Addiction to opioids

Long -term sequelae of chronic pancreatitis include dietary malabsorption, impaired glucose tolerance, cholangitis, and potential addiction to opioid analgesics. 

Women are more likely than men to receive prescribed drugs that are abused among adult populations. These prescribed drugs are most often antidepressants and pain relievers. Evidence indicates that men and women are at similar risk for becoming addicted to opioids. However, women are far more likely to become addicted to other types of prescription drugs than men. 

Those patients who do become addicted to opioids as well as those who become addicted for nonmedical reasons typically have a difficult time getting off the drugs. These individuals usually face a variety of problems along the way. They often have a difficult time holding a job, and their family life tends to be unstable. If untreated for addiction, many of these individuals eventually resort to living off welfare programs. 

Subutex (buprenorphine) and Subuxone (buprenor-phine/naloxone) are legal medications used to treat addiction to opioids. Buprenorphine prevents withdrawal symptoms. Subutex contains only the medicine buprenorphine, while Suboxone contains naloxone as well. When naloxone is injected or taken as a pill, it blocks the effects of medicines and drugs, such as heroin and morphine. Naloxone is added to Suboxone to stop people from injecting, or shooting-up. 

The opioid antagonists bind with high affinity to opioid receptors but fail to activate the receptor-mediated response. Administration of opioid antagonists produces no profound effects in normal individuals. However, in patients addicted to opioids, antagonists rapidly reverse the effect of agonists, such as heroin, and precipitate the symptoms of opiate withdrawal. 

Compared with naloxone, naltrexone retains much more of its efficacy by the oral route, and its duration of action approaches 24 hours after moderate oral doses. Peak concentrations in plasma are reached within 1-2 hours and the tj hours does not change with long-term use. Naltrexone is much more potent than naloxone, and 100-mg oral doses given to patients addicted to opioids produce concentrations in tissues sufficient to block the euphorigenic effects of 25-mg intravenous doses of heroin for 48 hours. 

Morphine is the prototype of the strong opioids. Meperidine is a variant used commonly for analgesia. Methadone is a strong agonist used in maintenance programs for patients addicted to opioids. Codeine, oxycodone, and hydrocodone are moderate agonists, whereas propoxyphene is a weak agonist. 

ER is fiction, but its depiction of a healthcare professional becoming a substance abuser is well founded as up to 15 percent of overall addiction to opioids have been attributed to healthcare professionals for more than 130 years. Many healthcare professionals who become dmg abusers feel they can self-medicate without becoming addicted because they know when to stop taking the medication. Craving for the dmg quickly overshadows their critieal thinking. 

Opioid Treatment Program Substance Abuse and Mental Health Services Administration (SAMHSA) certified program, usually comprising a facility, staff, administration, patients, and services that engages in supervised assessment and treatment, using methadone, buprenorphine, L-a-acetylmethadol (LAAM), or naltrexone, of individuals who are addicted to opioids. 

Tramadol is a pain reliever (analgesic). Its action is similar to opioid narcotics such as codeine and morphine, but it does not depress breathing the way the others can, and less often leads to abuse and addiction. 

Brief experimentation with illicit opioids rarely leads to dependence, but persons who use opioids commonly escalate to daily use, at least once per month for at least a brief period. Among Vietnam War-era soldiers, experimentation with opioids was widespread 73% of the soldiers who used opioids at least five times became dependent however, 88% of enlisted men who became addicted to heroin did not become readdicted at any time in the 3 years after return, and 56% did not use opioids at all during that time (Robins et al. 1975). 

Shi J, Hui L, Xu Y, et al Sequence variations in the mu-opioid receptor gene (OPRM1) associated with human addiction to heroin. Hum Mutat 19 459 60, 2002 Shinderman M, Maxwell S, Brawand-Arney M, etal Cytochrome P4503A4 metabolic activity, methadone blood concentrations, and methadone doses. Drug Alcohol Dependence 69 205-211, 2003... 

Azrin NH, Sisson RW, Meyers R, et al Alcoholism treatment by disulfiram and community reinforcement therapy. J Behav Ther Exp Psy 13 105-112, 1982 Bickel WK, Amass L, Higgins ST, et al Effects of adding behavioral treatment to opioid detoxification with buprenorphine. J Consult Clin Psychol 65 803—810, 1997 Bien TH, Miller WR, Tonigan JS Brief interventions for alcohol prohlems a review. Addiction 88 315-335, 1993... 

Buprenorphine is only recommended in the rehabilitation and continuing care stages of treatment for cocaine dependence if the patient is also addicted to an opioid. 

A derivative of methadone, L-a-acetyl-methadol (LAAM) has been approved for the treatment of opioid addiction. In some addicts whose degree of tolerance is not known, the patient is first given methadone to stabilize the withdrawal signs and is then switched to LAAM. LAAM has an advantage over methadone in that it has a longer duration of action. Dosing is required only three times per week in most addicts to prevent withdrawal. 

Babies bom to opioid-addicted women also exhibit withdrawal signs, but because of the slower metabolism of opioids in the newborn, the withdrawal signs are more protracted. The babies are often treated with the opium preparation paregoric to reduce withdrawal signs. 

Does not completely bind to opioid receptors caution in addicted patients... 

There are two main hypotheses about the involvement of endogenous opioid systems in the maintenance of self-injurious behaviors (Sandman, 1988 Buitelaar, 1993). The pain hypothesis suggests that in some subjects self-injury does not induce pain because excessive basal activity of opioid systems in the CNS has led to an opioid analgesic state. The addiction hypothesis posits that particularly repetitive and stereotyped forms of self-injury stimulate the production and release of en-dogeneous opioids. Therefore, chronic maintenance of self-injury may be due to addiction to endogenous opioids or to positive reinforcement by a central release of opioids triggered by the self-injurious behavior. Irrespective of which hypothesis one favors, treatment with opiate antagonists seems to be a rational approach. 

Sullivan LE, Metzger DS, Fudala PJ Fiellin DA (2005). Decreasing international HIV transmission the role of expanding access to opioid agonist therapies for injection drug users. Addiction, 100, 150-8... 

Depending on the compound and the effect measured, the degree of tolerance may be as great as 35-fold. Marked tolerance may develop to the analgesic, sedating, and respiratory depressant effects. It is possible to produce respiratory arrest in a nontolerant person with a dose of 60 mg of morphine, whereas in addicts maximally tolerant to opioids as much as 2000 mg of morphine taken over a 2- or 3-hour period may not produce significant respiratory depression. Tolerance also develops to the antidiuretic, emetic, and hypotensive effects but not to the miotic, convulsant, and constipating actions (Table 31-3). 

Patients who are prescribed opioids for a period of time may develop a physical dependence on them, which is not the same as addiction. Repeated exposure to opioids causes the body to adapt, sometimes resulting in tolerance (that is, more of the drug is needed to achieve the desired effect compared with when it was first prescribed) and in withdrawal symptoms upon abrupt cessation of drug use. Thus, individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but they should also be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia,... 

Individuals who abuse or are addicted to prescription opioid medications can be treated. Initially, they may need to undergo medically supervised detoxification to help reduce withdrawal symptoms however, that is just the first step. Options for effectively treating addiction to prescription opioids are drawn from research on treating heroin addiction. Behavioral treatments, usually combined with medications, have also been proven effective. Currently used medications are... 

Methadone, a synthetic opioid that eliminates withdrawal symptoms and relieves craving, has been used successfully for more than 30 years to treat people addicted to heroin as well as opiates. 

Buprenorphine, another synthetic opioid, is a more recently approved medication for treating addiction to heroin and other opiates. It can be prescribed in a physician s office. 

Portenoy and Payne (1997) insist upon a distinction between physical dependence and addiction. What they mean by physical dependence is roughly what 1 mean, but they define addiction as a condition in which one is unable to abstain "Use of the term addiction to describe patients who are merely physically dependent reinforces the stigma associated with opioid therapy and should be abandoned. If the clinician wishes to describe a patient who is believed to have the capacity for abstinence, the term physical dependency must be used (564). Since my second level of dependency, which I consider to be addiction proper, need not involve this inability, Portenoy and Payne are marking a different distinction. 

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