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Opioid AbuseAka: Narcotic Abuse, Opiate Abuse

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  1. See Also
    1. Chemical Dependence
    2. Substance Abuse Evaluation
    3. Opioid Withdrawal
  2. Epidemiology
    1. Incidence of Narcotic addiction U.S.: 0.5 to 1 Million
    2. Associated comorbid conditions
      1. HIV Infection (60%)
      2. Hepatitis B Infection (60 to 80%)
      3. Hepatitis C Infection (60 to 80%)
      4. Tuberculosis
  3. Class
    1. Narcotic
  4. Preparations
    1. Direct Opium Derivatives
      1. Morphine (Morphine Sulphate, "White Stuff", "M")
      2. Codeine (methyl-Morphine, "School boy")
    2. Morphine Derivative
      1. Heroin (Diacetyl-morphine)
        1. Street Names: H, Horse, Junk, Smack, Scag, Stuff
        2. Administered: IV, "snorted" or smoked
      2. Dilaudid (Dihydromorphinone)
    3. Semi-Synthetics and Synthetics
      1. Methadone (Dolophine amidone, "Dolly")
      2. LAAM
      3. Propoxyphene
      4. Meperidine
      5. Fentanyl
  5. Pharmacokinetics
    1. Heroin (2-8 mg): 4-6 hour duration
    2. Methadone (35-180 mg): 18-24 hour duration
  6. Signs: Toxicity
    1. Miosis
    2. Hypoventilation
    3. Bradycardia
    4. Hypotension
    5. Pulmonary edema
    6. Coma
    7. Seizures
  7. Management: Toxicity (antidotes)
    1. Naloxone (Narcan)
    2. Nalmefene (Revex)
  8. Management: Treatment Options
    1. See Opioid Withdrawal
    2. Counseling
      1. Chemical Dependency Rehabilitation
      2. Narcotics Anonymous
    3. Medical Management
      1. Methadone
      2. Levomethadyl (Orlaam)
      3. Buprenorphine (Buprenex)
      4. Naltrexone (Trexan)
  9. Resources
    1. Narcotics Anonymous (NA)
      2. Phone: 818-773-9999
    2. Nar-Anon Family Group Headquarters
      1. http://www.onlinerecovery.org/co/nfg
    3. Narcotic Treatment Programs Directory
      1. http://www.fda.gov/cder/compliance/ntpdir.pdf
  10. References
    1. Krambeer (2001) Am Fam Physician 63(12):2404

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