416 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
been approved for treating nausea and vomiting from
cancer chemotherapy (Voth & Schwartz, 1997).
INTOXICATION AND OVERDOSE
Cannabis begins to act less than 1 minute after in-
halation. Peak effects usually occur in 20 to 30 min-
utes and last at least 2 to 3 hours. Users report a high
feeling similar to that with alcohol, lowered inhibi-
tions, relaxation, euphoria, and increased appetite.
Symptoms of intoxication include impaired motor co-
ordination, inappropriate laughter, impaired judg-
ment and short-term memory, and distortions of time
and perception. Anxiety, dysphoria, and social with-
drawal may occur in some users. Physiologic effects,
in addition to increased appetite, include conjunctival
injection (bloodshot eyes), dry mouth, hypotension,
and tachycardia. Excessive use of cannabis may pro-
duce delirium or, rarely, cannabis-induced psychotic
disorder, both of which are treated symptomatically.
Overdoses of cannabis do not occur (Macfadden &
Woody, 2000).
WITHDRAWAL AND DETOXIFICATION
Although some people have reported withdrawal
symptoms of muscle aches, sweating, anxiety, and
tremors, no clinically significant withdrawal syn-
drome is identified (Lehne, 2001).
Opioids
Opioidsare popular drugs of abuse because they de-
sensitize the user to both physiologic and psychologi-
cal pain and induce a sense of euphoria and well being.
Opioid compounds include both potent prescription
analgesics such as morphine, meperidine (Demerol),
codeine, hydromorphone, oxycodone, methadone, oxy-
morphone, hydrocodone, and propoxyphene, and ille-
gal substances such as heroin and normethadone.
People who abuse opioids spend a great deal of their
time obtaining the drugs; they often engage in illegal
activity to get them. Health care professionals who
abuse opioids often write prescriptions for themselves
or divert prescribed pain medication for clients to
themselves (APA, 2000).
INTOXICATION AND OVERDOSE
Opioid intoxication develops soon after the initial
euphoric feeling; symptoms include apathy, lethargy,
listlessness, impaired judgment, psychomotor retar-
dation or agitation, constricted pupils, drowsiness,
slurred speech, and impaired attention and memory.
Severe intoxication or opioid overdose can lead to
coma, respiratory depression, pupillary constriction,
unconsciousness, and death. Administration of nalox-
one (Narcan), an opioid antagonist, is the treatment
of choice because it reverses all signs of opioid toxic-
ity. Naloxone is given every few hours until the opioid
level drops to nontoxic; this process may take days
(Lehne, 2001).WITHDRAWAL AND DETOXIFICATION
Opioid withdrawal develops when drug intake ceases
or decreases markedly, or it can be precipitated by the
administration of an opioid antagonist. Initial symp-
toms are anxiety, restlessness, aching back and legs,
and cravings for more opioids (Jaffe & Jaffe, 2000).
Symptoms that develop as withdrawal progresses
include nausea, vomiting, dysphoria, lacrimation,
rhinorrhea, sweating, diarrhea, yawning, fever, and
insomnia. Symptoms of opioid withdrawal cause sig-
nificant distress but do not require pharmacologic in-
tervention to support life or bodily functions. Short-
acting drugs such as heroin produce withdrawal
symptoms in 6 to 24 hours; the symptoms peak in 2 to
3 days and gradually subside in 5 to 7 days. Longer-
acting substances such as methadone may not pro-
duce significant withdrawal symptoms for 2 to 4 days,
and the symptoms may take 2 weeks to subside.
Methadone can be used as a replacement for the opi-
oid, and the dosage is then decreased over 2 weeks.
Substitution of methadone during detoxification re-
duces symptoms to no worse than a mild case of flu
(Lehne, 2001). Withdrawal symptoms such as anxi-
ety, insomnia, dysphoria, anhedonia, and drug crav-
ing may persist for weeks or months.Hallucinogens
Hallucinogensare substances that distort the user’s
perception of reality and produce symptoms similar
to psychosis including hallucinations (usually visual)
and depersonalization. Hallucinogens also cause
increased pulse, blood pressure, and temperature,
dilated pupils, and hyperreflexia. Examples of hallu-
cinogens are mescaline, psilocybin, lysergic acid dieth-
ylamide (LSD), and “designer drugs” such as Ecstasy.
Phencyclidine (PCP), developed as an anesthetic, is
included in this section because it acts similarly to
hallucinogens.INTOXICATION AND OVERDOSE
Hallucinogen intoxication is marked by several mal-
adaptive behavioral or psychological changes: anxiety,
depression, paranoid ideation, ideas of reference, fear
of losing one’s mind, and potentially dangerous be-
havior such as jumping out a window in the belief that
one can fly (Abraham, 2000). Physiologic symptoms
include sweating, tachycardia, palpitations, blurred
vision, tremors, and lack of coordination. PCP intoxi-