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PubMed1999

[Abuse of prescribed sleeping, narcotic or psychotropic agents].

Treating a drug addict in a state of lack or of weaning is no easy task, either on a strictly medical or judicial point of view. As far as the only judicial aspect is concerned, sleeping, narcotic or psychotropic drugs cannot be used without taking into account the legal provisions which regulate them: the December 24, 1921 law and the different complements and modifications it has been subjected to since then. According to that law, are considered as offences: the use of substances (described in the December 31, 1993 (royal) decree as sleeping or narcotic drugs, and in the December 2, 1998 decree as psychotropic drugs) likely to create, maintain or increase dependence, no result being required; the existence of excess, defined as antithetic notion of what is considered as normal and in accordance with the rules and the ordinary or permitted measure in the practice of the art of healing; the author's intention does not matter: it is not necessary for the author to have aimed at the effect which has been produced or is likely to be.

Belgium↗
PubMed2000

Intrathecal narcotics are associated with prolonged second-stage labor and increased oxytocin use.

BACKGROUND: Safe and effective labor analgesia is an important part of obstetric care. Intrathecally injected narcotics (ITN) are an effective alternative to epidural anesthesia, and are perceived less likely to interfere with the course and outcome of labor. Data on their effects, however, are sparse and contradictory. METHODS: Our retrospective study compared labor length, oxytocin use, delivery type, maternal side effects, and neonatal outcomes among women who received ITN (n=100) and a group who received intravenous narcotics or no analgesia during labor (n=100). We randomly sampled medical records with stratification for parity and collected data through systematic chart review. RESULTS: Women receiving ITN were more likely to be white. They experienced longer second-stage labors (73 minutes vs 40 minutes, P=.000) and used oxytocin twice as often. These differences remained significant after controlling for potential confounding factors. ITN use was also associated with a trend toward more cesarean sections (7% vs 1%, P=.06). More of the women receiving ITN required urinary catheterization (25% vs 5%, P=.000) and experienced significant pruritus (10% vs 0%, P=.001). Neonatal outcomes were similar for both groups. CONCLUSIONS: In our retrospective study, ITN use was associated with a significant prolongation of second-stage labor, which may be clinically relevant for women having their first child. ITN were also associated with increased oxytocin use and a trend toward more cesarean births. Whether these relationships are causal or a proxy for more difficult labors is a question for future prospective studies.

Adult↗
PubMed1975

Schedule-induced oral narcotic self-administration: acute and chronic effects.

A pattern of lever pressing was maintained in rats by presenting a food pellet following the first lever press to occur after at least 90-seconds had elapsed (fixed-interval 90-second schedule of food presentation, FI 90-second). With a drinking solution available, a pattern of excessive postpellet drinking (schedule-induced polydipsia) developed and was used to induce rats to drink solutions containing varying concentrations of narcotics. During acute exposure to morphine HCl, morphine SO4 or methadone HCl in the drinking solution, drinking decreased as a function of increasing drug concentration (from 0.3-1 mg/ml), but the total dose of narcotic ingested increased as a function of increasing drug concentration. The highest average dose of morphine HCl consumed in tap water was 30 mg/kg within an hour session. When morphine HCl was presented in an isotonic saline solution, drinking was increased and the highest average dose of morphine HCl ingested was 60 mg/kg within an hour session. The use of an isotonic saline solution did not appreceiably enhance the ingestion methadone HCl (about 30 mg/kg/hr). After chronic exposure to drug solutions for daily 4-hour sessions, the doses ingested averaged between 150 and 250 mg/kg/4 hr for 1 mg/ml solutions of morphine HCl and morphine SO4. The stable pattern of drinking exhibited by rats on the 0.5 mg/ml morphine HCl solution was characterized by a dissociation of drinking from pellet presentation. Chronic exposure to methadone HCl solutions (1 mg/ml) produced less drinking and lower doses ingested (approximately 100 mg/kg) than was obtained with either morphine HCl or morphine SO4 at an equal concentration.

Administration, Oral↗
PubMedDate not supplied

[Use of liver morphometry in the differential diagnosis of chronic alcohol and narcotic poisoning].

Data on the quantitative histomorphological involvement of the liver in chronic narcotic and ethanol poisoning and their combination are presented. Alcohol use by narcomaniacs augments hepatocyte damage, which manifests by increased fatty degeneration, increased activity of lobular hepatitis, appearance of the neutrophil admixture in inflammatory infiltration, and stimulation of sclerotic processes leading to an increase in the perimeter of portal tract section at the expense of connective tissue growth. Quantitative analysis of these processes is recommended for forensic medical histological differential diagnosis of chronic narcotic and ethanol poisoning.

Chronic Disease↗
PubMedDate not supplied

[Psychophysiological aspects of the problem of narcotic dependency].

An attempt has been made at analyzing mechanisms of formation of addiction to narcotics from the standpoint of a systemic approach to a functional organization of psychic activity. A model is proposed of the pathological functional system as the basis of narcodependence, which combines processes of two adjoining levels--those of psychic activity and of higher nervous activity. It is suggested that pathological hyperactivity of the functional structure maintaining the need for a change in the emotional state might be the basis of addiction to narcotic drugs.

Adolescent↗
PubMed2003

[Relevance of toxicological identification of narcotics in hair for maintenance therapy of opiate addicts].

The study was done in 57 psychoactive drug addicts (18 females and 39 males) who entered a methadone maintenance program in Szczecin. The age of participants ranged from 21 to 49 years (mean 32.14 years) and the mean duration of drug abuse as determined during history-taking was 11.6 years. Some of the patients became addicted at the age of just 11 years. The objectives of this work were: a) to apply segmental analysis of hair for studying psychoactive agents and their derivatives in drug abusers during the acute intoxication phase and maintenance therapy; b) to determine if narcotics found in hair matched with findings during history-taking; c) to check the relevance of toxicological tests for psychoactive drug content in hair for monitoring abstinence in maintenance programs. The material consisted of hair sampled from 57 patients who were visited the Outpatient Department for Drug Abusers of the Regional Mental Care Center in Szczecin (Poland). Opioids (morphine, codeine, 6-mono-acetyl-morphine, methadone) were determined using gas chromatography/mass spectrometry (GC/MS-ITD) and a Varian 3400 gas chromatography (USA) coupled to a mass spectrometer (Magnum ionic trapping system, Finnigan Mat, USA). Amphetamines (EP, MK, MA, AMP, MDA, MDMA, MDEA) were analyzed with a liquid chromatography/mass spectrometry (LC/MS) system (LC/MS HP-1100, Hewlett-Packard, USA), equipped with an atmospheric pressure chemical ionization (APCI) chamber and dedicated software. Statistical analysis of the results was done. The following conclusions were drawn: toxicological examination of narcotic content in hair is a useful method for studying the history of drug addiction during the period of time equivalent, to the length of hair. Psychoactive substances detected in hair were in most cases consistent with the history of drug abuse. Analysis of psychoactive substances in hair may be applied for identification of addicting drugs and for abstinence control in therapeutic and rehabilitation programs.

Adult↗
PubMedDate not supplied

Does this patient need a narcotic injection? A descriptive analysis of decision making.

Thirty six nurses divided into three groups were asked in a series of three questionnaires to evaluate patients' needs for post-operative narcotic pain relief. Using a decision-analytic procedure, which combined a version of the Delphi technique and the multi-attribute utility approach, the six most salient criteria in order of priority were identified. These criteria were then tested in the clinical situation using a series of scenarios. A difference between how nurses purportedly evaluated patients' needs for narcotic pain relief and what they actually did in hypothetical clinical situations was found. The theoretical implications of these results are discussed.

Decision Support Techniques↗
PubMedDate not supplied

[Fatal poisoning due to narcotic abuse in the analytic-toxicological practice of Forensic Medicine Department Silesian Medical Academy in Katowice in years 1996-202].

147 cases of fatal poisonings in people due to narcotic abuse examined in the Forensic Medicine Department Silesian School of Medicine, Katowice in the years 1996-2002 have been presented in the paper. In the group examined there were 126 males and 21 females at the age of 16-44. Opium narcotics were found in 139 out of 147 cases and amphetamine derivatives in 18. Opiates were indicated in 58 individuals and amphetamine only in 8. In 35 poisoned people opiates with barbituric acid derivatives were found. In 3 cases death resulted after taking opiates and amphetamine derivatives. 1 individual died after taking opiates and substances of the phenothiazine group. In the organic fluids of 18 people opiates and medicines being derivatives of 1,4-benzodiazepine and barbituric acid were found. Amphetamine and derivatives of 1,4-benzodiazepine were found in 6 individuals and opiates, barbiturates, benzodiazepines and amphetamine in 1 individual. Concentrations of all the substances indicated ranged widely and were as follows: < 0.10-17.40 > microgram/ml for opiates; < 0.24-30.00 > microgram/ml for amphetamine; < 0.12-1.90 > microgram/ml for 1.4-benzodiazepine derivatives and < 0.18-15.24 > microgram/ml for barbituric acid derivatives. Ethanol was found in 18 individuals and its concentration was < 0.2-2.5 >@1000.

Adolescent↗
PubMed1992

The legislative scheme of pre-trial destruction or lawful disposal of narcotic drugs and psychotropic substances in India.

The present article provides a description of the practice of pre-trial destruction of seized narcotic drugs and psychotropic substances in India as provided for in the Code of Criminal Procedure, 1973, and the Customs Act, 1962, and in the context of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988. It includes explanations of why, as well as how, the pre-trial destruction of such substances should be carried out.

Criminal Law↗
PubMedDate not supplied

Comparison of preparation and narcotic-sedative premedication in children undergoing surgery.

A psychological preparation program was developed for use prior to emergency surgery in children. The purpose of this study was to test the hypothesis that provision of specific information prior to an emergency operation would reduce the need for premedication to control anxiety and stress. Children were randomly assigned to either a verbally prepared group given narcotic-sedative premedication (control) or to a psychologically prepared group given only atropine as premedication. The child and parent rated their own anxiety on a Visual Analogue Scale (VAS). The children and parents were also assessed by a nurse preoperatively and postoperatively using a similar scale. The children's pulse, blood pressure, and cortisol were also measured. The results showed no significant difference between the psychologically prepared group and the premedicated group, suggesting that psychological preparation compares favorably with narcotic-sedative premedication.

Adolescent↗
PubMedDate not supplied

[Potentialities of histological examinations of the spleen in the diagnosis of alcoholic and narcotic intoxication].

Qualitative changes observed in the spleen in chronic narcotic and alcoholic intoxication are described. The below signs are recommended for use in the diagnosis of chronic exogenous intoxication: an increased thickness and sclerosis of the splenic connective structures and myelosis of the red pulp. The diagnostic criteria of chronic intoxication with intravenous opiates are the below changes in the spleen: hyperplasia of the splenic follicles, germinative foci in the follicles' stases and folds in vessels, edema of the vascular wall, hyperemia of follicular arteries and diapedetic hemorrhages. Hypoplasia of the follicles and venous hyperemia of the spleen should be regarded as signs of chronic alcoholic intoxication. The data obtained within the case study can be used by forensic medical experts in the diagnosis of narcotic and alcoholic intoxication.

Alcoholic Intoxication↗
PubMed2005

Regional analgesia combined with avoidance of narcotics may reduce the incidence of postoperative vomiting in children.

BACKGROUND: The anesthesia literature cites a high incidence of postoperative vomiting (POV) after pediatric ochidopexy and hernia repair (34-50%) and after penile procedures (37-49%). We hypothesized that regional analgesia combined with avoidance of narcotics administered to children scheduled for lower abdominal or urologic procedures may be associated with a lower incidence of POV. The aim of this prospective study was to 1) assess the incidence of POV in children in the hospital and during a 24-h post-anesthesia study period, and 2) evaluate the effect of age on POV. METHODS: After obtaining institutional and parental consent, 110 pediatric outpatients, 1-12 yr old, ASA physical status I or II, scheduled for elective outpatient urologic or lower abdominal procedures, were enrolled. Children were fasting and premedicated with midazolam, 0.5 mg/kg p.o. They received a combined light general anesthesia and a presurgical caudal block. Anesthesia was induced via a mask and consisted of halothane and nitrous oxide in oxygen. For the caudal block 1 ml/kg of 0.25% bupivacaine or 0.2% ropivacaine were used to provide intra- and postoperative pain relief. No prophylactic antiemetics were administered. RESULTS: All caudal blocks provided adequate intraoperative pain relief. The incidence of POV was low, 12% at the hospital, 13% for the 24-h study period, and was not affected by age. CONCLUSIONS: We concluded that regional analgesia combined with the avoidance of narcotics administered to children scheduled for elective urologic or lower abdominal procedures, is associated with a lower incidence of POV and that age did not affect the incidence of POV.

Age Factors↗
PubMedDate not supplied

[Suicide among narcotic addicts].

The majority of deaths occurring from acute or chronic narcotism declined as accidental are often termed as "overdose". But in some cases, the evidence found at the scene or the other data indicate intent of suicide. This report presents an analysis of suicide victims classified as drug or narcotic abusers. The cause and manner of death, the postmortem toxicologic and histopathologic findings are discussed.

Adult↗
PubMed1990

[Influence of local anesthetics and narcotics on the energy metabolism of Ehrlich ascites tumor cells].

The suitability of Ehrlich ascites tumour cells as a test object for potential drugs affecting ATP-producing or consuming processes directly or indirectly is made likely by actions of local anesthetics and narcotics on the energy metabolism of these cells. The influence of local anesthetics on cation transport and Ca+(+)-dependent processes as well as the inhibition of NADH-ubiquinone reductase by narcotics is demonstrated for Ehrlich ascites tumour cells, too.

Anesthetics, Local↗
PubMed1990

Intravenous narcotics in the ICU.

In summary, there are now available very potent narcotics, with small side effect liability. Critical care physicians should be experts in administration of intravenous narcotics and should understand the concepts behind different methods of administration. Much more patient satisfaction and safety can be obtained if as much attention is paid to how a drug is administered as to its pharmacologic actions. Intravenous administration allows rapid and almost complete control of desired effect. Intravenous access is universally available in the ICU population, and we should take every advantage of it.

Humans↗
PubMed1990

[Use of intraspinal narcotics in obstetric anesthesia and analgesia].

The use of intraspinal narcotics has attracted great interest worldwide, particularly in the discipline of obstetric anesthesia. As the advent of spinal and epidural local anesthetics dramatically effected the anesthetic management of labor, delivery and obstetric surgery, likewise spinally administered opioids are emerging as safe and very effective methods of relieving post-cesarean section pain, improving labor and cesarean section analgesia in combination with local anesthetics, and injected alone in the subarachnoid space for the management of labor itself. Though intraspinal narcotic analgesia is associated with a number of side effects, with proper knowledge these adverse reactions are wither preventable or can be greatly reduced. Compared to the benefits of nearly complete pain relief in the intrapartum and postpartum periods, the price paid in terms of these side effects in minimal. The review was based on a computer-assisted search for articles published after 1975.

Analgesia↗
PubMed1990

Narcotic analgesics. Clinical pharmacology and therapeutics.

Nurses often are responsible for administering narcotic analgesics to patients with pain due to cancer or the treatment of cancer. Because of frequent use of these agents, and their various and dramatic effects throughout the body, it is important to understand their pharmacological properties and appropriate therapeutic use. This article reviews the actions and side effects, appropriate selection and use of narcotic analgesics and provides guidelines for administration.

Administration, Oral↗
PubMed1989

Efficacy of transdermal clonidine for headache prophylaxis and reduction of narcotic use in migraine patients. A randomized crossover trial.

Thirty patients completed a double-blind, randomized crossover study utilizing transdermal clonidine and an identical-appearing placebo. Crossover occurred at 6 weeks, with a total study time of 12 weeks. Subjects were asked to record daily in a special diary (1) the presence or absence of headache, (2) duration of headache, (3) severity of headache, and (4) use of pain medication for headache relief. The severity of the headaches was rated from 1 (very mild) to 5 (very severe). Although the subjects reported a decrease in frequency, duration, and intensity of headaches while using the medicated patch, these differences did not reach statistical significance. Nineteen patients subjectively preferred the medicated patch, while five preferred the placebo (P less than .01). During use of the medicated patch, a significant reduction (P = .039) occurred in use of class II narcotics. Three doses of these substances were used by the patients when treated with clonidine, while 34 doses were taken during placebo use. These findings suggest that clonidine might have a role in reduction of parenteral narcotic use in acute pain syndromes.

Administration, Cutaneous↗