Opiate abusers

Di Chiara G and North RA (1992). Neurobiology of opiate abuse. Trends in Pharmacological Sciences, 13, 185-193. 

Subutex (buprenorphine) is used at the beginning of treatment for opiate abuse. 

Barr, M. et al., Escalating morphine exposures followed by withdrawal in feline immunodeficiency virus-infected cats A model for HIV infection in chronic opiate abusers, Drug Alcohol Depend.., 72, 141, 2005. 

Di Chiara G, North RA. (1992). Neurobiology of opiate abuse. Trends Pharmacol Sci. 13(5) 185-93. Diez-Guerra FJ, Augood S, Emson PC, Dyer RG. (1987). Opioid peptides inhibit the release of noradrenaline from slices of rat medial preoptic area. Exp Brain Res. 66(2) 378-84. 

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

Alcohol Abuse, Alcohol Dependence Amphetamine Abuse, Amphetamine Dependence Cannabis Abuse, Cannabis Dependence Cocaine Abuse, Cocaine Dependence Hallucinogen Abuse, Hallucinogen Dependence Inhalant Abuse, Inhalant Dependence Nicotine Dependence Opiate Abuse, Opiate Dependence Phencyclidine Abuse, Phencyclidine Dependence... 

Opiate abuse and dependence can exact a tremendous social toll. Abusers have difficulty holding jobs, are often divorced, and sometimes resort to crime to obtain either the drug or the money to buy it. Opiate abuse also has severe health consequences. Sharing needles is a common source of transmitting HIV, hepatitis, and other infectious diseases. In addition, opiate abusers are prone to accidents and are often victims of crime. 

In opiate abuse, smack ( junk, jazz, stuff, China white mostly heroin) is self administered by injection ( mainUning ) so as to avoid first-pass metabolism and to achieve a faster rise in brain concentration. Evidently, psychic effects ( kick, buzz, rush ) are especially intense with this route of administration. The user may also resort to other more unusual routes opium can be smoked, and heroin can be taken as snuff (B). 

Most of the research and results have been focused on the effects of drug therapy on the disorders induced by alcohol, and by opiates abuse. For all drugs, the first objective is to wean the patients from the drug, treating or preventing the effects of withdrawal for those drugs which cause physical dependence (alcohol, nicotine, opiates, caffeine, certain psychotropic agents such as benzodiazepines, possibly antidepressants). The second phase is the prevention of recurrence or relapse, which relies on a com-... 

Poisoning with opiates such as morphine, pethidine, and heroin is increasingly common as opiate abuse becomes more widespread. The drugs are often injected or inhaled. The cardinal clinical features are coma, pin-point pupils and respiratory depression, which strongly suggest opiate poisoning. 

Few brain morphometric studies of opiate abusers have been conducted and these have been poorly controlled and have utilized lower-resolution technologies, such as computed tomography. These preliminary studies have suggested that brain volume may be decreased in chronic opiate abusers. 

As in the case of chronic opiate abuse, few brain morphometric studies of human cannabis abusers have been conducted. However, recent preclinical work has demonstrated that 5 -THC concentrations as low as 0.5 to 1 lM, which are compatible with plasma 5 -THC levels achieved by humans ingesting marijuana, are toxic to hippocampal neurons (Chan et ah, 1998). This hippocampal toxicity may underlie the cognitive deficits observed in chronic marijuana users, which have been shown to persist after abstinence (Pope and Yurgel un-Todd, 1996). 

Di Chiara, G. and North, R.A. (1992) Neurohiology of opiate abuse. Trends Pharmacol Sci 13 185-193. 

Because BZDs can cause excessive sedation and misuse, especially in drug-abusing HIV-infected patients, buspirone may be a useful alternative. Batki ( 496) reported on the use of this agent in 17 opiate abusers with AIDS or ARC who were also taking methadone. In the 14 patients who remained on the drug for at least 2 weeks, there was a reduction in several aberrant behaviors without any incidence of abuse. 

He argues that supervised naltrexone is a very useful addition to the management of several aspects of opiate abuse. Naltrexone has only been available for prescription by medical practitioners in the UK since the summer of 1988 and its full potential can now be evaluated. 

Brewer, C. (1987) Naltrexone in the management of opiate abuse experiences with rapid withdrawal and the prevention and detection of relapse. A review of 70 cases , British Journal of Addiction, 82 1369. 

Treatment demand for opiates abuse continues to be highest in Asia and in Europe... 

Global opiate abuse has stabilised at an estimated 15.6 million people, or 0.4 per cent of the worlds population aged 15-64. Opiates continue to be the main problem drug worldwide, accounting for some 60 per cent of treatment demand in Asia and in Europe. 

A study published in India in 2004 revealed opiate prevalence rates of around 0.7 per cent for males2, which is equivalent to an annual prevalence of around 0.4 per cent of the general population aged 15-64, or slightly less than 3 million people. Opiate abuse in India increased in 2005, fuelled by the increasing availability of heroin smuggled from Afghanistan. 

Opiates abuse is basically stable or declining in West and Central Europe. The annual prevalence rate remained close to 0.5 per cent of the population aged 15-64 (1.5 million people). Major opiates markets in Western Europe are the United Kingdom (some 350,000 persons) and Italy (300,000), followed by France (170,000), Germany (120,000) and Spain (70,000). Data for Spain suggest that opiates abuse has declined in recent years. These data are derived from problem drug use estimates. Household survey results in all of the countries mentioned above show substantially lower figures (with prevalence rates typically around 0.2%). Household surveys, however, may not provide the optimal measure of the number of opiates abusers as many heroin addicts do not have a fixed or permanent residence. 

Heroin accounts for more than 70 per cent of opiates abuse... 

Countries in East Africa, particularly Kenya, Mozambique and United Republic of Tanzania, have reported large increases in heroin abuse in recent years. An increase in opiate abuse has also been reported by South Africa and a number of countries in West Africa. In general, these increases are linked to greater amounts of heroin transiting these regions. 

Opiate abuse continues rising in Asia, mainly among countries close to Afghanistan. .. 

Most countries of East and South-East Asia reported declines in opiate abuse in 2005, reflecting the strong declines of opium production in Myanmar and Lao PDR. The Chinese market was reported to have been stable, as declining levels of opiates from Myanmar were offset by a rising opiate supply from Afghanistan. From 1992 to 2005, the drug use perception indicator for... 

Childress, Anna R., A. Thomas McLellan, and Charles P. O Brien. 1986. "Abstinent Opiate Abusers Exhibit Conditioned Craving, Conditioned Withdrawal, and Reductions in Both Through Extinction." British Journal of Addiction... 

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