Opioid Abuse

Question: How do I stop opioid misuse, abuse, and diversion? Includes all opioids (narcotics) like oxycodone, hydrocodone, morphine, methadone, fentanyl

Answer: is it heroin or opium? What kind then i can tell you Detox and counseling

Question: There's no comparison between post-op pain analgesia opioid dependence and euphoria/escapism abuse (Obama) so why try to compare? When a patient is in extreme pain, opiates are dosed sparingly to avoid dependence, but pain treatment is the #1 priority. Anyone including YOU would become addicted if doses were high enough over a long enough period of time. Then the patient is left to deal with a debilitating chemical dependence which they often try to hide due to social stigma. This is VERY (100%) different from escapist/euphoria drug seeking, such as Obama did for SEVEN LOOONG YEARS. That is not "experimenting" that is deliberate brain damaging usage. He said he used cocaine and marijuana but avoided "smack" (how strong of him!). He said he was a confused teenager but he did drugs by his own admission well beyond his teenage years, which shows a weakness in mental fortitude. PET scans show marijuana use leads to permanent brain damage. Leno asked him "did you inhale?" and Obama joked "that was the point". He is being honest that he has no wisdom or strength or judgement. Instead of stating he made a mistake doing drugs, he gives excuses (typical Obama baby). This is NO ROLE MODEL for kids who can choose whether or not to use drugs.

Answer: You obviously think we are still in a place where we try to hold our leaders to a higher standard than just the average Joe Blow on the street. Unfortunately, we are now in a place where it is more popular to use the Oprah Winfrey touchy-feely approach and make excuses for their shortcomings and give them several chances because they "try so hard", rather than to find leaders who are worthy of their position.

Question: Lortab abuse and kidney troubles? I took my wife to the emergency room last night. She's having difficulty breathing, fatigues easily, and her BP has been all over the place. The nephrologist told her that she is in the beginning stages of acute renal failure. I suspect that she has been abusing Lortab for several months, and I wonder if that might have anything to do with her kidney problems. In the past year, I've hospitalized her for opioid detox three times, but she has legitimate pain issues resulting for major surgery complications, making it easy for her to convince several doctors to prescribe Lortab. Any professional insight would be greatly appreciated.

Answer: Yes Overuse of tylenol can cause renal failure-(I am a recipient of a kidney transplant)But the person would have to take thousands of milligrams of Tylenol a day for years to be in chronic renal failure-If she does have legitament pain issues#1 she should be referred to a pain clinic#2get off the painkillers thst have Tylenol in them(Vicodin,Norco,Anexia,Lortab,Lorcet,… She should be placed on any of the following to manage her pain,and I suggest starting on the first and move up if need be(Roxicodone,Morphine,Oxycontin,Opana,D… none of these have any aditives-just pure opiates-Her nephrologist will start doing bloodwork,24hr urine clearances,change diet,put on different meds,biopsies,etc-I wish her all the luck,and feel free to e-mail me anytime to ask or discuss anything about kidney disease and what to expect

Question: DXM (cough syrup) vs. Codeine? There are many similarities between DXM and codeine. For example, both are antitussives (i.e. they suppress coughing) that are used worldwide, and both are purported to be equally effective antitussives. But there is one major difference between the two in the U.S.: DXM is available over-the-counter, while codeine is only attainable with a prescription (assuming you're a good law-abiding citizen, which I'm sure you are :p) In the early '60s, DXM completely replaced codeine in the U.S., obviously because codeine, as a opioid, naturally runs a high risk for abuse. And this abuse is well documented. I once heard that 95 percent of codeine use in France is recreational. But honestly, did a little (or even a lot) codeine ever hurt anybody? DXM, on the other hand, is an extremely powerful drug that, as a dissociative, produces effects very similar to PCP (angle dust) and ketamine (special K), and what is perhaps most frightening, many people who have used the drug heavily have reported cognitive impairment that has stuck with them even years after quitting. I haven't been able to find anything suggesting that codeine is damaging to the brain, unlike the massive amounts of literature which suggest that DXM abuse can lead to a whole slew of brain problems. Also, there are frequent deaths related to DXM. As luck would have it, DXM is most popular amongst the teenage crowd. Isn't it great to think that America's youth are destroying their brains with cough syrup?!? The tables need to be turned. The lesser of two evils needs to be slain. DXM needs to be completely done away with, and America needs to be reintroduced to its erstwhile friend codeine. I'm sure some of you have tried DXM. Thoughts?

Answer: I agree. My step brother (15) tells me about his friends that will drink a bottle or two of NyQuil and then just freak out. I can't imagine what the hell they're doing to themselves, can't be good.

Question: HELP need help in medical!!! please please please help? Please help!!! medical question!!!I dont understand these question? Acetaminophen has advantages over aspirin. These do NOT include which of the following? a. It may be used for people who are allergic to aspirin or aspirin-like compounds. b. It does not cause liver damage. c. It rarely causes gastrointestinal upset or bleeding. d. It may be taken with anticoagulant therapy. e. It is associated with Reye's syndrome. NSAIDs are used for a. arthritis b. dental pain c. dysmenorrhea d. anti-inflammatory conditions e. all of the above The side effects of NSAIDs include a. GI distress b. headache c. bleeding disorders d. soreness of the mouth Analgesics that contain the word compound or "dan" have what as an ingredient? a. acetaminophen b. aspirin c. Phenergan d. antacids Analgesics that contain the word "cet" have what as an ingredient? a. acetaminophen b. aspirin c. antacids d. caffeine The side effects of opioid medications in the elderly include all the following EXCEPT a. confusion b. ototoxicity and tinnitus c. urinary retention d. hyperexcitability e. respiratory depression Which of the following is NOT a sign or symptom of drug abuse and misuse? a. changes in weight and sleep habits b. impaired memory or illogical thinking c. defensiveness, anxiety, changes in friends and appearance d. taking prescribed medications for known illnesses on a regular basis e. mood swings, irritability, depression and anger Which of the following are the most frequently abused substances? a. xanthines b. caffeine c. nicotine d. all of the above e. none of the above The side effects of smoking cessation include all of the following EXCEPT a. belching, hiccups, and indigestion b. hoarseness, soreness of the mouth and throat, and watering of the mouth c. tachycardia and insomnia d. decreased appetite, nausea, and diarrhea e. skin eruptions Which of the following is NOT true of central nervous system depressants? a. Barbiturates are used as downers for persons using central nervous system stimulants. b. Tolerance is a common effect of barbiturate and benzodiazepine usage, leading to physical dependence. c. Therapeutic use of benzodiazepines and barbiturates should be short-term. d. Withdrawal from barbiturates and benzodiazepines should be done rapidly to prevent long-term withdrawal signs and symptoms. e. Central nervous system depressants are safe for use by the elderly.

Answer: e, e, a, b, a, d, d, d, e, d.

Question: Why is Hydrocodone only available mixed with Tylenol (e.g. Vicoden) or something else, such as Advil)? Because of character limitations, I phrased my question as briefly as possible. My question is why the fairly common opioid analgesic, hydrocodone, is only available in forms that mix it with other, usually anti-inflammatory type drugs, such as acetaminophen (Tylenol) or ibuprofen (Advil)? Is there a medical purpose (which seems highly unlikely), a marketing purpose, or some other reason? The most common form of the drug is Vicoden, which is a combination of hydrocodone and acetaminophen, in varying amounts. Because acetaminophen is proven to be extremely dangerous to ones liver, one must limit the amount of Vicoden (or Norco, which contains the least Tylenol with the most hydrocodone of any of the products on the market, as far as I know) that one takes. Ibuprofen isn't dangerous for your liver, but can harm your stomach. This means that patients undergoing pain management therapy for chronic pain must often switch to stronger, higher "schedule" or "class" as rated by the FDA (hydrocodone is a schedule III controlled substance, whereas most of the drugs listed below are schedule II, which, though slightly confusing, is "higher" or "more controlled"), opioid drugs simply to avoid the serious health risks of these other, ironically over-the-counter, medications. With all of the myriad versions of hydrocodone-based medications, why do none of the drug manufacturers sell plain hydrocodone, as they do with Schedule II drugs such as oxycodone, morphine, demerol, fentanyl, methadone, etc.? Why should someone who could find relief from hydrocodone at a higher dosage have to switch to a potentially more addictive medication with a higher potential for side-effects such as drowsiness, dizziness, and generally "feeling high"? I don't wish this to become a forum about the addictive nature of these medications, as I am mostly concerned with the issues facing patients with legitimate chronic pain. However, while researching this question, I read many reports of how Vicoden abuse is on the rise. Since alcohol use and/or abuse is common among addicts, and alcohol greatly increases the risks of liver damage associated with acetaminophen (aka "Tylenol Toxicity"), it would seem an even greater moral imperative to stop combining hydrocodone with acetaminophen (this is a problem that has also been discussed in regards to over-the-counter cold remedies, etc.). If there is some medical reason why hydrocodone must be mixed with an anti-inflammatory or fever reducer, why not leave it up to doctors to prescribe them together either in their current premixed form or by taking two pills together? Thank you in advance to anyone with medical and/or pharmaceutical industry knowledge for your time and answers!

Answer: tylenol & advil help the hydrocodone bond to the pain receptors in the brain better. Also because just 5mg of hydrocodone is a strong amount for someone not opioid tolerant. Vicodin is made for people in pain who were not taking opiates before and it's strong enough for them. It is not meant for chronic pain. And it's impossible to make a 5mg pill large enough without some filler. Rather than using inactive fillers like many drugs do, they use Tylenol because it works on the same receptors & will help relieve the pain even better than just 5mg hydrocodone + inactive ingredients alone. Also because hydrocodone is addictive they want to prescribe the lowest dose possible. Adding tylenol provides more pain relief meaning less addictive medicine is needed. The pain management part, if you have enough pain to warrant use of opiate painkillers, several times a day, long term, then it is safer to switch to something like MS Contin or Oxycontin.codiene & hydrocodone are meant for moderate-severe acute pain (pain lasting 6 weeks or less), and if you need to take several vicodins a day longer than that, you can get better relief, with less pills from a long-lasting medicine. Once your pain starts it takes more medicine to stop it. A low constant dose or morphine can help people much more efficiently than hydrocodone which only lasts 4-6 hours with or without tylenol. If you are truly suffering from chronic pain there is not more risk of addiction from one opiate to another. And once you've become opiate tolerant from vicodins the side effects are minor when moving to a different opiate. It's not like vicodin is this amazing miracle painkiller but morphine is this awful dangerous medicine.

Question: My essay On Oxycontin.... Please read!!? ARE YOU REALLY IN PAIN? OxyContin… A miracle drug or an addict’s worst nightmare? A drug that has severe and sometimes fatal consequences when abused. Originally manufactured for terminally ill cancer patients facing the end stages of life, OxyContin has become widely over prescribed, thus creating an epidemic of abusers. So many times we go to the doctors with aches and pains and expect that the Doctor will remedy our problems in a safe manner. Often we don’t seek the truth behind medications. We don’t research the effects certain medicines can have on our bodies. When patients start to have a hard time coming off of medications such as OxyContin, only then do they think about the research, and by then, it often can be too late. Unknowingly and unintentionally patients using this drug become addicted through no fault of their own. In 1995 a pharmaceutical company by the name of Perdue Pharma Company introduced this opioid analgesic pain medication used for chronic moderate to severe pain due to illnesses such as cancer. As originally approved, OxyContin was supposed to be for end stage cancer patients and others with escalating pain. In the beginning of OxyContin’s existence studies showed that the medications addiction rates were so great that it should only be used as a last resort pain killer. According to Stephen F. Lynch (congressman) the makers of OxyContin started marketing the drug to physicians as a “virtually� non addicting medication, making way for the explosion of prescriptions written by primary care doctors for injuries such as back aches, headaches, and broken bones. Nearly 56 percent of all OxyContin addictions have occurred in patients for which the drug was legally prescribed. (Salerian, MD) Some patients become dependent on pain medications after a surgery or broken bones. The odds become even more escalated when OxyContin is prescribed. It is the Doctors responsibility as a caregiver to properly wean a patient from powerful pain medications and to investigate potential abuse factors. With this specific drug the patient is more likely to become addicted and begin using the medication in an abusive way, thus making coming off the drug even worse. The patient most likely then begins to seek the drug on the streets after the Doctor has stopped prescribing the medication. Street abuse can lead to crushing the pill and snorting it, to breaking it down into liquid and injecting it into the body, somewhat like heroin. When crushed and snorted, the time release is broken on the pill and the high is somewhat of a “super-power� feeling. Now the probability of addiction becomes even higher because the brain has been taken over by the rush of dopamine, creating intense feelings of pleasure. At this point, the body has become accustomed to the drug and with sudden loss of the medication the body begins to peril in withdrawal both physically and mentally. The side effects of Oxycontin withdrawal are similar to those you would find when coming off of heroin. Some withdrawal symptoms include increased agitation, anxiety, tremor like shakes, which I would describe as Parkinson’s disease. The legs begin to cramp and ache, creating a Parkinson’s disease effect. Also noted is extremely painful stomach aches followed by vomiting. Diarrhea and increased blood pressure are also common. Some would describe these feelings as “flu like symptoms times ten�. Intense feelings of hopelessness may accompany all of the other symptoms mentioned above. Life threatening symptoms include respiratory depression in which breathing in an individual decreases or ceases all together. It may also lead to Hypotension, which is low blood pressure or the sudden drop of blood pressure, causing the body to go into shock, and slowing the heart rate until oxygen is no longer circulating to the heart. With so many consequences to the effect this drug can have in your life, don’t you think it would be wise to do research on any prescription your doctor may give you? In case you didn’t know, many doctors are given lofty incentives to prescribe a certain drug for the manufacturer. Some manufactures represent their products in misleading manners that almost trick doctors into thinking that the drug their prescribing is safe; when studies would show that they are not. In fact, several letters were sent to the makers of OxyContin on its misleading advertisements and the omittance of potential abuse among consumers. Since we are all human, including our doctors, it is safe to say that you need to do your research on prescriptions before you start taking them, it could mean saving your life and in some cases your family. Written by S.L. Iddi Massillon OH I WOULD LIKE TO THANK EVERYONE FOR THEIR INPUT.. MOST WAS HELPFUL AND INFORMATIVE....

Answer: For a non-physician, you've done a fine job. I do think you came down a bit hard on Purdue and gave Mr. Lynch a bit of a pass. You also have only just scratched the surface of the problem of chronic, unremitting, but non-malignant pain. If you don't know much about addiction medicine, Purdue's sales pitch could appear to minimize the risk of addiction. But a physician who's contemplating its use should know that there's a vast difference among tolerance, dependency, and addiction. Tolerance will predictably occur over time. Dependency is not usual but common. Addiction is not. Healthy people also have a real tendency to underestimate the number of people who have chronic pain that interferes significantly with their life. It's a substantial subset of our population. If you take an extremely conservative number for argument's sake, let's say there are ten million people with such pain. And let's take a very liberal number, say one in ten thousand, who become addicted. That produces a thousand addicts, not counting the peripheral addicts who abuse it without the legal prescription (the roughly 9500 idiots you alluded to, who get what they asked for). Plenty for lawsuits or making political hay, but compared to the number of people helped, it's truly trivial. Who wouldn't take the 1:10,000 risk?

Question: Methadone????...... My Doctor is an IDOT? Okay, firstly, I was injured in combat in Iraq about four years ago, very badly. Secondly, I broke 5 bones in my body after the explosion of an IED, including the two bones used most often, my right and left styloid, my right and left triquetrium. Thats both wrists in MEDICINE language for those not familiar with anatomy LOL. Needless to say, since my discharge from the Army, I have been recieving medical care at the VA, they dont seem to apperciate opinions from patients, even if they're in medical school??? I have been on Oxycodone, Hydrocodone, Dilaudid, Percocet/Vicodin, Darvocet, Propoxyphene, THE WORKS!!! Recently, I was put on Morphine I.R. 15mg po tid prn, three times daily as needed for pain, for my chronic wrist pain, as I am actually in medical school now and am forced to write ridiculous papers and work with the wrists I broke in the Army on a daily/nightly basis. I researched every medication I've taken, including the Morphine. I dont like it. Morphine's sedative effects are too pronounced, it causes severe constipation, even worse than acetaminophen/hydrocodone does. So... I have requested Methadone. And I'll tell you why, aside from the fact that I've taken it before. Every narcotic/ opioid analgesic I've taken, I didnt like. The majority of the time, I actually returned them cause they do absolutely nothing. I returned a bottle of Oxycodone 15mg about two weeks ago that was practically full cause it doesnt make my pain go away. I am not for taking all these addictive medications, and my goal has always been to take as little medications as possible, as few times as possible. I researched Methadone and asked my doctor about it. I told him the following: It will only work, if prescribed in a dose that will be effective for someone 230lbs, not 5mg twice a day. I have taken this before with little pain alleviation, ONLY due to the extremely low dose. 1. It's rarely addictive, the potential for abuse is very low, as it has no euphoric values 2. It lasts longer than any medication I've ever taken. I take one 10mg tab, and my pain will be gone for almost a day or two, LITERALLY 3. No constipation 4. No nausea 5. It does not interfere with any other of my medications. SO WHAT THE HECK, is this guys problem. He will put me on all these other opioids, but not the one that actually BLOCKS the other opioid medications, and helps the most. Its not just used for withdrawl from heroin, but for chronic pain too. Any suggestions, again, I am in med school, money is tight, and VA care is free for me. GO potty Yes, Medical School, I know. My goal is not to be poppin Oxys or Percs in the middle of a bioethics class, LOL. So because of the long lasting pain alleviating effects of methadone, thats what I'm opting to take. Oh, for all you med students out there, I'm at UVA YEAH!!! Go Potty

Answer: Does the fact that Methadone withdrawal is 10 times more horrific than Heroin withdrawal bother you? So no, I don't think your doctor is an idiot. Either way, it's all poisons, brother, look into Wild Kratom, it's a natural alternative, just as strong as any of the crap you've been taking.

Question: How did scientists synthesize Oxycodone from Thebaine? I'm doing a research report on Oxycodone for my Drug Use and Abuse class, and everywhere I read about the origins of Oxycodone synthesis it only mention that it was "synthesized from Thebaine," a minor constituent of Opium that has atypical stimulatory effects rather than analgesic effects. I imagine it involves a lot of complex chemistry, but if there was anyone who could give a reasonable explanation about how the medicine was created, when it was first tested on animals or humans would be greatly appreciated. I guess my biggest question is, who were the scientists who sat down and created this? Which pharmaceutical company, if any, commissioned the research? What was it's original purpose, and why is it now in the top 20 most prescribed drugs in the country even though it's a drug that has an absurd amount of controversy surrounding it? Is there a book I could buy or check out at my school library that might be helpful that discusses the development, marketing and history of powerful synthetic opioid like this? I guess I asked a little more than one question! Any input is appreciated. Thanks.

Answer: Oxycodone is an opioid derived from an alkaloid of opium, thebaine. It was first synthesized in the early twentieth century, some sources indicating the year 1916. We do know that oxycodone has been available in Europe for oral and intravenous use since 1917, but some historians believe it was one year earlier. The drug was released in the United States during the 1950s.[1] Some prescription drugs containing oxycodone include Percocet, Percodan, Roxicet, OxyContin, and Roxicodone. The effects most sought after are pain relief, euphoria, reduction in anxiety, and sedation. Other side effects can include constipation, and dizziness. Many users report feeling itchy after ingesting oxycodone; this results from the release of histamine in the brain. In 1995, OxyContin, which is manufactured by Purdue and allows up to 12 hours of continuous pain relief, was approved for sale. OxyContin is available in 10, 20, 40, and 80 milligram pills. When it was first released on the market, a 160 milligram pill was manufactured, but Purdue eventually pulled it off the market. On the streets OxyContin is referred to as OC, hillbilly heroin, oxy, jawns, jimmies, "big guys" (refers to the 80 milligram pills), itchies, "Ocean City," or "Orange County." The growing OxyContin problem has become an epidemic in many parts of the United States. In southeastern Pennsylvania, users have been witnessed paying $80 for one 80 mg OxyContin pill. As habits grow, many people switch to heroin because of its availability and attractively lower prices. FAST FACTS: Oxycodone is not tested for in a standard drug screening; however, at very high doses it may cause a positive for opiates. It is typically in the urine for 3-4 days. Very rarely is it a part of extended drug screening. Oxycodone is addicting, and causes tolerance. Moderate use is hard to maintain with any opiate. Most people who say they will "only use once a week" end up using more often than they want to. Using opiates on a regular basis will cause a physical and possibly mental dependency. After using oxycodone for a few days, a larger dose is often needed to achieve the same effects. Those who have never done opiates or without a tolerance need to exercise extreme caution when dosing. It is not recommended that anyone take oxycodone without a proper prescription. Users beware, what one person can tolerate may kill another person. Another source of info: http://en.wikipedia.org/wiki/OxyContin

Question: Do undecided voters know Cindy McCain's medical and emotional past? "In 1989, Cindy McCain became addicted to opioid painkillers such as Percocet and Vicodin,[32] which she initially took to alleviate pain following two spinal surgeries for ruptured discs[33][34] and to ease emotional stress during the Keating Five scandal.[32] There, her role as a bookkeeper who had difficulty finding receipts for trips on Charles Keating's jet[15] caused complications for her husband when he was already being examined for his role regarding oversight of Keating's bank.[8] The addiction progressed to where she was taking upwards of twenty pills a day[8] and she resorted to stealing drugs from her own AVMT.[33]" http://en.wikipedia.org/wiki/Cindy_Hensl… ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- All a matter of public record. Do all prominent Republicans have an excuse to abuse prescription drugs for several years?

Answer: It's all a matter of opinion. I don't condone the use or abuse of drugs, either illegal or prescribed. However, that is not my reason, nor has it ever been an issue in choosing a president. I do not support nor will I vote for McCain. He's just too old. He stands too closely to what Bush has done, and will keep most of those tired old policies. And we all know, whether we'll admit it or not, where that has gotten us. Thanks just the same, for bringing this to our attention.