The Dangerous Disorders Caused by Opioid Use

Disorders from opioid use were, until the 1990s, the most frequent drug poisonings. Its consumption is a risk factor associated with accidental death due to acute intoxication or mixed intoxication.

Opioids include natural, semi-synthetic and synthetic substances. Among the natural ones are opium and morphine, among others. Regarding semisynthetics, we can highlight heroin and hydromorphine. Finally, methadone and meperidine can be classified as synthetic opiates.

Of all these substances, heroin is the most consumed. Thus, opiate users can be divided into heroin addicts and opiate abusers by prescription or "medical addicts." The latter are usually pain patients or health professionals who have access to medications.

Opiate toxicity mechanism

Opioid consumption disorders are triggered by the ability of these substances to interact with μ, δ and κ receptors.

However, the agonist effects on the μ receptor are the predominant factor in the development of the disorders. In addition, opiate overdose can lead to death by a lethal effect. This is due to its direct action on the respiratory center, which is characterized by respiratory depression and death.

Opioid use disorders are characterized by a series of clinical manifestations that can help with diagnosis. The symptom characteristic triad is:

  • Punctiform pupils: this symptom in particular makes it possible to differentiate an opioid poisoning from another substance.
  • Respiratory depression: is a respiratory disorder characterized by slow and ineffective breathing.
  • Coma.

Although these are the most characteristic symptoms, analgesic effects may also appear, as well as constipation, sweating or decreased libido in the chronic use of opiates.

On the other hand, a series of complications can also occur. Prolonged hypoxia, respiratory acidosis, rhabdomyolysis (leads to muscle necrosis) and hypothermia (due to central depression) are examples of the complications that can occur in opioid use disorders.

Diagnosis and treatment

A good diagnosis of opiate poisoning is made from the clinical manifestations described above in addition to an analytical determination. This technique is carried out by immunoassay or chromatography.

Another diagnostic method is the differential diagnosis. It consists in treating individuals with an antidote, naloxone, and observing whether or not it reverts the intoxication picture.

This antidote also serves as a treatment for opiate poisoning. It is a very potent and effective opioid receptor antagonist. It reverses the effects quickly, it takes between 3 and 4 minutes to reverse the characteristic triad. There are situations that require repeated dose administration due to its short half-life.

Disorders due to opioid use: pharmacopoeias

The chronic consumption of opiates produces a picture of drug dependence that is characterized by:

Compulsion to continue taking the drug

Tolerance: is the ability of our body to resist and accept the administration of certain substances having to increase the dose of them to achieve the same effects as at the beginning.

Risk of associated overdose.

Associated organic pathologies (related to the route of administration: for sharing syringes, infections such as hepatitis or AIDS).

Physical dependence: this dependence triggers the appearance of the withdrawal syndrome that, although it does not suppose a vital risk for the individual, is unpleasant. It can last from weeks, in its acute phase to months in its late phase.

Treatment of opiate withdrawal syndrome

Methadone, which is a synthetic opiate agonist, is used for detoxification. It can be administered orally, thus avoiding the associated pathologies, and it has a longer half-life than morphine and heroin. This fact keeps the opiate levels in time.

Depending on the doses that the individual was taking, the amount of methadone to be administered is calculated. In order to avoid overdose, daily jars equivalent to one-day doses are given. These doses are gradually reduced until their final suppression.

After detoxification, there is a period of detoxification. At this time, the risk of relapse is very high and it is when the social reintegration of the drug addict is sought.