Treatment of Drug Addiction in Medical Establishments - Term Paper Example

Name: Instructor: Course: Date: Heroin Introduction Substance abuse, not excluding tobacco use, alcohol abuse and heroin use is a thought increasingly fundamental to the National Institute on Drug Abuse’s concerns. Alcohol in addition to addiction of other drugs like heroin is a societal issue that is progressively growing, contributing to communities and families destruction. Research has recognized a strong link between alcohol and other substance addiction and family relationships that are disrupted. Additionally, substance abuse leads to massive expenses to the user, his or her kin and the entire community (Schafer, 2011). Since heroin addiction treatment is ambivalent as a socio-cultural issue is changed into a medical issue, this paper will discuss methods of treatment of drug addiction in medical establishments and problems encountered. Situation/problem Use of heroin can be understood as a socio-cultural issue. By itself it indicates a considerable questioning of community norms and values, an indication of some individual’s need for alteration of consciousness and escape from social life’s meaninglessness. The fight against drug abuse has become great frustration. The proliferation of the use of heroin has actually taken a lot of governments as well as health authorities by surprise (Have and Sporken, 1985). Generally for an issue of this capacity and character, current methods and existing structures have shown to be poor. The law and police have minimal hold on both addicts of criminal subculture as well as dealers. The fight against heroin use frequently has paradoxical consequences. For instance, police station, results in heroin’s higher price on the black market; hence this encourages heroin users’ criminal behavior, which eventually evokes additional efforts by law and police. The rising figure of convictions for dealing of heroin occupies majority of prison capacity. Additionally, this group of prisoners presents unusual demands on the prison warders. Practically, it seems to be unrealistic to eliminate drug traffic and drug use from prisons (Have and Sporken, 1985). Addicts of heroin are not actually inclined to make use of health facilities. Consequently, organizations of health themselves instigated trials to contact users of drugs, removing treatment and management to the street; for instance, professional dealers would meet a pub like group. Afterward, methadone supplying experiment was initiated. Of the methods initiated, none of them was very effective. This is because the meeting areas turned out to be illicit traffic’s hot beds; others were burnt while others finally closed (Have and Sporken, 1985). The experiment on methadone has not actually been sufficiently appraised yet, it encouraged other drugs’ use like cocaine in addition to not only being relatively unsuccessful. Currently, latest proposals for managing the drug issue were placed into effect. It is believed by several authors that addiction of heroin is a medical issue, and that hence medicine has a role to play during its management (Have and Sporken, 1985). Drugs are described in medical terminology: for instance there is epidemic of heroin, with a discrete focus, which entails transmission through direct contact as well as contamination of young individuals who have reduced resistance. This implies disease existence, relationships of cause-and-effect, and the necessity for management and prevention.The physical destruction in the user of the drug induced by addiction is thought to be evidence that addiction of heroin is actually a medical issue. In that case treatment ought to be aimed at working against the dependence of heroin. However, withdrawal appears to work simply temporarily. This shows that aside from somatic elements, psychosocial elements are involved as well (Have and Sporken, 1985). A lot of authors are in agreement that an addict’s lifestyle transformation is important: detoxification ought to be followed by rehabilitation that is psychosocial. On the other hand, the argument that numerous factors add to the heroin addiction’s origin is not factual in every case: the type of management generally adopted shows that healthcare providers believe the primary reason of addiction is simply physical (Have and Sporken, 1985). Whether addiction of heroin is regarded principally because of somatic factors or psychosocial circumstances, the question of why is still there, in both instances, the addiction is actually believed to be a health issue. According to Orford (2001) addiction can be understood as excessive appetitive conduct and it has the considerable shortcoming that it has actually turned out to be excessively recognized with substances that affect the central nervous system. Human mu-opioid receptor (OPRM1) is considered the major region for the analgesic activity of several opioid drugs like heroin, methadone and morphine (Shi et al, 2002). Previously, it was stated that a single nucleotide polymorphism (SNP) in exon1 (c.118A0->G) of OPRM1 may relatively change the affinity in interaction of beta-endorphin-Mu. By the use of denaturing high performance liquid chromatography (DHPLC) the entire OPRM1 gene’s coding site was screened for Han-Chinese heroin addicts’ SNP as well as normal control. 3 novel SNPs were discovered, one in intron3, one in exon3 and the other one in 3’ untranslated site (Shi et al, 2002). It was reported that the SNP c.118A->G changed Mu receptor’s interaction with opioid and had no considerable correlation with addiction of heroin in Han Chinese. On the other hand, addicted subjects who had the SNP in intron2 appeared to reveal a lot of dosages of heroin intake compared to those who had no SNP. It was also noted that people who carried both IVS2+31G->A and SNP c.118A->G consumed comparatively more drugs unlike the other addicts (Shi et al, 2002). Most women who abuse drugs ignore their health and are hence predisposed to numerous medical and obstetrical issues that affect their infants’ mortality and morbidity at birth (Hayford et al, 1988). Obstetrical complications linked to addiction of heroin include abruption placentae, abortion, chorioamnionitis, and amnionitis. Chorioamnionitis may result in meningitis and sepsis in the neonate together with significant neurologic deficits. Additional obstetrical complications entail intrauterine development retardation, eclampsia, preeclampsia, and placental insufficiency. Intrauterine development retardation might result in babies who are small-for-gestational-age who are at great risk of hypoglycaemia, perinatal asphyxia, pulmonary hemorrhage, necrotizing enterocolotis, polycythemia, and hypothermia (Hayford et al, 1988). Gestational diabetes mellitus might occur, leading to related increased potential for birth trauma, newborn’s transient tachypnea, and disease of the hyaline membrane. The newborns are also at risk for congenital abnormalities. Evidence increasingly recommends that the concept of substance abuse is a significant one, that the patterns of behaviour involved are essentially and not simply superficially related (Krasnegor, 1979). Several people involved in whichever of this behaviour know the negative outcomes, often would wish to change their conduct, and are not able to do so. Such disorders are particularly hard to treat, with great abrasion in the course of treatment, as well as increased relapse rates to use, surprisingly consistent from drug to drug (Krasnegor, 1979). Solution In reaction to the evident call for bringing the problem of heroin addiction under control, various strategies of intervention and treatments have been developed in various countries (DuPont and Greene, 1973). The approach towards the issue of drug is characterized largely by defeatism. Treatment’s aim appears to have moved from therapy to repression: rather than assisting the user of heroin to do away with his addiction, attempts are intended to fight heroin use expansion, to fight community crime and nuisance and to keep order and law to a great degree. Occasionally there is actually an endeavor at this attitude’s rationalization; it is supposed that, for numerous, addiction is just a temporary incident in life, which commonly will outdo its own accord. The uncertainty concerning the intentions of heroin addiction’s treatment have their basis in the presuppositions’ ambivalence regarding the problem’s nature on the one side, and the drug addicts’ personality on the other (Have and Sporken, 1985). Addicts are thought to be complex patients. The staff of treatment has to be alert when dealing with heroin users; this is because they will by all means to do anything to acquire drugs, they are agitating, manipulative, and unreliable. They are also believed to be badly motivated to stop drug usage. This broad heroin addict mistrust is evident from various recommendations and guidelines from treatment such as: do not believe voluntarily their statements; a urine examination should be performed on the people who have supposedly surrendered the habit; it is also important to be aware that addicts might seek advice from a general practitioner with a false name (Have and Sporken, 1985). The user of heroin is psychologically defined by ego weakness in the sense that he is thought to be incapable of coping with stress, and suffers from lack of ability to deal with his problems within a meaningful manner. On the other hand, it is inquisitive that a lot of intervention projects demand that the drug addicts should be encouraged for treatment (Have and Sporken, 1985). Conditions are inflicted on the therapy participants and those who obtain heroin’s free supply. The detoxification as well as stabilization period of treatment is intended for individuals who go through withdrawal symptoms after prolonged drug abuse (United Nations, 2002). Detoxification might be described as a process of pharmacotherapy and medical care that intends to assist the patient realize abstinence in addition to physiologically normal functioning levels with the least emotional and physical discomfort (United Nations, 2002). Pharmacotherapy entails a proper agonist medication administration, in progressively moderating amounts, to lessen withdrawal distress from benzodiazepine, bariburate and opioid dependence, where a distinctive rebound emotional and physiological withdrawal syndrome is seen normally around eight to twelve hours after the last dosage of the drug. Rehabilitation is suitable for individuals who are not suffering from the heightened emotional or physiological effects of current substance abuse anymore (United Nations, 2002). Intentions of this period of management are to help the individual in developing full control over drug abuse urges, to prevent going back to active drug abuse, and to help the person in attaining or regaining improved social functioning and personal health (United Nations, 2002). Maternal substance addiction together with its resulting detrimental effects on neonates as well as children is turning out to be a leading health program in various nations. Some of the recommendations to help address this issue include and not limited to: educating drug-addicted women on the potential damaging effects of their substance abuse on the unborn baby; expectant drug abusers need to be assigned as patients who are at high-risk and need to be given comprehensive obstetrical and pharmacotherapy care. Pharmacotherapy might entail voluntary drug detoxification or drug-free remedial communities; psychosocial counselling offered by skilled counsellors who understand social and medical needs of this population; careful evaluation and management of both development and behaviour patterns of the children whose mothers are drug-addicted should be carried out within the hospital as well as follow-up visits; and further research about methadone and heroin effects on the unexpected infant death syndrome must be done (Hayford et al, 1988). The mortality in a115 cohort street addicts of heroin was investigated for five to eight years by the use of survival estimate method of Kaplan-Meier (Gronbladh et al, 1990). This differed distinctly from the moderately low mortality of 166 equivalent heroin addicts provided with methadone maintenance treatment (MT). The mortality rate of street addicts was 63 times than usual, compared with formal statistics for a cluster of this sex and age distribution. When fifty three patients within MT were unwillingly ejected from treatment, as a result of programme rules’ violation, they came back to the street addicts’ high mortality (55 times the usual). A set of thirty four rehabilitated individuals who left MT having medical permission maintained the MT patients’ low mortality (their rate of mortality was four times the usual). Regardless of this tremendous progress in survival, MT patients also showed a relatively increased mortality (8 times the usual), principally because of diseases acquired prior to entering the programme of treatment. A conclusion is then made that MT has a principal improvement within the heroin addicts’ survival (Gronbladh et al, 1990). General practitioners (GPs) are highly recommended to become very involved during the treatment and care of substance abusers. A study indicated that patients who were given methadone treatment by the GPs were equal in their drug use behaviours, in demographics, and in different presenting issues at intake (Gossop et al, 1999). Heroin was regarded the principal problem drug. The certainty of the drug issue ought to be grasped- that regardless of the sense of powerlessness which might overwhelm the drug user occasionally, it is imperative to uphold a patent vision and understand the enormous possibility for change which is there. For, in any case, it is obviously possible to create a difference. In future, more thorough study ought to be carried out of the wider group of influences which might be brought to acceptance (Strang, 1992). Conclusion In conclusion, this paper has discussed various issues in relation to heroin. It is noted that the attitude’s ambivalence towards the characteristic of the issue as well as the drug user’s personality appears to be accountable for the improbabilities concerning the intentions of treatment. The intention of treatment might be described as either to realize heroin use abstinence or to counteract social consequences of the same use. Actually treatment attempts to realize both. The treatment staff’s intervention is targeted at controlling the issue which involves assistance, normalization and correction. Works cited Have Henk. & Sporken Paul. Heroin addiction, ethics and philosophy of medicine. Journal of medical ethics. 11 (1985): 173-177. 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