Consequences of chronic opiate use
If opiates are consumed continuously, their effects are somewhat different. As noted, opiates cause tolerance, so if you do not increase the dose, their effect decreases, which often happens. Chart 9-1 data show examples of the effects of opiates on humans and monkeys in the laboratory with continued drug use. Both graphs show daily drug use during the course of the experiment. Data relating to people was obtained through an experiment in which volunteers with extensive experience using drugs were tested in the laboratory and could regulate their own doses. Note the increase in the dose of the drug chosen by the subject each time. In the first month, the subject did not need more than 500 mg per day. By the fourth month, he was taking more than 1000 mg per day. Also pay attention to the bottom of the chart, which demonstrates similar behavior in monkeys that could receive heroin intravenously by pressing a lever. It can be seen that heroin addiction is a universal phenomenon.
Opiate use patterns may change over time. While initially re-use is motivated by the desire to re-experience the pleasant sensations, “tightly seated” drug addicts argue that the drug does not even bring them much satisfaction as before. However, they continue to use the drug in order to avoid unpleasant withdrawal symptoms (“withdrawal”). Thus, heroin use is motivated first by positive and then negative reinforcement. Symptoms of heroin addiction make themselves felt after one to two weeks of using heroin, morphine or synthetic opioid. These symptoms become more severe with prolonged use of large doses. The first symptoms appear 8–12 hours after taking the last dose and include runny nose, tears, sweating, irritability and tremors. Over time, these symptoms become more severe, others appear – pupil dilation, anorexia, and tumors appear. These symptoms continue to intensify and peak between 48–72 hours. At this time, the heartbeat quickens and blood pressure rises, and severe symptoms appear: nausea, diarrhea, sneezing, excessive sweating and bone pain. In addition, the addict can begin spasmodic movements of the arms and legs. Other strange symptoms that are associated with the addict’s sexuality are involuntary erection and ejaculation in men and orgasm in women. The loss of fluid and the reluctance of the addict to eat can physically and emotionally drain the addict and are often fatal.
It is quite simple to rid the addict of withdrawal symptoms and regain his well-being with a suitable dose of any kind of opioid. Inpatient detoxification is the treatment of withdrawal syndromes with low doses of synthetic opiates, for example, methadone. The dose of methadone is sufficient to reduce the severity of withdrawal symptoms, but it is not capable of anything more. Gradually, within a few weeks, the methadone dose is reduced, until the addict is completely cured of his physiological dependence. If heroin continued to be taken solely to relieve withdrawal symptoms, detoxification would be sufficient for treatment. However, after detoxification procedures, the established rate of re-use of the drug is 90% within two years after discharge from the hospital. Most of these relapses occur within the first 6 months. Thus, if the addict returns to the environment where he or she became addicted, it is highly likely that a relapse will occur, despite the absence of physical withdrawal symptoms.
The fact that addiction to heroin (and other drugs) depends not only on physical abstinence is illustrated by a heroin epidemic that has been prevented. In the early 1970s, when the Vietnam War came to an end, the number of drug addicts among American soldiers exceeded 21%. These soldiers were required to undergo detoxification before returning to the United States, but since the relapse rate is 90%, it was expected that most of them would continue to use heroin on their return. Thus, in the USA they expected a surge of a heroin epidemic. However, subsequent studies have shown that very few relapses occurred (less than 15%). This clearly showed that addiction and psychosocial factors associated with Vietnam largely contributed to the development of addiction. Returning to the United States, veterans of the Vietnam War found that heroin became less available. This circumstance, as well as a change in lifestyle and social environment, eased the pressure that initially led them to addiction. However, radical changes in the environment (from Vietnam to the USA) cannot be repeated in the usual treatment. This is one of the reasons for the difficulty of treating heroin addiction, despite the presence of various treatments. Graphsto 9-1 Similar examples of the use of opiates by humans and monkeys in the conditions of constant availability of the drug. Both graphs show the amount of drugs taken for a specific time. Data concerning a person is obtained on the basis of an experiment in which a volunteer with drug use experience consumed them without restriction. Data relating to animals are taken from an experiment in which monkeys who wish to receive a dose of heroin pressed a lever to receive an intravenous injection of heroin.