Inquiry into the misuse/abuse of benzodiazepines and other forms of pharmaceutical drugs in Victoria : final report / Drugs and Crime Prevention Committee.

  • Victoria. Parliament. Drugs and Crime Prevention Committee
Date:
2007
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Licence: In copyright

Credit: Inquiry into the misuse/abuse of benzodiazepines and other forms of pharmaceutical drugs in Victoria : final report / Drugs and Crime Prevention Committee. Source: Wellcome Collection.

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    Page 78 rashes and itching; sedation; fluid retention; loss of appetite; nausea and vomiting; abdominal cramps; dry mouth resulting in tooth decay; and irregular menstruation (Downie & Kettle 2000). Saunders and Young note that: Opioids...have little toxic potential per se. They may, however, cause anoxia [lack of oxygen] due to overdose because of the variable quality of street drugs and co-use with other drugs acting as central nervous system depressants. Neuropsychological damage can result from anoxic episodes and subsequent necrosis [death] of brain tissue. Ancillary problems can occur from, for example, cigarette burns due to smoking while in a drowsy drug-induced state, anorexia [poor appetite] or nausea leading to poor nutrition, or reproductive system impairment, for example menstrual irregularities. The greater part of the associated morbidity is related to injecting drug use (Saunders & Young 2002, p.39). Sedation One of the classic adverse effects associated with opioid use which is also apparent with other central nervous system depressant use, particularly soon after injecting, is sedation. This acute intoxication results in drifting in or out of consciousness, but without the signs and symptoms of an opioid overdose, which includes difficulty breathing, turning blue, lost consciousness, collapsing or being unable to be roused (Strang et al 1999). Tolerance and withdrawal Tolerance to opioids involves a shortened duration and reduced intensity of their analgesic, euphoric and sedative effects. This means once dependent, people need larger or more frequent doses to have the same effect. There are large individual differences in the development of tolerance, and tolerance to the different effects of these drugs does not develop at the same rate. Thus even chronic, long-term users can experience the respiratory depression effects associated with opioid use, but might experience less of the pleasant euphoric effects. Most people experience some withdrawal symptoms even in mild reduction of dosage (Young et al 2002). Signs of opioid withdrawal can start to occur within four to six hours after the last dose, depending on the half-life of the opioid that has been abused. Maximum effects occur normally after 36 to 72 hours, but this will vary according to opioid; if untreated, effects will take five to 10 days to subside. The severity of the withdrawal symptoms increases with the size of the opioid dose and duration of dependence. The symptoms of opiate withdrawal start initially with anxiety, craving, restlessness, lacrimation [teary], yawning, sweating and rhinorrhoea [runny nose]. A reliable early sign of withdrawal is a respiratory rate greater than 16 breaths per minute. Other symptoms include mydriasis [prolonged dilation of the pupil], piloerection [goose bumps], tremors, muscle twitch, hot and cold flushes, aching muscles and anorexia. In severe cases, tachycardia, hypertension or hypotension may occur (Downie & Kettle 2000, p.244). There is not a great deal of literature with regard to dependence on pharmaceutical opioids among illicit drugs users. This is probably because there is a recognised dependency syndrome related to all opioids, which has been described above. It is reasonable to believe that people using these drugs illicitly are at high risk of becoming dependent and that the dependence will be similar to that for other drugs in this class. A small number of studies have been undertaken in the United States on OxyContin® dependence. This is probably because of the rapid growth in the spread of this drug in that country and its use beginning in mid-adolescence for some with relatively little or no other prior opioid use or heroin use (Katz & Hays 2004). Two cases from the study by Katz and Hays (2004) are presented here. They show how adolescents may quickly develop serious addictions to OxyContin®: