Heroin opiates methadone

METHADONE (METHADONE HYDROCHLORIDE) Like LAAM, a synthetic opiate used to treat heroin addiction. Methadone is non-intoxicating and blunts symptoms of withdrawal. 

Methadone is used for the treatment of narcotic withdrawal and dependence. It occupies the opioid receptor in the brain and is the stabilizing factor that permits addicts to change their behavior and to discontinue heroin use. Methadone suppresses narcotic withdrawal for between 24 and 36 hours, and because it is effective in eliminating withdrawal symptoms, it is used in detoxifying opiate addicts. Ultimately, the patient remains physically dependent on the opioid, but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts.42... 

Morphine, heroin, and methadone bind to opiate receptors to varying degrees, reflecting their chemical affinity. 

Alkaloids range from the belladonna alkaloids, such as atropine and scopalomine—which are used as poisons, cold remedies, and truth serums —to dextromethorphan, a cough suppressant (anti-tussive). But the most widely known alkaloids are the opiates, such as morphine, heroin, fentanyl, oxycodone, and methadone. These act on... 

The initial dose of buprenorphine should be given at least 12-24 hours after the last heroin dose, 24 hours after the last methadone dose, or 48 hours after the last LAAM dose (see Table 2-3). The methadone dosage of methadone maintenance patients should be reduced to 30 mg/day before the transfer to buprenorphine is attempted. Ideally patients should show clear evidence of opiate withdrawal before receiving the first dose of buprenorphine, to avoid the risk that buprenorphine will precipitate more severe withdrawal. For the first day, sublingual buprenorphine/naloxone doses of 2/0.5-4/1 mg can be given every 2-4 hours, up to a maximum total dose of 8/2 mg/day. On the... 

Ball J, Corty E, Bond H, et al The reduction of intravenous heroin use, non-opiate use and crime during methadone maintenance treatment further findings. NIDA Res Monogr 81 224-230, 1988a... 

Table 1 provides the urinalysis test results for the 4,847 arrestees, While PCP was tested for by an EMIT test only, cocaine, opiates and methadone were tested for by both EMIT and thin layer chromatography (TLC). (The EMIT test for opiates is not specific to morphine, the metabolite of heroin, and can detect the recent use of a variety of opiates. A specimen positive for opiates is most likely to indicate the use of heroin in this population, however.) Our analyses will use only the results from the EMIT tests, because we have learned that the TLC general drug screen is less sensitive for detecting recent use of these illicit street drugs (Wish et al. 1983 Wish et al. 1984). 

Methadone A synthetic opiate used in the maintenance therapy of former heroin and morphine dependents. 

There are two main treatments for the opiate withdrawal syndrome. One is replacement therapy with methadone or other X agonists that have a longer half-life than heroin or morphine, and produce mild stimulation rather than euphoria. They also produce cross-tolerance to heroin, lessening heroin s effect if patients relapse. Withdrawal is also treated with the 0C2 agonist clonidine, which inhibits LC neurons, thus counteracting autonomic effects of opiate withdrawal — such as nausea, vomiting, cramps, sweating, tachycardia and hypertension — that are due in part to loss of opiate inhibition of LC neurons. 

The PE spectra of some other alkaloids like methadone and the opiate narcotics morphine, codeine and heroin have been investigated by Klasinc and coworkers95. Also in this study structure-activity relationships based on IPs were sought but not found. Since the interaction of the drug molecule with the receptor is highly specific, it is not unreasonable that the molecular rather than the electronic structure is more important for the physiological activity. 

Methadone (Dolophine). For over 30 years, methadone has been the mainstay of treatment for opiate dependence. A replacement therapy, methadone has been used both for detoxification and for long-term maintenance. It has a slower onset of action and is longer acting than other narcotic analgesics. It causes little of the euphoria produced by drugs such as heroin. 

In October 2002, the FDA approved two new medications for treating opiate addiction, both developed by Reckitt Benckiser Pharmaceuticals. The new drugs, Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) contain buprenorphine, a partial opioid agonist. Like methadone, buprenorphine binds to the brain s opioid receptors, but produces significantly reduced pleasurable effects than heroin. 

While there are extensive data on the use of methadone substitution therapy in adult opiate-dependent patients, there are only two published studies on opiate substitution therapy in adolescents and most of these subjects were 18 years of age or older (Hopfer et al., 2000). This lack of research is particularly concerning, given the recent increase in heroin use among adolescents (Hopfer et ah, 2000). Two newer substitution agents, L-oc acetylmethadol (LAAM) and buprenor-phine, offer alternatives to methadone, but remain untested in youth with SUD (Kranzler et al., 1999). 

Many addicts, however, report that weaning themseives off of methadone is just as bad as coming off of heroin or morphine addiction. Ultimately, primary treatments for opiate addiction rely on replacing one drug for another and are essentially palliative treatments. The user is never cured and will always be tormented by the specter of addiction. 

Suppression of heroin self-administration in opioid-dependent volunteers has been found to be greater at doses over lOOmg (Donny et al. 2005), and this relates to the three-level effects of methadone, the implications of which we often have to contend with in our discussions with patients. Basically low doses of methadone will suppress opiate withdrawal symptoms in dependent individuals, and this is what a lot of patients mean when they say that their dose (which may be considered too low by us) holds them. In medium to high levels of methadone there is less craving for opiates, and then at the highest doses there will be full narcotic blockade (Donny et al. 2002), but as already indicated the users themselves may not wish to take such dosages. 

In the reviews cited in this chapter there is often some breakdown of findings into those relating to heroin use, criminality, HIV-risk behaviours, social rehabilitation and nonopiate abuse. We have noted that crime was one of the earliest indicators in methadone treatment, while the wider range of outcomes is formalized in drug misuse rating instruments such as the Opiate Treatment Index (Darke et al. 1992a). The main areas in which methadone treatment has been found to be of substantial benefit are indicated in Table 1.3. 

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