Teenagers refer to boys and girls in the age where their brain is still growing and maturing. They learn to express their emotions and develop new behavior in the process to find their own identity. They are more connected to their friends than family. Teenagers are also known to be impulsive and prone to risk taking activities. Generally this is normal as it allows them to venture new things and ideas. However without proper guidance and information they may end up with serious problems like drug abuse. With wrong group of friends or environment they might just start taking drugs because of peer pressure and to fit in. Opiod is an example of drug commonly abused.

Remmy was a 20 years old man when he came for treatment. This was his story about how he got involved with drugs. He started smoking cigarette at the age of 12 years. At the age of 16 he hanged around with his friends who had dropped out from school. He noticed they were smoking a special ‘cigarette’. His friend offered it to him saying that it was just ‘cigarette’ and harmless. He tried and felt good. He came again the next few days and was given the same ‘cigarette’ for free. After a while he felt unwell and badly wants to smoke the ‘cigarette’. Unfortunately now he has to pay for it and it really costs a lot for him. It wasn’t long before he realised that what was offered to him was not just ‘cigarette’ but an opiod drug called Heroin. He was by then already addicted to it. He came to seek treatment after several attempts of trying to kick the habit on his own but in vain.

What is opiod?

Opiod is a group of drug that act on the opiod receptor in the body mainly in the nervous system( brain) and gastrointestinal tract. It is an old drug from poppy plant commonly prescribed by doctors to relieve pain. Activation of the opiod receptor has both wanted and unwanted effects. It is a depressant but it does not mean it causes depression. It slows down the body system.

What are the drugs in this group?

The drugs can be divided into natural, semi synthetic and synthetic opiod. Our body also produced opiod called endogenous opiod like endorphins, enkephalins and endomorphine. Below are some examples of the drugs.

Naturally occurring opiod :

• Morphine

  • Commonly used as treatment for pain reduction

• Codiene

  • Has cough suppressing and pain relieving properties

  • Commonly abused cough mixture contains this drug and another substance called promethazine

Semi synthetic opiod processed from morphine.

• Heroin (diacethymorphine)

  • Is an illicit drug also known as H, fit, ubat, dope, china white and etc.

  • Very addictive. Using heroin regularly for one week or so can result in addiction.

• Oxycodone, Hydrocodone

  • Available as tablets to reduced pain and commonly abused.

Fully Synthetic opiod:

• Fentanyl(commonly used as potent pain relieve medication and also as treatment for opiod dependence)

• Methadone (commonly used in treatment for opiod dependence)

• Buprenorphine (commonly used in treatment for opiod dependence)

• Loperamide (commonly used for diarrhea but has no effect on the brain)

• Tramadol

How does it work and what are the effects?

These groups of drug work by stimulating the opiod receptors in the brain, spinal cord and gut. Effects of opiod can be divided into wanted and unwanted effects.

Wanted effects are to:

• Reduces pain

• Suppress cough

Unwanted effects include:

• Euphoria

• Sedation

• Urinary retention

• Constipation.

• Respiratory depression/ slows down breathing

• Nausea and vomiting

• Slows down the heart rate

All opiods can be abused. Commonly abused opiod is heroin. Opiod based pain killers and cough mixtures containing codeine.

What does heroin looks like and how is it used?

Heroin can be found as white or brown powder or sometimes in off white granules. Heroin can be :

• smoked known as ‘chasing the dragon’,

• snorted, sniffed

• injected into the veins .

What are the bad effects of heroin?

Immediate

• Overdose.

  • You can get overdose with opiod. This is more so if you has never used it before, injected it, takes in a high dose or uses it with other opiod or depressant drugs like sleeping tablets. Your heart rate slows down, breathing becomes shallow, body temperature drops until finally you stop breathing and the heart stops.

Other effects

• Dependence/addiction

  • You will continue to use heroin to get the the same effect. Even though it may cause you problems with your study, at work, with parents or having legal issues you will continue using the drugs. After a few times using heroin for whatever reason you will need to use more to get the same desired effect. This is called tolerance.Later the effects plateau no matter how much you use thedrug. At this point you will need to continue using heroin or your body will go through painful withdrawal symptoms. People addicted to this drug continue using it mainly to overcome the withdrawal symptoms. Heroin can cause both physical and psychological dependence;

• Infection

  • Heroin is usually made of pure heroin and other chemicals. This can cause infectionand can produce absces  on the skin, veins, heart, lungs liver and brain

  • Sharing needles with someone who has the disease might cause you to be infected with HIV, Hepatitis B and or hepatitis C.

  • Poor injection practice\ can introduce bacterial infection to the heart.

• Cognitive impairment. Long term use can reduce the cognitive function.

• Skin infection. Unsanitary use of injection paraphernalias and unhygienic injection technique can causes absces and even gangrene.

• Track marks and collapsed veins. Injection scars and frequent used lead to collapse veins. This is dangerous especially in emergency situations where it will be difficult to set a line to you to give treatment.

• Menstrual irregularities for female.

• Malnutrition. Chronic user are more likely to spend money on drugs than on food

• Loss of sex drive

What is a withdrawal symptom?

When you are dependent on heroin and you have not used it for a period of time, you will feel painfully unwell. These symptoms are called withdrawal symptoms. The symptoms include:

• Craving for the drug

• Restlessness

• Yawning frequently described as ‘sangap’

• Goose bumps

• Watery eyes and nose

• Stomach and leg cramps, muscle cramps

• Vomiting

• Insomnia or difficult to sleep

• Loss of appetite

• Palpitation or increase heart rate

• Depression

Why do adolescents abuse opiod?

• To feel good

• To feel nothing at all

• To fit in

A person who is intoxicated with heroin will have the heroin ‘high’. This is described as

• Sensation perceived as intense pleasure, happiness, strong feeling of well being and contentment.

• A powerful false sense of well being

• Sleepy, drowsy and sedated.

• Sleepy but awake – a dreamlike state

• A feeling of warmth

Is there treatment for opiod or heroin addiction?

Treatment is mainly to reduced harm caused by drug such as to reduce HIV, Hepatitis B and C infection and to reduce crime associated with the drug use. Treatment options are:

• Detoxification via medically assisted detoxification or cold turkey method

• Replacement therapy with Buprenorphine and methadone or suboxone (buprenorphine plus naloxone).

All these option must be accompanied with serial counseling and psychosocial rehabilitation which is an important element in life long recovery process.

Prevention is always better than cureand cure from opiod dependence is not easy. Had Remmy at the age of 16 be alert with his environments including the friends he chosed, he could have been a successful person at that age of 20. Instead he end up a heroin addict. Fortunately he seeked treatment rather early.You may overcome the physical dependence but without good psychosocial support, the psychological craving may keep you hooked to drug for the rest of your life.