LECTURE № 3

Theme: Narcomania and toxicomania.

1.Narcomania and toxicomania – meaning.2.Opium narcomania. Classification of drug substances of

opium group. History of opiomania development. Pathogenesis of opiomania. Clinical view of the acute intoxication. Clinical characteristics of the first, the

second, the third stages of opium narcomania.

Clinical characteristics of abstinent syndrome of opium narcomania.

Diagnostics of opium narcomania.

The theme's actuality is defined that opium narcomania is more spread narcomania's form. Last time this kind of narcomania is marked among teenagers accompanied with high rate of crime. Distinctive addiction feature appearing during opium using is that the addiction can be with small dose using.

I. Narcomania (toxicomania) is a combined group of chronic diseases characterized by pathological desire to the different psychoactive substances (PAS), tolerance change, and development of addiction to them and also expressed medico-social consequences.

High patients' death rate caused by PAS overdose, accidents in thenarcotic intoxication, different somatic diseases that are thenarcotization result, often suicide.

Expressed medical consequences of drugs or PAS abuse: somaticand neurological complications, personality change.

Social narcomania «infections» mat can spread like epidemic andinfect the wide people's group.

High criminogenesis of narcomania patients that connected withpersonality change and moral-ethical decreasing. Drug userscommit criminogenic actions as with the aim of drug buying aswith the connection of psychotic state developed in the result ofdrug using.

The "narcomania" diagnosis is used only with the PAS abuses that are official admitted as narcotic. It is stipulated the necessity to include in the terminology of narcological diseases the meaning "toxicomania". Toxicomania- a disease caused by psychoactive substance using which is not in the narcotic list that is not admitted as narcotic by the state. The narcomania and toxicomania patients are different contingent. In clinic and medical view the method for narcomania and toxicomania patients is the same, the principles of treatment are identical.

In international diseases classification of the tenth revision (ICD-10) there is no share and toxicomania. All substances are the abuse pointed as "psychoactive substances". There are 10 groups of psychoactive substances, which have "psychic and behavior disorders": alcohol, opioids, cannabioids; sedative and hypnotic substances; cocaine; hallucinogenesis; tobacco; volatile solvents and combined drugs using and other psychoactive substances. Everyone of the kind of abuse has additional characteristics identified the patients' state. Thus the classification is based upon only activity features of different psychoactive substances that is upon the medical clinic criteria. The juridical criteria are not admitted.

Opiates refer to the narcotic analgesic class, include the big group of pharmacological preparations received from different kinds of Papaver Somniferum and other kinds of poppy and also by synthetic way. Phenanthrene group of alkaloids has narcotic effect and narcogenes properties of different sorts of poppy depend on the alkaloid numbers.

1. natural: Opium-cob dried milky sap of soporific poppy. Omnopon (pantopon). Clean opium alkaloids: morphine, caffeine and

others. Poppy straw (mature, dried, broken boxes

without seeds).2. synthetic:• promedone• methadone• Lidole.3. semisynthetic:• Heroin.

Semisynthetic connections are become by the chemical morphine molecule modifications, synthetic by the way of full chemical syntheses. The great numbers of synthetic connections are received by the principle of becoming easily of the natural morphine structure.

2. The humanity has known opium since the ancient time. There are some remembrances about its healing properties (soporific, tranquilizer, anaesthetic). Hippocrate used opium as a medicine. Opium using in medicine was dated 350 ВС.

In 19 century clean morphine was defined and later heroin was synthesized, they were used for medical aims at first for some diseases: flu, heart diseases, stomach, bowels, gynecological disorders, tuberculosis, pains, alcoholism treatment. So more than 100 years ago a German pharmaceftic firm "Bayer AG" issued "a miraculous medicine for cough" and called it "heroin". Only in the beginning of XX century it was known about its narcotic effect increasing more than morphine's effect. In our country the heroin production was banned in 1954. In Germany heroin selling in chemist's was banned in 1971.

In 1970-s AD some researches were held in the result of them there are some important information about opiates' effect on the receptors of brain. It was stated the presence of specific opiate receptors in brain, their maximum numbers is in limbic system. There were defined such hormones in organism as endorphins, enkephalins that connecting with these receptors have analgesic effect. Binding of morphine and receptors are supplied by the structure familiarity of definite part of its molecule with the molecule part of endorphins and enkephalins. Thus morphine like other opiates, in introduction in organism cooperates with the same receptors that intend for binding of endogenous compounds of endorphins and enkephalins, it is stipulated for its analgesic effect.

Euphoria with opiates using has two effect phases. The first phase starts just after drag introduction, when the patients feel "warm wave" that lifts from stomach to head. There is slight painful strike in head. Most patients have nose itch, chin itch and forehead inch. They feel joy state, cheerful mood, easy flow of ideas. The first euphoria phase lasts from 40 seconds to 1-3 minutes. Then the second phase comes. This is euphoria itself. The trouble ideas leave losing their actuality, the problems go away and the flow of ideas speeds up. There is peace and relax, dreams change one to another, consciousness state is similar to dream, the patients look flaccid, lethargy, slow moving. Then the dream is coming and lasts for 2-3 hours. The dream is superficial, easy interruptible by exogenous irritants. When the patients wake they have low mood with dysphoria and general psychic discomfort.

Objectively for acute opium intoxication the following symptomatic is typical: miotic pupils, pale face, dryness of skin, high and then low arterial pressure, heart rate, high tendon reflex, respiratory depression, low motor bowels' activity with constipation. The mood is equable, rapid speech and changeable associations, the critics to their behavior and talking is decreased. The state is similar to dream is observed in opiates overdose, it can express excitement accompanied with dryness in mouth, heat feeling, sharp weakness. The activity of cardiovascular system is broken.

Forming dates of disease depend on the preparation and the way of its introduction. Opium is used orally, subcutaneously, intravenous or in the form of smoke-opiumsmoking. The shorter forming date of addiction is in intravenous introduction. The more narcogenous preparations are heroin, introducted intravenous. In this introduction narcomania is observed in 3-5 injections but morphine introduction is in 10-15 injections.

The length of the first stage -2,3 months. It is characterized by systematic drug using, rapid drag dose increasing (increasing of tolerance). The psychic addiction syndrome is quickly produced with annoying desire to repeat the drag using. The patients sleep a little, have a bad appetite and constipation.

Chronic stage (the second) is characterized by much more increasing of tolerance that gets the highest rate. Drag doses can be higher than the first ones in 10 or more times. The physical addiction is formed, abstinence syndrome appears, the intoxication state changes. If the patient has euphoria in the first stage then there is a peace and relax but in the second time drug addict is flaccid, lethargy and after drug using he is energetic and hard working. The state is similar to maniac with its psychic and motor excitement. The length of the state is not big for 5-10 years.

Then the last (the third) stage of the disease is forming. Tolerance becomes lower. The drug addict completely loses capacity to work and activity without drug taking, he does not have a will or initiative. The main syndrome which defines his state is not annoying desire but abstinence, because every drug using stopping stimulates abstinence in 8-12 hours.

In the stage the patients have expressed asthenia, cachexy, depression. They become asocial- do not work, they do not have a family, and they commit crimes.

It is typical for opiates' abuse. It appears with somato-vegetative and psychopathological disorders. The abstinence starts developing in some hours after the last dose taking in the period when the next dose must be taken under the patient's set scheme; they reach the top in 36-72 hours; the acute appearing of abstinence syndrome disappears usually for 10 days, however residual events keep longer. Just in 6-8 hours after drugs stopping the patients have tension, alert, annoying and physical weakness. The early features of opium abstinence syndrome are yawning, running nose with sneezing, nose itch and in nasopharynx, lacrimation, increasing of bowels peristaltic.

If the patient has abstinence syndrome for the first time they rarely think that it's respiratory disease. And also there are such features as: mydriatic pupils, tremor, "warm waves", low appetite, and anorexia, dream disturbance, tiring feeling, weakness, tachycardia then rigor, "geese skin", increasing sweatiness. The pain is in hands, legs, back, waist muscles, and stomachache, in intermaxillary joints and chewing muscles. The pains are very terrible for patients and they define their general state, the ideas are only about drugs. Dispensive disorders are extremely agonizing: stomachaches, pains in bowels, often liquid stool about 10-15 times a day, vomiting, mild pyrexia, hypertension, tachycardia, dream disturbances are on the peak of abstinence syndrome.

The patients can be aggressive; they can commit suicide, crimes. The abstinence's length is 2 weeks but it can be longer. There is an order in symptomatic: stopping of dyspepsia events then pain feelings, dream disturbance, low mood and desire to drug keeps longer.

"Postabstinent state" - is a state that is observed after disappearing of acute events of abstinence syndrome. There is low mood, dysphoria, psychic discomfort feeling, and asthenia, dream disturbances. Vegetative features: mydriatic pupils, pale face, tachycardia, tachypnoe, constipation, dryness of skin. Postabstinence state can be from 2 till 5 weeks. In .the period there are often disease' recidivations.

"Pseudoabstinence" is a state that appears during the remission of the patient. It is defined like ordinary abstinence but the expression of all events is little. False abstinence can be a reason of recidivations.

7. Diagnostic of opium narcomania is based on the completely clinic examinations of the patient.

Appearance of opium drug addict especially for long narcotization period is typical: the patients look older than they are, with dry skin, pale face with typical icteric tone for patients who have liver disease. There are also some wrinkles on the face, early boldness, hair become dim, friable, lose their glitter, teeth ruin, veins changes after many injections, in the place of introduction there are so called 'pathways' as a result of veins atresia, losing weight but during the long narcotization-the patients' emaciation. _ On the last stages of opium narcomania there are also some changes of internal organs-cardiovascular, nervous, breathe systems, liver. Often pneumonia, hepatitis, glomerunephritis, polyneuritis are observed.

The changes of psychic and asthenia disorders are typical for the first stage. The patients can work only after drug using. On the last stages they become disabled, they have weakness, flaccidity, asthenia and anergy, poor memory and low intellect. The personality changes are gradually growing, decreasing interest's rate; all interests are about drugs and pointed to their researches, general emotional rudeness, falsity, and absence of shame feelings. The patients become indifferent to closed people and own happiness. Lost work, family does not matter for them. The individual characteristics is smoothed, the patients become look like each other that is the original defect is formed that characterizes by emotional rudeness, moral ethic decreasing, decreasing of energetic potential and some old authors compared it with similar to schizophrenia. The forecast is unfavourable.

To answer the following questions:

1. What is the narcomania?

2. What is the glue sniffing (toxicomania)?

3. What is narcotism?

4. What is the polynarcotism?

5. How does a dopamine level during time abstinent syndrome change?

2. To have an idea of: narcomania classification of opium group drugs history of opiomania development pathogenesis is of opiomania syndrome of acute intoxication in

opiomania clinic view of the first, second and third

narcomania stages opium narcomania abstinence syndrome diagnostics of opium narcomania