Cl.
Toxicolog1
Opioids
Opioids present with a syndrome which includes miosis, coma, respiratory
depression and vomiting. A rapid response to naloxone is usual if hypoxic brain
damage or other events have not been superimposed. The treatment is primarily
supportive, although naloxone may also be used in certain circumstances. In
recreational overdoses (i.e. dependent patients), a withdrawal reaction to non-
titrated doses naloxone is common.
Mechanism:
Opioids are opioid receptor agonists. Stimulation of these receptors in the central
nervous systems leads to analgesia, vomiting and profound sedation in a dose
dependent manner. These effects are potentiated by other sedative drugs (e.g.
alcohol, benzodiazepines) and the majority of fatal overdoses involve other
substances.
Narcotic withdrawal is an unpleasant condition but is not medically dangerous or
life threatening. This withdrawal syndrome has been greatly mythologised and is
psychologically more frightening than the true clinical picture. Withdrawal
symptoms are largely the reverse of the effects of the narcotic and require little
medical intervention.
Clinical (Toxic) Symptoms:
Often, the facts about the effects of opiate use are misleading because they may
only focus on the short-term impact. For example, opiates often cause vomiting
and diarrhea, sedation and delayed reactions in the short term.
Physical symptoms: Noticeable elation/euphoria, Marked sedation/drowsiness,
confusion, Constricted pupils, Slowed breathing, Intermittent nodding off, or loss
of consciousness and Constipation.
Other signs of opiate abuse include: Doctor shopping (getting multiple
prescriptions from different doctors) and Shifting or dramatically changing moods.
Extra pill bottles turning up in the trash. Social withdrawal/isolation and Sudden
financial problems.
Long-term symptoms include:
Weakened immune system functioning.
Gastric problems ranging from the troublesome (e.g., constipation) to severe
(e.g., intestinal ileus, bowel perforation).
A plethora of medical issues secondary to intravenous administration (e.g.,
localized abscesses, embolic events, systemic infection, contraction of
bloodborne illnesses).
Significant respiratory depression; cumulative hypoxic endorgan injury.
Opiate Abuse Treatment abuse
Opiate recovery typically starts with questions related to the
nature of the addiction, such as:
How long have you taken the drug?
When was the last time you took the drug?
How do you usually get your supply?
Three major options for opiate treatment include detoxification (or, simply,
detox programs), inpatient rehabilitation, and outpatient therapy.
Detox involves withdrawing from the drug, often slowly with the use of
stabilizing and maintenance medication under the supervision of a medical
treatment team. If detoxing from powerful opiates, it might be prescribed
methadone or buprenorphine to make the transition more manageable.
Detoxification is completed on an inpatient basis to maintain safety.
Following the transition from detox, most will be referred for continued
treatment via residential rehab or outpatient therapy depending on a number of
factors. Influencing the decision for treatment type is the individual's level of
opiate use, the presence of any home or family supports, as well as taking into
account any previous attempts at recovery. Rehab typically lasts anywhere from 30
to 90 days with much of the time being devoted to individual therapy, group
therapy, and other activities that help promote recovery from opiates and other
substances.
During therapy, you will attend sessions with a therapist or counselor. This will
help you to uncover the triggers of your addiction. It helps to impart effective
coping skills to resist the temptation of drugs while seeking out helpful supports. It
can also help you reconnect with your family and friends.
C
In conjunction with outpatient treatment, some in recovery may require more
support. For someone in recovery from opiate addiction, this might take the form
of a halfway house or sober living facility, which gives former users the chance to
get sober and rebuild their lives in a safe and supportive environment. Others may
simply need a peer support group, such as Narcotics Anonymous.
References:
a. Matthew J Ellenhorn. ELLENHORNS MEDICAL TOXICOLOGY –
DIAGNOSIS
AND TREATMENT OF POISONING. Second edition. Williams and Willkins
publication, London
b. V V Pillay. HANDBOOK OF FORENSIC MEDICINE AND TOXICOLOGY.
Thirteenth edition 2003 Paras Publication, Hyderabad
c. Pharmdosth
Submitted to:
Submitted by:
Dr. Ch. Rohit Kumar
K.V. Koti Reddy
Dept. of Pharmacy practise
15CDT0014
