Opioids abuse

A later study used DSM-III-R criteria to assess 716 opioid abusers seeking methadone maintenance treatment (Brooner et al. 1997). In evaluations conducted 1 month after admission, psychiatric comorbidity was found in 47% of... 

Umbricht A, Hoover DR, Tucker MJ, et al Opioid detoxification with buprenorphine, clonidine, or methadone in hospitalized heroin-dependent patients with HIV infection. Drug Alcohol Depend 69 263-272, 2003 Villagomez RE, Meyer TJ, Lin MM, et al Post-traumatic stress disorder among inner city methadone maintenance patients. Subst Abuse Treat 12 253—257, 1995 Mining E, Kosten TR, Kleber H Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br J Addict 83 567-575, 1988 Washton AM, Pottash AC, Gold MS Naltrexone in addicted business executives and physicians. J Clin Psychiatry 45 39 1, 1984 Wesson DR Revival of medical maintenance in the treatment of heroin dependence (editorial). JAMA 259 3314-3315, 1988... 

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

There is some evidence of a synergistic effect on reinforcement with concurrent administration of benzodiazepines and opioids (Walker and Ettenberg 2003). Cocaine abusers are less likely than opioid abusers to abuse benzodiazepines, preferring alcohol and opioids as secondary drugs of abuse. The most common pattern of benzodiazepine misuse in these individuals is intermittent use of therapeutic or supratherapeutic doses to counter unwanted effects of cocaine. 

Brooner RK, King YL, Kidorf M, Schmidt CW Jr and Bigelow GE (1997). Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Archives of General Psychiatry, 54(1), 71-80. 

Drug abuse and dependence Observe caution in prescribing nalbuphine to emotionally unstable patients or to individuals with a history of opioid abuse. Closely supervise such patients when long-term therapy is contemplated. 

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. 

The euphoria, indifference to stimuli, and sedation usually caused by the opioid analgesics, especially when injected intravenously, tend to promote their compulsive use. In addition, the addict experiences abdominal effects that have been likened to an intense sexual orgasm. These factors constitute the primary reasons for opioid abuse liability and are strongly reinforced by the development of physical dependence. This disorder has been linked to dysregulation of brain regions mediating reward and stress (see Chapter 32). 

Methadone is widely used in the treatment of opioid abuse. Tolerance and physical dependence develop more slowly with methadone than with morphine. The withdrawal signs and symptoms occurring after abrupt discontinuance of methadone are milder, although more prolonged, than those of morphine. These properties make methadone a useful drug for detoxification and for maintenance of the chronic relapsing heroin addict. 

Numerous studies have reported that performance on the DSST was impaired by various opioids, including morphine (2.5 to 10 mg),185,198 fentanyl (1 to 2.5 ng/ml),182 pentazocine (30 mg),184 butorphanol (0.5 to 2 mg),186 dezocine (2.5 to 10 mg),187 propofol (22 to 70 mg),193,199 nalbuphine (2.5 to 10 mg, IV),189 and the combination of fentanyl (50 pg) plus propofol (35 mg).194 In contrast, meperidine was found to have no effect on the DSST.192 Because the DSST is a timed test, it would appear that opioids slow speeded responses in a fairly consistent manner in opioid-naive subjects. However, in opioid abusers or opioid-dependent persons, Preston and colleagues have reported no effect on DSST performance of several opioids, including morphine (7.5 to 30 mg, IM),200 hydro-morphone (0.125 to 3 mg, IM),201 buprenorphine (0.5 to 8 mg, IM),202 pentazocine (7.5 to 120 mg, IM),203 butorphanol (0.375 to 1.5 mg, IV),204 and nalbuphine (3 to 24 mg, IM).205... 

Greenwald, M. and Stitzer, M., Butorphanol agonist effects and acute physical dependence in opioid abusers comparison with morphine, Drug Alcohol Depend., 53, 17, 1998. 

The existence of several classes of opioid receptors has therefore lead to the development of drugs that are somewhat more selective in the receptor class or subclass that they stimulate. In particular, drugs that selectively stimulate kappa or delta receptors may still provide sufficient analgesia, but will be less likely to provoke problems like respiratory depression and opioid abuse if they avoid or even block (antagonize) the mu receptors. Certain opioid drugs, for example, stimulate kappa receptors while avoiding or blocking... 

In the U.S. opioid abuse was accentuated by the unrestricted availability of opium until the early years of the 20th century and by the influx of opium-smoking immigrants from the East. In addition, the invention of the hypodermic needle led to the parenteral use of morphine and to a more severe variety of compulsive drug abuse. 

Health professionals (doctors, nurses, dentists, veterinarians, etc.) and their staff may be at risk for codeine abuse because of their ready access to the drug. On the other hand, one would expect health care workers to be at less risk due to their training and knowledge of the effects of drug abuse. In fact, health care workers do not appear to have rates of codeine or other opioid abuse much different from the rest of the population. 

One final set of data has addressed the possible connection between delta receptors and opioid abuse in humans. In a population of 103 German heroin abusers, a correlation was identified between a polymorphism in the delta receptor gene and the likelihood of heroin abuse [111]. However, two subsequent studies in larger populations failed to replicate this finding [112,113],... 

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