The Theoretical Basis of Narcotic Addiction Treatment with Narcotic Antagonists

The theoretical basis of narcotic addiction treatment with narcotic antagonists was well stated by Martin et al. (). Briefly, outpatient maintenance of a previously detoxified opioid addict on a daily oral opioid-blocking dose of a narcotic antagonist is expected to accomplish two objectives: (a) to remove the incentive for seeking and using opioid drugs; and (b), to extinguish conditioned abstinence (including “craving”) should this phenomenon occur as a response to environmental stimuli to which unconditioned abstinence had previously become conditioned (). Needless to add, such a period of out-patient maintenance on a narcotic antagonist should be used to “rehabilitate” the patient – i.e., to train him in the skills necessary for holding a socially useful job. to form new, mutually supportive relationships with non-drug using persons, and to persuade him to give up the illegal “hustling” activities which had become self-reinforcing during previous periods of opioid addiction. Such a period of out-patient maintenance on a narcotic antagonist would have advantages over detoxification followed by enforced abstention from opioids (by prison sentences with or without a subsequent probationary period) in Read more […]

Human Dependence on Tobacco and Opioids: Common Factors

Recent years have seen increasing acceptance of the notion that tobacco is an addictive or dependence-producing substance, particularly as it is used in cigarette smoking. This idea is supported by the observations that tobacco serves as a reinforcer (i.e., it maintains behavior leading to its use) and that most people who smoke cigarettes would like to quit but cannot, even in the face of well documented health risks and economic sacrifices (Surgeon General’s Report 1979). The term “drug dependence” suggests that (1) the drug serves as a reinforcer, (2) behavior occurs which is maintained by the opportunity to take the drug, and/or (3) other reinforcers are sacrificed as a consequence of taking the drug (). Many cigarette smokers in some degree satisfy these criteria for drug dependence (). Since cigarette smoking has only recently been conceptualized as an instance of drug dependence, it should be useful to systematically compare cigarette smoking with another more thoroughly studied dependence process such as opioid dependence or narcotic addiction. At first blush, cigarette smoke and opioid drugs appear to produce vastly differing pharmacological and behavioral effects: large doses of opioids can produce Read more […]

Effects of antagonists of opiate self-administration

Clinical Studies Since narcotic antagonists can block the effects of opiates, proponents of narcotic antagonist maintenance for the treatment of heroin addiction argue that pharmacological blockade will eventually eliminate opiate self-administration (). However, recent studies of the efficacy of naltrexone maintenance in modulating heroin self-administration on a clinical research ward have shown that some addicts may continue to sample heroin during antagonist blockade (). The frequency of heroin self-administration during antagonist blockade was influenced by a number of factors, including whether or not the heroin addict was told that he was given naltrexone. When subjects were not told who was receiving naltrexone and who was receiving naltrexone placebo, seven of the nine subjects maintained on naltrexone blockade (75 mg/day PO) sampled heroin an average of 13 times (range: 2-46) over a ten-day period of heroin availability. Assessments of temperature, blood pressure, pulse, respiration and pupil diameter revealed no physiological effect of heroin during naltrexone blockade. Although all subjects took less heroin during naltrexone blockade than under unblocked conditions (X occasions = 55.07; range: 32-78), the Read more […]

Update on Naltrexone Treatment

Our group in Philadelphia has used naltrexone in the treatment of 201 narcotic addicts in 258 separate treatment episodes as of 1 July 1977. The antagonist treatment program is an important part of our overall multimodality program which includes methadone or propoxyphene maintenance treatment, inpatient detoxification, long-term therapeutic community, family, group, and individual therapies, and a variety of behavioral treatments. Narcotic antagonist treatment, of course, appeals only to those patients who are genuinely interested in becoming drug free. It is not nearly as popular as methadone treatment, but it occupies an important niche — amounting to 5-10 percent of our total patient population at some time in their treatment careers. Our narcotic antagonist patients are demographically similar to our other patients: mean age 27, 60 percent black, more than 95 percent male, and more than 95 percent veterans of military service. Our methods for detoxification from narcotics and institution of antagonist therapy have been reported elsewhere (2, 4); they are similar to those described by others. We use intravenous naloxone prior to the first naltrexone dose to detect residual physical dependence and thus reduce Read more […]

Hydromorphone Hydrochloride

  Common generic and trade names Assilaudid-, e Dimorphinon Laudicon Biomorfil Dimorphisid Laudaconum Biomorphyl Escolaudol Morfodid Cofalaudide Hydal Morphicon Cofalaudid, -e Hydromorph Contin Morphodid Dilauden Hydromorphone Novelaudon Dilaudid, -e * Hydromorphone HC1 Novolaudon Dilocol * HydroStat Opiol Dimorfid Hymorphan Palladone Dimorfinon Hymorphen PMS Hydromorphone Dimorphid Imorfan Semcox Read more […]

Oxycodone: Therapeutic use, Treatment. Oxycodone rehab.

Oxycodone: Composition, Therapeutic use, Usage trends. Treatment and rehabilitation. Oxycodone effects. Reactions with other drugs.

Meperidine: Usage trends

Meperidine: Composition, Therapeutic use, Usage trends. Treatment and rehabilitation. Meperidine effects. Reactions with other drugs.

Hydromorphone: Fact or fiction

Hydromorphone: Composition, Therapeutic use, Usage trends. Treatment and rehabilitation. Hydromorphone effects. Reactions with other drugs.

Hydromorphone: In the news

Hydromorphone: Composition, Therapeutic use, Usage trends. Treatment and rehabilitation. Hydromorphone effects. Reactions with other drugs.

Hydromorphone: In the news

Hydromorphone: Composition, Therapeutic use, Usage trends. Treatment and rehabilitation. Hydromorphone effects. Reactions with other drugs.