The term opioid refers to a group of compounds that includes opium, opium derivatives, and synthetic substitutes. Opioids exert both a sedative and an analgesic effect, and used to relieve pain, cough and treatment of diarrhea. They induce a pleasurable effect on the CNS that promotes abuse. These drugs are capable of inducing tolerance and physiological and psychological addiction.

1. OPIOID
USE
DISORDER

2. INTRODUCTION
The term opioid refers to a group
of compounds that includes opium, opium
derivatives, and synthetic substitutes.
Opioids exert both a sedative and an
analgesic effect, and used to relieve pain,
cough and treatment of diarrhea. They
induce a pleasurable effect on the CNS
that promotes abuse. These drugs are
capable of inducing tolerance and
physiological and psychological addiction.

3. HISTORICAL ASPECTS
• Use of opiates have been found in the Egyptian, Greek, and Arabian
cultures as early as 3000 BC.
• The drug became widely used both medicinally and recreationally
throughout Europe during the 16th and 17th centuries.
• Most of the opium supply came from China, where the drug was
introduced by Arabic traders in late 17th century.
• Morphine and crude opium were used all over the world extensively till
1803.
• Development of hypodermic syringe in 1853 brought advancement by
self-administration of morphine.
• By the early part of the 20th century, opium addiction was widespread.
• In 1914 the U.S. government passed the Harrison Narcotic Act, which
created strict controls on the accessibility of opiates.
• The Harrison Act banned the use of opiates for other than medicinal
purposes and drove the use of heroin underground.

4. SUBSTANCE PROFILE
Opioids of natural
origin
Opium, Morphine, Codeine
Opioid
derivatives
Heroin, Hydromorphone, Oxycodone, Hydrocodone
Synthetic opiate
like drugs
Meperidine, Methadone, Pentazocine, Fentanyl
The available opioids and related substances are as follows;

5. PATTERNS OF USE
LEGAL PATTERN
● Individual who has obtained the
drug by prescription from a
physician for the relief of a
medical problem.
● Abuse and addiction occur
when the individual increases
the amount and frequency of
use, justifying the behavior as
symptom treatment.
ILLEGAL PATTERN
● Individuals who use the
drugs for recreational
purposes and obtain them
from illegal sources.
Magnitude of substance use in India, 2019

6. Magnitude of substance use in India, 2019
● As per survey in 2019, the prevalence of opioid was 2.06%. Heroin
the most commonly used opioid in India (1.14%). This was
followed by pharmaceutical opioids (0.96%) and opium (0.52%).
● In general, the prevalence of opioid use in the north-east and
north-west region of India is higher compared to other regions.
● It’s estimated that 77 lakh problematic opioid users were in the
country.
● In the last 10 years, there has been a dramatic increase in the
abuse of prescription pain medication.

7. MODES OF
ADMINISTRATION
The common methods of
administration of opioid drugs include;
• Oral
• Snorting/ smoking
• Subcutaneous, IM or IV injection

8. EFFECTS ON THE BODY
Opiates are sometimes classified as narcotic analgesics. Their major effects are on CNS,
eyes and GI tract. Intensity of symptoms is largely dose dependent.
CNS Effects • Euphoria
• Mood changes
• Respiratory depression
• Nausea & Vomiting
GI Effects • Decreased peristaltic movement
• Severe diarrhoea
• Constipation, Fecal impaction (Chronic opioid user)
CVS Effects • Hypotension
Sexual
functioning
• Diminished libido
• Decreased sexual function
• Delayed ejaculation
• Impotence
• Orgasm failure

9. OPIOID INTOXICATION
Opioid intoxication constitutes clinically significant problematic behavioral or
psychological changes that develop during, or shortly after, opioid use.
Psychological Symptoms
• Euphoria
• Apathy
• Dysphoria
• Psychomotor agitation/ retardation
• Impaired judgement, attention & memory
Physical Symptoms
• Pupillary constriction
• Drowsiness
• Slurred speech
Symptoms are consistent with most opioid drugs, and usually last for several hours.
Severe opioid intoxication can lead to respiratory depression, coma, and death.
No treatment required unless respiratory depression or coma occurs. Naloxone IV used
for respiratory depression or come. May need to give several doses due to short-half life.

10. OPIOID WITHDRAWAL
Opioid withdrawal produces a syndrome of symptoms that develops after cessation of, or
reduction in, heavy and prolonged use of an opiate or related substance.
Symptoms
• Dysphoric mood
• Nausea or vomiting
• Muscle aches
• Pupillary dilation
• Piloerection
With short-acting drugs such as heroin, withdrawal symptoms occur within 6 to 8 hours after
the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 10 days.
With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days
after the last dose, peak between 4 and 6 days, and complete in 14 to 21 days.
Withdrawal from the ultra-short-acting meperidine begins quickly, reaches a peak in 8 to 12
hours, and complete in 4 to 5 days.
• Sweating
• Diarrhoea
• Yawning
• Fever
• Insomnia

11. • Methadone 40mg – 200mg/day (decrease opioid use,
criminal activity)
• Buprenorphine 4mg – 24mg/day (partial agonist can
be used for long term maintenance)
• L-acetyl-α-methadol(LAAM) taken oral 3times/ week
(long acting)
• Naltrexone (blocks euphoric effects of opiates)
MANAGEMENT
Pharmacotherapy
Psychosocial Therapy
• Useful as adjuvant, but rarely successful if not used in
combination with pharmacotherapy.
• Behavioral therapy
• Counseling
• Narcotics Anonymous (NA)
• Inpatient rehabs
• Therapeutic communities

12. TREATMENT – General Guidelines
• Abstinence
• Harm minimization
• Improvement of health, social and
occupational functions
• Improvement of quality of life
• Community clinic
• Specialized De-addiction centre
• Non specialized settings (Medical
OPD, Dispensary)
• Government and non-government
centre
• Psychiatric hospital
• Prison
Goals Settings
• Multi-disciplinary
• Traditional hospital setting –
clarity of role, division of
work
• Community clinic –
Multiplicity of role
Personnel

13. LEVELS OF CARE
Level 1: Acute intoxication, overdose and withdrawal symptoms are treated
Level 2: Short-term pharmacotherapy, brief interventions, community care
and general measures of rehabilitation are given
Level 3: Multiple psychosocial interventions with or without pharmacotherapy

14. NURSING MANAGEMENT
• Continuously monitor the patient’s vital signs and urine output.
• Watch for complications of overdose & withdrawal.
• Maintain safe and quiet environment
• Take appropriate measures to prevent suicide attempts and assaults.
• Remove harmful objects from room and use restrains only if the patient might harm
himself or others.
• Approach the patient in a non-threatening way. Limit eye contact, which he may
perceive as threatening.
• Administer IV fluids to increase circulatory volume.
• Give medications as per order
• Monitor and record patient’s effectiveness.
Acute Episodes:

15. NURSING MANAGEMENT
• Administer medications as ordered, to decrease withdrawal symptoms.
• Monitor and record patient’s effectiveness.
• Maintain a quiet and safe environment, because excessive noise may agitate the
patient.
Withdrawal State
• Carefully monitor the patient.
• Provide adequate nutrition.
• Administer drugs carefully, to prevent hoarding.
• Check patients’ mouth to ensure that he has swallowed oral medications.
• Closely monitor visitors who might supply him drugs.
• Refer the patient for rehabilitation if needed.
• Encourage family members to seek help.
• Suggest private therapy or community mental health clinics.
• Use the particular episode to develop personal self-awareness and positive attitude
towards the patient.
• Set limits when dealing with demanding manipulative behavior.
Maintenance Care
Cont…

16. PREVENTION
• Reduction of prescribing by Doctors (Anxiolytics especially benzodiazepines)
• Identification & treatment of family members who may be contributing to drug
abuse.
• Introduction of social changes by
o Increasing the price of drugs or alcohol
o Controlling/ abolishing the advertising of alcohol or drugs
o Controls on sales by limiting hours or limiting number of shops
o Restricting availability
• Strengthen the individual’s personal and social skills to increase self esteem &
resistance to peer pressure.
• Health education to college students and the youth about “dangers of drug abuse”.
• Overall improvement in the socio-economic condition of the population.
Primary Prevention:

17. PREVENTION
• Early detection and counselling.
• Brief intervention in primary care (simple advices from practitioner and educational leaflet)
• Motivational interviewing.
• Full assessment (medical, psychosocial and social problems)
• Detoxification with benzodiazepines
Secondary Prevention:
Cont…
• Assertive training
• Teaching coping skills
• Behavior counselling
• Family counseling
• Supportive and individual psychotherapy
• Craving management
• Dealing with faulty cognitions
Tertiary Prevention:
• Handling negative mood states
• Spirituality
• Anger control
• Financial management
• Stress management
• Sleep hygiene
• Recreation

18. REHABILITATION
To enable him to leave the drug sub-culture.
To develop new social contacts.
To continue social support, which is usually required when the person
makes the transition to normal work and living.
The aim of rehabilitation of an individual de-addicted from the effects of
alcohol/ drugs are;

19. PSYCHOEDUCATION
• Teach about the physical, psychological and social complication of drug/ alcohol
use.
• Inform them that psychoactive substance may alter the persons’ mood,
perceptions, consciousness or behavior.
• Explain the family members that patient may use lies, denial or manipulation to
continue drug/ alcohol usage and to avoid treatment.
• Teach the patient and family members that drug overdose or withdrawal can result
in medical emergency and even death. Give the family members emergency
resources for help the patient.
• Explain the patient that sharing dirty or used needles can result in life threatening
diseases such as AIDS, Hep-B, etc.
• Teach the family to establish trust with the patient and to use firm limit setting.
• Teach how to recognize psychosocial stressors that may exacerbate substance
abuse problem and how to avoid or prevent them.
• Emphasize the importance of changing lifestyle, friendships and habits that
promote drug use to remain sober.
• Teach about the availability of local self-help programs(AA, AI- Anon, AI- Teen) to
strengthen the patients recovery and support the family’s assistance.

20. NURSING PRIORITIES
• Risk for injury
• Ineffective coping
• Powerlessness
• Imbalanced nutritional pattern
• Low self-esteem
• Dysfunctional family process
• Sexual dysfunction
• Knowledge deficit

21. • Keeps free from injury.
• Maintains general health status.
Nursing Goals
• Monitor the patient 24/7 if he has suicidal ideas.
• Assess the gait of the patient, if possible
• Provide environmental safety, keep sharp objects in locker.
• Administer medications as per order.
Intervention
1. Risk for injury related to drug usage, vitamin deficiency, confusion
• Accepts the dependence and ask for help
• Cope with the dependence using positive coping
Nursing Goals
• Review about drug dependence and categories of symptoms(patterns of use, impairment caused
by use, tolerance to substance).
• Answer questions honestly and provide factual information.
• Explain about addictive use versus experimental, occasional use.
• Discuss current life situation and impact of substance use.
• Provide positive feedback for expressing awareness of denial in self/ others.
Intervention
2. Ineffective coping, Denial evidenced by lying, frequent fights with family members,
anger out bursts.

22. • Establishes trusting relationship
• Verbalizes the needs to care givers
Nursing Goals
• Assist patient to recognize the problem exists, how drug has interfered the life
• Discuss alternative solutions and assist in selecting an appropriate alternative.
• Assist patient to learn ways to enhance health and structure healthy diversion from drug use.
• Assist patient in self examination of spirituality and faith.
• Provide information on ongoing treatment needs.
Intervention
3. Powerlessness related to inability to take decision as evidenced by low self-
esteem, inability to divert his/her mind from drugs.
• Maintains normal nutritional status evidenced by weight gain, participating in ward activities.
Nursing Goals
• Assess height/weight, BMI, body build, strength, activity.
• Assess the nutritional status of the patient- 24 hrs recall.
• Plan diet according to like and dislike of the patient.
• Advice the patient to hydrate accordingly.
• Monitor weight weekly.
Intervention
4. Imbalanced nutritional pattern less than body requirements as evidenced by
decreased weight, unable to perform activities, easy fatigability.

23. • Participates in his own treatment plan
• Verbalizes his/her needs and feeling to family members
Nursing Goals
• Assess mental status of the patient
• Spend time with the patient
• Provide opportunity and encourage the patient to verbalize
• Provide reinforcement for positive action
• Administer antipsychotic medications as per order.
Intervention
5. Low self-esteem related to guilty feeling as evidenced by shame, anger and
fighting with family members.
• Maintains normal family process
• Demonstrates normal functional family process evidenced by well understanding family.
Nursing Goals
• Review family history, explore roles of family members.
• Assess the methods of coping used by the family members.
• Provide information about addictive disease characteristics.
• Identify and discuss about behaviors of family members.
• Involve family in discharge referral plans.
Intervention
6. Dysfunctional family process related to drug usage as evidenced by relationship
discord, frequent fights misunderstanding and confusion.

24. SUMMARY

25. ANY DOUBTS??

26. REFERENCE
Mary C. Towsend.(2015). Psychiatric Mental Health Nursing (8th ed.). P. 379-385
C. L. Subash Indra Kumar.(2014). Psychiatry and Mental Health Nursing. P. 441-
447
Dr. K. Lalitha.(2015). Mental Health and Psychiatric Nursing. P. 387-429
Norman, Lee, Carol. Psychiatric Nursing (5th Edition). P. 539-544
Sheila L. Videbeck.(2015). Psychiatric - Mental Health Nursing (5th ed.). P. 357-
359
Books:
Indian Journal of Forensic Medicine & Toxicology, Inhalant Abuses in
India, Vol 14, Issue 1, 2020.
The American Journal on Addictions, Differences in substance use,
psychiatric disorders and social affairs, Vol 27, Issue 8, 2018, P. 625-631
Social psychiatry and psychiatric epidemiology, Inhalant use in
adolescents, Vol 53, Issue 7, 2018, P. 709-716
Journals:

27. THANK YOU
EVERYONE