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At least 469 records · Page 26Linked to original sources
PubMed2002

Use of anti-inflammatory and non-narcotic analgesic drugs and risk of non-Hodgkin's lymphoma (NHL) (United States).

OBJECTIVE: To examine whether exposures to anti-inflammatory and non-narcotic analgesic drugs are associated with risk of non-Hodgkin's lymphoma (NHL). METHODS: A case-control study was conducted among women living in upstate New York. The study involved 376 cases of NHL identified through the New York State Cancer Registry and 463 controls randomly selected from the Medicare beneficiary files and New York State driver's license records. Information regarding use of common medications in the past 20 years and potential confounding variables was obtained by telephone interview. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using an unconditional logistic regression model. RESULTS: There were non-significant increases in risk associated with ever use of cortisone injections and oral cortisone (OR = 1.44 (CI 0.98-2.11) for injections and 1.21 (CI 0.73-2.00) for oral cortisone, although there was no clear dose-response relationship with either type. On the other hand, the risk of NHL progressively increased with the frequency of use of non-steroidal anti-inflammatory and non-narcotic analgesic drugs (NSAID/NNAD) (p-value for trend 0.008). Women who used any of these medications daily for more than 10 years had an OR of 1.90 (CI 1.01-3.57), compared with those who used it less than once a month on average. The risk associated with long-term use was most pronounced for ibuprofen, intermediate for aspirin, and least for acetaminophen. CONCLUSIONS: Because the population-attributable risk associated with NSAID/NNAD use is potentially large, our results need to be verified in further epidemiologic studies.

Adult↗
PubMed2001

Coordinated outpatient care of the narcotic-dependent infant.

OBJECTIVE: Concern regarding parental capacity to manage their infant's drug withdrawal traditionally leads to prolonged hospitalization for both mother and infant. This study examines the impact of a multidisciplinary follow-up clinic for infants discharged home on morphine. METHODOLOGY: Records of full-term infants born to mothers with narcotic dependency were reviewed retrospectively. Two periods were compared: 1995-1997 (period A) and 1998 to September 1999 with clinic established (period B). RESULTS: Twenty-five and 26 mothers were identified in periods A and B, respectively. Almost half had fewer than four antenatal clinic visits and most were on methadone with other substance usage. Despite higher maternal methadone doses (mean 48.5 vs 89.5 mg/day, P = 0.009) and withdrawal rates, the mean length of stay was significantly shorter for period B mothers (7.8 +/- 4.8 vs 5.4 +/- 3.3 days, P = 0.01) and babies (14.8 +/- 9.7 vs 8.7 +/- 7.2, P = 0.01). Median duration of morphine treatment was significantly shorter in period A (17 vs 60 days, P = 0.0001) when only four babies were discharged on morphine. In contrast, 18 treated period B babies were discharged on morphine. No families were lost to follow up. Compliance with clinic attendance was 92%. CONCLUSIONS: Hospital stay was reduced with establishment of the clinic. The shorter treatment duration before establishment of the clinic could have been related to a lesser abstinence severity or a perceived need of a more rapid weaning prior to discharge. Further studies are needed to assess the impact of this model of care on the health outcome of the narcotic-dependent mother and infant unit.

Ambulatory Care↗
PubMed2001

Inverse agonists and neutral antagonists at mu opioid receptor (MOR): possible role of basal receptor signaling in narcotic dependence.

The mu opioid receptor, MOR, displays spontaneous agonist-independent (basal) G protein coupling in vitro. To determine whether basal MOR signaling contributes to narcotic dependence, antagonists were tested for intrinsic effects on basal MOR signaling in vitro and in vivo, before and after morphine pretreatment. Intrinsic effects of MOR ligands were tested by measuring GTPgammaS binding to cell membranes and cAMP levels in intact cells. beta-CNA, C-CAM, BNTX, and nalmefene were identified as inverse agonists (suppressing basal MOR signaling). Naloxone and naltrexone were neutral antagonists (not affecting basal signaling) in untreated cells, whereas inverse agonistic effects became apparent only after morphine pretreatment. In contrast, 6alpha- and 6beta-naltrexol and -naloxol, and 6beta-naltrexamine were neutral antagonists regardless of morphine pretreatment. In an acute and chronic mouse model of morphine-induced dependence, 6beta-naltrexol caused significantly reduced withdrawal jumping compared to naloxone and naltrexone, at doses effective in blocking morphine antinociception. This supports the hypothesis that naloxone-induced withdrawal symptoms result at least in part from suppression of basal signaling activity of MOR in morphine-dependent animals. Neutral antagonists have promise in treatment of narcotic addiction.

Analgesics, Opioid↗
PubMedDate not supplied

Direct antiglobulin tests in narcotic addicted patients.

Direct Antiglobulin Tests (DAT) as well as a number of immunological parameters (immunoglobulin levels, latex fixation, VDRL) were studied in 168 narcotic-addicted patients. Of these, 94 were untreated narcotic addicts (Group I), 61 were methadone maintained patients (Group II), and 13 had completed successful detoxification with methadone and were drug-free (Group III). Weakly positive DAT were detected in 2.1 per cent of individuals in Group I, 18 per cent in Group II, and 15 per cent in Group III. The reactions were usually transient. A number of other immunological aberrations were also present in individuals of all three groups, but there was no correlation between these parameters and the positive direct antiglobulin reactions.

Adolescent↗
PubMed2002

Serratia marcescens bacteremia traced to an infused narcotic.

BACKGROUND: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. METHODS: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. RESULTS: Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescens bacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received fentanyl in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of fentanyl and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P=0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with fentanyl; his hair sample tested positive for fentanyl. Cultures of fentanyl infusions from two case patients yielded S. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. CONCLUSIONS: An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers.

Allied Health Personnel↗
PubMed1983

Narcotics for acute postoperative pain. Is intramuscular administration passé?

Intramuscular (IM) injection of narcotic has been the mainstay of postoperative analgesia. However, problems inherent in IM administration--pulmonary dysfunction and inadequate pain control due to variable peak levels of drug concentration and variable absorption rate--have resulted in continuing efforts to find a more desirable method of administration. Intravenous (IV) infusion on a continuous or self-administered intermittent basis controls pain more effectively than IM injection. The total amount of drug required is significantly less and pulmonary dysfunction seems to occur less frequently. Some investigators are studying injection of narcotic into the epidural or subarachnoid space of the spine as a means of providing postoperative analgesia. This method provides an unusually intense, prolonged, and segmental analgesic action, as well as greater improvement in respiratory dynamics than with IV infusion. Although the advantages of the IV and spinal methods seem to outweigh the disadvantages, further research is needed before they can be recommended as alternatives to the standard IM method used to control postoperative pain.

Humans↗
PubMedDate not supplied

Becoming a problematic consumer of narcotics.

Based on participant observation studies of problematic consumers of narcotics in Stockholm, Sweden, this paper presents a life-history model illuminating why the research subjects started using narcotics and continued to do so. The model consists of four stages. The first two are initiated before the individual begins taking drugs. and lead to the development of a drastically negative self-image. The third stage consists of consciously breaching societal norms, thereby provoking responses which confirm and consolidate the negative self-image. In the fourth stage still more drastic deviant behavior and an increasingly negative self-image mutually reinforce each other.

Humans↗
PubMedDate not supplied

Application of solid-phase microextraction to antidoping analysis: determination of stimulants, narcotics, and other classes of substances excreted free in urine.

This paper describes the application of solid-phase microextraction (SPME) with subsequent injection in a gas chromatograph-mass spectrometer (GC-MS) (electron impact, full scan) for the screening analysis of stimulants and narcotics in urine. Several different kinds of fibers were preliminarily tested and comparatively evaluated considering the influence on the overall analytical performance of the method; other experimental parameters; and, primarily among them, the volume of urine, the pH value, and the time of adsorbtion. The optimal experimental conditions have been recorded using 0.5 mL of urine with the pH value adjusted to 10 with carbonate buffer, and in which is immersed a polydimethylsiloxane/divinylbenzene fiber, with a sampling time of 30 min; the fiber is then directly desorbed in the injection port of the GC-MS equipment. All the analytes show a good linearity (R2 > 0.99 for most substances) and a good reproducibility at the concentration corresponding to the minimum performance requirement limit or at the cut-off value fixed by the World AntiDoping Agency (CV% < 11). The limit of detection of the method is 50 ng/mL for the majority of the substances investigated. Imidazole-based drugs (e.g., naphazoline) and local anesthetics can also be included in this screening method. Whenever necessary, confirmation analyses may also be performed by following the same pre-chromatographic procedure. Integrating the SPME process and the GC-MS analysis with a dedicated autosampler that combines the microextraction and injection capacities maximizes the overall analytical capacity of a single GC-MS system and reduces the human labor necessary for and the environmental impact of screening for stimulants and narcotics excreted free in urine.

Anesthetics, Local↗
PubMed1987

Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery.

The authors examined the effect of clonidine, a preferential alpha 2-adrenergic agonist, upon narcotic requirements, hemodynamics, and adrenergic responses during the perioperative period in patients undergoing CABG surgery. Anesthesia was provided by sufentanil supplemented with isoflurane; sodium nitroprusside was given as needed for hemodynamic control. Ten patients received oral clonidine preoperatively at the time of premedication, and again intraoperatively by nasogastric tube. Another group of ten untreated patients were otherwise managed identically. Intergroup differences in required anesthetic and vasoactive drug doses and recovery times were measured and evaluated, as well as hemodynamics and plasma catecholamines prior to induction, after intubation, and at intervals intra- and postoperatively. Patients who received clonidine required less diazepam prior to induction, and received 40% less sufentanil during the anesthetic period, than did untreated controls. More control patients required the addition of isoflurane to prevent hypertension. Mean blood pressures and heart rates were elevated at many sampling points in patients not treated with clonidine. Four of the clonidine-treated group required atropine for treatment of bradycardia in the pre-incision period. Plasma catecholamines were significantly lower throughout most of the study period in patients treated with clonidine. After cardiopulmonary bypass and postoperatively, cardiac outputs were significantly higher in the treated group. Patients who had received clonidine were extubated significantly earlier, and fewer of them shivered postoperatively. We conclude that perioperative treatment with clonidine reduced narcotic and anesthetic requirements, improved hemodynamics, reduced plasma catecholamines, and shortened the period of postoperative ventilation in patients undergoing coronary artery surgery.

Anesthetics↗
PubMed1997

Controlling substance abuse. A narcotic audit tool.

A medical center formed a narcotic task force because of widespread concern over misuse of drugs. Systems and staff issues were addressed. Audits to help identify and alleviate the problem were conducted; two narcotic audit tools are shown.

Humans↗
PubMedDate not supplied

Timed release analgesics: Part 1. Narcotics.

The problem of relieving patients' pain is a major challenge for health care professionals. New formulations of time-released pain medications offer exciting possibilities. However, there are cautions and patient education factors that are important when considering any timed-release product. This article looks at selected timed-release forms of narcotics used for pain relief. Knowledge of the differences and similarities, benefits and cautions, and patient education factors will help the reader make safer and more informed decisions about prescribing and administering timed-release narcotics.

Analgesics↗
PubMed1999

Use of combined oral narcotic and benzodiazepine for control of pain associated with bone marrow examination.

BACKGROUND: Bone marrow aspirate and biopsy is universally recognized as being painful. Few descriptions of effective analgesia or premedication for this procedure exist. In this study, we assessed an oral narcotic and benzodiazepine combination in controlling pain associated with bone marrow examination. METHODS: Twenty-four consecutive ambulatory, adult patients referred for bone marrow examination received oral medications 90 minutes before the scheduled procedure. Patients reported perceived pain, using both Likert numerical and "Faces Pain Rating Scale," immediately after bone marrow examination and within 1 week after the procedure. Physicians' and nurses' evaluations of patient tolerance and the patients' memories of the aspiration and biopsy were recorded. RESULTS: Two thirds (66%) of the respondents reported none or only mild pain (3 or less on a scale of 1 to 10). Memory of the procedure was vague or nonexistent in approximately half of the patients. There were no complications of biopsies or premedication. CONCLUSIONS: Premedication with oral narcotic and benzodiazepine is effective in preventing or lessening pain associated with bone marrow examination in adults. Premedication induces amnesia for some or most of the procedure in about half of the patients.

Administration, Oral↗
PubMed1979

Human pharmacology of narcotic antagonists.

1 Human studies at the Addiction Research Center enable narcotic antagonists to be classified into three subgroups: (1) nalorphine-like agents; (2) pure antagonists; and (3) morphine-like agents. 2 Six narcotic antagonists (pentazocine, nalbuphine, cyclazocine, butorphanol, propiram and buprenorphine) developed in recent years seem to have a lesser abuse potential than codeine or propoxyphene. 3 When adjusted for relative availability of the agents, epidemiological data shows that pentazocine is abused less than codeine or propoxyphene in the US. 4 Recent studies with buprenorphine indicate that this agent would find application both as an analgesic of low abuse potential and as a new type of drug for the treatment of addiction.

Humans↗
PubMed1979

Use of narcotic antagonists in anaesthesia.

1 The introduction of morphine antagonists into anaesthesiology has aroused great scientific interest, increased our knowledge of analgesia, and opened new frontiers for therapeutics. 2 The advantages and disadvantages of these compounds are described and assessed. 3 The best choices for treatment of pain are the most potent and long-acting drugs of this group with a wide safety margin. As an antidote to narcotic agonists, naloxone seems to be the most suitable drug in the majority of cases, although in certain conditions drugs having less rapid onset of action and of longer duration may be more desirable. 4 In all cases of treatment after anaesthesia when antagonists to narcotic analgesics are used, drug administration must depend on careful control, which necessitates specific and prolonged patient care by specifically trained and competent staff.

Anesthesia↗
PubMed1997

Infants born to narcotic dependent mothers: physical growth patterns in the first 12 months of life.

OBJECTIVES: To describe the physical growth patterns of infants born to narcotic dependent mothers (INDM) over a 12 months period and, if possible, to relate the growth to drug taking patterns during pregnancy. METHODOLOGY: The growth of a cohort of 43 INDM was measured during the first 12 months of life. Weight and length measurements were compared with percentile charts and converted to Z scores. Questionnaire data about drug taking practices, demographic variables and the neonatal period (including withdrawal scores) were obtained. RESULTS: Twenty-four (55.8%) of INDM had evidence of neonatal drug withdrawal requiring treatment with phenobarbitone. At birth, Z scores for weight and length indicated relative intrauterine growth retardation. By 12 months, there had been some catch up growth, but Z scores for weight and length were still below zero. Persistent weight retardation at 12 months was correlated with methadone dosage during pregnancy, but not the need for phenobarbitone therapy. CONCLUSIONS: The growth patterns of INDM in the first 12 months of life indicated that at birth there was evidence of intrauterine growth retardation, but by 12 months the growth was little different from the rest of the community. There appears to be some influence of narcotic agents taken while pregnant on subsequent growth of INDM.

Adult↗
PubMedDate not supplied

Intrathecal narcotics: new approach for labor analgesia.

Injection of narcotics in the subarachnoid space is the most recent advancement in managing pain during childbirth. This article reviews the history of labor pain control and discusses the introduction of intrathecal narcotics (ITNs), including administration, side effects, and nursing care, in one birthing center. The responses of clients and nurses to ITNs are discussed.

Analgesia, Obstetrical↗
PubMed1978

Clinical pharmacology of narcotic antagonists.

Both naloxone and naltrexone are effective narcotic antagonists with minimal agonistic effects and a wide margin of safety. Naloxone is useful in the treatment of narcotic overdose and it is helpful in the quantification of physical dependence. Naltrexone is pharmacologically successful as an orally effective, long-acting antagonist but its clinical usefulness in the prevention of relapse is still being determined.

Animals↗