Opiates :

•  Presentation:
Opiates are natural drugs and their synthetic derivatives, all derived from the poppy plant. Opium is obtained from a thickened juice extracted from the capsules of the poppy plant. Codeine and morphine can also be extracted from that juice. Heroin it is a synthetic drug derived from morphine, and methadone is a synthetic drug derived from opium.

Opium takes the form of small dark brown blocks or powder, and can be ingested or smoked (when it has been refined) in a pipe, in which case it takes the form of lumps.

Codeine is used as an analgesic, and can take a variety of forms, such as capsules, tablets, suppositories and syrups.

Morphine is used as an analgesic, especially in postoperative care, and is never prescribed for long durations. It takes the form of tablets, powder, syrup or injectable preparations. Like codeine, it can sometimes be diverted from its main pain relief use and used to obtain psychoactive effects, and to relieve craving.

Heroin: It takes the form of a soluble powder (either white, brown, black or pink), and is sometimes snorted, inhaled ("chasing the dragon") or smoked, but most of the time it is injected intravenously or intramuscularly after being dissolved and heated.

Methadone: Currently used to treat individuals suffering from heroin addiction, it is available as a soluble powder to be taken orally. It can be used sometimes to serve drug addiction and can then be injected or mixed with other psychoactive elements, of which it reduces the effects.

•  Effects :

Opium use induces euphoria, intense excitement and a sense of well being followed by a state of bliss.

Morphine has more or less the same effects as opium, but it is 5 times more powerful although its effects are short-term.

Heroin induces relaxation and causes an altered sense of reality, well being, hot sweats, loss of inhibition. Heroin use inhibits pain, sexual urges (loss of sexual drive), hunger, and thirst.

Methadone , unlike heroin, does not induce intense sensations, but rather a slight euphoria, indifference and a tendency to withdraw. In sufficient quantities, it can prevent the withdrawal syndrome and the craving for opiates.

Codeine produces a sense of relaxation, slight euphoria and a change in sensory perceptions. The effects produced by injecting or inhaling an opiate are immediate, while they are more gradual if taken orally. The effects of one dose can linger from 2 to 30 hours, depending on the opiate used and the user, his/her health, dependence and tolerance to opiates. Unwanted effects appear from the intake of the first doses. They usually include agitation, nausea, vomiting, constipation, vasodilatation with hot sweats, myosis, dryness of the mouth, a feeling of heaviness in the extremities. A state of prostration can also be observed.The risk of respiratory depression followed by death is to be considered, especially when higher doses are taken. Addiction to opiates can be established from the first doses.

•  Dependence, tolerance and other complications associated with opiates intake: Physical and psychological dependence on opiates is powerful. The symptoms of physical dependence are a compulsive behaviour in order to find more of the drug and feel its effects again. Psychological dependence is associated with the sensation of pleasure and self-satisfaction. Drug addicts using opiates are exposed to serious psychiatric complications with the appearance of affective disorders, anxiety disorders and serious psychiatric pathologies such as psychosis or schizophrenia. Compared to individuals not using the drug, these complications can be more frequent and serious. Other infectious somatic complications (AIDS, hepatitis…) and cardio-respiratory, digestive, sexual and metabolic complications threaten individuals addicted to opiates. Intoxication caused by various products, such as strychnine and quinine used to dilute (or "cut") the drug, can also cause complications.

•  Overdosing : There is a risk of lethal overdose. The overdose is characterised by the lowering of consciousness, which may lead to deep areactive coma, "pinned" constricted myosis (pinpoint pupils), respiratory depression (bradypnea < 14 cycles/min) leading to anoxic cardiac arrest; an acute pulmonary oedema by pulmonary overload consisting in extreme bradypnea, aerated pink saliva, and pulmonary auscultation of the rales, hypotension with collapse and cardiogenic shock following toxic myocardial damage, hypothermia, rhabdomyolysis. Inhalation pneumopathy and convulsions can also be observed.

•  Treatment of addiction - Withdrawal : The first step is to stop the use of the product, which will result in the withdrawal syndrome. Symptoms typically include great anxiety, insomnia, abundant sweating, muscular spasms, shivering, tremor… These symptoms begin 4 to 6 hours after the last dosage and linger for 7 to 10 days. The most acute symptoms intervene within 36 to 72 hours following the beginning of withdrawal and 6 months at least are necessary to see all symptoms disappear. Treating the withdrawal syndrome consists in giving appropriate treatment for the clinical manifestations of pharmacological dependence, with the objective of improving the general state of patients and favour the long-term therapeutic treatment.