See Also
1. Chemical Dependence
2. Substance Abuse Evaluation
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
Class
1. Narcotic
Forms
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
Pharmacokinetics
1. Heroin (2-8 mg): 4-6 hour duration
2. Methadone (35-180 mg): 18-24 hour duration
Toxicity
1. Miosis
2. Hypoventilation
3. Bradycardia
4. Hypotension
5. Pulmonary edema
6. Coma
7. Seizures
Toxicity Management
1. Naloxone (Narcan)
2. Nalmefene (Revex)
Withdrawal
1. Classic triad for Opioid withdrawal
  1. Piloerection
  2. Rhinorrhea
  3. Lacrimation
2. Clonidine (Catapres) Indications
  1. Non-life threatening Symptoms and Signs
  2. Anxiety
  3. Piloerection
  4. Yawning
  5. Sneezing
  6. Rhinorrhea
  7. Nausea or Vomiting
  8. Diarrhea
  9. Abdominal muscle cramps
3. Other medications used for withdrawal symptoms
  1. Dicyclomine for abdominal cramping
  2. Hydroxyzine for agitation
  3. Loperamide for Diarrhea
  4. Trazodone for Insomnia
  5. NSAIDs for myalgias
Management: Treatment Options
1. Counseling
  1. Chemical Dependency Rehabilitation
  2. Narcotics Anonymous
2. Medical Management
  1. Methadone
  2. Levomethadyl (Orlaam)
  3. Buprenorphine (Buprenex)
  4. Naltrexone (Trexan)
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
References
1. Krambeer (2001) Am Fam Physician 63(12):2404

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.