Journal Reading Noby

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JOURNAL READING

Oleh : Novita Agustina

(201420401011084)

MENTAL DISORDER DUE TO OPIOID AND ALKOHOL

Supervisor : dr. Iwan Sys, Sp. KJ

SMF ILMU KEDOKTERAN JIWAFAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG2016



Alcohol Research & Health

Diagnosing Co-Morbid Drug Use in Patients With Alcohol Use

Disorders

Bachaar Arnaout, M.D., and Ismene L. Petrais, M.D. Vol. 31,No. 2, 2008



!omor"idity o# menta$ disorders and su"stance use:A "rie# %uide #or the primary care c$inician

Dru% and A$coho$ Services South Austra$ia &''(



THE PRESCRIPTION OPIOID AND HEROIN

CRISIS: A PUBLIC HEALTH APPROACH TO AN

EPIDEMIC OF ADDICTION

www.annualreviews.org

)uide$ines #or the Psychosocia$$y

Assisted Pharmaco$o%ica$ *reatmento# +pioid Dependence

or$d -ea$th +r%aniation &''/



Pharmacological treatment of mental

disorders in primary health care

World Health Organization 2009



DEFINITION

OPIOIDS (Heroin,codeine,morphine,oxycodone,hydromorphone,

buprenorphine,pethidine,dextropropoxyphene,methadone,tramadol ).

Opioid dependence is characterized by a cluster of cognitive, behavioural and

physiological features. The International Classification of Diseases, 10th edition(ICD-10) identifies six such features:

• a strong desire or sense of compulsion to take opioids

• difficulties in controlling opioid use

• a physiological withdrawal state

• tolerance• progressive neglect of alternative pleasures or interests

because of opioid use

• persisting with opioid use despite clear evidence of overtly

harmful consequences.



Symptoms of dependence include tolerance, withdrawal,

drinking more than intended, giving up social, occupational

or recreational activities because of drinking, and continued

drinking despite knowledge of having a persistent or

recurrent problem.

The depressive effects of alcohol make it a significant risk

factor in the development of mental health problems,

particularly depression. If dependence is established, then

withdrawal effects include nausea and vomiting,agitation,tremor, sweating, hallucinations, and seizures.



EPIDEMIOLOGY

According to the National Survey on Drug Use and Health

(NSDUH), in 2012 about669,000 Americans reported using

heroin. This trend appears to be driven largely by young

adults aged 18–25 among whom there have been the

greatest increases.



Alcohol dependence is common, affecting approximately 6.5%

of men and 1.5% of women. It often develops in early

adulthood, but can start at any age after repeated continued

exposure to alcohol beverages.

The prevalence of alcohol dependence varies in different

countries according to the prevalence and patterns of alcohol

consumption, but in some countries, the 12-month

prevalence of alcohol dependence among adult men is as

high as 10-15%.

In Australia, the 12 month prevalence of harmful use of

alcohol is 3.0% while the prevalence of dependence is 3.5%.

Men are twice as likely to experience dependence compared

with women.



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The opioid effects of analgesia, euphoria and sedation are

mediated primarily by the mu receptor. Opioids induce

dopamine release indirectly by decreasing gamma-aminobutyric acid (GABA) inhibition. They also induce

dopamine release directly, by interacting with opioid

receptors in the nucleus accumbens.



The effect of chronic opioid exposure on opioid receptor levels has

not been well defined in humans. Tolerance develops throughmultiple mechanisms, including an acute desensitization of the

opioid receptor (which develops within minutes of opioid use and

resolves within hours after use), and a long-term desensitization

of the opioid receptor (which persists for several days after

removal of opioid agonists). Changes also occur in the number ofopioid receptors[25], and there is compensatory up-regulation of

the cyclic adenosine monophosphate (cAMP) producing enzymes.

When the opioid is withdrawn, the cAMP cascade becomes

overactive, leading to the “noradrenergic storm” seen clinically

as opioid withdrawal, which may create a drive to reinstate

substance use. The intensely dysphoric withdrawal syndrome ischaracterized by watery eyes, runny nose, yawning, sweating,

restlessness, irritability, tremor, nausea, vomiting, diarrhoea,

increased blood pressure, chills, cramps and muscles aches; it

can last seven days or even longer.



EFFECTS OF HEROIN USE



TREATMENTS

Three types of medications include:

1. Opioid agonist maintenance treatment,

which activate opioid receptors

2. Partial agonistswhich also activate opioidreceptors but produce a smaller response

3. Antagonists,which block the receptor and

interfere with the rewarding effects of opioids.



TREATMENTS

Oral methadone liquid and sublingual buprenorphine tablets are the medications

most widely used for opioid.

Methadone (Dolophine® or Methadose®) is a slow-acting opioid agonist.

Methadone is taken orally so that it reaches the brain slowly, dampening the

“high” that occurs with other routes of administration while preventing

withdrawal symptoms. The initial methadone dose should be 60-120 mg.

Naltrexone can be useful in preventing relapse in those who have withdrawn from

opioids, particularly in those who are already motivated to abstain from opioid

use. Following opioid withdrawal, patients who are motivated to abstain from

opioid use should be advised to consider naltrexone to prevent relapse.

Buprenorphine (Subutex®) is a partial opioid agonist. Buprenorphine relieves

drug cravings without producing the “high” or dangerous side effects of other

opioids. Suboxone® is a novel formulation of buprenorphine that is taken orally or

sublingually and contains naloxone (an opioid antagonist) to prevent attempts to

get high by injecting the medication.



Psychosocial treatment

Psychosocial interventions including cognitive and

behavioural approaches and contingency management

techniques can add to the effectiveness of treatment, if

combined with agonist maintenance treatment andmedications for assisting opioid withdrawal. Psychosocial

services should be made available to all patients, although

those who do not take up the offer should not be denied

effective pharmacological treatment.



MANAGEMENT



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Journal Reading Noby

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