Opioid, Nicotine &

Phencyclidine AbuseBy: Ismah Haron

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Opioid • Endogenous opioids peptides, natural opium alkaloids

(morphine & codeine), semi synthetic opioid (heroin) and fully synthetic opioids (pethidine & methadone)

• Routes of administration: oral, IM, IV, SC, sniffed or inhaled (chasing the dragon)

• Can be detected in urine: Heroin 36-72h Morphine 48-72h Methadone 72h

• Result of overdose; respiratory depression and DEATH

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DSM IV (Diagnostic Criteria for Opioid Intoxication)

Recent use of opioid Significant psychological changes, with initial euphoria

followed by:• Apathy• Dysphoria• Psychomotor retardation• Impaired judgment, social functioning

Pupillary constriction/ dilation and one of the following:• Drowsiness or coma• Slurred speech• Impairment in attention or memory

Symptoms not due to general medicine 3

DSM IV (Diagnostic Criteria for Opioid Withdrawal)

Either one of the following:• Cessation/ reduction of heavy/prolonged opioid

• Administration of antagonist after a period of use

Three or more of the following:• Dysphoric mood

• Nausea and vomiting

• Muscle aches

• Lacrimation and rhinorrhea

• Pupillary dilatation, sweating

• Diarrhea

• Yawning

• Fever

• Insomnia

Symptoms above cause significant impairment. Symptoms not due to general medical condition.

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Nicotine • Tobacco smoking• Tolerance and dependence develop rapidly• Toxicity and overdose are possible but occur infrequently

5Solanaceae

Features of toxicity• Abdominal pain• Agitation• Breathing difficulty• Convulsions • Diarrhea• Dizziness• Excessive salivation• Headache• Tremors

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DSM IV (Diagnostic Criteria for Nicotine Withdrawal)

• Abrupt cessation use/reduce in amount followed within 24 hours, >4 following signs: Dysphoric/depressed Insomnia Irritability, frustration/anger Anxiety Difficulty concentrating Restlessness Decreased heart rate Increase appetite/ weight gain

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Phencyclidine

• Street names; PCP, Hog, Angel Dust, Loveboat or Lovely• Synthetic substance, commercially developed in the

1950s by the Parke-Davis pharmaceutical company• Previously used as anesthetic drug• Route of administration; oral, IV or smoked• Exhibits both hallucinogenic and neurotoxic effects• Detected in urine up to 48 hours after ingestion• Complications; acute rhabdomyolysis, renal failure and

death due to hyperpyrexia8

DSM IV (Diagnostic Criteria for Phencyclidine Intoxication)

• Recent use of PCP• Significant behavioral changes like assaultiveness,

impulsiveness, unpredictability and impaired judgment.• 2 of the following signs:

Vertical and horizontal nystagmus Hypertension and tachycardia Numbness Ataxia Dysarthria Muscle rigidity Seizures or coma Hyperacusis

• Symptoms are not due general medical condition. 9

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THANK YOU

References: 1. Psychiatry 2nd edition by Neel Burton2. http://www.psychtreatment.com/index.htm3. http://www.mdguidelines.com/

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