Buprenorphine, Heroin, and Methadone: Comparison of Relative’ Reinforcing Properties

Buprenorphine is a partial agonist of the morphine type. It is both a long-acting opiate antagonist, like naltrexone, and a potent opiate agonist with respect to analgesia, physiological and subjective reactions in man (). However, buprenorphine does not induce physical dependence in several species and appears to produce only minimal physical dependence in man (). Buprenorphine’s positive morphine-like agonist effects combined with its antagonist potency, low toxicity, and minimal capacity for producing physical dependence, suggested that it should be valuable for the treatment of opiate addiction (). Clinical studies have shown that buprenorphine maintenance (8 mg/ day s.c.) significantly suppressed self-administration of heroin (21 to 40.5 mg/day) by male heroin addicts over 10 days of heroin availability in comparison to buprenorphine placebo (). Buprenorphine (0.282 to 0.789 mg/kg/day i.v.) also significantly suppressed opiate self-administration in the rhesus monkey drug self-administration model (). Recent clinical studies have shown that sublingual administration of buprenorphine (1-2 mg) should be suitable for daily maintenance for the treatment of narcotic addiction (). The opiate agonist effects of Read more […]

Opioid Use by Adolescents

Screening for alcohol abuse and illicit drug use needs to be a standard procedure in any practice that cares for adolescents and young adults. Recent national surveys indicate that prescription pain relievers have replaced marijuana as the most common entry drugs for adolescents beginning to experiment with drugs. In this chapter, we review appropriate screening tools and management approaches for use in this population. We cover standard treatment options with a focus on the treatment of adolescents dependent on heroin or opioid pharmaceuticals and the promising role of buprenorphine in the treatment of this high-risk population. A case is presented at the end of this chapter, including related questions for additional consideration. Epidemiology Opioid abuse among adolescents is a growing problem in the United States. According to data from the National Institute on Drug Abuse’s Monitoring the Future study, use of “narcotics other than heroin” has doubled among high school students since the year 2000, with marked increases in the use of long-acting oxycodone tablets and hydrocodone-acetaminophen combination tablets. In 2007, the annual prevalence for oxycodone and hydrocodone use reached its highest level Read more […]

Opioid Use by Adolescents: Prevention and Pharmacotherapy

Non-Opioid-Dependent Teens Primary Prevention When prescribing opioid medications, clinicians should provide anticipatory guidance. Teens and parents should be advised that although pain medications are highly effective and safe when used as prescribed, they are also highly addictive and can be dangerous when misused. Parents should monitor use to ensure that medications are always used as directed. Any leftover medication should be discarded by returning it to the pharmacy. Medications should never be shared or given to anyone other than the patient for whom the prescription was written. Pain medication can be safe for use even in patients with substance use disorders, and pain should not be left untreated because of a history of substance abuse or dependence. However, in these situations clinicians should require increased supervision and monitoring to avoid misuse. Parents should be asked to hold, dispense, and observe all medication doses. When treating chronic pain the clinician should insist on the patient receiving all prescriptions from a single prescriber, open communication among all treating physicians, and use of a single pharmacy to fill all prescriptions. A parent should bring in remaining medication Read more […]

Methadone Maintenance Treatment: Dissatisfied Customers

Some of the rhetorics of drug treatment offer only two subject-positions that clients can occupy: the chaotic addict or the compliant/subdued ‘stable’ consumer. However, much of our interview data show resistance to these narrow categories and activity in a mode familiar from other contexts, notably consumer complaints. Here, is a description of the day-to-day frustration of being made to wait for no apparent good reason from Steve, a Sydney client. A description of the experience of attending a methadone clinic for dosing, it would not be out of place in a register of complaints of poor service anywhere: And, it’s like they get their kicks out of you sitting there and making you wait. You go in there and they’ll be having conversations, drinking coffee, and then like, and you’ll stand there, and they’ll finish the conversation before they dose you. (Steve, Sydney, NSW, client, 29) Similarly, Lisa, also a client from Sydney, complains of distracted and ineffectual treatment from her doctor: I mean I tend to get on okay with my doctor although at times I think she is inconsistent and she, she works very long hours and often seems tired and only seems to be half listening to what I’m saying. She’ll get interrupted Read more […]

Opioid-Related Disorders

Opioid abuse manifests in various ways in patients in medical settings. Psychiatrists are frequently consulted regarding opioid therapy for patients who are prescribed methadone, are thought or known to be dependent on prescription or illicit narcotics, engage in drug-seeking behavior, exhibit personality problems that interfere with medical care, or have overdosed. Suspicion is heightened by exaggerated pain complaints, by visits to multiple providers for multiple pain complaints requiring a narcotic prescription (e.g., migraine, back pain, dental pain, fibromyalgia, and endometriosis), and by claims to be “allergic” to every analgesic except for particular opioids (e.g., hydro-codone or oxycodone). Opioid-dependent patients often provoke angry reactions from staff, which can result in discharging a patient prematurely or underprescribing pain medications. Chronic pain patients who develop tolerance to opioids and experience opiate withdrawal on cessation of use are often misla-beled addicts (see “Pain”). Tolerance and withdrawal alone are not sufficient for the diagnosis of either substance abuse or dependence. For example, cancer patients with painful bone metastatic lesions may need high doses of narcotics and Read more […]

Methadone: Tracing metaphor

The ‘worn-out’ metaphor of addiction In examining the metaphors used in references to methadone in the New York Times, The Times and the Sydney Morning Herald during 2004 and 2005, it is important to emphasise that such references were relatively uncommon in all three, and that where they did occur, they were most often isolated instances, surrounded by little or no explanatory detail. Contexts for these references varied enormously, from stories about the use of sniffer dogs on New South Wales railway stations (Gibbs, SMH, 2 July 2004) and the gentrification of New York neighbourhoods (Mooney, NYT, 25 January 2004), to the development of iris recognition technology (Chessell, SMH, 19 March 2004), and a court case surrounding an aged pensioner charged with supplying heroin (N.A., Times, 16 October 2004). The consistent absence of explanatory detail accompanying these references suggests that authors take for granted reader familiarity with methadone, and its implications. In this respect, these references recall Smith’s observation on metaphor in that they produce some elements in a text as known, and others as unknown. What does it mean that methadone is regularly referenced as if it were widely understood ― Read more […]

Drug Info: Therapeutic use. Treatment. Mental and Physiological Effects. Rehab.

Entries are arranged alphabetically and follow a standardized format that allows to easily find information, and also facilitates comparisons of different drugs. Rubrics include: • Official names, Street names: This section lists the alternate names for a substance, including brand names, generic names, and chemical names for drugs, as well as common “street” names for drugs and other substances. • Drug classification: This section lists the type of drug and its classification and schedule by the U.S. Drug Enforcement Administration, if applicable. • Key terms: This is a mini-glossary of terms in the entry that may be unfamiliar to students. • Overview: Historical background is included here, including the drug’s origin, development, and introduction to society. The current impact of the drug is discussed. • Chemical/organic composition: This section includes discussion on the various compositions of the drug, if it is found in pure or altered forms, and whether or not it is often mixed with other substances or drugs. • Ingestion methods: Availability of the drug or substance in different forms, for example, pill or powder, is discussed. • Therapeutic use: This section describes Read more […]