Dependence on other psychoactive substances

Introduction to other psychoactive substances There are more than 20 kinds of opioid chemicals used in clinical practice, but they are used in non-therapeutic purposes in China, which leads to a large number of problems, mainly opioids and heroin. There are 9 kinds of diseases related to opioid dependence. They are: 1 Opioid poisoning; 2 opioid withdrawal syndrome; 3 opioid toxic sputum; 4 opioid-induced mental disorder, delusional state; 5 opioid-induced mental disorder, hallucinatory state; 6 opioid-induced emotions Barriers; 7 sexual dysfunction caused by opioids; 8 sleep disorders caused by opioids; 9 associated with opioid use and not classified as described above (Jerome H. Jaffe, 1995). basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: malnutrition hepatitis syphilis tetanus cellulitis thrombophlebitis sepsis AIDS pulmonary embolism constipation

Other psychoactive substances depend on the cause

(1) Causes of the disease

In recent years, the pharmacological effects of opioids have been studied more and more, especially at the molecular level, receptor level and genetic research. Many biological studies have shown that in the various stages of opioid use to addiction, , The , receptors, the dopaminergic system in the brain, the cAMP, the serotoninergic system, the noradrenergic system, and the cholinergic system have changed to varying degrees. The results of each local study seem to We have seen the dawn of solving problems, but when you consider the problem from the human brain as a whole and from the system of people and society, you will find that it is still awkward, such as: flank and nucleus accumbens dopaminergic neurons How are changes in their neurotransmitters formed? What are the connections between them and other neurons and neurotransmitters? What is the relationship between psychosocial factors and neurophysiological changes? What is the role of environment and heredity?

In recent years, opioid dependence is the result of a variety of factors (biological, psychological, social, cultural) interactions, it is a biological-psychological-social disease, various factors in the initial stage of the use of opioids, Both the continuous use phase and the relapse phase after detoxification play an important role. Pharmacological, social, environmental, personality, psychopathological, genetic and family factors are all in the process of opioid dependence. An irreplaceable role (Jerome H. Jaffe, 1995).

(two) pathogenesis

Opioids include opioids, morphine (alkaloids in opioids), heroin (derivatives of morphine), and morphine-like compounds such as pethidine, methadone, etc., which are prone to dependence after abuse. A mandatory pursuit of repeated drug use, can not be liberated, clinically known as opioid addiction, addiction mechanism:

Opioid receptor dysfunction

Drug users enter the body as a source of exogenous opioids, acting on opioid receptors. Due to the continuous intake of a large number of drugs, the receptors produce a series of post-effects, resulting in many internal organs affected by the regulation of normal receptor function. Tissue systems such as norepinephrine system, dopamine system, serotonin system, acetylcholine system, calcium channel system, and intracellular delivery system function imbalance, such as stopping drug use, stopping the supply of exogenous opioids, the above functions The system can not mobilize the endogenous opioid peptide system from its own body to adjust to achieve a steady state balance, which results in the withdrawal of central and peripheral norepinephrine and cholinergic system dysfunction. Syndrome.

According to research, opioids and heroin drugs mainly act through opioid receptors in the brain. After long-term effects of drugs or drugs, opioid receptor systems, opioid receptor-mediated signaling in nerve cells and Its feedback regulation, the interaction between opioid receptors and other receptors and ion channels, the gene expression profile of nerve cells or glial cells, etc., will undergo significant changes, forming opioid and drug-dependent molecules and cells. The basis of learning.

2. From the perspective of behavioral medicine

Opioid addiction is a learned dependent behavior. The euphoric experience of continuous drug use is a strong positive strengthening factor. The painful withdrawal symptoms in the case of detoxification are another strong negative reinforcement from the other side. Factors, such as the time of repeated strengthening, have caused the individual to form a fixed and difficult to correct behavioral pattern, that is, the behavior of repeated recurrence.

Other types of psychoactive substance dependence prevention

1. Opioid-based chemical-dependent three-level prevention program

First-level prevention is aimed at the prevention of the general population, using various media, such as: radio and television, newspapers and magazines, slogans, posters and various propaganda days to publicize the harm of drugs to human beings, so as to raise the public's awareness of drugs. Sexuality, this is an important prevention strategy, but the shortcoming is that it has certain limitations. For example, such prevention methods use a single form that cannot meet the needs of different groups of people. Therefore, it is difficult. Dissemination of effective information to susceptible populations, secondary prevention and tertiary prevention is a supplement to this inadequate prevention strategy.

Secondary prevention indicators for the prevention activities of susceptible populations, such prevention activities must go deep into the susceptible population, and develop corresponding prevention activities according to the actual needs of different groups of people. This prevention activity focuses on the promotion of healthy lifestyles. Involvement of prevention into participatory prevention activities, through the improvement of knowledge, the change of attitudes and the training of social skills, to change the behavior of participants, so as to achieve the purpose of prevention, secondary prevention should be a human-centered And prevention activities that focus on the needs of the population, can such prevention activities be accepted by the target population before they can develop and be sustainable.

In terms of reducing drug demand, tertiary prevention means providing drug users with a series of services such as detoxification, rehabilitation, reintegration and aftercare, with a view to reducing the number of drug users and reducing the demand for drugs. The first, second and third prevention Together, they constitute a disease prevention and control network, complement each other and are indispensable.

Clinical practice shows that treatment of opioid dependent patients can not be limited to detoxification, prevention of relapse, psychological rehabilitation of opioid dependent patients, aftercare, reintegration, life and social skills training Vocational training should be done by professionally trained staff. Rehabilitation treatment includes behavior correction, emotional control, thinking mode training and life outlook education. Foreign rehabilitation programs run by self-medication and self-administered rehabilitation programs are called treatment communities. (therapeutic community).

The treatment community believes that people can change, the collective can promote this change, the hierarchy is the framework for treating the community, the group activity is the soul of the treatment community, the hierarchy system, the responsibility and rights can promote the growth of the individual, and the treatment community focuses on the occupants. Behavioral changes, it emphasizes responsible love and responsible care, the treatment community uses the form of residential treatment, the time is 6 to 18 months, recent research reports indicate that as long as the rehabilitation in the treatment community is completed After the procedure, the success rate of detoxification can rise to 60% to 70% (Page RC, 1983), and the initial experience in China is successful.

The narcotic anonymous (NA) is a self-help organization for drug addicts. The drug addicts participating in the anonymous drug addicts association follow the twelve traditions and twelve steps, and help each other by mutual help, mutual support and mutual supervision. the goal of.

2. Reduce the dependence of opioid chemical dependence

The most closely related injury to opioid chemicals is AIDS. Epidemiological data on AIDS indicate that about 70% of people living with HIV are intravenous drug users, and more innocent women and children are infected. China Yunnan AIDS Monitoring Center According to the data, about 70% of the HIV-infected people in Yunnan Province are injecting drug users. The seroprevalence rate of injecting drug users from local areas is observed. In less than 3 years, injecting drug users in the area The seroprevalence rate has risen sharply from 10% to 72% (Cheng Hehe, 1996; Pan Yifeng, 1997). Therefore, the early investment in prevention work is to reduce more investment in the future. Here are some domestic and international drug abusers. Projects to reduce the risk of drugs, these effective work can reduce input and increase output, thus maximizing the protection of public health and personal legitimate rights.

(1) Methadone maintenance treatment program - By 1996, 121 countries in the world have found intravenous drug use, and 80 countries have reported the AIDS epidemic among intravenous drug users. The spread of intravenous drug use in developing countries has been The intravenous drug use patterns in developed countries are consistent, and the relapse rate of drug users after detoxification is also a major problem in the world today. The successful experience of some countries shows that methadone maintenance treatment can achieve better harm reduction and prevention of AIDS transmission. Joyce H, 1992; Money next year, 1998).

The goals of the methadone maintenance treatment program are:

1 Provide a convenient, legal, medically safe and effective drug for drug users to replace long-term illegal use of narcotic drugs.

2 Maintain the professional and social functions of drug users.

3 Reduce the crime rate, commercial sexual activity and anti-social behavior caused by the use of narcotic drugs.

4 Keep in touch with drug users, provide timely knowledge of disease prevention, social support and psychological counseling, and encourage him or her to gradually quit drugs.

5 reduce the opportunity for drug users to inject intravenously and share syringes to prevent various blood-borne diseases such as hepatitis B, hepatitis C and AIDS.

(2) Needle exchange programThe results of behavioral science research show that knowledge improvement and attitude change are easier to do, but it is very difficult to change one's inherent behavioral patterns. Therefore, alternative behavior is more complete. It is easier to ban a behavior. You need to let intravenous drug users learn to disinfect the syringe. It is not difficult to share the syringe and use the condom. He or she can know that these methods can protect themselves, but if the follow-up service It is not possible to provide disinfection water, clean syringes and condoms for him or her. It is difficult for drug users to ensure that syringes will be disinfected, condoms will not be used when sharing syringes and sexual activity (Joyce H, 1992), needle exchange The objectives of the project are:

1 Provide disinfected syringes for drug users, recycle contaminated syringes, avoid threats to healthy people, educate drug users on safe injection, teach them how to disinfect syringes and disinfect syringes for them water.

2 Keep in touch with drug users and provide them with disease prevention knowledge, social support, psychological counseling and medical services.

3 Reduce the chances of drug users sharing syringes and prevent various blood-borne diseases such as hepatitis B, hepatitis C and AIDS.

(3) Disinfecting syringes, the correct use of condom education programs - there are a large number of high-risk behaviors among intravenous drug users, who can directly and/or indirectly transmit HIV through these high-risk behaviors. The general population goes, so the method of teaching sterile syringes and the proper use of condoms in drug abusers may help slow the spread of HIV in this population.

The goals of self-protection skills training are:

1 Provide self-protection knowledge and skills for drug users to reduce high-risk behavior among them.

2 Keep in touch with drug users and provide timely knowledge of disease prevention, social support, psychological counseling and medical services.

3 Reduce the chances of drug users sharing syringes, prevent blood-borne diseases such as hepatitis B, hepatitis C and AIDS, reduce the number of sexual partners of drug users and reduce unprotected sex, prevent sexually transmitted diseases and AIDS, this project The staff should go to injecting drug users and provide counseling and skills training for them. They recommend that injecting drug users should follow: A. Detoxification: Stop drug use; B. Injecting drug users if they want to reduce or control the danger Can not detoxify: stop the injection; C. If you can not stop the injection: stop sharing or reuse the syringe, needle and other equipment; D. If you can not stop sharing or reuse the syringe: disinfection syringe, E. in terms of sex: a. abstinence; b If you can't abstain from sex: sexual fantasies, masturbation; c. mutual loyal sexual partners, monogamy; d. insist on the correct use of condoms.

Drug abuse is both a public health issue and a social issue. Therefore, multi-sectoral, multi-disciplinary cooperation and complementary knowledge; different approaches to different needs of different groups of people can achieve results, the government formulates policies for macro management, Intensify the investment in prevention work, and the first-level prevention work should always be unremitting, encourage and support government organizations at all levels, and NGOs go deep into different communities and different groups to do prevention projects. Rehabilitation work is the focus of drug demand reduction. Therefore, it is imperative to change the current attitude of light drug rehabilitation, to provide rehabilitation training for drug rehabilitation workers, and to strengthen aftercare. In addition, given the current characteristics of drug abuse and AIDS epidemic in China, it is recommended to combine the prevention work of the two.

3. Other

(1) Strict drug administration.

(2) Combat and ban illegal cultivation and drug trafficking.

(3) Strengthen psychological treatment, reduce the abuse caused by adverse events of life events, family and environment, and focus on strengthening the promotion and management of high-risk groups.

Other psychoactive substances rely on complications Complications malnutrition hepatitis syphilis tetanus cellulitis thrombophlebitis sepsis AIDS pulmonary embolism constipation

On the one hand, malnutrition caused by irregular daily life, low immunity; on the other hand, when intravenous drug use, it can not be strictly disinfected and infected with hepatitis, syphilis, dysentery, tetanus, skin abscess, cellulitis, thrombophlebitis , sepsis, bacterial endocarditis, AIDS, etc., in addition to pulmonary embolism and constipation.

Other types of psychoactive substance dependence symptoms Common symptoms Nausea mobile phone dependence convulsions abdominal pain Emotional dependence fatigue sneezing network syndrome

Opioids are very addictive. For example, morphine 30mg intramuscular injection can be addicted for 2 weeks. If you stop using opioids, you will have withdrawal symptoms. If you apply again, the symptoms will disappear.

1. Characteristics of opioid addiction syndrome

(1) The main manifestation of opioid addicts is behavioral recklessness, often using whatever means to engage in drugs (such as theft, fraud, prostitution, etc.).

(2) The rhythm of daily life is obviously changed (inverted day and night), the diet is reduced, the body is weak, and the libido is diminished; often regretting and having a desire to quit, but it is unable to extricate itself due to drug addiction.

(3) Tolerance: The tolerance of many opioids can be expressed after repeated administration in animal experimental systems and even single nerve devices in vitro. Once the animals are tolerant, they need to increase the dosage to obtain The original effect has been used, the usual dose has been used to reduce the expected drug effect, the patient's tolerance to opioids is increasing, the usual dose of morphine 10mg intramuscular, addicts can use more than 500mg each time, for abuse For opioids, increased tolerance promotes stereotyped behavior and strengthens drug-seeking behavior.

(4) Taking opioids may result in a state of stagnation, which is characterized by alternating depression and dizziness after discontinuation of medication and intermittent depression.

2. Withdrawal syndrome

Addicts often develop pharmacological tolerance in the long-term abuse of opioid drugs. If the drug is reduced or discontinued, there will be withdrawal syndromes including subjective symptoms and objective signs. In general, the ring The break syndrome includes the following aspects.

(1) Psychiatric symptoms are mainly internal sensuous discomfort, psychomotor dysphorism in various manifestations, difficulty falling asleep or easy to wake up, bad mood, anxiety, irritability, restlessness, panic, agitation or self-harm, etc., strong desire for drugs and expectorants Behavior, severe cases have psychomotor excitement or inhibition.

(2) physical symptoms are yawning, runny nose, tears, sneezing, sweating, vertical hair (similar to falling turkey), pupil dilation, chills, pulse increase, blood pressure increased, hands tremble, male prone to spontaneous venting Fine, women have sexual excitement, extensive pain (muscle pain, joint pain, abdominal pain), anorexia, nausea, vomiting, severe convulsions.

(3) withdrawal symptoms often occur in short-acting opioid drugs, such as heroin withdrawal symptoms often appear 12 to 24 hours after withdrawal, generally gradually disappear after 72h, while long-acting opioid drugs such as methadone are in Withdrawal syndrome occurred 48 to 72 hours after stopping the drug for 1 to 2 weeks. The withdrawal of any opioid addicts often eliminated the major withdrawal symptoms and signs in a short period of time.

(4) Various opioids have cross-addictiveness.

(5) Opioids often have chronic withdrawal syndrome, which is characterized by acute withdrawal syndrome, long-term pain, gastrointestinal discomfort, obvious internal discomfort, fatigue, emotional vulnerability, anxiety, depression, susceptibility It is difficult to endure frustration and blows, lack of appetite, and intractable insomnia, which is often the reason for re-medication.

3. Acute poisoning

Opioid overdose often manifests as triad, ie, needle-like pupil, respiratory depression (can be as slow as 4 times per minute) and coma, patient facial blemishes, cold skin, low body temperature and blood pressure, decreased muscle tone, and loose jaw. The tongue can block the airway, pulmonary edema, oliguria or anuria. Severe hypoxia can make the pupil dilated, no light reaction, until death, common in intravenous injection of heroin excessive poisoning.

Other types of psychoactive substance dependent examination

Laboratory tests met positive changes in complications.

It is in line with the opioid-based chemical substance-dependent auxiliary examination: opioid chemicals including blood and body fluids and excretions are positively detected.

Other types of psychoactive substances rely on diagnostic identification

diagnosis

Diagnosing dependence on opioid chemical substances As long as the medical history is detailed and the clinical manifestations and physical examinations are mastered, it is generally not difficult to diagnose. However, the following criteria should be mastered. First, there must be conclusive evidence in the drug human body. The dosage and use time are sufficient to cause mental disorders; At the same time, physical or psychological symptoms such as poisoning, dependence syndrome, withdrawal syndrome, psychotic symptoms, affective disorder, sexual dysfunction and personality changes occur clinically.

1. Diagnosis of the abuse of opioids

(1) There is a pathological mode of administration, almost every day, and drug overdose may occur.

(2) Abuse of drugs affects normal work and study, as well as social interaction.

(3) Duration lasts longer than 1 month.

2. Diagnosis of opioid dependence

(1) Meet the criteria for opiate abuse.

(2) It has a certain tolerance to the drug and needs to be continuously increased to maintain it.

(3) A series of physiological and psychological disorders occur after drug reduction or withdrawal, and withdrawal symptoms appear.

3. Opioid chemical withdrawal syndrome

(1) Long-term use of large quantities of opioids.

(2) At least 4 of the following symptoms occur when discontinued or reduced: tearing, runny, enlarged pupils, vertical hair, sweating, diarrhea, yawning, mild blood pressure, increased heart rate, fever, insomnia.

(3) The above symptoms are caused by other physical or mental illnesses.

Differential diagnosis

Special care should be taken during diagnosis to avoid misdiagnosis as a more serious mental disorder, such as schizophrenia.

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