Administration, medication controlling narcotics

Finally, intravenous drug administration and the sharing of needles and syringes is common among opiate addicts this creates a serious risk of cross-infection. Many studies have shown a high incidence of HIV and hepatitis B and C among heroin addicts. This risk is somewhat reduced in medically controlled narcotic prescription... 

Epidural/Intrathecal administration Limit epidural or intrathecal administration of preservative-free morphine and sufentanil to the lumbar area. Intrathecal use has been associated with a higher incidence of respiratory depression than epidural use. Asthma and other respiratory conditions The use of bisulfites is contraindicated in asthmatic patients. Bisulfites and morphine may potentiate each other, preventing use by causing severe adverse reactions. Use with extreme caution in patients having an acute asthmatic attack, bronchial asthma, chronic obstructive pulmonary disease or cor pulmonale, a substantially decreased respiratory reserve, and preexisting respiratory depression, hypoxia, or hypercapnia. Even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. Reserve use for those whose conditions require endotracheal intubation and respiratory support or control of ventilation. In these patients, consider alternative nonopioid analgesics, and employ only under careful medical supervision at the lowest effective dose. 

The Opiates. The International Narcotics Control Board—Vienna, tracks the licit production of narcotic drugs and annually estimates world requirements for the United Nations. Their most recent publication (100) points out that more than 95% of the opium for licit medical and scientific purposes is produced by India and, in a declining trend, only about 600 t was utilized in 1988. This trend appears to be due to the fact that the United States, the largest user of opium for alkaloid extraction, reduced the amount of opium being imported from about 440 t in 1986 to 249 t in 1987 and 2241 in 1988. The United States used about 48 t of morphine (2, R = H) in 1988, most (about 90%) being converted to codeine (2, R = CH3) and the remainder being used for oral administration to the terminally ill (about 2 t) and for conversion to other materials of minor commercial import which, while clearly alkaloid-derived, are not naturally occurring. 

Separated from the main Law in 1960, the Pharmacists Law deals with the activities of pharmacists, examination, licensing and duties the Law concerning the Organization for Pharmaceuticals and Medical Devices was recently revised. Several other laws are involved in pharmaceutical administration. Their scope is restricted to limited areas and most of them aim at preventing drug abuse and health damages. They are the Poisonous and Deleterious Substances Control Law, the Narcotics and Psychotropics Control Law, the Cannabis Control Law, the Opium Law, the Stimulants Control Law, and the Blood Collection and Blood Donation Services Control Law. 

Osteoporotic vertebral compression fracture with excruciating pain and/or adverse elfects to opioid treatment or opioid tolerance developed in patients with formerly controlled pain. Failure of medical therapy is defined as minimal or no pain relief with the administration of analgesics for 3-4 weeks or achievement of adequate pain relief with only narcotic dosages that induce excessive intolerable adverse effects (constipation, urinary retention, and/ or confusion). 

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