawal syndrome
- Shop docs
- Opioid receptor
- Physical dependency
- Post-acute withdrawal syndrome
- Misuse of prescription drugs
References
External links
- Heroin information from the National Institute on Drug Abuse
- Opioid information in Opioids.Net
- Treatment of Opioid Dependency and Guidelines
- Opioid Risk Tool (ORT) for Narcotics Abuse
Source of the article : Wikipedia
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