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P01: olicognography

P02: addictions

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OLICOGNOGRAPHY on ADDICTIONS

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Opioids Addictions Heroin, Morphine, Methadone, Fentanyl ...

Basic Olicognograph: Process addiction

Side effects of mu opioids (drugs acting on those nervous system receptors involved in pain control) are dose-related and include sedation, cognitive blurring, respiratory depression, myosis (pupillary constriction), nausea, urinary retention, constipation, and reward. Except for constipation, side effects tend to be transient and generally resolve within a few days at a stable dosage. Side effects may reemerge with an increase in dosage.

Opioid dependence is a severe condition associated with substantial psychological, social and medical impairment, as well as poor treatment outcomes. The aetiology of opioid dependence is not quite established. According to the self-medication hypothesis, emotionally unstable individuals may experience that their psychological distress is alleviated when they use opioids. Opioid use has also been associated with sensation seeking and engagement in risk behaviours. The five-factor model (FFM) comprise behavioural, emotional and cognitive patterns. FFM has a hierarchical structure; each of the five domains: Neuroticism, Extraversion, Openness to experience, Agreeableness and Conscientiousness. It has been proved to be stable from the age of 30 and has been reproduced in a number of culturally different countries, indicating a universally valid structure. People with psychiatric disorders have distinct personality patterns. People with various substance use disorders also seem to have a common personality profile: high Neuroticism, low Conscientiousness and low Agreeableness. Patients with opioid dependence were more emotionally unstable, more introverted and less structured than the non-clinical controls. These findings may represent risk factors for opioid dependence, but may also be results of the lifestyles of illicit substance users.

Opioid addicts, especially injecting heroin users, suffer increased health problems and reduced health related quality of life (HRQOL) as well as increased mortality. This is particularly related to overdoses, injuries, human immunodeficiency virus (HIV)-infection, viral hepatitis B (HBV) and viral hepatitis C (HCV) with end-state liver disease and other infections like endocarditis, osteomyelitis and others. Studies show vulnerability among injecting drug users (IDUs) to rare infectious diseases like tetanus, botulism and gas gangrene due to Clostridium. Increased prevalence of various psychiatric diseases among substance users is well documented in population surveys and among persons entering opioid maintenance treatment (OMT). In spite of considerable morbidity, drug users frequently neglect their health problems, and diseases may remain untreated.

OMT leads to reduced illegal opioid use and injection which probably reduces overdoses and infections. It is also likely it improves nutritional status and general health. Moreover, patients may become more motivated to seek medical help, and it may remove or at least reduce tension between patients and health service providers, thus leading to improved health care followup. It is therefore reasonable to assume that over time OMT will reduce morbidity and mortality. Reduction in mortality during OMT has been shown in observational studies.

Heroin (methadone: smoother and prolonged effect ), buprenorphine (opiate maintenance treatment alternative) and naloxone (opioids' intoxication antidote or test for opioids dependence) produce contrasting effects because they interact differently with the brain’s mu opioid receptors. Chemicals differ in how much each stimulates the receptors. The stronger the stimulation, the more pronounced will be the opioid effects of pain relief, feelings of well-being, respiratory depression, and so on. Heroin, classified as a full receptor agonist (stimulator), nearly fills the activity zone. Buprenorphine, a partial receptor agonist, fills a smaller portion of it. Naloxone does not stimulate the receptor at all. Each chemical binds to the receptors more or less strongly. A chemical that forms a tighter bond can push one with a weaker bond off the receptors and take its place. Buprenorphine can push heroin off the receptors so replace heroin’s full receptor stimulation with its own partial stimulation. Buprenorphine also binds more tightly than naloxone. Naloxone can compete with heroin and because it can block heroin and other opioids from stimulating it can precipitate opioid withdrawal so is classified as an opioid receptor “antagonist.”

Clinically Opiates Maintenance Treatment (OMT) purpose is to prevent opioid withdrawal signs and symptoms (strong physical dependence); to provide a comfortable induction onto the medication; to then attenuate the motivations (such as craving)to use illicit opioids. By eliminating illicit drug use, patients dependent on opioids can begin to focus on repairing family and social relationships, finding positive social support networks, better employment fullfilling, and engage in new forms of recreation and other activities that contribute to healthy, balanced living. Once stabilized at lowest possible dosis, complete withdrawal in a matter of monthes especially if social environmental conditions and will are apropriated.

Opiates are medically y used as pain killers. Pain is integral to life; it is a critical component of the body’s natural defense system, signaling threats to body integrity and provoking self-preservation behaviors to further survival. Because pain often signals an urgent need to act (e.g., to flee, strike back, or otherwise respond aggressively to a threat), significant pain is typically associated with strong feelings (e.g., combinations of fear, anxiety, anger, or rage). Pain also sometimes occurs in the absence of any discernible threat or identifiable tissue damage, due to alterations in normal neural processing. It is not uncommon, therefore, to encounter distressed patients complaining of pain for which the origin is elusive. When pain is complicated by a co-occurring addictive disorder, particularly in a patient using opioids for pain control, evaluation and treatment may present a complex clinical challenge to care providers and generate considerable frustration and prolonged suffering for the patient. Like chronic pain, addiction often results in nonrestorative sleep, anxiety and/or depression, inability to function in important life roles, and resultant stress. In addition, persons who are addicted to a substance rarely use it in a manner that creates a steady state (stability) and physiological homeostasis (good inner body medium).

Despite important advances in pain treatment, opioids remain the most potent class of analgesic medications available. They relieve most types of pain, are widely available, and are generally safe and do not cause organ toxicity when used appropriately. Moreover heroin drug trafficking (street drugs), diversion of prescription opioids from legitimate therapeutic channels is clearly occurring, but it is uncertain which points in the distribution system are leaking the most. Diversion at the level of patient prescriptions likely contributes substantially to illicitly available medications, but it appears that truck and pharmacy robberies also contribute.

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