Opiate (or opioid) classes of drugs include heroin, codeine, pethidine, morphine and methadone. Heroin use in this country emerged in the 1980s and was initially confined to the Dublin area. This pattern has changed in the last decade and the drug is now found in almost every major city and town in the country. Unfortunately treatment services have not grown to meet this need and many areas of the country have no little or no treatment.
Symptoms of heroin dependence include users taking greater amounts of the drug to achieve the same effect, cravings for the drug, difficulty stopping the drug or will symptoms of withdrawal if an attempt is made to stop using the drug. Users may also develop other consequences of drug use such as deterioration in relationships, job losses etc. Heroin can be smoked (‘chasing the dragon’) or injected.
Complications of injecting include the development of skin infections or abscesses and the transmission of blood borne viruses such as Hepatitis C or HIV (from sharing contaminated syringes and paraphernalia). Blood clots can occur particularly if users inject into their groin.
The treatment of choice for opiate addiction is opioid pharmacotherapy (e.g. methadone and buprenorphine) usually in long term maintenance doses although patients may decide to detoxify from the drug. ‘Detox’, however, is associated with a high risk of relapse and possibly death due to loss of opiate tolerance.
Codeine is found in many over the counter preparations (e.g. Solpadeine, Nurofen Plus). The prevalence of codeine addiction in Ireland is unknown. Users often take the medication legitimately as analgesia. A small but significant minority develop physical dependence. One of the biggest complications of maintaining codeine addiction is the side effects of the other compounds contained in the these preparations. For example, Solpadeine contains paracetamol which in sufficient quantities can cause liver damage and, potentially, liver failure. Nurofen Plus contains Ibuprofen which can cause peptic ulceration. These ulcers can bleed or perforate and this is a surgical emergency.
Like heroin addiction, codeine addiction can be successfully treated with methadone, buprenorphine or even codeine itself in either maintenance or detox regimes.