Archive for December, 2009

The Relationship of Drugs and Alcohol in Bi-Polar Patients

December 30th, 2009 admin

Objective: Previous work has shown that manic-depressive illness and alcohol abuse are linked. This study further explores the relationship of alcohol and drug abuse in bipolar I patients and unipolar depressives and a comparison group obtained through the acquaintance method.

Method: Diagnosis was accomplished according to Research Diagnostic Criteria (RDC): controls=469; bipolars=277; unipolar depressives=678. Systematic data were gathered using the SADS on lifetime and current drug abuse and alcoholism. Both patients and comparison subjects were then followed prospectively for 10 years. First degree family members were interviewed using the RDC family history method.

Results: The group of bipolar patients and the group of unipolar patients had higher rates of drug and alcohol abuse than the comparison group when primary and secondary affective disorder patients were combined. However, primary unipolar patients did not have higher rates of alcohol or drug abuse than the comparison group.

In contrast, primary bipolar patients had higher rates of alcoholism, stimulant abuse, and ever having abused a drug than the primary unipolar group and the control group. In an evaluation of the bipolar patients, drug abusers were significantly younger at intake and had a significantly younger age of onset of bipolar disorder. There was a significant increase in family history of mania or schizoaffective mania in the drug-abusing bipolar patients as compared to the non-abusing bipolar patients.

Limitation: As in all adult samples of patients with affective illness, the chronology of alcohol and substance problems vis-à-vis the onset of illness was determined retrospectively.

Conclusions: (1) Alcoholism and drug abuse are more frequent in bipolar than unipolar patients. (2) The drug abuse of bipolar patients tends toward the abuse of stimulant drugs. (3) In a bipolar patient, familial diathesis for mania is significantly associated with the abuse of alcohol and drugs. (4) More provocatively, these findings suggest the hypothesis of a common familial-genetic diathesis for a subtype of bipolar I, alcohol and stimulant abuse.

Clinical implications: The present analyses, coupled with two previous ones from the CDS, suggest that drug abuse may precipitate an earlier onset of bipolar I disorder in those who already have a familial predisposition for mania. Furthermore, in dually diagnosed patients with manic-depressive and alcohol/stimulant abuse history, mood stabilization of the bipolar disorder represents a rational approach to control concurrent alcohol and drug problems, and should be studied in systematic controlled trials.

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Oxycodone and Pain Management

December 30th, 2009 admin

Oxycodone and Pain Management


Oxycodone hydrochloride is an opiate agonist. Opiate agonists provide pain relief by acting on opioid receptors in the spinal cord and the brain, and provide the most effective pain relief available. Oxycodone has an extremely high abuse potential and is prescribed for severe pain associated with injuries, bursitis, dislocations, fractures, neuralgia, arthritis, lower back pain, and
cancer. It is also used postoperatively and for pain relief after childbirth. Individuals who take the drug repeatedly can develop a tolerance or resistance to its effects. Thus, a cancer patient who has developed a tolerance for the drug can take a dose of oxycodone on a regular basis that would be fatal to a person never exposed to oxycodone.


The prescription drug OxyContin contains the narcotic oxycodone hydrochloride and is available in controlled-release tablets of 10, 20, 40, and 80 milligrams. OxyContin is prescribed in the United States to treat moderate to severe pain and is abused for its heroin-like effects. The diversion and abuse of OxyContin have increased sharply since the drug became available in 1996, raising concerns among law enforcement and public health agencies.


Most OxyContin abused in the United States is diverted by illegally written or forged prescriptions, “doctor shopping”-when individuals, who may or may not have a legitimate ailment, visit numerous doctors to obtain drugs in excess of what should be prescribed legitimately, and theft. According to law enforcement reporting, the availability of diverted OxyContin may be stabilizing and has decreased in some areas. According to the Drug Enforcement Administration (DEA), OxyContin abusers also steal or buy OxyContin from friends or family members with legitimate prescriptions who often are prescribed a 30-day supply of the drug.

Fraudulent OxyContin Prescriptions

The U.S. Attorney’s Office announced that an Indiana doctor was sentenced to serve 51 months’ imprisonment following his guilty pleas to unlawful trafficking in OxyContin and healthcare fraud. In a 5 month period, the doctor prescribed OxyContin to a woman in amounts that were not medically necessary. For example, in one 14-day period the doctor prescribed 860 80-mg tablets of OxyContin. In just one year, $130,000 was paid by the Indiana Medicaid program for OxyContin prescribed to this individual. After the prescriptions written by the doctor had been filled, the OxyContin was allegedly sold for cash. The woman pled guilty to unlawful trafficking in OxyContin and healthcare fraud and was sentenced in to 41 months’ imprisonment.

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Physical Dependence and Opiate Withdrawal

December 30th, 2009 admin

Opiate withdrawal is caused by stopping, or dramatically reducing, opiate use after heavy and prolonged use (several weeks or more). Opiates include heroin, morphine, codeine, Oxycontin, Dilaudid, Methadone, and others.

Causes, incidence, and risk factors:

About 9% of the population is believed to misuse opiates over the course of their lifetime, including illegal drugs like heroin and prescribed pain medications such as Oxycontin.

These drugs can cause physical dependence. This means that a person relies on the drug to prevent symptoms of withdrawal. Over time, greater amounts of the drug become necessary to produce the same effect. The time it takes to become physically dependent varies with each individual.

When the drugs are stopped, the body needs time to recover, and withdrawal symptoms result. Withdrawal from opiates can occur whenever any chronic use is discontinued or reduced. Some people even withdraw from opiates after hospitalization for painful conditions without realizing what is happening to them. They think they have the flu, and because they don’t know that opiates would fix the problem, they don’t crave the drugs.

Symptoms

Symptoms of drug addiction withdrawal include:

Dilated pupils
Diarrhea
Runny nose
Goose bumps
Abdominal pain.
Sweating
Agitation
Nausea
Vomiting

Treatment of withdrawal includes supportive care and medications. The most commonly used medications are clonidine, Suboxone and Valium, primarily to reduce or prevent physical symptoms.

Another detox method is to use a slowly tapered (reduced overtime) dose of methadone to reduce the intensity of withdrawal symptoms.

Methadone maintenance involves ongoing use of methadone. This was the most effective treatment for opiate addiction, according to the Institutes of Medicine.

A new medication called buprenorphine has been shown to be more effective than other medications for treating withdrawal from opiates, and can shorten the length of detox. It may also be used for long-term maintenance like methadone.

Some drug treatment programs have widely advertised treatments for opiate withdrawal called detox under anesthesia or rapid opiate detox. This involves anesthetizing the patient and injecting large doses of opiate-blocking drugs, with hopes that this will speed up the transition to normal opioid system function.

There is no evidence that these programs actually reduce the time spent suffering withdrawal. In some cases, they may reduce the intensity of symptoms. However, there have been several deaths associated with the procedure, particularly when it is performed outside a hospital.

Because opiate withdrawal produces vomiting, and vomiting during anesthesia significantly increases death risk, many specialists think the risks of this procedure significantly outweigh the potential (and unproven) benefits.

Support Groups

Support groups, such as Narcotics Anonymous and SMART Recovery can be enormously helpful to people suffering opiate addiction.

Expectations (prognosis)

Withdrawal from opiates is painful, but not life-threatening.

Complications

The biggest complication is return to drug use. Most opiate overdose deaths occur in people who have just withdrawn or detoxed. Because withdrawal reduces a previously-developed tolerance, recently withdrawn addicts can overdose on a much smaller dose than they used to take daily. Addicts should be warned about this possibility.

Longer term treatment is recommended for most addicts following withdrawal. This can include self-help groups, like Narcotics Anonymous or SMART Recovery, outpatient counseling, intensive outpatient treatment (day hospitalization), or in-patient treatment.

Addicts withdrawing from opiates should be assessed for depression and other mental illnesses. Appropriate treatment of such disorders can reduce the risk of relapse. Antidepressant medications should NOT be withheld under the assumption that the depression is only related to withdrawal, and not a pre-existing condition.

Treatment goals should be discussed with the patient and recommendations for care made accordingly. If an opiate addict has withdrawn repeatedly only to relapse repeatedly, methadone maintenance is strongly recommended.



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Drug Withdrawal Treatment

December 30th, 2009 admin

Today, there are almost as many treatments as there are addicts and alcoholics. Educate yourself before making any type of life-changing decision regarding detox and treatment for alcoholism and addictions.

Typically, withdrawal involves steps to help you remove all of the abused substance from your system in a pain-free, comfortable manner. Treatment helps you look at underlying causes; the “why” you may have done drugs in the first place. Finally, counseling and attending self-help groups help you resist using the addictive drug again and build a support system in your home community.

Withdrawal Therapy
The goal of withdrawal therapy (detoxification) is for you to stop taking the addicting drug as quickly and safely as possible. Detoxification may involve gradually reducing the dose of the drug or temporarily substituting other substances that have less severe side effects. For some people it may be safe to undergo withdrawal therapy on an outpatient basis. Other people may require placement in a hospital or a residential treatment center.
Withdrawal from different categories of drugs produces different side effects and requires different approaches.

Central nervous system depressants
CNS depressants slow down normal brain function. In higher doses, some CNS depressants can become general anesthetics.

CNS depressants can be divided into two groups, based on their chemistry and pharmacology: Barbiturates, such as mephobarbital (Mebaral) and pentobarbital sodium (Nembutal), which are used to treat anxiety, tension, and sleep disorders.

Benzodiazepines, such as diazepam (Valium), chlordiazepoxide HCl (Librium), and alprazolam (Xanax), which can be prescribed to treat anxiety, acute stress reactions, and panic attacks. Benzodiazepines that have a more sedating effect, such as triazolam (Halcion) and estazolam (ProSom) can be prescriped for short-term treatment of sleep disorders.

Minor side effects of withdrawal may include restlessness, anxiety, sleep problems and sweating. More serious signs and symptoms also could include hallucinations, whole-body tremors, seizures, dehydration and weakness. The most serious stage of withdrawal may include delirium and is potentially life-threatening. Withdrawal therapy may involve your gradually scaling back the amount of the drug.

Opioids
Among the drugs that fall within this class – sometimes referred to as narcotics – are morphine, codeine, and related drugs. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContin-an oral, controlled release form of the drug); propoxyphene (Darvon); hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain relieving properties, some of these drugs can be used to relieve severe diarrhea (Lomotil, for example, which is diphenoxylate) or severe coughs (codeine).

Side effects of withdrawal of opioids such as heroin, morphine, oxycodone or codeine can range from relatively minor to severe. On the minor end, they may include runny nose, perspiration, yawning, feeling anxiety and craving the drug. Severe reactions can include sleeplessness, depression, dilated pupils, rapid pulse, rapid breathing, high blood pressure, abdominal cramps, tremors, bone and muscle pain, vomiting, and diarrhea. Doctors may substitute a synthetic opiate, such as methadone, to reduce the craving for heroin and to gently ease people away from heroin. The most recently approved medication to ease withdrawal from opiates is buprenorphine (Suboxone, Subutex). This drug is the first narcotic medications used for the addiction treatment that may be prescribed in a doctor’s office rather than a treatment center.

Researchers are continually searching for new ways to help ease the symptoms of withdrawal and to treat addiction more effectively.

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