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Mixed Drug Abuse
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Cross tolerance is the basis of some but not all of the use of drugs in sequence or combination. Thus cocaine and amphetamines produce marked cross tolerance; opiates abusers have cross tolerance for nearly all sedatives and alcohol. In other cases opposite effects are used to produce a prolonged “high”. Amphetamine use with opiates is probably the most widely abused pair among the major drugs. More recently, intravenous cocaine has been used by opioid addicts.4 Desipramine treatment has been proposed for such users.5
Historical Notes
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
When tolerance develops very rapidly following either a single dose or a few doses administered over a brief time, usually minutes to hours, it is designated as acute tolerance (tachyphylaxis).43 When tolerance develops after repeated administration of the drug over a longer period of time, usually days to months, it is termed chronic tolerance and is generally implied when the term is used alone. Moreover, drugs having similar pharmacological activity may be cross-tolerant to each other and manifest either a specific or nonspecific cross-tolerance. Specific cross-tolerance denotes the fact that the test compound has the ability to evoke the same adaptive change (tolerance) as the original drug and that the two substances are interchangeable in maintaining a state of tolerance. Nonspecific cross-tolerance is usually a low-grade tolerance evidenced for compounds of different pharmacological classes.
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
Cross tolerance may be defined as diminished responsiveness of the system to one drug, induced by the development of tolerance to another drug of a similar or dissimilar chemical structure or pharmacological action.298Specific cross tolerance denotes the fact that the test compound has the ability to evoke the same adaptive change (tolerance) as the original drug and that the two substances are mutually interchangeable in maintaining a state of tolerance. Generally, cross tolerance develops among drugs of the same pharmacological class.74,151,295,370 Within each phar-malogical class, cross tolerance may develop more readily among compounds from the same chemical class,295 although the latter is not always true. Nonspecific cross tolerance, in contrast, is usually a low-grade tolerance evident for compounds of different pharmacological classes (e.g., tolerance to general anesthetics in chronic alcoholics.6,120,181)
Promoting a comprehensive understanding of the opioid epidemic
Published in International Review of Psychiatry, 2018
The term ‘opioid’ broadly refers to licit products, such as the prescription opioid medications that are a mainstay for pain management throughout the world, and illicit products, such as heroin. Opioids confer effects on the human body by engaging the endogenous opioid system, which initially produces positive feelings such as euphoria and pain relief, but can, following extended exposure to either prescribed or illicit opioids, produce a physical dependence that is characterized by patterns of tolerance (e.g. the need to consume more opioids to get the same effect) and an aversive withdrawal syndrome. Opioids also produce high levels of cross-tolerance, which allows individuals to substitute different opioids to achieve the same effects. Although heroin has traditionally been the predominant opioid of abuse, an aggressive emphasis on treating pain in the 1990s (Baker, 2017) led to a thriving market for prescription opioids, and an eventual abundance of potential opioid products to use, misuse, and substitute. By the early 2010s, the US was consuming 43,879 doses of opioids per million individuals a day, which far exceeded all other countries examined, and almost doubled the consumption of the 2nd country in the list (Germany, with 23,352 units per day) (Berterame et al., 2016). Given this context, the quiet but steady increase in the misuse and abuse of prescription opioids and heroin over the past decade is perhaps not surprising. However, the magnitude of morbidity and mortality that has been associated with chronic opioid exposure was certainly unexpected and alarming. The US, as well as other parts of the world, has now recognized opioid misuse as an epidemic.
Impact of chronic medications in the perioperative period –anesthetic implications (Part II)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Methadone has been used for managing pain in patients with chronic pain syndromes and treating OUD for over 50 years. When used in combination with other CNS depressants, including other opioids, sedative or hypnotic drugs, or alcohol it can be toxic. Psychiatric prescribed medications (e.g. fluoxetine, amitriptyline, quetiapine, and alprazolam) also can increase methadone accumulation and risk of toxicity. In general, 4 to 5 half-lives (∼5 days) are required to reach steady state at a given methadone dose. Adjusting the dose in increments of 5 to 10 mgs every 3 to 5 days (based on symptoms of withdrawal or sedation) usually is adequate[51]. For patients taking methadone on a chronic basis for OUD, they should continue with the same methadone dose during the acute postoperative period to maintain a stable baseline opioid level and multimodal nonopioid analgesic techniques should be utilized. When acute pain decreases, they should be rapidly tapered off the supplemental opioid medication. Incomplete cross-tolerance with other opioids and/or addition of sedatives may increase side effects such as respiratory depression [52,53]. For patients who are on methadone maintenance therapy (MMT), methadone should be continued as described previously. If oral medication is contraindicated, the IV or subcutaneous route of administration can be used. Optimize non-opioid analgesic multimodal strategies as appropriate (e.g. non-opioid analgesics, adjuvant medications, regional anesthesia techniques, physical measures, integrative therapies, and psychosocial or behavioral management strategies). For ambulatory pain management, administer a nonopioid pain medication (e.g. ketorolac) prior to discharge [52,53]. When methadone dose has been interrupted for more than 5 days, an experienced provider with MMT should be consulted before restarting the treatment [54,55].
Induction of cross-tolerance between protective effect of morphine and nicotine in 6-hydroxydopamine-induce neurotoxicity in SH-SY5Y human dopaminergic neuroblastoma cells
Published in International Journal of Neuroscience, 2019
Leila Elyasi, Seyed Hassan Eftekhar-Vaghefi, Majid Asadi-Shekaari, Saeed Esmaeili-Mahani
Cross-tolerance is tolerance or resistance to a drug that develops through continued use of another drug with similar pharmacological action. Cross tolerance between some biological effects of morphine and nicotine has been reported. Such phenomenon has been demonstrated in their antinociceptive [6,7] conditioned place preference [8] and hypothermic [9] effects.