Opiate addiction

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Opiate addiction is the name given to a medical diagnosis. Opiate addiction is essentially characterized by the continued use of opioids or opiates, regardless of negative health and social consequences, as well as the occurrence of physical withdrawal symptoms after the end of consumption.

frequency

It is estimated that there are around 150,000 opiate addicts in Germany. For 90% of them, heroin was or is the main opiate or opioid consumed. Around half of all opiate addicts in Germany (as of 2015) are in substitution therapy , in the context of which they receive opioids such as methadone, buprenorphine or morphine as a substitute for heroin.

opiate

Opium poppy ( Papaver somniferum ) from whose milk opiates are obtained

Opiates are the natural substances found in opium . Opium is obtained from the dried milky sap of the opium poppy ( Papaver somniferum ). It consists of numerous alkaloids , with morphine being the main alkaloid of this plant. Alkaloids contain nitrogenous compounds that affect the nervous system, so they are also used as medicinal and intoxicants. Heroin, the best known opiate, is a diester of acetic acid .

The German pharmacist Friedrich Sertürner isolated morphine from opium for the first time in 1803/1804. Almost 100 years later, Bayer brought heroin onto the market as a pain reliever.

Opium poppies are grown in the "Golden Crescent" (Afghanistan, Pakistan, Iran), the " Golden Triangle " (Thailand, Laos, Burma) and Mexico. Currently, more than 80% of the world's opium production, a total of 5800 tons, comes from Afghanistan.

Since the 1960s, the consumption of heroin has also increased in the German-speaking area. The manufacture, possession, and distribution of heroin is prohibited without proper authorization. Heroin, chemically called diamorphine or diacetylmorphine , has been permitted in Germany since the Bundestag resolution of May 29, 2009 for the treatment of severely dependent people. Synthetically produced opioids (except tramadol ) are also subject to the Narcotics Act (BtMG) in the Federal Republic of Germany .

Opioids

Opioids, in contrast to opiates, are made fully synthetically, e.g. B. oxycodone , methadone , tilidine etc. These substances are called exogenous (not produced by the body) opioids. On the other hand, a distinction is made between endogenous opioids (produced by the body itself), so-called endorphins ("happiness hormones"). Strictly speaking, heroin is also an opioid, as it is not found in its natural substance in opium and is only processed into heroin using a chemical process (semi-synthetic).

Side effects of opioids and opiates

Common side effects are sedation , respiratory depression , bradycardia , hypotension, miosis, and constipation . When taking it for the first time, nausea and vomiting can also occur. An overdose or the combination with other sedating substances (such as alcohol and benzodiazepines) can lead to life-threatening respiratory failure.

Opiate addiction

Heroin is the most commonly abused opiate. It is usually taken up intravenously or by inhalation; nasal or oral application is also possible. Consumers describe the desired psychotropic effect as euphoric, anxiety-relieving, pain-relieving, sleep-inducing and describe a pleasant feeling of indifference.

Heroin is characterized by psychological and physical dependence that occurs within a short period of time. Psychological dependence is the most serious and almost insurmountable problem. The central criterion here is the uncontrollable craving for the effects of the addictive substance. The physical and mental health takes a back seat. Social contacts and integration also suffer greatly from the influence of addiction.

For the addict, the intoxicant is the center of life. In order to purchase the drug every day, he needs larger amounts of money. As a result, unemployed and low-income opiate addicts in particular have to secure funding through illegal activities or prostitution. The resulting crime against acquisitions is a significant social problem.

A distinction is made between different forms of drug abuse. A distinction must therefore be made between procurement offenses, including the trafficking and smuggling of illegal drugs, fraud in the sale of drugs, inducing others to abuse and the so-called “white-collar crimes” (white-collar crimes). In addition, there are direct and indirect procurement offenses aimed at acquiring money to procure drugs. A third category is the sequential sequence. These include direct offenses such as B. Aggression or street offenses under the influence of drugs, and indirect offenses such as begging or prostitution.

Dependency criteria according to the ICD-10

The ICD-10 ( International Statistical Classification of Diseases and Related Health Problems ) deals with internationally recognized classifications and criteria for clarifying medical diagnostics. To diagnose “drug addiction” or dependence on illegal drugs, at least three of the following symptoms or behaviors must have occurred during the past year:

  1. a strong desire or compulsion to consume the psychoactive substance,
  2. reduced ability to control consumption (loss of control ),
  3. Substance use with the aim of alleviating withdrawal symptoms,
  4. physical withdrawal syndrome,
  5. Development of tolerance (getting used to higher doses),
  6. progressive neglect of other pleasures or interests,
  7. persistent drug use despite evidence of clear harmful consequences (such as fatigue, depressive mood, loss of job) and
  8. restricted behavior pattern in handling the substance.

Withdrawal symptoms

The first symptoms of withdrawal become noticeable about 4–6 hours after the last opiate consumption. The consumer feels fears and the compulsion to take heroin again. The thoughts revolve around the procurement of further supplies of heroin. After 8 hours there are also: Yawning (occasionally so strong that the jaw dislocates), runny nose, tears, sneezing, sweating, goose bumps, body temperature fluctuations and itching. After about 12 hours, the symptoms worsen and there are also dilated pupils, muscle twitching, restless legs , muscle and bone pain. Some symptoms are similar to those of a strong flu. Symptoms worsen for up to 24 hours and more are added. These include hypertension , fever, tachycardia , tachypnea up to shock, muscle cramps, hypoglycaemia and diarrhea . Food intake is difficult due to stomach cramps and vomiting. During withdrawal, the patient goes through emotional states of emergency. The symptoms of " cold withdrawal " can hardly be alleviated during the acute phase, but they subside after about 4 days. The patient slowly stabilizes himself mentally and physically. The physical detox is complete after about 14 days. The craving for the drug, i.e. the psychological addiction, persists.

Health side effects of opiate addiction

Due to unsanitary conditions, intravenous administration often leads to bacterial infections and viral infections, abscesses , liver, kidney and joint diseases. About 80% of heroin addicts are hepatitis C positive. Other infections, such as AIDS and hepatitis B , are also a frequent consequence of the conditions under which the consumption takes place, since the unhygienic exchange of the injection set occurs without sufficient possibilities to obtain sterile consumables.

Methadone is also known to have the potential to prolong the QT time . This problem can be solved by switching to levomethadone .

The mortality among opiate users is 6 to 20 times higher than their peers in the general population.

The majority of heroin addicts suffer from comorbid mental disorders (double diagnoses) such as anxiety disorders (43–46%), affective disorders (34–46%), psychoses (5–15%) and eating disorders (5%). Often they existed before substance use began. The self-medication hypothesis of According Kantzian use those affected heroin to hide or treat their fears and moods. Therefore, these diseases often only come to light during and after detoxification treatment. If these ailments are not treated successfully, there is an increased risk of relapse.

Individual evidence

  1. ^ Kunstmann, Wilfried; Hessenauer, Frieder: Substitution of opiate addicts: supply becomes more difficult. Deutsches Ärzteblatt 2009; 106 (30): A-1508 / B-1289 / C-1257
  2. ↑ Federal Office for Drugs, Report on the Substitution Register, January 2016
  3. ↑ European Monitoring Center for Drugs and Drug Addiction (EMCDDA) (2010): National report 2010: Germany. August 8, 2012.
  4. ↑ Bernd Schäfer: Natural substances in the chemical industry , Spektrum Akademischer Verlag, 2007, p. 236, ISBN 978-3-8274-1614-8 .
  5. ^ T. Velocity: Intoxicating drugs. Springer, Berlin 2003.
  6. ↑ P. Loviscach (1996): Social work in the field of addiction. An introduction. Lambertus-Verlag, Freiburg im Breisgau 1996.
  7. ↑ Afghanistan's opium farmers have record sales. In: Süddeutsche Zeitung. August 8, 2012.
  8. ↑ German Bundestag: Plenary Protocol 16/224 of May 28, 2009: Draft of a law on diamorphine-based substitution treatment. 2009.
  9. ↑ a b c A. Batra, O. Bilke-Hentsch: Praxisbuch Sucht. Thieme, Stuttgart 2012.
  10. ^ E. Freye: Opioids in medicine. Springer, Berlin 2009.
  11. ↑ a b W. Schmidbauer, J. vom Scheidt: Handbuch der Rauschdrogen. Fischer, Frankfurt am Main 2003.
  12. ↑ K. Kegel, B. Hoffmann: The substitution therapy. 2nd Edition. Scientific publishing company, Stuttgart 2010.
  13. ^ W. Heinz, T. Poehlke, H. Stöver: Glossary: ​​Substitution therapy in drug addiction. Springer, Berlin 2010.
  14. ↑ A. Kreuzer, R. Römer-Klees, H. Schneider: Beschaffungskriminalität drug addicts. Federal Criminal Police Office (Ed.), Volume 24, BKA research series, Wiesbaden 1991.
  15. ↑ a b H. Dilling, W. Mambour, H. Schmidt: International Classification of Mental Disorders: ICD-10. 2nd Edition. World Health Organization, Huber, Bern 2008.
  16. ↑ E. Beubler, H. Haltmayer, A. Springer (Eds.): Opiate Dependence - Interdisciplinary Aspects for Practice. Springer, Berlin 2007.
  17. ↑ ECG: QT - prolongation by methadone. Retrieved March 4, 2020 .
  18. ↑ E. Beubler, H. Haltmayer, A. Springer (Eds.): Opiate Dependence - Interdisciplinary Aspects for Practice. Springer, Berlin 2007.
  19. ↑ YI Hser, E. Evans, C. Grella, W. Ling, D. Anglin: Long-term course of opioid addiction. In: Harvard review of psychiatry. Volume 23, number 2, 2015 Mar-Apr, pp. 76-89, doi : 10.1097 / HRP.0000000000000052 , PMID 25747921 (review).
  20. ^ I. Maremmani, M. Pacini, P. Pani et al .: The mental status of 1090 heroin addicts at entry into treatment: should depression be considered a 'dual diagnosis'? 2007. PMC 2216008 (free full text).
  21. ↑ Comorbid mental disorders in opiate addicts . Addiction Therapy 2014; 15 (01): 22-28