Opiates and opiate antagonists
Opiates, including heroin, methadone, opium, morphine and codeine, work by binding to the opioid receptors in the brain. The opioid receptors also detect the body’s own naturally-occurring chemicals such as endorphins. Opiates are drugs derived from opium. There are also a number of synthetic opioids including methadone and buprenorphine.
When a person regularly uses a drug like heroin or morphine, the opioid receptors in the brain become much less sensitive. When an opiate antagonist is taken, it attaches to the opiate receptors in the brain. This stops opiate molecules being able to bind to the receptors and so the effects or ‘high’ associated with the opiate are eliminated. It also allows the opioid receptors to recover to their former sensitivity.
For intravenous opiate users, sharing injecting equipment is extremely risky because diseases like hepatitis and AIDS are spread even by small amounts of blood. The “cutting” agents in street heroin can cause poisoning. Many heroin users suffer chronic constipation. Heroin can also cause nausea and vomiting.
Overdose causes breathing to become shallower. This can cause death by a lack of oxygen. Overdose death can also occur if someone breathes in vomit when unconscious. A lot of overdose deaths are also caused by a using combination of drugs, such as heroin and benzodiazepines.
Patients who are part of the Fresh Start program will undergo detox as they come off opiates. This will be least severe for those who have managed to stop their opiates for 3 or 4 days beforehand. However, this is not possible for many of our patients. It is more important to come for treatment than to try to detox at home.
Heroin users can choose to switch to a partial opiate agonist for the 3 or 4 days before they get their implant. However many prefer to simply get on and have their implant with a view to getting better as quickly as possible. Detoxing off a normal dose of heroin will be rapid and uncomfortable so, for this reason, we tend to use light sedation for the first 24 to 48 hours.
Methadone is more difficult to detox from and we ask users to go through a 2-week process of changing to partial agonists. Users are encouraged to stop their methadone on a Tuesday and arrive at the clinic early the next day. We will then usually start them on partial agonist treatment for approximately 10 days. Fresh Start will organise the first day of partial agonists in the clinic if the methadone dose has been more than 40 mg/day. The highest dose of methadone that we have detoxed patients from is more than 500 mg/day. At the end of 10 days of partial agonists we usually arrange three days off all drugs before continuing the treatment plan. This means two reasonably ‘gentle’ detoxes.
Nat decided she wanted to change during a holiday to Thailand. “As I sat in the poppy fields I was struck with how empty life was and how heroin was not worth it,” she says. Desperate to be drug-free she saw Dr George O’Neil in 1999 who prescribed oral antagonists. “George treated me like a person and not a junkie,” says Nat. “He gave me a sense of hope when I felt like giving up.” Now drug-free for the past 10 years and loving life, Nat works in disability services, having completed a TAFE course, and has reconciled with her former husband — a recovering addict — who she plans to re-marry later this year.