Dependence, drug opioids

Jaffe JH Drug dependence opioids, nonnarcotics, nicotine (tobacco), and caffeine, in Comprehensive Textbook of Psychiatry, 5th Edition, Vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams c Wilkins, 1989, pp 642-686 Jaffe J, Knapp CM, Ciraulo DA Opiates clinical aspects, in Substance Abuse A Comprehensive Textbook. Edited by Lowinson JH, Ruiz P, Millman RB, et al. New York, Lippincott Williams and Wilkins, 2004, pp 158—165 Jarvis MA, Schnoll SH Methadone use dming pregnancy. NIDA Res Monogr 149 58— 77, 1995... 

Gelemter, J., Kranzler, H., and CubeUs, J. (1999) Genetics of two mu opioid receptor gene (OPRMl) exon 1 polymorphisms population studies, and allele frequencies in alcohol- and drug-dependent subjects. Mol. Psychiatry. 4, 476 83. 

Drug dependence Administer cautiously to people who are known or suspected to be physically dependent on opioids, including newborns of mothers with narcotic dependence. Reversal of narcotic effect will precipitate acute abstinence syndrome. Repeat administration The patient who has satisfactorily responded should be kept under continued surveillance. Administer repeated doses as necessary, because the duration of action of some narcotics may exceed that of the narcotic antagonist. Respiratory depression Not effective against respiratory depression due to nonopioid drugs. 

Use opioids with caution in patients with alcoholism or other drug dependencies because of the increased frequency of opioid tolerance, dependence, and the risk of addiction observed in these patient populations. Abuse of opioids in combination with other CNS depressants can result in serious risk to the patient. 

It is beheved that phenomena such as sensitization, tolerance and drug-dependence might also involve synaptic plasticity. In fact, numerous studies indicate that NMDA receptor antagonists block sensitization to amphetamine and cocaine as well as tolerance and dependence to ethanol and opioids in animal models (Trujillo and Akil 1991 Pasternak and Inturrisi 1995 Trujillo and Akil 1995 Mao 1999). Recent studies indicate that the uncompetitive NMDA receptor antagonists dextromethorphan, memantine and neramexane not only prevent the development of morphine tolerance, but also reverse estabhshed tolerance in the continuing presence of this opioid, prevent the expression of withdrawal symptoms in rats (Popik and Skolnick 1996 Popik and Danysz 1997 Popik and Kozela 1999 Houghton et al. 2001) and attenuate the expres-... 

To achieve all the objectives, a combination of 2 or 3 drugs is used depending on the need. The commonly employed drugs are opioids, sedative-hypnotics, antianxiety agents, anti-cholinergics, neuroleptics and antiemetics. 

Non-steroidal antiinflammatory drugs (NSAIDs) are also known as nonopioid analgesics. They relieve pain without interacting with opioid receptors and do not depress CNS and have no drug dependence or drug abuse property and possess antipyretic activity also. They act primarily on peripheral pain mechanisms and also in CNS to raise pain threshold. 

Schedule II - The drugs at this level also have a high abuse potential and could cause psychic or physical dependence. They may be prescribed but are under stringent control. Schedule II drugs include opioids(morphine), amphetamines and methamphetamines used alone or in combination as well as some barbiturates. 

Natsuki, R. and Dewey, W. L. Changes in the levels of several endogenous opioid peptides in dog cerebrospinal fluid following morphine administration, Japanese Journal of Alcohol and Drug Dependence 1993, 28, 379-394. 

Zacny, J. et al., College on Problems of Drug Dependence taskforce on prescription opioid nonmedical use and abuse position statement, Drug Alcohol Depend., 69, 215, 2003. 

Gerrits MA, Lesscher HB, van Ree JM. Drug dependence and the endogenous opioid system. Eur Neuropsychopharmacol. 2003 13 424-434. 

Morphine has a strong analgesic effect and has been used for the alleviation of postoperative and cancer pain since antiquity, but its use is now restricted because of its drug dependency. Morphine and its homologues were called opiates after opium, which was extracted from poppy seeds. This class of drugs are now termed opioids. 

Drug Dependence, Withdrawal, and Treatment of Opioid Dependence... 

Drug dependence and self- or cross-tolerance develop with the use of opioid analgesics. Abrupt termination of therapy leads to severe withdrawal symptoms... 

Alfentanil Hydrochloride Alfentanil hydrochloride can cause drug dependence similar to that of opioid analgesics. Since this may cause irritation and related adverse effects, it is important to avoid skin contact and the inhalation of alfentanil hydrochloride particles to contain adverse effects. 

Butorphanol Tartrate With this drug, dependence, withdrawal, and interactions are similar to that of opioids. Butorphanol has less potential to produce dependence when compared with morphine, but it is a drug of abuse. Naloxone acts as an antagonist and can be used for the treatment of overdose.35... 

Codeine Phosphate The presence of aspirin along with codeine, even at a low moisture level, leads to acetylation of codeine phosphate in solid dose forms and is incompatible.36 Codeine sulfate solutions are more stable than phosphate salts.37 Drug dependence and withdrawal resemble that of opioid analgesics. Overdose causes acute intoxication in children, as accidental or deliberate ingestion of cough preparations containing codeine.38... 

Drugs that stimulate one receptor but block another are termed mixed agonist-antagonists. The effects of these drugs depend on previous exposure to opioids. In individuals who have not recently received opioids,... 

The non-precipitated withdrawal procedure represents a first screen for possible induction of drug dependence and has been shown to be sensitive to withdrawal effects with a variety of dependence-inducing agents including amphetamines, cocaine, opioids and benzodiazepines. It therefore possesses face validity. On the other hand, it is remarkably difficult, under the conditions of the protocol described, to show signs of withdrawal after treatment with agents such as nicotine... 

OPIOIDS DRUG DEPENDENCE THERAPIES-BUPROPION T plasma concentrations of these substrates, with risk of toxic effects Bupropion and its metabolite hydroxybupropion inhibit CYP2D6 Initiate therapy of these drugs at the lowest effective dose... 

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