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Opiates
(Special thanks to Dr Ricky Tung of Institute of Mental Health, Castle Peak Hospital, for authoring this article)

 
1. What are opiates? What are their medical usages?
2. What is opiates abuse?
3. What are the hazards of opiate abuse?
4. What are the benefits of in-patient detoxification programme?



1. What are opiates? What are their medical usages?

Opiates refer to the opioid alkaloids extracted from opium poppy, as well as synthetic chemical of such alkaloids. Common examples are morphine, heroin, tramadol and Physeptone. They are potent analgesics, which relieve pain sensation and enhance tolerance to pain. Therefore, they are being widely used in pain-related disorders. Because of the opiate’s anti-coughing effect and inhibitory effect on gut mobility, some cough mixture and anti-diarrhea medications also contain opiates.

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2. What is opiates abuse?

Non-medical use of opiates was first documented in history around 500 years ago. Apart from analgesic effect, opiates can induce euphoria. Different kinds of opiates vary in their onset of action, intensity and duration of effects. Among them, heroin gives the quickest and most intense effect, especially upon injection into bloodstream. Therefore, heroin is the most commonly abused opiates.

Strong psychological craving develops rapidly in heroin abusers, who soon require daily consumption of heroin with escalating amount in order to suppress the withdrawal. Their route of use will gradually change from inhalation to injection, in order to achieve adequate effect. Highly distressing withdrawal symptoms, including restlessness, anxiety, irritability, shivering, insomnia, sweating, gastric upset and aching limbs etc, develop a few hours after stop using heroin and may last for three to five days. Because of the intense suffering upon withdrawal, the abusers often become totally reckless in behavior when seeking heroin to relieve the withdrawal. In chronic users, they may gain no pleasure at all from the heroin, and continuation of heroin use is merely just for avoiding withdrawal.

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3. What are the hazards of opiate abuse?

Intoxication happens upon an overdose of heroin, leading to loss of conscience, suffocation and possibly death. Those who abuse heroin by injection commonly encounter accidental intoxication, because the concentration of heroin in each dose can vary widely and an unexpected high dose delivered to bloodstream can cause intoxication rapidly. Sometimes, when an abuser resumes previous usual dose of his after a period of cessation, intoxication may occur because of the lowered tolerance to heroin.

Chronic use of opiate leads to depressed mood, unstable emotion, dry mouth, constipation, loss of libido etc. The impurities in heroin may contain sedatives and stimulants, and they can cause mental symptoms such as disorganized thought, hallucination and delusion. Those who have coexisting mental illness are particularly vulnerable to these adverse effects.

Injection o f heroin, comparing to other routes of consumption, poses much more harm to body, especially when the needles are shared. Complications include transmission of HIV and hepatitis, infection and permanent damage of skin, blood vessels and heart valves.

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4. What are the benefits of in-patient detoxification programme?

Among interventions for opiate abusers, residential detoxification programme offers higher chance of success and relatively less suffering. Doctors in the substance abuse service will closely monitor the person’s body condition and provide adequate replacement medication for mitigating the withdrawal. By using newer medication regimen, shorter length of stay (2-3 weeks) is needed and lesser withdrawal symptoms are experienced when comparing with traditional detoxification programme by methadone.

Hospital environment helps the person to stay away from negative influence and temptation, allowing the person to focus on his or her drug misuse problem. This period of hospitalization allows the substance abuse professionals to thoroughly assess and manage all the mental and physical problems, as well as social difficulties related to substance abuse problem.

Although residential detoxification can effectively mitigate the physical dependence, it is just the beginning of the whole journey of conquering the drug problem. Minimizing the risk of relapse needs further counseling, psychological support and vocational rehabilitation services.

Websites with relevant information / Reference

Government antidrug website

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