Psychologic dependence with opioids

The antipsychotics do not produce a ciassic withdrawai syndrome of the type seen with barbiturates or opioids nor do they produce psychological dependency, as seen with psychostimuiants (e.g., cocaine, amphetamine). Addicts and patients both dislike these drugs and do not spontaneously increase their dose. Indeed, they are more likely to discontinue them without medical advice. 

Neurotransmission events involved in the sensation of reward are also important. Alcohol affects local concentrations of serotonin, opioids, and dopamine—neurotransmitters involved in brain reward circuits. Alcohol also has complex effects on the expression of receptors for these neurotransmitters and their signaling pathways. The discovery that naltrexone, a nonselective opioid receptor antagonist, helps patients who are recovering from alcoholism abstain from drinking supports the idea that the neurochemical reward system is shared by drugs associated with physical and psychological dependence. 

It has been suggested that the risk of producing opioid dependence in the medical setting is greater in those who prescribe and administer them than in those who receive them (8). The likelihood of dependence in patients treated with opioids has been examined. In the treatment of cancer pain, tolerance and physical dependence occur but psychological dependence (addiction) is rare (9,10). 

What Schedule II medications are at high risk for abuse, and physical and psychological dependence Opioids, barbiturates, and stimulants that are not combined with other medication are at high risk for abuse, and physical and psychological dependence. 

In an interview study (Robson and Bruce 1997), the dependence potential of various street drugs was assessed in 201 problem and 380 social users of heroin, cocaine or amphetamine using the well-validated Severity of Dependence Scale (SDS). Scores (maximum = 15) in the problem group were 12.9 for heroin, 9.6 for other opioids, 6.1 for amphetamine and 5.5 for crack cocaine. All of these scores were consistent with findings in other studies. Cannabis SDS score was 2.6 and comparable with those of LSD (3.1) and ecstasy (1.3), two drugs that are generally not associated with physical or psychological dependence. In the parallel sample of social users, the cannabis SDS was similar at 3.4. 

The patterns of anabolic-androgenic steroid use by sportspeople and body-builders, and their physical and psychological side-effects and dependence potential, have been very well reviewed by Brower (2002). Much of the use is by injection, and so many of this population attend needle exchanges, with the advice on reducing infection risks relevant. To increase energy, burn fat and to go through the pain barrier some will use amphetamines and opiates, either street preparations or illicit pharmaceutical supplies. In the UK the opioid nalbuphine (Nubain) has been abused in this way and, in cases where dependence becomes established, detoxification treatments can be necessary. 

Psychological and physical dependence may occur. Tolerance may develop, resulting in the need for higher and more frequent dosing. Some oral pentazocine preparations also contain naloxone (an opioid antagonist) to reduce parenteral abuse. Naloxone does not affect the efficacy of pentazocine administered by the oral route naloxone does inhibit pentazocine s opioid effect if tablets are solubilized and injected. Pentazocine may be abused as a heroin alternative or in combination with other drugs. The most publicized combination was T s and Blues ... 

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