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PubMed1980

Epidural narcotics in volunteers: sensitivity to pain and to carbon dioxide.

Tolerance to pain and sensitivity to rising concentrations of inhaled carbon dioxide were measured before and after administration of methadone, 5 mg, or hydromorphone, 0.5 mg, by the intravenous route and by epidural injection in the lumbar or upper thoracic region in 5 subjects. Tolerance to periosteal pressure, cutaneous electrical stimulation and the cold pressor response to ice-water immersion were measured in both upper and lower limbs. Tolerance to all three pain modalities was greater in the epidural "blocked" limbs than in the "unblocked" limbs or after intravenous administration, and this difference was sustained after a second injection of narcotic. Sensitivity to carbon dioxide was less depressed by epidural narcotic than by intravenous administration; however, after a second dose of narcotic, depression of CO2 sensitivity by epidural injection was comparable to that produced by intravenous injection. These observations support the hypothesis that epidural narcotics have a segmental action as well as a systemic effect, and that both actions are dose-dependent.

Adult↗
PubMed1992

Circadian distribution of extra doses of narcotic analgesics in patients with cancer pain: a preliminary report.

In this open study we reviewed the circadian distribution of extra doses of narcotic analgesics in 61 bed-ridden patients with cancer pain. The information was collected prospectively and retrospectively in 34 and 27 cases, respectively. All patients were receiving parenteral narcotics using the Edmonton Injector, and none had incidental pain or cognitive impairment. A total of 1322 extra doses of narcotics (each dose = 10% of the daily dose) were administered during 610 patient days (average of 2.17 +/- 1.6 doses/patient/day). The mean daily number of extra doses during each interval was as follows: 02.00-06.00 h (0.24 +/- 0.27), 06.00-10.00 h (0.26 +/- 0.31), 10.00-14.00 h (0.43 +/- 0.44), 14.00-18.00 h (0.44 +/- 0.41), 18.00-22.00 h (0.40 +/- 0.36), and 22.00-02.00 h (0.40 +/- 0.36) (02.00-06.00 h and 06.00-10.00 h vs. 10.00-02.00 h: P less than 0.01). Forty-five of 61 patients (76%) received most of their extra doses of narcotics between 10.00 and 22.00 h. The data suggest that our patients require a larger number of extra doses during day time. Our design cannot establish the reason for this circadian variation.

Adult↗
PubMedDate not supplied

Deaths among narcotic addicts in Denmark in 1978 and 1979.

Since 1968 the number of deaths registered among narcotic addicts has increased considerably from 9 deaths in 1968 to 121 in 1979. Data concerning 215 deaths among narcotic addicts in 1978 and 1979 examined at the three Danish University Institutes of Forensic Medicine are presented. Four-fifths of the cases were males; the average age in both males and females was 26 years. In most cases a mixed abuse was present, the predominant drug being heroin. In 27% of the cases there was an abuse of alcohol. The material was divided into two groups. Group A included 181 cases in which the cause of death was poisoning by one or more drugs. In group B (34 cases) narcomania was a contributory factor to death. The place of death, gross autopsy findings and toxicological data are reported. The manner of death was in 62% of the cases stated as accident, in 19% as suicide, in 14% as accident?/suicide?, in 3% as natural death and finally in 1% as homicide. Next to traffic accidents narcotic addiction today is the greatest single cause of death in the age group 18 - 35 years. These facts call for active political steps against narcotic addiction.

Adolescent↗
PubMed1985

Narcotic withdrawal in the emergency department.

Patients in narcotic withdrawal can be very disruptive in an emergency department. An understanding of the dynamics of narcotic addiction and withdrawal is useful for the emergency physician. Narcotics are used for the euphoria they provide; however, chronic use results in physiological and psychological changes. Research into the endorphin system has provided a model of narcotic addiction and withdrawal. Effective therapies now exist for use in the emergency department.

Clonidine↗
PubMed1991

Transdermal scopolamine use in the control of narcotic-induced nausea.

Nausea affects from 40% to 70% of cancer patients who received narcotics to manage their pain. This occurs more frequently when they are ambulatory than when they are recumbent and may be the result of narcotic-enhanced labyrinthine sensitivity to motion. Scopolamine has previously been found to be an effective antiemetic for motion sickness. In a prospective pilot study, 9 (69%) of 13 cancer patients experienced rapid relief of their narcotic-induced nausea when they used Scopolamine Transderm-V patches alone. Only two patients experienced side effects with the scopolamine, and in one patient, the side effects may have been dose related. Although tolerance to the increased vestibular sensitivity may occur, this was not universal. Further prospective trials are necessary to establish whether transdermal scopolamine is useful in controlling the narcotic-induced nausea experienced by cancer patients.

Administration, Cutaneous↗
PubMed1993

Pro: midazolam is the sedative of choice to supplement narcotic anesthesia.

Having examined the options for adjuvant drug use during cardiac anesthesia, it becomes increasingly apparent that midazolam is "the drug" of choice and that supplementation with an opioid is an ideal adjuvant. In the hands of experienced cardiac anesthesiologists, the majority of the drugs discussed could provide adequate anesthesia with outcomes that would be difficult to distinguish, with the exception of awakening and time to extubation. Regardless of the inability to differentiate overall outcome, when comparing ease of providing complete "balanced" anesthesia, minimal cost increase, ease of use, hemodynamic stability, reliability of amnesia and ability to decrease narcotic requirement and allow early extubation, midazolam is a clear winner. Given as a continuous infusion or a bolus, potent opioids such as alfentanil, fentanyl or sufentanil enhance the amnestic and hypnotic effect of midazolam, decreasing the required dose. In addition, the combination of midazolam and narcotics decreases the catecholamine response that either one alone would produce. This removes the necessity of marked narcotic overdose required when narcotics alone are used. The result of this anesthetic combination is a technique that can be used in the majority of cardiac patients regardless of their ventricular performance, allowing options for earlier awakening, earlier extubation and decreased ICU stay. The goal of complete "balanced" anesthesia is best achieved with continuous infusions of midazolam and opioids. Accepting recall of intraoperative events as a necessary evil is unacceptable in the stable cardiac surgery patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed2004

Narcotic and benzodiazepine use after withdrawal of life support: association with time to death?

OBJECTIVE: To determine whether the dose of narcotics and benzodiazepines is associated with length of time from mechanical ventilation withdrawal to death in the setting of withdrawal of life-sustaining treatment in the ICU. DESIGN: Retrospective chart review. SETTING: University-affiliated, level I trauma center. PATIENTS: Consecutive critically ill patients who had mechanical ventilation withdrawn and subsequently died in the ICU during two study time periods. RESULTS: There were 75 eligible patients with a mean age of 59 years. The primary ICU admission diagnoses included intracranial hemorrhage (37%), trauma (27%), acute respiratory failure (27%), and acute renal failure (20%). Patients died during a median of 35 min (range, 1 to 890 min) after ventilator withdrawal. On average, 16.2 mg/h opiates in morphine equivalents and 7.5 mg/h benzodiazepine in lorazepam equivalents were administered during the time period starting 1 h before ventilator withdrawal and ending at death. There was no statistically significant relationship between the average hourly narcotic and benzodiazepine use during the 1-h period prior to ventilator withdrawal until death, and the time from ventilator withdrawal to death. The restriction of medication assessment in the last 2 h of life showed an inverse association between the use of benzodiazepines and time to death. For every 1 mg/h increase in benzodiazepine use, time to death was increased by 13 min (p = 0.015). There was no relationship between narcotic dose and time to death during the last 2 h of life (p = 0.11). CONCLUSIONS: We found no evidence that the use of narcotics or benzodiazepines to treat discomfort after the withdrawal of life support hastens death in critically ill patients at our center. Clinicians should strive to control patient symptoms in this setting and should document the rationale for escalating drug doses.

APACHE↗
PubMed1993

Postoperative narcotic analgesic administration.

The administration of narcotic analgesics to postoperative patients was examined with 180 uncomplicated adult appendectomy patients. Narcotic analgesic doses were transcribed from the hospital records of these patients for the entire postoperative period. Equianalgesic doses were calculated so that all medications were comparable with meperidine. Eighty-three percent (n = 150) of the patients received meperidine. Patients who received meperidine were given significantly more narcotic analgesics than those who received morphine sulfate. The amount of narcotic analgesics received by patients was significantly related to their length of hospital stay. Meperidine and Tylenol #3 (acetaminophen with codeine phosphate; McNeil Pharmaceutical, Spring House, PA) comprised the significantly associated analgesics. These findings suggest a need to reexamine the current use of meperidine in postoperative analgesia.

Adolescent↗
PubMed1985

Skills of medical students and house officers in prescribing narcotic medications.

Eighty-eight medical students and house officers were given patient management questions to assess their ability to convert from one narcotic regimen to an approximately equal analgesic dose of a second regimen. Only 8 percent of their answers were within the correct range, even though commonly used reference material was supplied to assist them in answering the questions. There were no significant differences in the responses of house officers from different medical specialties or among all the individuals at different educational levels. Correct answers to the patient management questions markedly increased after instruction on the use of a narcotic equivalency table. More emphasis on the importance of adequate pain control, better teaching of the pharmacology of narcotic analgesic drugs, and additional instruction on the use of narcotic equivalency tables are needed in medical school and house staff training programs.

Clinical Competence↗
PubMed1994

Neonatal narcotic withdrawal in Hong Kong Chinese.

A retrospective case controlled study was carried out to study the neonatal characteristics, outcome and narcotic withdrawal syndrome in 51 neonates exposed to narcotic antenatally. The birth weight, head circumference and body length were significantly smaller in the study group while the incidence of prematurity (41%) and small-for-gestational age babies was increased (27.5%). Narcotic withdrawal occurred in 83% of narcotic exposed neonates. About half of them had onset of withdrawal symptoms within the first 24 hours. All of these newborns were treated by either phenobarbitone (45%), chlorpromazine (9.5%) or both (40.5%). The average duration of treatment was 15.7 days. There was one neonatal death due to in utero withdrawal and hypoxia, and another post-neonatal death due to sudden infant death. Neonatal jaundice, necrotising enterocolitis, clinical sepsis and congenital syphilis were more common in the drug-addicted group.

Asian People↗
PubMed2004

Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis.

OBJECTIVE: To assess the efficacy of long-term sacral neuromodulation (InterStim(R), Medtronic Inc., Minneapolis, MN) in treating chronic pelvic pain associated with interstitial cystitis (IC, a symptom complex of urinary urgency, frequency and pelvic pain, often necessitating narcotics) refractory to standard therapy. PATIENTS AND METHODS: Twenty-one patients (17 female, four male, mean age 45.5 years, range 17-68) with refractory IC with chronic pelvic pain were reviewed retrospectively. In these patients a mean of six previous treatments for IC had failed. All patients had had cystoscopy and hydrodistension to confirm their diagnoses. All had a permanent InterStim device implanted by one surgeon (K.M.P.) between 2000 and 2002, after responding to a temporary test. Data were collected from chart reviews and patient questionnaires. Intramuscular morphine dose equivalents (MDEs) were calculated before and after implantation. RESULTS: All 21 patients responded to the questionnaire; the mean (range) follow-up after implantation was 15.4 (7.4-23.1) months. Eighteen patients used chronic narcotics before the InterStim and 20 reported moderate or marked improvement in pain afterward. The mean MDE decreased from 81.6 to 52.0 mg/day (36%) after implantation (P = 0.015). Four of 18 patients stopped all narcotics after InterStim implantation. CONCLUSIONS: Sacral neuromodulation decreases narcotic requirements and subjective pelvic pain in patients with refractory IC. Further decreases in MDE are anticipated as dose reductions continue in patients who improved.

Adolescent↗
PubMed2003

Basal signaling activity of mu opioid receptor in mouse brain: role in narcotic dependence.

Narcotic analgesics cause addiction by poorly understood mechanisms, involving mu opoid receptor (MOR). Previous cell culture studies have demonstrated significant basal, spontaneous MOR signaling activity, but its relevance to narcotic addiction remained unclear. In this study, we tested basal MOR-signaling activity in brain tissue from untreated and morphine-pretreated mice, in comparison to antagonist-induced withdrawal in morphine-dependent mice. Using guanosine 5'-O-(3-[(35)S]thio)triphosphate ([(35)S]GTP gamma S) binding and adenylyl cyclase activity assay in brain homogenates, we demonstrated that morphine pretreatment of mice enhanced basal MOR signaling in mouse brain homogenates and, moreover, caused persistent changes in the effects of naloxone and naltrexone, antagonists that elicit severe withdrawal in dependent subjects. Naloxone and naltrexone suppressed basal [(35)S]GTP gamma S binding (acting as "inverse agonists") only after morphine pretreatment, but not in drug-naive animals. Moreover, naloxone and naltrexone stimulated adenylyl cyclase activity in striatum homogenates only after morphine pretreatment, by reversing the inhibitory effects of basal MOR activity. After cessation of morphine treatment, the time course of inverse naloxone effects on basal MOR signaling was similar to the time course of naltrexone-stimulated narcotic withdrawal over several days. The neutral antagonist 6 beta-naltrexol blocked MOR activation without affecting basal signaling (G protein coupling and adenylyl cyclase regulation) and also elicited substantially less severe withdrawal. These results demonstrate long-lasting regulation of basal MOR signaling as a potential factor in narcotic dependence.

Adenylyl Cyclases↗
PubMedDate not supplied

[Forensic medical expert evaluation of lethal poisoning with narcotics].

Morphological manifestations of lethal narcotic poisoning are analyzed on the basis of results presented in "Acts of Medical Examination of Corpse" and "Expert Conclusions" on 352 cases with lethal narcotic poisoning, suspected (with good grounds) poisoning, and combined poisoning with narcotics and other agents. Causes of failure to detect narcotics in forensic chemical analysis of biological material from the corpse are enumerated.

Cadaver↗
PubMed1975

Quantification of the analgesic activity of narcotic antagonists by a modified hot-plate procedure.

The analgesic activity of morphine and the narcotic antagonists, pentazocine, cyclazocine, levallorphan and nalorphine, was assessed in the rat using two hot plates: one maintained at 49.5 degrees C and the other at the "standard" 54.5 degrees C. The analgesic effects of morphine using the 49.5 degrees C hot plate were of a significantly greater magnitude than its effects using the 54.5 degrees C hot plate for both nontolerant and morphine-tolerant subjects. Dose-related effects were observed with all of the narcotic antagonists tested using the 49.5 degrees C hot plate; only the highest dose of pentazocine exhibited activity using the 54.5 degrees C hot plate. Naloxone (3.0 mg/kg) antagonized the analgesic effects of morphine and all of the narcotic antagonists, but was without activity itself when tested using the 49.5 degrees C hot plate at doses as high as 30 mg/kg. Aspirin was also inactive using the 49.5 degrees C plate, whereas physostigmine increased latencies only at a dose that produced severe motor deficit. A low temperature hot plate is recommended for evaluating the analgesic activity of narcotic antagonists in the rat. This simple procedure provides results which are dose-related, quantifiable, reproducible, of a large magnitude and specific.

Analgesia↗
PubMed2002

Classification of narcotics in solid mixtures using principal component analysis and Raman spectroscopy.

Eighty-five solid samples consisting of illegal narcotics diluted with several different materials were analyzed by near-infrared (785 nm excitation) Raman spectroscopy. Principal Component Analysis (PCA) was employed to classify the samples according to narcotic type. The best sample discrimination was obtained by using the first derivative of the Raman spectra. Furthermore, restricting the spectral variables for PCA to 2 or 3% of the original spectral data according to the most intense peaks in the Raman spectrum of the pure narcotic resulted in a rapid discrimination method for classifying samples according to narcotic type. This method allows for the easy discrimination between cocaine, heroin, and MDMA mixtures even when the Raman spectra are complex or very similar. This approach of restricting the spectral variables also decreases the computational time by a factor of 30 (compared to the complete spectrum), making the methodology attractive for rapid automatic classification and identification of suspect materials.

Cocaine↗
PubMed1964

TREATMENT IN ENGLAND OF CANADIAN PATIENTS ADDICTED TO NARCOTIC DRUGS.

The method of treatment and the results obtained from the treatment of 50 Canadian patients addicted to narcotic drugs who went to England are recorded. These patients were first stabilized on the minimal dose of narcotic drug which permitted them to work, and to acquire security and self-respect. Then, after psychiatric treatment dealing with the basic problem of their personality disorder, complete withdrawal treatment of the narcotic drug was undertaken.Nine of 10 patients aged between 20 and 30, of good social and cultural background, have been relieved of dependence on drugs for over two years.The other 40 patients came from a different background. Nearly all had been imprisoned for drug offences and they had come to England to obtain treatment and to avoid further prison sentences in Canada.The 31 patients whose prison sentences had been directly connected with drug offences are working steadily and leading an apparently normal life.The remaining nine patients had been convicted of criminal acts before becoming addicted to narcotic drugs and, with two exceptions, the results of their treatment compare unfavourably with the other patients, seven having been convicted and imprisoned in London.

Antisocial Personality Disorder↗
PubMed1992

Constipation related to narcotic therapy. A protocol for nurses and patients.

Constipation is a well-known side effect of narcotics and can add to the total burden of pain of cancer patients in need of pain medication. There is little literature on this topic, and it has been suggested that one reason is that the definitions are vague and socially bound. It has also been suggested that some physicians consider constipation a trivial problem, resulting in a relative lack of attention to the subject. Although this article addresses narcotic-induced constipation, other types related to poor dietary and exercise habits and to disease are mentioned and may be contributing factors. There are a number of drugs and treatments available to treat the problem, but the emphasis of nursing care should be on prevention of constipation. Senna derivatives have been noted to reverse the major constipating effect of narcotics, i.e., the decrease in propulsive movements of the colon, and it is recommended they be given right along with narcotics as a preventive measure. A protocol that incorporates a schedule of drugs and dosages and specific patient and nursing guidelines for daily evaluation of bowel function, with education about dietary, fluid, and exercise requirements, will help nurses practice prevention and contribute to patients' comfort.

Constipation↗
PubMed2005

Comparative assessment of blood and urine analyses in patients with acute poisonings by medical, narcotic substances and alcohol in clinical toxicology.

Acute poisonings by medical, narcotic substances and alcohol are actual in Russia in the recent years. Comparison of analytic facilities of modern analytical techniques: chromatographic (HPLC, GC, GC-MS) and immuno-chemical (FPIA) in clinical toxicology for urgent diagnostics, assessment of the severity of acute poisoning and the efficacy of the treatment in patients with acute poisonings by psychotropic drugs, narcotics and alcohol have been done. The object of the study were serum, blood, urine of 611 patients with acute poisonings by amitriptyline, clozapine, carbamazepine, opiates and also alcohol. Threshold concentrations (threshold, critical and lethal) of the toxicants and their active metabolites which corresponded to different degrees of poisoning severity have been determined. The most comfortable and informative screening method for express diagnostics and assessment of severity of acute poisonings by psychotropic drugs and narcotics showed the HPLC with using automatic analyzers. FPIA using the automatic analyzer could be applied for screening studies, if group identification is enough. GC-FID method is advisable in case of poisoning by medical substances and narcotics in view of repeated investigation for assessment of the efficacy of the therapy. GC-MS could be advisable for confirming the results of other methods. GC-TCD possess high sensitivity and specificity and is optimal for express differential diagnostics and quantitative assessment of acute poisoning by ethanol and other alcohols.

Acute Disease↗