Tag Archives: Opioid

Types of Opioids and Their Uses

October 4, 2014

Type of Opioids, Their Uses and Side Effects

172468400_80_80Opioids are drugs that many people cannot do without. They are essential in hospitals as they are the most effective drugs that can be used to aid the pain patients. Diseases such as cancer are synonymous to pain and in some situations going through the treatments will be very painful and therefore there is need for a drug that will work in different ways to curb the pain that may be disabling to the patient. Chronic pain in itself presents a torture to the patient and without pain relievers, such pain may cripple a patient. The opioids are not news to many years; people know them some as dangerous drugs that should never have been created in the first place. While to many they has become very valuable essentials that they cannot survive without- the pain patients (and even addicts). However, people are not always informed about the given types of opioids.  The opioids are mostly classified according to their source. There are opioids that are naturally extracted from the poppy plant and used without designing or any other further processing. These will fall under natural opioids.  Opioids may be extracted from the poppy plant but then is further processed. This group is referred to use semi-synthetic opioids while there are some that are some opioids that are processed in the labs. The opioids falling in this group are known as synthetic opioids.

The naturally sourced opioids

The natural opioids are those that are naturally available from the poppy plant. After extraction they are not further processed in a manner that will deplete their contents. Some of these natural opioids are used as pain relievers in hospitals.

Here are examples of the opioids;

Morphine

Morphine is naturally extracted from poppy plant. It is the most dominant opiate in the poppy plant. It was the first active ingredient that was extracted from the poppy plant. Apart from morphine there are also other alkanoids of different types that are found in the opium. The major source of morphine is a chemical extraction from opium.

Despite its use in hospitals for pain relief in patients with intense pain, morphine has a high potential of addiction, tolerance and psychological dependence which develops very rapidly. However psychological dependence takes a little bit longer to develop and may take several months. With morphine, tolerance to respiratory depression and euphoria develops more rapidly than tolerance to analgesia.

Thebaine

Thebaine is naturally available in small quantities in opium. It is also known as Paramorphine. It is white, crystalline, slightly water-soluble and poisonous alkaloid.  The Thebaine-Constituent of Raw-Opium is normally between 0.2% and 1.5%. However higher amounts have been reported. It is not used for therapeutic or recreational purposes, but is converted industrially into a variety of compounds such as oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, buprenorphine and etorphine.

In the past thabaine was believed to have no properties that were like those of morphine. However there are many studies that have found that thebaine has a considerable potential for dependence both psychological and physical when used in large doses for a long period of time.

Codeine

Naturally extracted from the poppy plant, codeine is used in hospitals as a narcotic pain-reliever and cough suppressant. It functions similar to morphine and hydrocodone. Moreover, when taken a small amount of codeine is converted to morphine in the body. However the mechanism of action of codeine is not known but just like morphine, codeine binds to opioid receptors in the brain. These receptors are important for transmitting the sensation of pain throughout the body and brain. Codeine increases tolerance to pain, decreasing discomfort, but the pain still is apparent to the patient. Despite its ability to suppress coughs and enable pain tolerance, it has the following side effects, noisy breathing, sighing, slow breathing with long pauses between breaths, drowsiness and blue colored lips.

Semi-synthetic opioids

This is a group of drugs that are naturally extracted from the poppy plant but are further processed before they are used. An example is heroine.

Heroine

Comes from the opium poppy but is further processed. When pure it is a white powder that has a bad taste. Some heroin is dark brown, and black tar heroin is either sticky or hard and looks like roofing tar. It has pain relieving properties. Unlike most pain relieving narcotics that are accepted in most states when prescribed by doctors, heroin is illegal in most countries basically because it is highly addictive and has quite grave side effects. Some of the withdrawal symptoms include; sleeplessness, bad chills and sweats, muscle pain, stomach cramps, nausea, vomiting, and diarrhea.

Synthetic opioids

These are opioids that are made in laboratories. They include;

Methadone

Methadone is used as a pain reliever and as part of drug addiction detoxification and maintenance programs and is only available from certified pharmacies. This drug helps reduce the severity of withdrawal symptoms that are suffered by heroin addicts when they stop using heroin. Some of its side effects include; rapid heart rhythm, severe dizziness and chest pain among others.

Oxycodone

This is an FDA approved drug for use in pain relief as well as suppressing coughs. This drug is a strong pain reliever and works better for both opioidsmoderate and severe pain. It increases tolerance to pain hence eliminating discomfort. It also causes sedation. May cause very severe side effects when mixed with alcohol. Cases of death have been reported.

Fentanyl

Fentanyl is an opioid medication that is used for anesthesia to help prevent pain after surgery or any other medical procedure that may result in moderate or severe pain. It is injected in the muscle or in the vain through IV. It is mostly used before surgery. Side effects include severe dizziness, drowsiness and impaired reactions.

Finally, you need more information to stay away from dependence on alcohol and drugs as these have crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain or any type of addiction as well as other diseases.

Type of Opioids, Their Uses and Side Effects 

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Buprenorphine and opioids

October 2, 2014

Buprenorphine as Opioid Receptor Antagonist

buprenorphineBuprenorphine is a semi-synthetic opioid derived from thebaine. It is a pain killer and has gained a great deal of notoriety for its ability to interrupt severe opiate addiction, including heroin and methadone addictions. It got approved in 2002 by the FDA for use as an opiate addiction treatment. Dependence on pain drugs is common but very dangerous and that is why buprenorphine is of importance in fighting opioid independence.

Today, buprenorphine is being used in office based treatment of opioid dependent patients. Buprenorphine is a partial mu-opioid receptor agonist. Several clinical studies indicate buprenorphine is effective in managing opioid addiction and dependence. In all of the clinical tests Buprenorphine was found to be more effective than placebo for managing opioid addiction. However, it may not be superior to methadone incase high doses are needed. It is comparable to lower doses of methadone, however. When using buprenorphine, there are critical phases that must be followed. These phases include; include induction, stabilization, and maintenance. Experts advise that Buprenorphine therapy should be initiated at the onset of withdrawal symptoms and adjusted to address withdrawal symptoms and cravings. Advantages of buprenorphine include low abuse potential and high availability for office use. Disadvantages include high cost and possible lack of effectiveness in patients who require high methadone doses. Most family physicians are required to complete eight hours of training before they can prescribe buprenorphine for opioid addiction. Let’s get all the detailed facts here.

It is estimated that 898,000 adults in the United States are opioid dependent. Treating opioid dependence as a chronic disorder improves outcomes and opioid maintenance is the most effective way to decrease illicit use in patients who are addicted to opioids. Without opioid maintenance, it will be easy for any user of opiates for pain to be an addict of the same therefore various strategies must be put in place to exercise opioid maintenance for the safety of the patients. Over the past years Methadone has been the treatment of choice in the United States; however, methadone maintenance programs typically have stringent entrance criteria, long waiting lists, and primarily are located in urban areas. It has been verified that only 14 percent of patients who are addicted to opioids are treated in traditional methadone clinics. Research from the 1970s demonstrated that the analgesic buprenorphine (Subutex), a partial mu-opioid receptor agonist, may effectively treat patients with heroin addiction.

In the Drug Addiction Treatment Act of 2000 physicians are authorized to provide office-based treatment for opioid addiction. Through this act physicians are allowed to prescribe Schedule III, IV, or V “narcotic” medications that are approved by the U.S. Food and Drug Administration (FDA) for patients with narcotic-use disorders. In 2002, buprenorphine and combination buprenorphine/naloxone (Suboxone) was approved by the FDA to manage opioid dependence .It is therefore a legally usable drug that is available in health centers and clinics.

How to use

As stated earlier the Management of opioid addiction with buprenorphine can be divided into three phases: induction, stabilization, and maintenance. The induction phase includes the initial transition from illicit opioid use to buprenorphine and typically lasts three to seven days. Patient education is important during this phase and should emphasize the risk of precipitating withdrawal if buprenorphine is initiated too soon after opioid use. Generally, buprenorphine should be initiated 12 to 24 hours after short-acting opioid use and 24 to 48 hours after long-acting opioid use. It is preferable for most patients to use combination of buprenorphine/naloxone tablets.  It is however advised that pregnant women who are to use buprenorphine and some patients using long-acting opioids such as methadone should use the buprenorphine-only formulation. For those who are on long- acting opioid use, the methadone dose should be less than 30 mg and the patient should switch to the combination tablet after several days.

When the patient has shown opioid withdrawal symptoms, the initial doses should be administered under physician observation (4/1 mg buprenorphine/naloxone or 2 mg buprenorphine if the patient is dependent on a long-acting opioid). It is important for the physician to monitor the patient for precipitated withdrawal and excessive side effects like sedation). If the patient continues to exhibit signs of opioid withdrawal after two hours, another 4/1 mg dose of buprenorphine/naloxone should be administered. Patients who are dependent on long-acting opioids should receive 2 mg buprenorphine every one to two hours. The maximum recommended first-day dosage of buprenorphine is 8 to 12 mg. If the patient continues to show signs of withdrawal, the physician may administer adjunctive nonopioid and symptomatic treatments to help the situation.

Difference between methadone and morphine

There are some differences between methadone and morphine. Some of the differences lie in their costs and uses. Here are some of the differences.

Methadone is much cheaper as compared to morphine. For this reason many physicians favor methadone. Methadone also lasts longer than morphine- it lasts ten times longer than morphine. Methadone also lasts longer than morphine in the body. It takes 24 hours while morphine takes only 2-3 hours only in the body. However methadone should not be used for slight pain despite its availability and cheaper cost.

Another difference is that methadone is excreted through urine while morphine is excreted through the liver and bile ducts before its exit in the urine.

 

BuprenorphineThese drugs are also used in different situations. Methadone is mostly used after unsuccessful use of morphine or when the patient has a history of drug abuse. If tis patient is morphine it may lead to relapse hence methadone is considered safer than morphine. Morphine is addictive while methadone is not addictive.

Here at AWAREmed we are dedicated to finding the best solutions to chronic illnesses and that is why Dr. Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.

 

Buprenorphine as Opioid Receptor Antagonist

 

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Proper use Opioids to Curb Addiction and Dependence

October 1, 2014

 

Better Use of Opioids to Curb Addiction and Dependence

opioidsThe opioid drugs have brought relief to many people that were suffering severe pain enough to even disable them. The use of these drugs however should be done with extreme caution as this is like a double aged knife. We talk of collateral damage here with this I mean that these drugs should be used in a manner that they are safe enough not to cause myriad problem such as addiction and dependence on these records.  Today there are millions of Americans who depend on these opioid drugs to overcome what might otherwise be agonizing, crippling pain. However, each year, the numbers of people who have become addicted to these drugs rise. The very same drugs that help them to overcome the pain are poising a great danger in their lives needless to mention the use of these drugs has led to death of many Americans. The main cause of these deaths is overdose. Prescription opioid overdoses caused more than 16,000 deaths in the United States in the year 2010 alone. This is for times the number of deaths that were recorded in 1999 to have been caused by prescription opioid overdose. In the past it was not  easy for both private and public health facilities to act on these unpleasant statistics but slowly they seem to lay strategies to curb the use of these opioid drugs and so far these strategies have shown positive results as very many lives have been saved not only in America but also in other continents.

The Centers for Disease Control and Prevention has cited Florida as one of the cities where the deaths have dropped owing to these strategies that have been employed by the health sector. The deaths dropped from 3201 as was in 2010 to 2666 in 2012. The report clarifies that most of these deaths were reduced due to reduction in prescription of these drugs to pain patients. There were fewer prescriptions to these opioid drugs as a result of in the policy that regulated the flow of these drugs. These policy changes led to a close of 250 of the state’s pill mills that were considered high volume pain medication dispensaries.

The United States remains far and away the world’s largest user of prescription opioids, with 259 million prescriptions written in 2012, according to the CDC — twice as many, per capita, as the next-largest consumer, Canada. A separate CDC report issued the same day as the Florida update showed that prescription rates vary widely among states. Now, when we take America out of the picture and we begin to find reasons why there are problems with the opioid medications we learn that one of the causes of these problems is;

Irresponsible prescription

Every patient entrusts his with the doctor, however in some situations this dependence may be abused either intentionally or unintentionally. Some doctors are opiophobiac and hence reluctant to give right doses to the patients while in some scenarios a patient may be handled by a doctor who is not experienced in pain treatment hence may either overdose or under dose the patient. Cases of overdose are a major cause of deaths from use of these pain drugs.

Another source of complication is, the patient may be afraid of these drugs as they are often portrayed negatively by the media. The fear of addiction and dependence may make a patient not to use the drugs as prescribed.

Due to the problems that were faced by both doctors and patients in dealing with the opioid medications, the universal precautions were developed to offer a structured rational approach to pain patients and serve “as a guide to start a discussion within the pain management and addictions communities. They are not promoted as complete precautionary measures but as a guide to opioid medications.

The difference between physical dependence, addiction and PSEUDO-ADDICTION

These three have different meanings. However they have always been confused causing fear among patients using these drugs. Physical dependence is the case that arises when a person has been using these drugs for some time. The body physically becomes dependent on these drugs so much that when you stop using them you will show signs of withdrawal. This is normal and happens with other medications not only with opiates.

Addiction on the other hand is a case when a person losses control of the drugs. He no longer can maintain the doses as prescribed but begins to take much more than the prescribed doses. In most cases those addicted to a drug will not accept that they are but will go through all hustles to satisfy their craving for the drug.

 What is pseudo-addiction?

opioidsWhen a pain patient on opioids begins behaving in a manner that most addicts do but in real sense he is not addicted, this is called pseudo-addiction. The patient will demand for more drugs because the doses he got have not settled the pain. They will even use more than the prescribed doses in a bid to cool the pain and are often early to request for more drugs since they overused the ones they were given to cool the pain . The difference between pseudo-addiction and addiction is the reason behind the need for more drugs; an addict needs more drugs to satisfy his craving while in pseudo-addiction a patient needs more drugs because of the pain.

You need more information to stay away from dependence on alcohol and drugs as these have crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain or any type of addiction as well as other diseases.

Better Use of Opioids to Curb Addiction and Dependence

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Opiophilia Replaced By Opiophobia

October 1, 2014

Opiophilia Replaced By Opiophobia the Pendulum Is Again In Motion

OpiophobiaThere are certain phenomena in the medical field that are rather hard to understand. We were brought up knowing that opioids and like substances were bad and should be avoided at all costs and we did that but as we grew and each of us went his way in matters there are mysteries that we met. As everybody else chose careers I chose to be here practicing medicine and I tell here my perception of opiates and like substances were changed here we use them as drugs especially as pain management drugs. To many people this may sound irrational. How do you use a drug that has dangerous effects to treat an illness? Don’t worry we had the same questions and curiously we waited to have these mysteries unraveled. We use these drugs in doses that are only able to address the pain and for a time that may not cause any serious health problems. However as patients were put on these drugs the whole medical industry work up to the realization that the use of these drugs in most cases resulted in the patients being addicted to the drugs and hence demanded more and more of these drugs. These drugs are rewarding in nature and so patients that are put on these drugs will automatically tend to crave for them. That is when opiophilia became a disease to be fought from all corners to help patients on these drugs to evade addiction and dependence on these drugs.

What is Opiophilia?

Opiophilia is a love of opioids, the love for opioids may not begin as a choice but may begin gradually when a patient is prescribed opiates to help him in pain management.  In the past the doctors had given a blind to the possibility of pain patients under opiate drugs to be addicted on these drugs as they believed that the dosage was not enough to make the develop dependence on these drugs. However as patients take these drugs they will become addicted as the drugs are rewarding in nature. This therefore means that before a doctor prescribes opiate to a chronic pain patient he should assess the patient and develop exit strategies that will help these patients avoid addiction.

Fortunately, the medical industry has fought opiophilia and better strategies have been put in place to ensure that patients on these drugs are safe. Opiophilia seems an already won battle. Apart from proper pain management by use of these drugs other natural ways of pain management have been embraced to help patients where necessary. These natural pain cures include Prolozone therapy, PRP and prolotherapy. These natural pain cures are now used worldwide to help patients with chronic pain.

The fight against opiophilia was won but that did not end all the problems associated with the use of opiates in managing pain in patients. Another disease came and replaced opiophilia and this is opiophobia.

Opiophobia is a disorder or affliction, so named because people affected have a great aversion to the use of prescription opioids for the treatment of pain, to the point where they will actually refuse to take or administer it. This is rather new disease in field of drugs and addiction. This term is also used to refer to instances when doctors fear or are unwilling to prescribe opioid medication to patients.

In most cases doctors who have had unwillingness to prescribe opioid medications are often counseled and so they go back to administer the drugs. Opiophobia should be addressed just as much as opiophilia since it is the opioid that goes deep in managing pain. This is because the only direct biologic pain-relief system in the human body is the endogenous opioid receptor system, consisting of endorphins and their tissue based action sites, or receptors. Using opioid based drug in pain offers instant relief and so the opiates still remain to be the best pain relief medication. The public as well as the doctors may be subject to opiophobia owing to the negative information that are spreading concerning the use of opiates in dealing with pain. The major concern of these groups is that they know that when a patient has used the opiates for a short term or long-term pain then he becomes addicted and will show symptoms of withdrawal once he stops using the drugs. This may be true but this is also true with other medications doesn’t a diabetic patient become dependent on insulin? Needless to mention several strategies have been put in place to ensure safe exit from the use of these drugs. When you are dependent on any drug for medical purposes. That is not abuse.

Because of opiophobia and opiophilia State regulators have been introducing legislation to severely curtail availability of opioid class of medication this unfortunately may be a disadvantage rather than an advantage as there are patients that are already dependent on these drugs needless to mention there is no alternative that has been put in place that can work effectively enough to replace opioid class of drugs in managing pain.

OpiophobiaExit strategy from opioid therapy

There is need for a safe exit strategy to help the patients evade any possible danger that may come from using the drug. However it is better for a doctor to formulate a safe exit strategy. He will be able to do so depending on such factors as; consistence of a patient’s behavior with drug addiction, patient’s willingness to cooperate with an outpatient-based opioid analgesic tapering plan, patient’s history with substances disorders. All these assessments will help the doctor to formulate a safer exit plan for the patient.

Here at AWAREmed we are dedicated to finding the best solutions to chronic illnesses and that is why Dr. Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.

Opiophilia Replaced By Opiophobia the Pendulum Is Again In Motion

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Opioids and Cancer

September 27, 2014

How the use of opioids disturbs the cancer balance

OpioidsWhat are opiods?

There are several important things about opiods that you need to know at this stage. First, it is important to note that strictly speaking, the term ‘opioids’ is used to describe a group of chemical compounds that are defined by two important characteristics: having chemical action that is similar to that of morphine and being made of a distinct chemical structure. For many of the compounds that are categorized under this umbrella, their structures vary. Whereas some have distinct alkaloid structures, others occur in the form of peptides.

The second thing is about the occurrence of opioids. Naturally, opioids are found in two distinctive forms: occurring freely in the environment and within the body of human beings. Although initially the possibility of occurrence of opioids within the body of humans was strongly refuted, rigorous research has indicated that indeed the human brain contains specific endogenous opioids that play important role in different functions.

The third thing regards the interaction of opioids with complementary chemical compounds. Further studies have indicated that there are compounds whose actions contradict that of opioids. Known as antagonists, such compounds play a highly important role in their interaction with opioids in relation to influencing particular processes in the body. We shall examine this subject later.

How are opioids used?

For years, opioids have been used for a range of functions. Basically, the use of opioids has been in the form of morphine, which is a commonly occurring plant. Morphine has been used for medicinal as well as recreational purposes for long. Since the use of the plant for medicinal purposes is what matters with regard to our discussion, we shall focus on it.

At the commercial level, morphine has actually been used to relieve pain in chronically ill patients. Take cancer for example, the disease has been known to produce intense pain in patients. To relieve patients of this, morphine-based painkillers are extensively used. This is one common and formal way in which morphine (a common source of opioids) is used for commercial purposes.

The ability of opioids in general and morphine in particular to act as a strong analgesic has been a subject of research for long. Studies have indicated that the compounds have specific effects on the nervous system which translates to drastic reduction in pain. This explains the popularity of morphine-based painkillers as the standard therapy for cancer patients who have undergone an operation as part of the therapy or simply those in advanced stages of cancer.

Therefore, whether for recreation or medicinal use, opioids, have been extensively used to relieve cancer patients of pain in the course of treatment.

How opioids act

Basically, the action of opioids on the body can best be understood when you understand what opioid receptors are. Your body is made of special compounds which act as receptors for opioids. The receptors are distributed in several parts of your body, with many of them being in the central nervous system. It is this phenomenon that explains why opioids have a very strong effect on the nervous system. Others are distributed in different parts of your body such as the lungs, liver and other internal organs.

There are several types of receptors. It is the interaction between specific opioids and receptors that causes particular feelings in the body. Whereas some receptors are meant to trigger feelings of relief when they come into contact with opioids, others are designed to trigger changes in other physiological processes when opioids are introduced. The interaction between opioids and receptors is an important process when it comes to how opioids may disturb the cancer balance in the body.

How do opioids disturb cancer balance?

Simply put, cancer balance is a situation in which the process of metastasis, angiogenesis and invasion of healthy body cells by cancerous ones is completely inhibited. Research has indicated that use of opioids as painkillers can disturb this balance, thus leading to development of cancer in the body. On the other hand, other studies have indicated that morphine, in particular, may have anti-cancer properties by inhibiting the cancer development process mentioned above.

One way in which opioids used as painkillers can disturb the cancer balance is by altering the normal functioning of the immune system. Since cancer development largely depends on the state of the immune system, any compound that alters the immune system can indirectly influence the possible occurrence, development and spread of cancer. From several studies conducted, it can be concluded that particular opioids are able to alter the normal functioning of the immune system, thus exposing a patient on whom they are used to cancer development.

On the other hand, some studies have indicated that morphine is able to induce natural cell death and, as a result, control the growth of cancer cells in the body. However, this property, which highly depends on a number of different factors such as the concentration of the morphine that is used and the state of the opioid receptors in the body, remains a subject of research. What you need to know is that there has been concrete evidence to the effect that the use of opioids for relief of pain in cancer patients may actually disturb the cancer balance and trigger fresh development of cancer. This happens because of the effect that opioids have on the immune system of the patient in the form of production and inhibition of production of important hormones.

OpioidsConcluding remarks

Here at AWAREmed Health and Wellness Resource Center, we use the best approaches to administer alternative and complementary treatment of cancer to patients. Dr. Dalal Akoury is a specialist in this field. One thing, though, that sets her apart is her devotion to helping cancer patients successfully fight the devastating effects of the disease. Feel free to visit us in Myrtle Beach, South Carolina for a completely personalized administration of alternative and complementary therapies for cancer.

How the use of opioids disturbs the cancer balance

 

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