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Detoxification Strategies
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Jennifer Kljajic, Ahmed Zaafran
Despite maintaining a therapeutic dose in many cases, tolerance to the medication is a risk, and patients may start to experience withdrawal symptoms. As a result, increasing doses become necessary in order to achieve a similar therapeutic effect. While physical dependence is one problem, medication withdrawal often leads to physiological as well as mental health symptomology. Those symptoms may include depersonalization, derealization, panic attacks, and anxiety, which may last long after withdrawal.5
Is caffeine a drug of dependence? criteria and comparisons
Published in B.S. Gupta, Uma Gupta, Caffeine and Behavior, 2020
Stephen J. Heishman, Jack E. Henningfield
The three secondary criteria to be considered in evaluating caffeine as a drug of dependence are: (1) pleasant or euphoric effects, (2) tolerance, and (3) physical dependence. Drug-induced euphoria is typically assessed through the use of self-report measures, such as visual analog scales and standardized questionnaires. Tolerance is defined as decreased responsiveness to an effect of a drug that results from prior drug exposure. Physical dependence refers to an altered physiological state resulting from prior drug exposure, which requires the maintenance of drug administration for normal functioning and is defined by an abstinence syndrome when the drug is discontinued.9 These three effects are often, but not always, observed after exposure to dependence-producing drugs; thus, they are neither necessary nor sufficient conditions to define drug dependence. However, each of these effects can strengthen the control of a drug on behavior, increasing the probability that initial drug use will escalate to drug dependence or that drug dependence will be maintained.
Characteristics and Theories Related to Acute and Chronic Tolerance Development
Published in S.J. Mulé, Henry Brill, Chemical and Biological Aspects of Drug Dependence, 2019
Thus far, it appears that tolerance develops to some of the actions of all drugs which can induce physical dependence. However, there is no consistent qualitative or quantitative relationship between physical dependence and tolerance.172,295 Certainly, tolerance develops to the effects of many drugs which do not induce physical dependence, and tolerance develops in non-nervous tissues which do not exhibit any signs of physical dependence when the drug is removed.295 Thus, although the two phenomena may exhibit certain parallelisms, they are not necessarily related fundamentally. In fact, it has been suggested that tolerance relates to physical dependence largely as a means by which cells (specifically neurons) can be exposed to sufficiently high concentrations of drug so that significant degrees of physical dependence can be developed.295 Without tolerance development the organism would succumb before sufficiently large concentrations could be achieved.
DOJ Overreach: The Criminalization of Physicians
Published in Journal of Legal Medicine, 2021
It is a flawed argument that people became accidently addicted from a prescription. The vast majority of nonmedical use of opioids has been among people who obtained the drugs from friends, relatives, or dealers.41 As far as pharmaceutical pain medication being a “gateway drug,” the government’s own data refute this; approximately 4% of people who abuse prescription drugs go on to use heroin.42 Cochrane reviews show addiction rates to pain medication at about 1%.43 There is a tendency, even among medical professionals, to conflate physical dependence with addiction. “Addiction is a compulsive behavior whereas physical dependence describes the symptoms abrupt withdrawal will cause.”44 Tolerance and physical dependence are predictable results of opioid prescribing. It is why doses need adjustment over time for the same analgesic effect.45 Addiction, on the other hand, is not a predictable result of opioid prescribing. “Cardinal features of addiction include a pronounced craving for the drug, obsessive thinking about the drug, erosion of inhibitory control over efforts to refrain from drug use, and compulsive drug taking.”46 These behavioral changes are associated with structural changes in the brain.
Association between Functional Independence Measure and mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis: A single-center observational study
Published in Modern Rheumatology, 2021
Yoshinosuke Shimamura, Takuto Maeda, Koki Abe, Yayoi Ogawa, Hideki Takizawa
However, this study has some limitations. First, the retrospective study design limited the interpretation of results. Second, the presence of unmeasured confounding factors remains possible, despite the application of adjustments for several covariates. Third, our findings might not be generalizable since this is a single-center small-cohort study with a rather short observation period. Fourth, most patients in our cohort were MPA patients, therefore not representative of all the AAV patients; however, this study includes representative AAV patients in Japan since MPA is more common than GPA in Asia [42]. Fifth, due to its small sample size, this study may not be adequately powered to detect all the potentially significant differences. Additionally, the rule of 10 events per dependent variable was not strictly followed in our analyses due to the small number of events; therefore, multivariable analysis may not be appropriate for the outcomes. Lastly, the FIM has ceiling effects. Due to the aforementioned reasons, we advise caution when interpreting our results. As a suggestion, future prospective studies should examine whether the assessment of physical dependence contributes to improve outcomes in this particular population.
Small area estimation and hotspot identification of opioid use disorder among military veterans living in the Southern United States
Published in Substance Abuse, 2021
David L. Albright, Justin McDaniel, Stefan Kertesz, David Seal, Katie Prather, Thomas English, Kirsten Laha-Walsh
Misuse of prescribed and illicit opioids is a substantial public health crisis, as shown in the results of this study. The consequences of opioid use disorder, which may apply to veterans in Alabama, include significant overdose risk, physical, social, and legal consequences, and community harms.23 Neuropsychological impairments are side effects frequently seen with long-term use and abuse.24 PTSD is often co-occurring with substance abuse disorders, including opioid use disorder; preceding studies show that an opioid use disorder creates a more severe presentation of PTSD symptoms than other substance abuse disorders – a finding that is especially relevant for Alabama’s veterans.25 Physical dependence and physical health issues are also common side effects of opioid use and misuse.26 The aforementioned health outcomes should be considered in opioid use disorder treatment interventions for Alabama veterans.