Heroin is often abused, and the abuse of prescription and subject to the narcotics law opioid-containing analgesics (eg., Morphine, oxycodone, hydrocodone and fentanyl) to said development is partly attributed to the fact believed that these painkillers are initially taken legally of pain patients , Patients with chronic pain who need opioids for a long time, should not be referred to as “dependent” or “addict” even if there can be some problems with regard to the development of tolerance and physical dependence. People who are taking opiates parenterally have a risk of all complications of drug use by injection.
Opioid is a term for a series of natural materials (originally derived from the opium poppy) and their semi-synthetic and synthetic analogs that bind to specific opioid receptors. Opioids are potent analgesics that are frequently abused, as they are widely available and have euphoric properties. See also opioid analgesics and opioid toxicity and weaning. Heroin is often abused, and the abuse of prescription and subject to the narcotics law opioid-containing analgesics (eg., Morphine, oxycodone, hydrocodone and fentanyl) to said development is partly attributed to the fact believed that these painkillers are initially taken legally of pain patients , Patients with chronic pain who need opioids for a long time, should not be referred to as “dependent” or “addict” even if there can be some problems with regard to the development of tolerance and physical dependence. People who are taking opiates parenterally have a risk of all complications of drug use by injection. Opioid use disorder A opioid use disorder involves obsessive, long-term self-administration of opioids for non-medical purposes. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) assumes that a Opiodkonsumstörung present when the use causing clinically significant impairment or distress, which are characterized by the presence of ? 2 of the following over a period of 12 manifest months: opioids to take in larger amounts or for a longer time than planned Persistent desire or unsuccessful attempt to reduce opioid use a lot of time is used for the collection, use and Recreation opioid craving opioids Repeated failure to comply with obligations at work, to home or school due to opioids the ongoing Opiodlkonsum although why recurrent social or interpersonal problems are present. Abandonment of important social, occupational or recreational activities because of opioids opioid use in physically dangerous situations more use of opioids in spite of a physical or mental disorder that is caused by opioids or worse. Tolerance to opioids (a criterion for medical use) opioid withdrawal symptoms or taking opioids for withdrawal therapy for severe, recurrent dependence is preferred to maintain a controlled opioid withdrawal and detoxification. For controlled maintenance buprenorphine or methadone is used. Continued counseling and support doctors need to know the federal, state and local regulations on the use of opioids to treat addicted patients. To treat an addict in a legal manner with an opioid-containing medication, the doctor must prove the existence of opioid dependence. In the US, the treatment is continued by the negative social attitude towards addicts impaired (including settings of law enforcement, by physicians and other healthcare officials) and in relation to treatment programs that consider some as encouraging drug use. In most cases, the doctor opioid dependent patients should be transferred to specialized treatment centers. However, if they are trained for this, doctors can treat outpatients in special cases. In European countries, access to long-term methadone or Buprenorphinprogrammen and alternative ways of treatment is easier and the stigma by prescription of psychoactive substances is not as pronounced. Maintenance treatment Long-term treatment with oral opioids such as methadone or buprenorphine (an opioid agonist-antagonist) is an alternative to substitution treatment with continuous reduction. Oral opioids suppress withdrawal symptoms and the strong desire for the substance. However, it comes after the capture at no “kick” and no strong sedation. In addition, the problem of obtaining fair falls away what the patient makes it possible to find social connection again. In the US, there are thousands of opioid addicts in licensed methadone programs. For many of these programs are a good solution. Since the participants, however, continue to play an opioid, many parts of society disapprove of these programs. Selection criteria are: A positive result in a test for opioids Physical dependence> 1 year with continuous use of opioids or even longer intermittent use evidence of a withdrawal or physical findings that a substance use show doctors and patients must decide whether a withdrawal (detoxification) is displayed or an opioid maintenance therapy. In general, patients take a severe, chronic and repeated dependence with opioid maintenance treatment better. Withdrawal and detoxification, while effective in the short term, poor results show in patients with severe opioid dependence. Which therapy is also chosen, they must be accompanied by ongoing mentoring and support measures. Methadone is often used, doctors can begin the substitution, but then the administration of methadone should be monitored in a licensed methadone program. Buprenorphine is increasingly used for the long-term treatment. Its effectiveness is comparable to that of methadone, and because it blocks the receptors, it inhibits the same time the demand for illegal substances like heroin or other opioids. Buprenorphine can be prescribed for outpatient treatment by specially trained doctors, including family physicians who have the necessary training to and are state certified. The dose of buprenorphine is usually p.o. at 8 or 16 mg once a day. Many patients prefer this option because it makes the necessity of staying in a methadone clinic obsolete. Buprenorphine is also available in combination with naloxone. The addition of naloxone can further prevent the craving for illicit opioids. This drug combination is used in outpatient treatment. The SAMHSA Web site provides additional information about buprenorphine and the necessary training for the qualification of “waivers” to prescribe the drug. Protocols for the use of buprenorphine for detoxification or maintenance treatment are available for download from the US Department of Health and Human Services. Naltrexone, an opioid antagonist, blocks the effects of heroin. The usual dose is 50 mg once daily or 350 mg per week, divided into 2 or 3 doses. A monatlichlich i.m. to be administered depot preparation is also available. As Naltrexone is an opioid antagonist and has no direct agonist effect on opioid receptors, naltrexone is often unacceptable for opioid-dependent patients, especially for those who are chronically and repeatedly dependent on opioids. opioid maintenance treatment is much more effective for such patients. Naltrexone may be useful for patients with less severe dependence, early-stage opioid dependence and a strong motivation to remain abstinent. For example, opioid-dependent health workers may be excellent candidates for naltrexone because they know that their professional future depends on the success of the therapy. Levomethadyl acetate (LAAM), a longer-acting opioid, which is related to methadone, is no longer used because it causes QT interval abnormalities in some patients. LAAM is taken 3 times a week in the doctor’s office. Thus, the daily doctor visits, and unnecessary problems with the taking at home are avoided. A dose of 100 mg three times a week with the administration of methadone 80 mg once daily compared. Clinical Calculator: QT interval correction (ECG) Support Much of the treatment of opioid dependence takes place in outpatient settings, usually in licensed opioid treatment programs, but increasingly also in doctors’ offices. The concept of therapeutic community, which was developed in the US with “Daytop Village” and “Phoenix House” includes a drug-free treatment in community residential facilities where get-dependent training, education and support so they can build a new life. Participants often live for 15 months in one of these communities. This concept could help some addicts, and has made some even brand new people. However, the drop-out rates at the beginning are extremely high. Open remains how well these communities work, how many offered and how far they are to be financially supported by the company. For more information Daytop Village Phoenix House US Substance Abuse and Mental Health Services Administration (SAMHSA)