Challenges Facing the American Healthcare System
Kant Patel, Mark Rushefsky in Healthcare Politics and Policy in America, 2019
Opioids are drugs designed to replicate the pain-reducing properties of opium and they include both legal painkillers like morphine, oxycodone or hydrocodone prescribed by doctors for acute or chronic pain, and illegal drugs like heroin or illicitly made fentanyl. Opioids are addictive because they push the buttons of the brain usually triggered by pleasurable activities like eating. However, opioids are more powerful and they prompt the body to release the chemical dopamine, creating a feeling of euphoria or a “high” that encourages more use. Opioids bind the receptors to the brain and spinal cord, disrupting pain signals. Opioids such as morphine and codeine are naturally derived from poppy plants while hydrocodone and oxycodone are semi-synthetic opioids manufactured in labs with both natural and synthetic ingredients. Fentanyl is a totally synthetic opioid. It was originally developed as a powerful anesthetic for surgery and is also often administered to alleviate severe pain associated with a terminal illness such as cancer. Fentanyl is up to 100 times more powerful than morphine (Gander 2017; “Opioid Crisis Fast Facts” 2017). The clinical term used for opioid addiction or abuse is opioid use disorder. Individuals who become dependent on pain pills may switch to heroin because it is less expensive than prescription drugs. The National Institute on Drug Abuse estimates that half of the young people who inject heroin turned to the street drug after abusing prescription painkillers and three in four new heroin users start out using prescription drugs (“Opioid Crisis Fast Facts” 2017).
Opiates
G. Hussein Rassool in Alcohol and Drug Misuse, 2017
Users often experience nausea or vomiting on the first occasions that they use heroin, or when returning to use after a period of abstinence. Heroin dependence develops after repeated use over several weeks and sudden withdrawal leads to anxiety, nausea, muscle pains, sweating, diarrhoea and goose flesh. Tolerance develops quickly so that larger amounts of the same drug are needed to produce the same effect. During a period of abstinence (in treatment or prison), tolerance diminishes quickly so that an individual can easily overdose by taking their usual dose. Overdose occurs as a result of depression of the respiratory centre in the brain, which leads to respiratory and cardiac arrest and death unless immediate medical attention is received. Though stupor, coma and death can occur from overdoses, there is generally little effect on the motor skills and sensation. The user of opiates may appear detached or withdrawn with contraction of the pupils. Whilst pharmaceutical heroin is not especially toxic to human organs, adulterants in street heroin way well cause more damage, especially when they are injected. Injecting brings with it the risks of vein damage and collapse, local infections, abscesses, circulatory problems, ulcers, thrombosis, infections in heart valves and systemic infections. It also exposes users who share injecting equipment to blood-borne viruses including Hepatitis B and C, and HIV. However, most complications arise from unsterile injections and adulterated street drugs. Heroin, taken by injection, is also a risk factor in contracting hepatitis B and C, HIV and septicaemia.
Cocaine Use in Persons on Methadone Maintenance
Mark S. Gold, Marc Galanter, Barry Stimmel in Cocaine: Pharmacology, Addiction, and Therapy, 2014
Although the desire to use heroin is significantly reduced with MM, the cross-tolerance induced by methadone is effective only with other narcotics. Since anxiety is frequently a contributing factor toward initiation of heroin dependence, institution of methadone maintenance may cause the anxiety of heroin dependence to resurface, resulting in the use of other mood-altering drugs. Although alcohol is probably among the least expensive agents, its prevalence among patients in MM is less than that seen for cocaine use.6 This may be related to a number of factors, including the association of cocaine with a specific status, the conditioning effects that prior use of cocaine has on reinforcing subsequent use in order to relieve anxiety and its ready availability in every neighborhood at what has now become relatively low cost.
Craving and implicit attitude toward heroin use and their relationships with the levels of heroin dependence and methadone adherence in heroin users
Published in Journal of Addictive Diseases, 2021
Peng-Wei Wang, Huang-Chi Lin, Kun-Hua Lee, Lin Pai-Cheng, Hung-Chi Wu, Chih-Yao Hsu, Kuan-Sheng Chung, Chih-Hung Ko, Yi-Hsin Connie Yang, Cheng-Fang Yen
Craving has re-merged as a criterion for substance use disorders in the DSM-5.29 A previous study showed that craving for heroin may increase heroin use.26 In addition, heroin users undergoing MMT who have a low level of craving are more likely to remain abstinent from heroin use, whereas those with high levels of cravings are more likely to reuse heroin while in the MMT program.29,30 The present study found that craving for heroin had medium contributions to levels of heroin dependence and MMT adherence. Therefore, craving is still important for heroin users even though they have receiving MMT for a long time. This also highlights the importance of measuring craving for heroin users with MMT. Craving can be easily measured using the VAS, and thus clinicians should measure the level of craving for heroin routinely. In addition, influences of craving on heroin users’ addictive problems during MMT may vary because our results indicated the effect of craving on level of misuse was greater than that on attendance. This meant more studies may need to get a better understanding for how craving contributes to various addictive problems. Research on substance use other than heroin has shown that implicit attitude toward substances is related to relapse or continuing substance use8,31,32 and is also a reliable predictor of substance use.7 Research into alcohol use showed that a positive implicit attitude toward alcohol is associated with low motivation to change the drinking quantity and an increased amount of alcohol consumed per occasion.33
Opioid epidemic: lessons learned and updated recommendations for misuse involving prescription versus non-prescription opioids
Published in Expert Review of Clinical Pharmacology, 2022
Ajda Bedene, Albert Dahan, Frits R. Rosendaal, Eveline L.A. van Dorp
Until recently, it seemed improbable that an opioid use disorder (formerly named ‘addiction’) could be present in a clinical setting because the compulsive need for opioids, with disregard of any negative consequences, was rarely observed in patients [93]. However, dependence and complementary withdrawal symptoms are neither necessary nor sufficient for the manifestation of opioid use disorder in a clinical setting [94,95]. For example, it is common for dependence to occur without a concomitant opioid use disorder, in the treatment of malignant pain [96]. Still, recent evidence suggests that opioid use disorder may be common among cancer survivors and patients in remission [97,98]. The presence of substance use disorder in any clinical setting is not improbable and may very well be more prevalent than originally considered. In a 2015 review study [55], 38 different studies on opioid misuse and ‘addiction’ from diverse clinical settings were included. The authors concluded that the rates of ‘addiction’ varied between 8% and 12% and appeared to be highest in pain clinics.
Case report: Increasing the frequency of intramuscular naltrexone administration in a high risk patient with opioid use disorder
Published in Substance Abuse, 2021
Melissa Wright, Joao P. De Aquino, Tamara Bystrak
The United States is in the grip of an opioid crisis. Opioid overdose deaths have significantly increased over the past decade.1 Among individuals with opioid use disorder (OUD), risk factors for overdose include prior overdoses, injection drug use, male sex, greater pain severity, and psychiatric comorbidity.2 Another important risk factor for opioid overdose has recently come to light: the intentional or unintentional use of high-potency synthetic opioids (HPSO) such as fentanyl. HPSO have increased potency and lipophilicity, causing more robust and faster effects compared to heroin (Figure 1A). HPSO can, for instance, lead to life-threatening respiratory depression in under two minutes.3 In 2017 alone, fentanyl was implicated in up to 28,400 fatalities, in what is being referred to as the “third wave of the opioid crisis”.4
Related Knowledge Centers
- ADDiction
- Diagnostic & Statistical Manual of Mental Disorders
- Hepatitis C
- Suicide
- Substance Use Disorder
- Opioid
- Opioid Withdrawal
- Substance Dependence
- Opioid Overdose
- HIV/AIDS
- Diagnostic & Statistical Manual of Mental Disorders