FATIMAH MASYHUR

201320401011129

MENTAL DISORDERS DUE

TO HEROIN ABUSE

What is opioid?
Opioids are a family of drugs used to relieve pain.
Some opioids, such as morphine and codeine, are made
from the opium poppy plant.
Other opioids are synthetically made from chemicals.
Heroin is a highly addictive, illegal opioid made by adding
a chemical to morphine.
Commonly misused prescription drugs include:

Oxycodone (Percodan, Percocet, OxyContin)

Hydrocodone (Tussionex)
Codeine (Tynelol 1, Tynelol 3)
Morphine
Hydromorphone (Dilaudid)
Meperidine (Demerol)

Heroin
An opiate (narcotic) drug processed from
morphine. Morphine is a powerful drug, and it
naturally occurs in the seedpods of Asian
(opium) poppy plants.
Heroin is a highly addictive drug and the most
rapidly acting of the opiates.

Common street names

Big H
Black Tar
Chiva
Hell Dust
Horse
Negra
Smack
Thunder
Junk
Caballo (Spanish)
8-ball (heroin mixed with crack cocaine)
TNT
Skag

ASIAN HEROIN

BLACK TAR HEROIN

HEROIN POWDER

What is its origin?

Heroin is processed from morphine, a
naturally occuring substance extracted
from the seed pod of certain varieties of
poppy plants grown in:
Southeast Asia (Thailand, Laos, and Myanmar
(Burma)), Southwest Asia (Afghanistan and
Pakistan), Mexico, and Colombia.

It comes in several forms, the main one

being black tar from Mexico and white
heroin from Colombia.

What does it look like?

Heroin is typically sold as white or
brownish powder, or as the black sticky
substance.
Althought purer heroin is becoming more
common, most street heroin is cut with
other drugs or with substances such as
sugar, starch, powdered milk, or quinine.

The Fact
In 2011, 4.2 million Americans aged 12 or
older (or 1.6 percent) had used heroin at
least once in their lives.
It is estimated that about 23 percent of
individuals who use heroin become
dependent on it.

How is it abused?
Injected
It can be mixed with water and injected
with a needle.

Smoked (high purity)

Sniffed/Snorted (high purity)
Heroin can also be smoked or snorted up
the nose.

Paraphernalia

NEEDLE
Syringe used
to inject drugs
directly
into
body, such as
heroin.

PIPE
Made of metal,
wooden, acrylic,
glass,
stone,
plastic, ceramic
materials, used
to
smoke
marijuana,
cocaine
and
other drugs.

In heroin, used to
dissolve drug in
water for injection
purposes

Short plastic
straws, rolled-up
paper tubes
(dollar bills) are
used to snort
powdered forms
of drugs, such as
cocaine or heroin.

 Heroin-dependent patients are at risk

for a wide variety of medical,
psychiatric, and behavioral health
problems.

How does heroin affect the

brain
When it enters the brain, heroin is converted back into
morphine, which binds to opioid receptors.
These receptors are located in many areas of the brain,
especially those involved in the perception of pain and in reward.
Opioid receptors are also located in the brain stem, which
controls automatic processes critical for life, such as blood
pressure, arousal, and respiration.

Heroin overdoses frequently involve a suppression of

breathing. This can affect the amount of oxygen that
reaches the brain and causing hypoxia. Hypoxia have
short- and long-term psychological and neurological
effects, including coma and permanent brain damage.

 After an intravenous injection of heroin, users report

feeling a surge of euphoria (rush) accompanied by:

dry mouth,
a warm flushing of the skin,
heaviness of the extremities, and
clouded mental functioning.
Following this initial euphoria, the user goes on the nod,
an alternately wakeful and drowsy state.

Users who do not inject the drug may not experience

the initial rush, but other effects are the same.
The long-term effects of opioid is brain addiction:

Brain addiction
Tolerance
Dependence, characterized by the need to continue use of the drug to avoid
withdrawal symptoms.
Deterioration of the brains white matter due to heroin use, which may affect:

decision-making abilities,
the ability to regulate behavior, and
responses to stressful situations.

What is its effect on the mind?

Because it enters the brain so rapidly,
heroin is particularly addictive, both
psychologically and physically. Heroin
abusers report feeling a surge of euphoria
or rush, followed by a twilight state of
sleep and wakefulness.

How does it affect the body?

Highly addictive.
Initial surge of euphoria or rush, followed by
a twilight state of sleep and wakefulness
Physical symptoms of use include: drowsiness,
respiratory depression, constricted pupils,
nausea, a warm flushing of the skin, dry
mouth, and heavy extremities.
Overdose symptoms: slow and shallow
breathing, blue lips and fingernails, clammy
skin, convulsions, coma, and possible death.

What Are the Other Health Effects of

Heroin?
Heroin abuse is associated with a number of serious health
conditions, including fatal overdose, spontaneous abortion, and
infectious diseases like hepatitis and HIV.
Chronic users may develop collapsed veins, infection of the
heart lining and valves, abscesses, constipation and
gastrointestinal cramping, and liver or kidney disease.
Pulmonary complications, including pneumonia.
In addition to the effects of the drug itself, street heroin often
contains toxic contaminants or additives that can clog blood
vessels causing permanent damage to vital organs.
Chronic use of heroin leads to physical dependence, a state in
which the body has adapted to the presence of the drug. If a
dependent user reduces or stops use of the drug abruptly, he
or she may experience severe symptoms of withdrawal.

Physical symptoms of heroin

use:

Drowsiness
Respiratory depression
Constricted pupils
Nausea
A warm flushing of the skin
Dry mouth
Heavy.

Withdrawal
One of the most significant effects of heroin
use is addiction.
With regular heroin use, tolerance to the drug
develops. Once this happens, the abuser must
use more heroin to achieve the same intensity.
As higher doses of the drug are used over time,
physical dependence and addiction to the drug
develop.
Users also experience severe craving for the
drug during withdrawal, which can precipitate
continued abuse and/or relapse.

It can begin as early as a few hours after the

last drug administration, can include:
Cardiovascular system
Tachycardia
Hypertension

Central nervous system

Pupillary dilatation
Restlessness
Irritability
Insomnia
Craving

Gastrointestinal system
Nausea
Vomiting
Diarrhea

Skin
Piloerection

Mucous membranes
Rhinorrhea
Lacrimation

 Symptoms of heroin withdrawal

usually begin 4 to 6 hours after last
use and may last for 7 to 14 days.
Withdrawal from heroin is usually
managed with initial dosages of
methadone in the range of 15 to 30
mg per day.

Symptoms Heroine
Overdose
Airways and lungs

No breathing
Shallow breathing
Slow and difficult breathing
Eyes, ears, nose, and throat
Dry mouth
Extremely small pupils, sometimes as small as
the head of a pin (pinpoint pupils)
Tongue discoloration
Heart and blood
Low blood pressure
Weak pulse
Skin
Blue lips and fingernails
Clammy skin

Two main treatment options are

available:
Withdrawal management
Subtitution drug therapies using methadone
or buprenorphine.

Psychiatric Comorbidity

Personality disorders
Depression
Anxiety disorders
Other substance abuse (alcohol,
cocaine, and prescription drugs).
Other behavior-related problems:
family dysfunction, unemployment,
and legal problems.

Medication
Methadone (Dolophine or Methadose) is a slow-acting
opioid agonist.
Buprenorphine (Subutex) is a partial opioid agonist.
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.
Naltrexone (Depade or Revia) is an opioid antagonist.
Naltrexone blocks the action of opioids, is not addictive or
sedating, and does not result in physical dependence;
however, patients often have trouble complying with the
treatment, and this has limited its effectiveness.

Methadon