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PubMed1976

Reversal of narcotic depression in the neonate by nalozone.

Naloxone 40 mug was administered intravenously one minute after birth to 20 out of 44 neonates whose mother had been given pethidine in labour. These neonates were compared with 20 others whose mothers had had only lumbar epidural block. Alveolar PCO2, alveolar ventilation, and ventilatory rate were measured 10 and 30 minutes after birth. The untreated neonates of mothers who had had pethidine showed significant ventilatory depression compared with infants in the epidural and naloxone-treated groups. The naloxone-treated neonates were comparable with the epidural group, although the effects of naloxone were diminishing at 30 minutes. Naloxone is an effective narcotic antagonist which should be considered to be the drug of choice for treating narcotic depression in the neonate.

Anesthesia, Obstetrical↗
PubMed1994

A case of narcotic bowel syndrome successfully treated with clonidine.

Patients with chronic abdominal pain without an organic basis present a difficult management problem. Some of these patients may be prescribed opiates initially which may result in requiring progressively higher doses for pain relief. In this clinical setting, the suspicion of narcotic bowel syndrome should be borne in mind. With appropriate treatment and counselling, further invasive investigations including laparotomy may be avoided and resolution of symptoms can be achieved with clonidine. This case report demonstrates such a typical clinical scenario and discusses the possible aetiology and pathophysiology of narcotic bowel syndrome as well as the role of clonidine in controlling opiate withdrawal symptoms.

Abdominal Pain↗
PubMed1994

Relative narcotic potency and mode of action of sulfur hexafluoride and nitrogen in humans.

Impairments of psychomotor, perceptual, and cognitive abilities were determined in nine male subjects exposed to inhaled SF6 partial pressures of 0, 52, 104, and 156 kPa and to inhaled N2 partial pressures of 103, 575, 825, and 1,075 kPa. Also data from a previous study with inhaled N2O partial pressures of 0, 13, 26, and 39 kPa were included. With the highest gas concentrations, performances were reduced by 41-57%. Effective doses for a 20% performance impairment were 830, 97, and 21.5 kPa for N2, SF6, and N2O, respectively, yielding relative narcotic potencies of 1.0:8.5:39. The order of narcotic potencies is the same as for the lipid solubility of the three gases. In contrast, the order of increasing tendency for hydrate formation (decreasing hydrate dissociation pressure) for the three gases is N2, N2O, and SF6. Thus, mild to moderate inert gas narcosis in humans shows the same positive relationship to lipid solubility as was shown in previous animal models that utilized much deeper levels of anesthesia.

Adult↗
PubMed2002

Complications of intranasal prescription narcotic abuse.

The abuse of drugs via an intranasal route is an increasingly prevalent pattern of behavior. In the past year, a number of patients received care at our institution for complications resulting from the previously unreported phenomenon of intranasal prescription narcotic abuse. This report describes the clinical manifestations of this form of drug abuse in 5 patients. Their symptoms consisted of nasal and/or facial pain, nasal obstruction, and chronic foul-smelling drainage. Common physical findings were nasal septal perforation; erosion of the lateral nasal walls, nasopharynx, and soft palate; and mucopurulent exudate on affected nasal surfaces. In addition, 2 of the 5 patients had invasive fungal rhinosinusitis, which appears to be a complication unique to intranasal narcotic abuse.

Administration, Intranasal↗
PubMed1989

Quality of parenting in alcoholics and narcotic addicts.

Alcoholics and heroin addicts were compared with a normal control group to determine whether there were differences in quality of parenting during childhood, assessed using the Parental Bonding Instrument. Maternal and paternal overprotection were reported more commonly by narcotic addicts. Maternal overprotection alone was implicated in alcoholics. Narcotic addicts seem to have more disturbed parenting than alcoholics, especially paternal parenting.

Adult↗
PubMed2006

Life expectancy and productivity loss among narcotics addicts thirty-three years after index treatment.

This study computed the life expectancy of a cohort of male narcotics addicts followed for 33 years and assessed the productivity lost as a result of premature mortality. The future life expectancy was constructed for the narcotics addicts and for a comparable cohort from the general U.S. population. The average future life expectancy of the cohort was 18.84 years compared to 33.48 years for comparable U.S. males (t = 49.49, p < .00001). As a result of this premature mortality, the estimated monetary value of lost productivity was greater than 174 million dollars. The lives of heroin addicts were severely truncated at productive ages resulting in a loss of potential productivity that increases social and economic burdens.

Adult↗
PubMed1975

Increased sensitivity of regional measurements in early detection of narcotic lung disease.

Intravascular foreign body thromboembolism and interstitial or vascular granulomata in the lungs are common sequelae to intravenous drug abuse. Early detection of such complications is important, because of the youthful population often involved. Conventional pulmonary function tests, including forced expiratory volumes, diffusion capacity for CO (DLco), chest radiograph and arterial blood gas analysis were performed in 23 narcotic addicts, most of whom had no pulmonary symptoms. The results were compared with radionuclide pulmonary function studies obtained following inhalation of 133Xe gas and injection of 99-mTc albumin microparticles. Thirteen subjects who had normal nonnuclear pulmonary function tests, including DLco and chest radiograph, demonstrated significant abnormalities of regional lung perfusion by lung scan. Of the ten subjects with abnormal DLco all had abnormal perfusion scans and five were noted to have hypoxia at rest. In addition, six of the ten subjects with abnormal DLco revealed a history of concomitant "solid pill abuse" along with heroin abuse, whereas only 2 of 13 subjects with normal DLco admitted tooccasional solid pill abuse. The perfusion lung scan is therefore a sensitive means for detection of early lung disease in narcotic addicts.

Adolescent↗
PubMed2001

Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.

BACKGROUND: It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems. METHODS: We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically. RESULTS: The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. CONCLUSIONS: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.

Adult↗
PubMed1986

Effects of non-narcotic analgesics on the kidney.

Non-narcotic analgesics have acute and chronic effects on the kidney. Until quite recently chronic effects have received much more attention than acute effects. Renal papillary necrosis attributed to prolonged intake of analgesic compounds was first described from Switzerland in the 1950s, and subsequently in many countries including Scandinavia, Australia, Belgium and Canada. Renal papillary necrosis is now accepted as an effect of over-the-counter analgesic compounds and has also been recorded with many individual non-steroidal anti-inflammatory drugs (NSAIDs). Evidence suggests that uroepithelial tumours also occur as a complication of prolonged abuse of analgesic compounds. Clinical evidence associating renal papillary necrosis with compound analgesics and NSAIDs has been backed up by experimental evidence showing that these drugs cause renal papillary necrosis in animals. Acute effects of non-narcotic analgesics have been described mainly in association with aspirin and NSAIDs. In high renin states, including salt-depleted normal subjects, NSAID administration may be associated with an acute decrease in renal function, which is more obvious in patients who have underlying renal disease. Clinical syndromes which occur in association with NSAIDs include oedema, hyperkalaemia and acute renal failure and the acute nephrotic syndrome. Acute renal failure may be associated with acute interstitial nephritis and the nephrotic syndrome or may be due to acute tubular necrosis. Patients who have the nephrotic syndrome show fusion of foot processes of glomerular epithelial cells on electron microscopy as well as acute interstitial nephritis. Patients who suffer these episodes of acute renal function deterioration associated with NSAIDs recover slowly after withdrawal of the drugs, and the recovery may not be complete.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1979

Depression in treated narcotic addicts, ex-addicts, nonaddicts, and suicide attempters: validation of a very Brief Depression Scale.

Samples of heroin-addicted veterans in treatment at a VA drug clinic, ex-addict and nonaddict Vietnam veterans followed-up after return to the United States, and male suicide attempters who were not drug abusers completed a very short (five item) form of the Beck Depression Inventory developed for screening and research purposes. Results confirmed prior findings of high rates of depression among narcotic addicts in treatment. Two samples of patients assessed at intake to treatment did not differ significantly from the suicide patients in BDI-5 scores. Methadone maintenance patients and ex-addicts scored below those groups, but higher than nonaddicts. Relief of inner tensions or worries was chosen most frequently as the reason for continuing use of narcotics by patients in treatment, suggesting that self-medication for psychiatric problems may be common. The BDI-5 proved to be an efficient method for screening for depression in these samples, and thus might be useful in clinical or research settings when a very brief method is needed.

Depression↗
PubMed1980

Increased serum thyroid hormone binding in narcotic addicts is due to liver disease.

The cause of increased thyroid hormone binding in narcotic addicts has been investigated. The average T3, T4, and T3 binding ratio were all significantly higher in addicts than in controls. Free T4 and free T3 indices were normal. Those patients who had abnormally high T3 binding ratios had significantly more severe abnormalities of liver function than the other methadone-treated addicts. Together with evidence that chronic active hepatitis in the nonaddicted population is associated with increased serum thyroid hormone binding, these observations lead us to conclude that the increased serum thyroid hormone binding and total thyroid hormone concentration found in sera of narcotic addicts is due to associated liver disease.

Alanine Transaminase↗
PubMed1984

Trends in the commission of crime among narcotic addicts over successive periods of addiction and nonaddiction.

Although several studies have documented high levels of criminal activity among narcotic addicts, especially during periods of active addiction, few studies have delineated the types of criminal activities involved or have attempted to uncover trends in such activities over successive periods of addiction and nonaddiction in addicts' careers. In the present series of analyses, the criminal activities of 354 male narcotic addicts were categorized and traced individually over time using five, standardized, crime-days-per-year-at-risk measures in the areas of theft, violence, drug sales, deception/forgery, and other crimes. In addition, a sixth composite measure was also employed. Although large differences among addicts in patterns of criminal activity over time were much in evidence and may be useful as a basis for a criminal typology, this same heterogeneity tends to preclude definitive statements concerning addicts as a group. This caveat notwithstanding, there does appear to be a general tendency for criminal activity to diminish over successive periods of nonaddiction and to increase irregularly over successive periods of addiction. The agreement of these findings with those of earlier group analyses by the authors is discussed.

Adult↗
PubMed1986

A comparison by race/ethnicity of narcotic addict crime rates in Baltimore, New York, and Philadelphia.

In an effort to provide timely information concerning the criminal activities of narcotic addicts in three different metropolitan areas, male narcotic addicts attending methadone maintenance/detoxification centers in Baltimore, Philadelphia, and New York City participated in extensive, confidential interviews conducted between May 1983 and April 1984. The information obtained focused on the amounts and types of crimes committed during the addict's longest period of active addiction to opiates, their derivatives and synthetics, as well as his first period of nonaddiction. Crimes committed were placed in one of five categories as follows: Theft, Violence, Drug Sales, Deception/Forgery, and Other. Several different measures of criminal activity were utilized, all embodying the concept of crime-days per year at risk. Such crime-days measures involve annualizing, i.e., the number of crime-days accumulated by each subject in each category during a specified time at large in the community is expressed as crime-days per year at risk by taking the ratio of crime-days to total days at large and multiplying by 365. Addicts were compared by race/ethnicity (Black, White, and Hispanic) within cities as well as by race/ethnicity across cities using one-way analysis of variance procedures. Addict crime rates were also compared for the period of active addiction and nonaddiction. Several mean differences by race/ethnicity within city, as well as by race across cities, were noted. Moreover, crime rates tended to be higher during the period of active addiction. In this sense, then, drugs may be said to "drive" crime.

Adult↗
PubMed1997

The early emergence of narcotic addict types.

Providing retrospective self-reports of their activities, perceptions, and experiences during their early adolescent years (ages 12 to 14), 255 narcotic addicts were classified into four distinct types on the basis of a clustering technique applied to risk factor information derived from five major descriptive domains: family; peer deviance; personal deviance; psychological status; and protective factors. Differentiations among the types largely involved the extent of early drug and other behavioral deviance and family dysfunction. The predictive utility of the typology was examined in terms of outcome over the first ten years of the addiction career, including age at first narcotic addiction, amount of time incarcerated, and percentage of time addicted while in the community. The implications of the typology for both substance abuse prevention and treatment are discussed.

Adolescent↗
PubMed1975

Self-perception among narcotic addicts: an exploratory study employing multidimensional scaling techniques.

The self-perception of narcotic addicts was investigated using multidimensional scaling techniques. Subjects consisted of two groups of narcotic addicts and one groups of treatment personnel at a federal addiction treatment facility. One group of addict subjects was newly admitted to the treatment center, while the other group had been in treatment for 3 to 5 months. All Ss judged the similarity of pairs of "stimulus people" representing several personality dimensions thought to be relevant to the study of narcoticaddiction. The judgment were analyzed using the INDSCAL, an individual differences scaling procedure. The data for all groups are adequately explained by a three-dimensional solution. Interpretations of the dimensions and their relative importance to the self-perception of the different groups are discussed.

Allied Health Personnel↗
PubMed1985

Narcotics anonymous: its history, structure, and approach.

Although Narcotics Anonymous (NA) is the oldest and largest self-help group for the support of drug abusers, it has received little study. This paper provides an overview of the history, structure, philosophy, and activities of the NA fellowship based on interviews with members, a survey of the NA literature, and observation at a residential therapeutic community employing the NA approach. The latter data provide a means of analyzing the relationship between NA and those implementing its program. Suggestions for research are advanced in recognition of Narcotics Anonymous as both underground social movement and major treatment modality for drug abusers.

Goals↗
PubMed1987

The relationship of preaddiction characteristics to the types and amounts of crime committed by narcotic addicts.

Postaddiction crime rates among narcotic (principally heroin) addicts in five different areas (theft, violence, dealing, confidence games, and other crime) were found to be substantially related to a number of preaddiction characteristics, especially criminal activity and drug and alcohol use prior to addiction to narcotics. Early family influences such as lack of religious training, history of parents' arrest, and use of drugs and alcohol by other family members also appear to play an important role. Early identification of extremely crime-prone individuals followed by intensive intervention efforts might reduce the amounts of crime such persons might otherwise commit.

Adult↗
PubMed1987

Abusers of alcohol and narcotics: who are they?

Problem drinking among addicts was studied by interviewing 781 narcotic addicts on entrance to treatment. Hierarchical multiple regression analysis (MRA) assessed the ability of 56 demographic, childhood, psychological, social, and drug history measures to predict abstinence, alcohol consumption among nonabstainers, and alcohol-related problems among heavy drinkers. MRA explained 33% of lifetime problem-drinking variance. Best predictors were traumatic events and hyperactivity in childhood, residential instability, psychopathology, and seriousness of drug problems. It was concluded that problem-drinking addicts may differ from other addicts in kind as well as in degree. The findings suggest that problem drinking in narcotic addicts may serve as a marker for some serious psychological problems, that drug treatment professionals therefore should be trained in alcohol abuse identification and treatment, and that psychiatric consultation for these addicts should be available.

Adult↗