Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

7. Opioids 147der with water, heat it, and use cotton or a cigarette filter to block the entry ofundissolved particles as the solution is drawn into the syringe. As a result, fibersenter the venous bloodstream and lodge in the lungs, where conditions becomefavorable for the development over time of pulmonary thrombosis (emboli ariseat distant sites), pulmonary hypertension, and right-side heart failure. Opioidabusers are at further risk of compromised pulmonary function if they use cigarettesand marijuana, as they often do. The antitussive effect of opioids alsocompromises pulmonary function, contributing to frequent pneumonia andother respiratory tract infections.A number of lesions may occur in the central nervous system of those personswho have survived overdoses that featured anoxia and coma. The residualeffects of such trauma include partial paralysis, parkinsonism, intellectualimpairment, personality changes, peripheral neuropathy, acute transversemyelitis, and blindness.Psychiatric comorbidity caused by opioid dependence occurs most frequentlyin the form of depression. When depression is observed during therecovery period, treatment with antidepressants and psychotherapy is indicatedand frequently helpful if the individual is abstinent from illicit drug use.Dysphoria is common during with withdrawal interval, and is not helped byantidepressants, but rather by appropriate treatment of withdrawal symptoms.The following disorders also are seen in association with opioid dependence:1. Bipolar disorder.2. Antisocial personality disorder.3. Anxiety disorders.4. Other personality disorders, including paranoid, schizoid, schizotypal,histrionic, narcissistic, borderline, dependent, obsessive–compulsive,and mixed.5. Delirium and dementia (rare).6. Schizophrenia (very rare).Mood disorders may be diagnosable in many opioid addicts (Mirin, Weiss,Michael, & Griffin, 1989). Major depression is the most common mood disorder,diagnosed at almost 16% (Brooner, King, Kidorf, Schmidt, & Bigelow,1997); it may have preceded the onset of drug abuse as chronic, episodic lowgradedepression or dysthymia, and a full-blown major depressive episode maydevelop in the stressful and traumatic context of opioid addiction. Depressionoccurs more frequently in women than in men. Depression coexisting withopioid dependence is more strongly associated with a history of concomitantpolydrug abuse. More attention is being paid to the complicating presence ofattention-deficit/hyperactivity disorder (ADHD; King, Brooner, Kidorf, Stoller,& Mirsky, 1999).