PHAR0003

What are opioids? - ANS Opioids: • Street use - not for physical pain states. • Patients (signalling in pain pathways) - used in presence of pain. Presence of opioid in presence of pain does not have same effect as recreational use. • Self administration and access, but patient controlled analgesia (PCA) also involves self administration. • Animals and patients pick doses. • Heroin vs morphine - same drug. • Pain must counter reinforcement. • Patients become physically dependent. • SM - control of the pain. What are the changes in opioid use? - ANS Changes in opioid use: • Kratom - mitraygnine - herbal opioid used by middle aged mid-income users for pain and anxiety. • Opiophobia - fears of addiction in pain patients. • Based on oxycodone - widely prescribed in the US, in poor area, diversion widespread - 30,000 deaths per annum from overdose. • Fentanyl is a synthetic opioid that is highly potent and mixed with heroin. Pain may block dopamine and reward: - ANS IMAGE How do individuals get their drugs in the UK? - ANS How individuals get their drugs: • 65% of individuals say they receive drugs from their friends. • 25% of individuals say they known their dealer. • 10% of individuals say the do not know their dealer. How much do individuals spend on drugs? - ANS 0 = 39% 40 = 31% 40-100 = 16% 100-200 = 5% 200 = 8% Drugs and me - UCL study: - ANS IMAGE What is the current drug use in Europe? - ANS IMAGE Drug use study in the UK from individuals: - ANS IMAGE How has the purity of drugs changed? - ANS IMAGE What are examples of drugs that have appeared more recently? - ANS IMAGE What are the pharmacoeconomics of various drugs? - ANS IMAGE Difference between alcohol and cannabis? - ANS • Drug on the left (alcohol) is legal, drug on the right (cannabis) is illegal. University of Essex cannabis research - if cannabis was legalised: - ANS IMAGE What are the effects of prohibition - making a drug illegal (alcohol)? - ANS IMAGE What is drug dependence? - ANS Drug dependence: Drug dependence = a physical or psychological state, resulting from an interaction between a drug and organism, characterised by a compulsion to take the drug on a periodic or continuous basis to experience its psychic effects and/or avoid the discomfort of its absence. • Wish, need, desire, craving - psychological (all drugs). • Physical withdrawal - only depressant drugs (opioids, alcohol). How do inhibitory and excitatory drugs use different mechanisms to increase the levels of dopamine within the brain? - ANS • Inhibitory and excitatory drugs use different mechanisms to increase the levels of dopamine within the brain. What are reward dependence systems? - ANS Reward dependence systems: IMAGE 20% of individuals that go through withdrawal stay clean: - ANS • If the reason and incentive for use is still present, most individuals will go back to the drug. • However, binge drinking in young adults is down to 18% from 29% a decade ago - resorted to trying new drugs? Example - Vietnam war: • The Vietnam war shows that the environment and circumstances for drug use was a very powerful drive for the majority of soldiers. What treatment is available for individuals that are dependent? - ANS Treatment for dependence: • 20-30 years ago aversion therapy was used (chemicals that interacted with drugs). Antabuse was used for alcohol, which made consuming alcohol a very unpleasant experience. • Most successful treatment for opioid use is substitution drug therapy. Methadone is an opioid that can be prescribed, is a liquid, and is long lasting. It also takes individuals away from the environment they were using drugs in. • Clinics are extremely expensive facilities where many celebrities go to undergo drug rehabilitation.