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Substance Abuse during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Opiates are a class of drugs with sedative and analgesic effects derived from white, milky secretions of the flower bud of the opium poppy plant (Papaver somniferum). Medically, opiates are used to treat moderate to severe pain. Synthetic opioids are also available (e.g., meperidine). Opiates (natural and synthetic) are pharmacological narcotics, not to be confused with the legally defined narcotic class that includes such nonnarcotic drugs as marijuana, amphetamines, and methamphetamines. Narcotics include opium, morphine, oxycodone, codeine, meperidine, paperavine, thebaine, and heroin. Opiates act on opioid receptors to produce analgesia and euphoria. A severe opiate withdrawal syndrome occurs after discontinuation of chronic use, medical or illicit. Importantly, withdrawal occurs in adults and neonates chronically exposed to these opiates. An increasingly more common source of opiates for abuse is prescription drugs such as oxycodone and hydrocodone, obtained either legally or illegally.
Palliative care
Published in Henry J. Woodford, Essential Geriatrics, 2022
There is no pharmacological logic in combining weak (e.g. codeine) and strong opioid (e.g. morphine) agents regularly together. Side effects of opiates can include sedation, nausea/vomiting and constipation. The nausea and vomiting may settle after several days of therapy, but anti-emetics may be required initially. For individual patients, different opiates may cause differing degrees of constipation. In frail older people, consideration should be given to co-prescribing laxative medications when starting opiates due to the high risk of developing constipation. Tolerance and addiction are not seen in the context of acute pain. Toxicity can cause delirium and myoclonic jerks. Warning signs of toxicity include pinpoint pupils and oversedation.8 The risk is increased in those with renal impairment, where smaller and/or less frequent doses are usually required.
The Opioid Epidemic
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Opioids are natural or synthetic substances that bind to opiate receptors. An opiate is a drug derived from opium—from the poppy plant Papaver somniferum. Morphine, codeine, thebaine, and papaverine are examples of opiates. Semi-synthetic opioids include drugs such as hydrocodone, oxycodone, oxymorphone, hydromorphone, and heroin. Synthetic opioids include methadone, fentanyl, and tramadol.
Prescribing patterns for treating common complications of spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Shikha Gupta, Mary Ann McColl, Karen Smith, Alexander McColl
The use of opiates is not generally recommended in SCI patients due to the risk of fatal overdose in case of chronic pain and has been found to be associated with adverse drug interactions, increased risk of falls and reduced mobility.30 However, many possible reasons can explain the use of opiates to treat pain in SCI patients. Firstly, SCI-related pain is complex and challenging to diagnose; and many participants and prescribers may have confused neuropathic pain with nociceptive pain. Secondly, medication failure is a common issue due to altered pharmacokinetics related to SCI. Effects of medication on function, fatigue and quality of life of the patient,31,32 may result in the choice of second- or fourth-line agents. Third, SCI patients may have pain, acute and chronic, from multiple sources – related to initial trauma; overuse syndromes secondary to altered means of mobilization; or post-surgical pain. Opiates may be used as part of a multi-modality pain control program, or control nociceptive or visceral pain. Further, the third- and fourth-line choices for treating neuropathic pain in SCI – transcranial direct current stimulation and transcutaneous electrical nerve stimulation are less readily available and are inconvenient options for patients.
Percutaneous electrical nerve field stimulation to reduce clinical opiate withdrawal: a case series
Published in Journal of Substance Use, 2022
Frank D. Buono, Rosemary Pickering, Rebecca Berlepsch, Shelley Halligan
Percutaneous nerve field stimulation (PNFS) has shown moderate-to-high level of evidence and utility for the implementation of alternative methods to facilitate within chronic pain management (Deer et al., 2020). As opposed to pharmacological interventions, research has shown PNFS to have milder symptoms (i.e., nausea, cramping, and fevers) than standard approaches within pain samples (Gilmore et al., 2020; Roberts et al., 2016). None-the-less, within the induction period of detoxification from OUD, few articles have examined the effectiveness of the PNFS device (Miranda & Taca, 2018; Ward et al., 2020). Moreover, to the knowledge of the authors, research has not evaluated the impact of standardized assessments for clinical opiate withdrawal over the course of the device’s treatment. Given this, the current retrospective case series focused on five patients who were administered a PNFS over the course of 5 days while obtaining clinical withdrawal data through patient’s interviews.
Depressive symptoms in early alcohol or opioid abstinence: course & correlates
Published in Journal of Addictive Diseases, 2022
Prabhat Sapkota, Surendra K. Mattoo, Tathagata Mahintamani, Abhishek Ghosh
The baseline mean score of Obsessive Compulsive Drug Use Scale was 42.41 ± 8.48, which decreased to 13.27 ± 9.15, 2.87 ± 5.13, 0.59 ± 1.98, 0.69 ± 4.04 at the end of first, second, third and fourth weeks respectively. The last observation of the mean score of Obsessive Compulsive Drug Use Scale showed a further reduction of score to 0.018 ± 0.13. The baseline mean score of Clinical Opiate Withdrawal Scale was 10.10 ± 3.57, which decreased to 3.93 ± 2.58, 1.74 ± 1.90, 0.66 ± 0.94 and 0.53 ± 1.89 at the end of first, second, third and fourth weeks respectively. The last observation of the mean score of the Clinical Opiate Withdrawal Scale showed a further reduction of score to 0.16 ± 0.37. The baseline mean score of Hamilton Anxiety Rating Scale was 14.40 ± 6.17, which decreased to 5.58 ± 3.85, 2.25 ± 2.31, 0.43 ± 0.97 and 0.41 ± 2.46 at the end of first, second, third and fourth weeks respectively. The last observation of the mean score of the Hamilton Anxiety Rating Scale showed a further reduction of score to 0.0037 ± 0.19. All these scores point toward a reducing trend of the severity of the addiction, withdrawal symptoms and anxiety among opioid-dependent participants.