- 1 What is Opiate (Opioid) Addiction?
- 1.1 What are the Risk Factors that May Cause Opiate (Opioid) Addiction?
- 1.2 How to Treat Opiate (Opioid) Addiction in Turkey?
What is Opiate (Opioid) Addiction?
Opiate (Opioid) is the name of the class of painkillers that are obtained from poppy, contain morphine, give a relaxation effect to the person and create addiction over time. Its regular use results in Opiate (Opioid) Addiction. Heroin, codeine, morphine, methadone, buprenorphine (suboxone, subutex) etc. are in the opiate class.
Opiates are very effective in pain relief, they have been used historically for the relief of acute, severe and chronic pain in diseases such as cancer. It is also aimed to relieve surgical pain. People can develop addiction to opiates during medical treatment. We see that the health professionals who have access to drugs and people who have relationships with medical providers can develop opiate (opioid) addiction. Long-term use of these drugs causes the development of tolerance in the person, that is, the person should increase the dose after a while in order to feel the effect of the drug. This is how opiate (opioid) addiction develops.
Among people with opiate (opioid) addiction, heroin use is the most common. It was previously produced to be used as a drug in the treatment of tuberculosis and morphine addiction, but when it was understood that it caused severe addiction, it was discontinued as a drug and its use was prohibited.
Methadone is a synthetic opiate produced for use in heroin therapy. It is used as a replacement therapy for heroin addiction in the UK, USA, Australia and some European countries. When people started to show addiction to methadone, the drug suboxone was produced to be used for heroin treatment.
Suboxone is a combination of Buprenorphine and Naloxone. It is produced with the aim of low abuse potential. It is used in substitution treatment in Turkey. Like Methadone, Suboxone blocks the opioid receptors in the brain, thereby closing the ports to which heroin will bind. In summary, both are drugs that are produced to prevent heroin withdrawal and cravings, which can cause addiction when abused.
What are the Risk Factors that May Cause Opiate (Opioid) Addiction?
Risk factors for opiate (opioid) addiction may be genetic, environmental, or lifestyle related. From a genetic point of view, some people appear to be more prone to becoming addicted. In addition, factors such as the person’s previous substance use, depression or other psychiatric disorders, childhood neglect and abuse, certain character traits (impulsivity, sensation seeking), low socioeconomic status, being in contact with people with opiate abuse or other substance addictions, easy access to prescription or illegal opiates, etc. are risk factors for people to develop opiate (opioid) addiction. The combination of these risk factors puts people at greater risk of developing an opiate (opioid) addiction.
How to Know if a Person is an Opiate (Opioid) Addicted?
A psychiatrist can decide whether a person is opiate (opioid) addicted by evaluating the patient’s compliance with the diagnostic criteria specified in the Opiate Disorder section of the DSM (Diagnostic and Statistical Manual of Mental Disorders).
The diagnostic criteria in the opiate disorder section of this handbook include the following in summary; The person uses more than he wants and for a long time, although he wants to quit opiates, his efforts are inconclusive, he is very busy in obtaining and using opiates, he has an intense desire to use opiates, he has difficulty in fulfilling his responsibilities, he continues to use despite having problems with society and his relatives, he cannot spare time for activities other than opiate use, uses opiates in situations that may be dangerous, uses opiates even though he knows that it causes physical or mental problems, increases the dose to feel the effect of opiate, and experiences withdrawal when not using it. Accordingly, if at least two of the conditions mentioned are present within twelve months, the person can be diagnosed with opiate (opioid) addiction. (Get original diagnostic criteria from DSM).
What are the Problems Caused by Opiate (Opioid) Addiction?
Opiate (opioid) addiction is a chronic disease that can cause physical, social and economic problems.
In physical terms, opiate (opioid) addiction causes severe withdrawal symptoms. This, on its own, is a problem for people with opiate (opioid) addiction. Symptoms such as widespread body aches, abdominal pain, diarrhea, sweating, bone, joint and muscle pain, insomnia, intense desire for opiates, dilated pupils, restlessness, yawning, tearing, runny nose, sneezing, loss of appetite can be seen in opioid withdrawal. Similar withdrawal symptoms occur with all opiates. However, the time and severity of withdrawal vary according to the type of opiate. In addition, opiate (opioid) addiction affects breathing, digestion and blood pressure in the long term. It causes constipation, stomach spasms, dizziness and tooth decay. An overdose of opiates can lower the heart and breathing rate to dangerous levels, resulting in death.
Opiate (opioid) addiction causes difficulties in business life and negatively affects relationships with their relatives.
What are the Most Common Psychological Problems with Opiate (Opioid) Addiction?
Opiate (opioid) addiction with a psychiatric disorder is very likely to be seen. Depression, generalized anxiety disorder, panic disorder, attention deficit and hyperactivity disorder, bipolar disorder, post-traumatic stress disorder, sexual dysfunctions are among the most common psychological problems with opiate (opioid) addiction. People with opiate (opioid) addiction may also have sleep problems and a risk of suicide.
How to Treat Opiate (Opioid) Addiction in Turkey?
Opiate addiction treatment in Moodist is in the form of inpatient treatment. For this treatment, the person must accept hospitalization voluntarily. Within the framework of the HAP (Accelerated Detoxification Program), patients go through a 4 night and 5 day detoxification process by being hospitalized. (Depending on the type of opiate that patients develop addiction to, the length of stay in the hospital may be longer). In this process, the withdrawal symptoms of the patients are regularly monitored every day. In this process, patients receive psychological support as well as serum and drug support to quit opiates. The clinical psychologist conducts an individual interview with each patient. In this meeting, risky situations that may lead people to use opiates, prevention of reuse and methods of coping with cravings are discussed. In addition, addiction tests, psychoeducation and group therapies are applied to patients with opiate (opioid) addiction. In addition, patients can participate in psychosocial activities (training, art therapy, etc.) that will contribute to recovery.
Patients hospitalized for opiate (opioid) addiction receive implant (chip, pellet) treatment before noon on their last day after the hospitalization is completed. The patients are discharged after the implant is placed under the skin. After the implant is placed, it is recommended that the family meet the discharged patient and accompany him to the place where he will stay. Apart from the implant included in the Accelerated Detoxification Program, our hospital also has outpatient implants. Patients who do not receive implant treatment for any reason can be given medication after detoxification.
Implant treatment will prevent people with opiate addiction from craving substances. The effect period of the applied implant is approximately 3 months. In order not to be in a risky situation, it is recommended to take at least four implant treatments every two and a half months, that is, every seventy-five days, when the time comes. The reason for this is that recovery in opiate addiction occurs within a year. Implant treatment, which is taken on time and continuously, allows the person with opiate addiction to reach the Detoxification period necessary for recovery and protects the person against opiate use.
Although quitting opiate use is an important step, it alone is not enough for recovery. Opiate (opioid) addiction is a chronic disease that requires addicted people to take lifelong precautions. Therefore, it is necessary for people to make life changes (Staying away from addicted friends, being away from the risky area/neighbourhood in terms of substance use, a planned living arrangement to keep oneself busy, giving importance to physical activity and nutrition, etc.) to prevent reuse. People with opiate addiction must continue psychological treatment after drug treatment. It is important for them to continue psychiatric examination and speech therapy at certain intervals.
Accelerated Detoxification Program (H.A.P)
“Rapid detoxification” aims at symptomatic relief that will allow patients to tolerate the procedure. The process of accelerating withdrawal from heroin (or other opioids) by administration of an opioid antagonist. HAP is not a routine treatment, it is a method that should be used in patients requiring short-term hospitalization. In the treatment of HAP, a treatment program is organized for each patient. It should be applied together with long-term psychosocial treatment rather than used alone.
Symptoms such as common body aches, abdominal pain, hot and cold flushes, bone, joint and muscle pain, insomnia and/or disturbed sleep, cramps, craving for opioids, restlessness, yawning, tearing, sneezing, loss of appetite can be seen in opioid withdrawal.
Our clients who will participate in the HAP program must first of all come voluntarily and accept the hospitalization. It is not appropriate to be hospitalized with the compulsion of family members or relatives. It would be more appropriate to include patients with good social support and no depression in the program History of psychosis, heart disease, chronic kidney failure, severe liver disease (jaundice, encephalopathy, etc.), pregnancy, and alcohol, benzodiazepine or stimulant addiction are not included in the treatment program.
Before hospitalization, the patient is informed about minimizing the amount of substance used. Before hospitalization, information is given about the side effects of the HAP and the problems it may experience. Make client the admission approval form signed. The patient and the family are informed about the importance of follow-up after hospitalization. The patient and family are informed about the clinical rules. Urine screening tests are done.
HAP treatment at Moodist Psychiatric Hospital was planned as 4 nights and 5 days. We planned the hospitalization to be short-term (patients do not want to stay in bed for a long time) and low-cost. During the patient’s stay, serum and drug therapy (to minimize both cravings and withdrawal symptoms) are applied for rapid detoxification.
Withdrawal symptoms are monitored daily on a regular basis. Psychosocial support is started. As psychosocial support, group therapy, individual psychoeducation, artistic activities (such as marbling and wood painting are organized on certain days of the week). At the end of the process, that is, on the 5th day, the opioid antagonist naltrexone implant is applied under the skin in the abdomen. The effect period of the applied implant is 3 months. Naltrexone implant binds to opioid receptors in the brain, preventing heroin cravings and withdrawal. When the effect period of the implant is over, there is a tendency to opioid again. Therefore, it is recommended to install the implant repeatedly, not once, but to provide protection for at least one year.
Information for Those Who Have a Relative with Opiate (Opioid) Addiction
- Learn about opiate (opioid) addiction, read reliable sources on the subject. Ask your patient’s psychiatrist to inform you about addiction.
- Opiate (opioid) addiction is a disease that progresses with recovery and relapses, prepare yourself for a long treatment process. Collaborate and communicate with the treatment team.
- It would always make sense to encourage the person with an opiate (opioid) addiction to continue treatment. Quitting opiates alone is not enough. Follow the meeting dates and encourage the patient to participate so that the person with opiate (opioid) addiction regularly attends the psychologist and physician meetings.
- As a family, it is important that you support the opiate (opioid) addict, listen without judgment, and make them feel understood. Family relationships weaken in addiction. Develop a relationship with him outside of addiction. Plan activities together.
- While the person with opiate (opioid) addiction is in the treatment process, ask your patient’s decision about the changes you plan to make about him (changing the house, changing his phone number, communicating with his friends, etc.), and decide together with the patient. Likewise, help your patient with opiate addiction plan his life so that he does not have free time after quitting opiates (such as finding a job, assigning some duties and responsibilities, etc.).
- Instead of focusing on the past, pay attention to the present and the future. Focus on what can be done to make the most of the moment with the person with an opiate (opioid) addiction.
- The opiate (opioid) addiction process wounds the entire family. It also pushes family members to misbehave. Avoid hurtful words and accusatory attitudes towards the person with an opiate (opioid) addiction. Your only focus should be on what needs to be done to avoid taking opiates later. Do not forget that patients and family members can receive free therapy support from YEDAM (Green Crescent Counselling Centres).
- Avoid frequently asking the person with an opiate (opioid) addiction if they have relapsed into opiates, as this can lead to triggering and relapses. If you are sure that the person with opiate addiction is turning to reuse, offer him treatment.
The information on this page has been prepared by the Moodist Psychiatry and Neurology Hospital Medical Team.