Anxiety and depression in opiate addicts treated with methadone and buprenorphine

INTRODUCTIONPsychoactive substances represent a problem dating from the fifties and starting to threaten the usual standards of life. People who get addicted to psychoactive substances become slaves of their problem and try to focus all their abilities towards providing a certain amount of psychoactive substance, weakening their integrity even further. The average age when the substance is taken for the first time is about 15 years, first injection happens about 21 (18 in the age group 18-24), while the time of the first addiction treatment ranges between 22-25 years of age.It is a rule that an addict takes more substances at the same time, usually starting with alcohol and marijuana and then quickly turning to opiates.1 Opiates include psychoactive substances of herbal origin, first of all opium, the dried milky juice from the not yet ripe fruits of white poppies, from which the morphine is later extracted. By means of twice-acetallizing the morphine, heroin (half-synthetic drug) is produced. This group also includes synthetic derivates of morphine, codeine and methadone, with similar effect.2 Addiction to heroin is in most cases very difficult to cure. So nowadays, it is usual to try to help the individuals and their families by means of replacing the expensive illegal psychoactive drug with narcotics heptanone (methadone) and buprenorphine. Patients receive these substances directly from their doctors.3 Methadone is widely used in treating the addiction throughout the world since 1960, while it was introduced to Croatia in 1990. The effects of methadone differ from the effects of other narcotics, because they last longer and there is no initial euphoria. The effect of methadone lasts up to 24 hours, thus enabling the patients to take it just once a day.4 The main effects of methadone are alleviating the craving, suppressing the withdrawal symptoms and blocking the euphoric effect of opiates. It is a paradox that the use of methadone has resulted in greater number of fatalities due to the drug overdose.5 Buprenorphine is used as a substitution therapy in treating the opiate addiction. It is used also as a substitution for methadone therapy if and when a patient decides to stop taking methadone. As opposed to methadone, buprenorphine may be given 3 times a week, enabling the users to have a better professional and social rehabilitation and generally, better quality of life. Higher doses of buprenorphine are better tolerated than high doses of methadone, seldom lead to the development of tolerance and is less addictive than methadone.6AnxietyAnxiety is a painful state of helplessness and vulnerability. It is a state of being tense, worried and expecting something terrible to happen. The feeling of anxiety, along with accompanying organic and physiological disturbances, or more precisely, with secretory and motoric discharge, overwhelms the person and in the most severe cases, represents an unbearable state and an incomparable experience.7 Anxiety is a constitutive part of life and we all feel it from time to time. We consider it a disease only when the anxiety is always present (general anxiety disorder), happening in particular situations which are usually not frightening, i.e. entering an elevator or taking a tram ride, leaving the house, social situations (phobias) or when it appears abruptly as an attack of particularly strong feeling of anxiety, called panic (panic disorder) and when that anxiety significantly limits the individual in achieving her/his personal, professional and other goals in life, thus reducing the quality of life. Not all anxiety should be feared, because it is common and informs the individual if he was in an alarming situation.8Anxiety is manifested with a variety of symptoms, such as heart thumping, sweating, tremor of hands and body, dry mouth, breathing difficulties, nausea, feeling warm or hot, muscle tension, feeling that we are unable to relax and feeling of having a globe in the throat. …