Induced Addiction

There are on record a few authenticated cases of congenital morphinism, that is, morphinism in the newborn of addicted mothers convulsions are a prominent feature. Unless the syndrome is promptly recognized and properly treated, the infant may succumb. 

The opium narcotics used in the U.S. are, particularly, morphine and heroin, especially the former but juveniles definitely prefer heroin. Heroin has greater addiction liability than other narcotics, produces more euphoria and stimulation, requires smaller doses, and is easier to traffic in illicitly. Codeine addiction is rare because the drug produces relatively little euphoria, and is thus less desirable to the potential addict, and because it is quite expensive and bulky in effective amounts. Codeine addicts are usually persons who originally received the drug for clinical purposes. Many narcotic addicts also use cocaine, usually in combination with heroin, and resort to whisky or barbiturate when their supply of narcotic is low. Every conceivable method and route are used to get the narcotic into the body. Morphine and heroin, however, are ordinarily taken hypodermically or intravenously cocaine and heroin are employed by snuffing. The use of galenical preparations of opium is rare in the U.S. Occasionally, however, a paregoric addict is discovered. 

Addiction occurs after a variable period of time. Although it usually requires more than 2 weeks of repeated use of a narcotic, addiction may develop in a few days and, in some unstable personalities, after only a few doses. Physical dependence has been shown to develop within 2 d by the use of nalorphine. Great care should therefore be exercised not to prescribe a narcotic for a longer period of time than is absolutely necessary, and to avoid clocklike regularity in its administration. The continued employment of an opiate to relieve pain in terminal illnesses or neoplastic diseases does not come under the scope of the present discussion, and addiction under such circumstances is often unavoidable. 

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Drug addiction is much more complex than this simple summary can indicate. This can be seen in the fact that millions of people use alcohol, for example, without becoming addicted to it—but some people can literally drink themselves to death. Even for drugs such as cocaine and heroin that are considered highly addictive, the amount of use needed to induce addiction varies considerably among individuals, and some individuals seem to be able to wean themselves off the drug when desired. 

Side-effects Oxymorphone has a morphine-type side-effect profile and can induce addiction and dependence (Copland etal., 1987). 

Pharmacologically, lithium as a drug does not lose its efficacy, and does not induce addiction or dependence. Consequently, lithium retains its full effect even if it has been administered for long periods (even years). Moreover, both the effects and side effects of lithium are completely reversible indeed, a mechanical switch-on and -off function of lithium s biochemical mechanism has been discussed, though the details of this remain unknown (Schafer 1998,... 

However, fear of inducing addiction or respiratory depression interferes with pain management. Addiction is rare in clinical practice. Some patients who are treated with opioid analgesics can develop a tolerance to the medication requiring an increased dose to maintain pain relief. However, the need to increase the dose of the medication is usually related to an increase in pain due to disease progression or complications. Physical dependence on a medication occurs when the physiological condition of the patient is altered. 

Levopropoxyphene [2338-37-6] (42), the optical antipode of the dextrorotatory analgetic propoxyphene, is an antitussive without analgetic activity. The 2-naphthalenesulfonate salt has a less unpleasant taste than the hydrochloride salt, and is widely used. Clinical effectiveness has been demonstrated against pathological and artificially induced cough, but the potency is somewhat less than codeine. The compound is reported not to cause addiction. Levopropoxyphene can be prepared (62) by first resolving [ -dimethylamino-CX-methylpropiophenone with dibenzoyl-(+)-tartaric acid. The resolved... 

Codeine (morphine methyl ether) resembles morphine in its general effect, but is less toxic and its depressant action less marked and less prolonged, whilst its stimulating action involves not only the spinal cord, but also the lower parts of the brain. In small doses in man it induces sleep, which is not so deep as that caused by morphine, and in large doses it causes restlessness and increased reflex excitability rather than sleep. The respiration is slowed less than by morphine (cf. table, p. 261). Cases of addiction for codeine can occur but according to Wolff they are rare. The best known ethers of morphine are ethylmorphine and benzyl-morphine [cf., table, p. 261), both used to replace morphine or codeine for special purposes. 

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

Caffeine binds to adenosine receptors in the brain, preventing adenosine from inducing sleep or opening blood vessels. Caffeine also increases levels of dopamine, the neurotransmitter associated with pleasure. This is the chemical mechanism for addiction. The response to adenosine competition causes increased adrenaline flow. 

Personality variables, state of mind at time of withdrawal, and expectations of severity of symptoms all may affect withdrawal severity (Kleber 1981). One study found that merely providing addicts information about the withdrawal syndrome resulted in lower levels of withdrawal symptoms (Green and Gos-sop 1988). Naloxone rapidly induces a severe withdrawal syndrome, which peaks within 30 minutes and then declines rapidly. Until the antagonist is eliminated, only partial suppression of the withdrawal syndrome is possible, and then only by using very high opioid doses, which may cause respiratory depression when naloxone is metabolized. 

Kleber HD, Weissman MM, Rounsaville BJ, et al Imipramine as treatment for depression in addicts. Arch Gen Psychiatry 40 649-633, 1983 Kleber HD, Riordan CE, Rounsaville BJ, et al Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 42 391-394, 1983 Kleber HD, Topazian M, Gaspari J, et al Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am J Drug Alcohol Abuse 13 1-17, 1987 Kornetsky C. Brain stimulation reward, morphine-induced stereotypy, and sensitization implications for abuse. Neurosci Biobehav Rev 27 777-786, 2004 Kosten TR, Kleber HD Buprenorphine detoxification from opioid dependence a pilot study. Life Sci 42 633-641, 1988... 

Toluene, volatile nitrites, and anesthetics, like other substances of abuse such as cocaine, nicotine, and heroin, are characterized by rapid absorption, rapid entry into the brain, high bioavailability, a short half-life, and a rapid rate of metabolism and clearance (Gerasimov et al. 2002 Pontieri et al. 1996, 1998). Because these pharmacokinetic parameters are associated with the ability of addictive substances to induce positive reinforcing effects, it appears that the pharmacokinetic features of inhalants contribute to their high abuse liability among susceptible individuals. 

In humans, a comparative examination of the positive reinforcing effects of solvents showed that among inhalant-dependent subjects, solvents induced a more intense sensation of pleasant feelings than that induced by alcohol and nicotine in subjects addicted to these substances (Kono et al. 2001). Solvent-dependent subjects reported pleasant feelings comparable to those reported by stimulant-dependent subjects after use of methamphetamine. However,... 

McLellan AT, Kushner H, Metzger D, et al The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 9 199—213, 1992 Mechanic JA, Maynard BT, Holloway FA Treatment with the atypical antipsychotic, olanzapine, prevents the expression of amphetamine-induced place conditioning in the rat. Prog Nemopsychopharmacol Biol Psychiatry 27 43—54, 2003... 

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