Doctors and Substance Misuse Disorder
Clare Gerada, Zaid Al-Najjar in Beneath the White Coat, 2020
In 2017 an anaesthetist was jailed after stealing codeine. He had opiate addiction. The trial judge accepted his problems were genuine, but stated as a doctor, he should have known where to get help. 1 For a host of reasons, many of which have been discussed in this book, doctors with mental illness, and especially those with addiction, do not know where to get help. They have poor access to confidential, accessible and supportive care. Doctors are often in denial, terrified of acknowledging to themselves, let alone to others, that they have a problem. Colleagues tend not see the obvious and ignore the unmistakable and unpleasant stale smell of alcohol, the pinpoint pupils of someone using opiates or the bizarre behaviour of colleagues using stimulants.
Care of opiate users: maintenance treatment
David Haslam in Care of Drug Users in General Practice, 2021
Long-term opiate dependence is now increasingly viewed as a chronic relapsing condition which may persist in a disabling fashion for many years, with opiate users often undergoing cycles of drug use during which periods of abstinence may be followed by periods of relapse. The need to obtain and use heroin at least three times a day can come to predominate over all other activities. The drugs most commonly used for maintenance are methadone and increasingly buprenorphine, both synthetic opioids with a long half-life, so that relatively stable blood levels can be achieved, avoiding both euphoria and withdrawal, when taken orally on a once-daily basis. Buprenorphine (Subutex) is now increasingly used in the United Kingdom (UK) for maintenance treatment and whilst most studies have been carried out in non-UK settings, the evidence base for its efficacy as maintenance treatment is considerable. The use of injectable methadone in primary care is not currently recommended.
Historical Notes
Albert A. Kurland in Psychiatric Aspects of Opiate Dependence, 2019
Opium preparations were prescribed to reduce pain and produce calmness or sleep, as well as for complaints as cough or diarrhea. The beginning of the 19th century witnessed the isolation of morphine, the active compound of opium. The rate of development of physical dependence is believed to be slightly slower than the onset of tolerance to narcotic analgesics. The administrative actions concerned with regulation and control of what may be seen as harmful, aside from its ethical and moral considerations, must be integrated in the social fabric in a manner that will allow some degree of management over the drug-taking behavior of the individual. The experimental paradigm requires the elimination of the stimulus control exerted both by the primary pharmacological re inforcer and by conditioned reinforcer in treatment regimens which seek to eliminate opiate dependence by the use of drugs blocking reinforcement.
The case for implementing the levels of prevention model: Opiate abuse on American college campuses
Published in Journal of American College Health, 2017
Quri Daniels-Witt, Amy Thompson, Tavis Glassman, Sara Federman, Katie Bott
Opiate abuse in the United States is on the rise among the college student population. This public health crisis requires immediate action from professionals and stakeholders who are committed to addressing the needs of prospective, current, and recovering opiate users using comprehensive prevention methods. Such approaches have been used to deliver primary, secondary, and tertiary intervention to alcohol and other drug users but are underutilized in the case of opiate abuse among college students in the United States. There is a definite need for involving college campus faculty, staff, students, and others in efforts to prevent opiate abuse at all levels. Our recommendations include specific strategies to address this imminent issue using an innovative application of the traditional Levels of Prevention Model.
Illicit Use of Prescription Opiates among Graduate Students
Published in Journal of Evidence-Informed Social Work, 2015
Matthew D. Varga, Mark Parrish
Through this study the authors assessed the prevalence rate, reasons for use, and poly-substance use of prescription opiates among graduate students. The authors employed a cross-sectional survey research design using an online, self-administered questionnaire to assess the prevalence rates of prescription opiate use among graduate students (N = 1,033), reasons for use, and their likelihood for poly-substance use. The survey was e-mailed to 5,000 graduate students. Graduate students (19.7%) reported illicit use of prescription opiates in their lifetime and 6.6% reported past-year illicit use. Those who indicated illicitly using prescription opiates did so for self-medication reasons; a few respondents indicated recreational use. Students using prescription opiates were 75% less likely to use marijuana; 79% less likely to use cocaine; and 75% less likely to use ecstasy. Graduate students are illicitly using prescription opiates, but primarily for self-medication, and, while doing so, are less likely to use other substances.
Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain
Published in Journal of Psychoactive Drugs, 2012
There is a growing body of evidence to support the use of medical cannabis as an adjunct to or substitute for prescription opiates in the treatment of chronic pain. When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective. Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates. Despite a lack of regulatory oversight by federal governments in North America, community-based medical cannabis dispensaries have proven successful at supplying patients with a safe source of cannabis within an environment conducive to healing, and may be reducing the problematic use of pharmaceutical opiates and other potentially harmful substances in their communities.
Related Knowledge Centers
- Opioid Receptors
- Opium
- Papaver
- Analgesics
- Alkaloids
- Opioids
- Narcotics