Dependence opiate

Two opioids are used in the treatment and management of opiate dependence levomethadyl and methadone. Levomethadyl is given in an opiate dependency clinic to maintain control over the delivery of the drug. Because of its potential for serious and life-threatening proarrhythmic effects, levomethadyl is reserved for use in the treatment of addicted patients who have no response to other treatments. Levomethadyl is not taken daily the drug is administered three times a week (Monday/Wednesday/Thursday or Tuesday/Thursday/ Saturday). Daily use of the usual dose will cause serious overdose. 

Gossop M, Bradley B, Phillips GT An investigation of withdrawal symptoms shown by opiate addicts during and subsequent to a 21 -day in-patient methadone detoxification procedure. Addict Behav 12 1-6, 1987 GreenJ, Jaffe JH Alcohol and opiate dependence. J Stud Alcohol 38 1274-1293,1977 Green L, Gossop M Effects of information on the opiate withdrawal syndrome. Br J Addict 83 305-309, 1988... 

Krausz M, Degkwitz P, Kuhne A, et al Comorbidity of opiate dependence and mental disorders. Addict Behav 23 767-783, 1998... 

Ling W, Weiss DG, Charuvastra VC, et al Use of disulfiram for alcoholics in methadone maintenance programs. Arch Gen Psychiarry 40 851—854, 1983 Ling W, Charuvastra C, Collins JF, er al Buprenorphine maintenance treatment of opiate dependence a multi-center, randomized clinical trial. Addiction 93 475-486, 1998... 

McLellan AT, Childress AR, Ehrman R, et al Extinguishing conditioned responses during opiate dependence treatment turning laboratory findings into clinical procedures. J Subst Abuse Treat 3 33 0, 1986... 

National Research Council Clinical evaluation of naltrexone treatment of opiate-dependent individuals report of the National Research Council Committee on Clinical Evaluation of Narcotic Antagonists. Arch Gen Psychiatry 35 335—340, 1978... 

Nestler EJ, Hyman SE, Malenka RC Molecular Neuropharmacology A Foundation for Clinical Neuroscience. New York, McGraw Hill, 2001 Novick DM, Pascarelli EE, Joseph H, et al Methadone maintenance patients in general medical practice a preliminary report. JAMA 259 3299—3302, 1988 Nunes EV, Quitkin EM, Donovan SJ, et al. Imipramine treatment of opiate-dependent patients with depressive disorders a placebo-controlled trial. Arch Gen Psychiatry 55 153-160, 1998... 

Woody GE, Luborsky L, McLellan AT, et al Psychotherapy for opiate addicts does it help Arch Gen Psychiatry 40 639—645, 1983 Woody GE, McLellan AT, Luborsky L, et al Severity of psychiatric symptoms as a predictor of benefits from psychotherapy the Veterans Administration-Penn study. Am J Psychiatry 141 1172—1177, 1984 Woody GE, McLellan AT, Luborsky L, et al Twelve-month follow-up of psychotherapy for opiate dependence. Am J Psychiatry 144 590-596, 1987 Yabaluri N, Medzihradsky F Down-regulation of mu-opioid receptor by full but not partial agonists is independent of G protein coupling. Mol Pharmacol 52 896-902, 1997... 

Donahoe RM, Byrd LD, McClure HM, Fultz P, Brantley M, MarsteUer F, Ansari AA, Wenzel D, Aceto M (1993) Consequences of opiate-dependency in a monkey model of AIDS. Adv Exp Med Biol 335(21-8) 21-28... 

Wang, G.J., Volkow, N.D., Fowler, J.S. et al. Dopamine D2 receptor availability in opiate-dependent subjects before and after naloxone-precipitated withdrawal. Neuropsychopharmacology. 16 174, 1997. 

Children of opiate addicts have been shown to have poorer social, educational and health status and to be at higher risk of abuse than their peers (Keen et al., 2000). However, given the high rates of psychiatric comorbidity (in particular, depression) in opiate-dependent patients (Brooner et al., 1997 Khantzian and Treece, 1985), it may be that some of the increased risk in children stems from this greater parental depression. Nunes et al. (1998) reported higher incidence of conduct disorder and global and social impairment for children of addicts with major depression compared to addicts without depression and controls, but not compared with children of depressed patients without substance use disorders. 

Nunes EY, Weissman MM, Goldstein RB, McAvay G, Seracini AM, Verdeli H and Wickra-maratne PJ (1998). Psychopathology in children of parents with opiate dependence and/ or major depression. Journal of the American Academy of Child and Adolescent Psychiatry, 37(11), 1142-1151. 

Buprenorphine does not cause dependence in humans [96]. Unbke morphine, buprenorphine desensitizes the /< receptor coupling to adenylyl cyclase [80]. The desensitization occurs in the absence of any receptor internalization or downregu-lation [80]. The desensitization of the /x receptor may be the underlying basis for why buprenorphine does not cause a heightened adenylyl cyclase activity in // receptor-responsive cells. Buprenorphine s unique cellular regulation of the // receptor may explain its ability to be a non-addictive analgesic as well as its usefulness in treating opiate dependence. 

Chronic opiate-induced upregulation of the cAMP pathway appears to be mediated in part by CREB chronic opiate administration increases CREB expression mice deficient in CREB show attenuated physical opiate dependence and withdrawal and selective reductions of CREB in the locus ceruleus prevent upregulation of specific components of the cAMP pathway in response to chronic opiate administration [66]. This latter action is associated with attenuation of the electrical excitability of locus ceruleus neurons and of physical opiate dependence and withdrawal. 

Kaufman, M. J., Pollack, M. H., Villafuerte, R. A. et al Cerebral phosphorus metabolite abnormalities in opiate-dependent polydrug abusers in methadone maintenance. Psychiat. Res. 90 143-152,1999. 

Malin DH, Lake JR, Hammond MV, Fowler DE, RogiUio RB, Brown SL, Sims JL, Leecraft BM, Yang HY (1990) EMRE-NH2-like mammahan octapeptide possible role in opiate dependence and abstinence. Peptides 11 969-972... 

Alcohol Abuse, Alcohol Dependence Amphetamine Abuse, Amphetamine Dependence Cannabis Abuse, Cannabis Dependence Cocaine Abuse, Cocaine Dependence Hallucinogen Abuse, Hallucinogen Dependence Inhalant Abuse, Inhalant Dependence Nicotine Dependence Opiate Abuse, Opiate Dependence Phencyclidine Abuse, Phencyclidine Dependence... 

Few patients with opiate dependence achieve long-term total abstinence. Instead, maintenance programs have become the mainstay of treatment. These replacement... 

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. 

When beginning treatment for opiate dependence, it is imperative to assess the patient s long-term goals for treatment. The key variable is whether the patient desires to control his/her opiate nse or whether the patient wants to achieve total abstinence. In both cases, the first stage of treatment is detoxification. The endpoint of detoxification differs, however. Detoxification is complete in a patient desiring abstinence when (s)he is entirely tapered from the opiate. Conversely, detoxification is complete in a patient desiring maintenance therapy when the withdrawal symptoms have abated. 

Thebaine (46) Naltrexone (49) Benzyltetrahydro-isoquinoline alkaloid Alcohol and opiate dependence... 

The treatment of opioid abuse and dependence aims also at preventing the social complications of abuse, especially infections linked to parenteral administration (HIV and HepB). It relies on the use of substimtive drugs that can be either pure agonists, or partial agonist-antagonists (methadone, buprenor-phine, naltrexone), with the objective of limiting receptor desensitization and the development of tolerance. Any success in the treatment of opiate dependence may stem as much from the re-establishment of healthcare contact and social reinsertion as from any treatment induced decrease in the abuse behaviour itself. 

Postmortem studies of humans with opiate dependence have shown that p-opiate receptor density is unchanged in frontal cortex, thalamus, and caudate. In contrast, a-2 adrenoceptor density is decreased in these... 

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). 

Catalytic hydrogenation of the hydrolysis product leads to the orally active compound oxycodenone (7-1), which is used in a number of analgesic drugs. Cleavage of the methyl ether to the free phenol leads to one of the most potent close analogues of morphine, oxymorphone (7-2) [5]. Note that both of these compounds carry the hazards of classical opiate dependence liability. 

Table 1.1 Desirable properties of methadone as a substitution (agonist) treatment in opiate dependence...

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