1/53. Opioid withdrawal during risperidone treatment.A small but significant percentage of opioid-dependent patients will require neuroleptic treatment. Several classes of drugs have been shown to affect opioid metabolism. Two patients who were hospitalized with a diagnosis of opioid dependence received concomitant treatment with opioids and risperidone. After receiving risperidone for several days, both patients exhibited symptoms of opioid withdrawal despite having no change in their opioid doses. These withdrawal symptoms resolved soon after risperidone was discontinued. This finding suggests the possibility that risperidone may precipitate opioid withdrawal in opioid-dependent patients.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/53. nevirapine induced opiate withdrawal among injection drug users with hiv infection receiving methadone.BACKGROUND: Pharmacokinetic interactions complicate and potentially compromise the use of antiretroviral and other hiv therapeutic agents in patients with hiv disease. This may be particularly so among those receiving treatment for substance abuse. OBJECTIVE: We describe seven cases of opiate withdrawal among patients receiving chronic methadone maintenance therapy following initiation of therapy with the non-nucleoside reverse transcriptase inhibitor, nevirapine. DESIGN: Retrospective chart review. RESULTS: In all seven patients, due to the lack of prior information regarding a significant pharmacokinetic interaction between these agents, the possibility of opiate withdrawal was not anticipated. Three patients, for whom methadone levels were available at the time of development of opiate withdrawal symptoms, had subtherapeutic methadone levels. In each case, a marked escalation in methadone dose was required to counteract the development of withdrawal symptoms and allow continuation of antiretroviral therapy. Three patients continued nevirapine with methadone administered at an increased dose; however, four chose to discontinue nevirapine. CONCLUSION: To maximize hiv therapeutic benefit among opiate users, information is needed about pharmacokinetic interactions between antiretrovirals and therapies for substance abuse.- - - - - - - - - - ranking = 4keywords = drug (Clic here for more details about this article) |
3/53. Report on intrauterine drug exposure during second trimester of pregnancy in a heroin-associated death.A 17-year-old girl was found dead in a public toilet with fresh needle puncture marks. She was 18-20 weeks pregnant with a male fetus. Drug screening of her blood and urine indicated recent heroin use. Chronic drug use was confirmed by hair analysis. amniotic fluid as well as fetal and maternal tissues and body fluids were analyzed by GC/MS and HPLC. All the fetal specimens were investigated, and the following levels of drugs were found: 6-monoacetyl-morphine (blood: 152 ng/g; amniotic fluid: 128 ng/g; brain: 140 ng/g; lung: 110 ng/g; liver: 2 ng/g; kidney: 40 ng/g), morphine (blood: 1360 ng/g; amniotic fluid: 604 ng/g; brain: 710 ng/g; lung: 1030 ng/g; liver: 2060 ng/g; kidney: 1100 ng/g), codeine (blood: 70 ng/g; brain: 60 ng/g; lung: 60 ng/g; liver: 90 ng/g; kidney: 70 ng/g), and morphine-3-glucuronide (amniotic fluid: 209 ng/g; brain: 170 ng/g; lung: 325 ng/g; kidney: 231 ng/g). morphine-6-glucuronide was present in the maternal circulation but could not be detected in the fetal circulation.- - - - - - - - - - ranking = 6keywords = drug (Clic here for more details about this article) |
4/53. A therapeutic use of the methadone fluvoxamine drug interaction.BACKGROUND: methadone has been effectively used in the treatment of opiate dependence. Adequate dose and blood level have correlated with success in treatment. A number of factors including the regular use of alcohol, medications, and urinary pH can influence blood level and thereby effectiveness. fluvoxamine has been shown to increase methadone blood levels. methods: Single case report. RESULTS: A patient unable to maintain an effective methadone blood level despite a dose of 200 mg per day was administered fluvoxamine with subsequent increase in her methadone blood level and reduction of opiate withdrawal symptoms. CONCLUSIONS: In patients unable to maintain an effective methadone blood level throughout the dosing interval, fluvoxamine can help increase the methadone blood level and alleviate opiate withdrawal symptoms.- - - - - - - - - - ranking = 4keywords = drug (Clic here for more details about this article) |
5/53. drug-seeking behavior in urolithiasis in the noncontrast computed tomography era: 2 cases.Symptomatic urolithiasis is usually treated with narcotic pain management. This leads to the potential for use of its symptoms for personal gain. Historically, the typical presentation of a narcotic-seeking "stone patient" was a history of radiolucent stones and an intravenous contrast allergy. With the increased use of non-contrast-enhanced computed tomography to evaluate patients suspected of having acute urolithiasis, we have seen a change in the strategy of narcotic-seeking patients. We report 2 patients with pelvic calcifications on non-contrast-enhanced computed tomography feigning symptoms of urolithiasis to receive narcotic drugs.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
6/53. A case study of employment case management with chronically unemployed methadone maintained clients.employment interventions implemented in drug treatment programs have been marginally successful, but few interventions have been found to address the needs of chronically unemployed clients. employment case management (ECM) is a comprehensive employment intervention strategy designed to motivate chronically unemployed persons to engage in work, assist in job placement, and provide post employment support through workforce integration, while maintaining progress in drug treatment. This clinical case study reports on a convenience sample of 10 chronically unemployed methadone maintained clients who voluntarily enrolled in the ECM project. Clients received individual ECM services for a period of 26 weeks. Clients were assessed at two- and eight-month follow-up intervals. Nine of the 10 clients were employed at the two-month follow-up assessment and six maintained employment at the eight-month follow-up. Moreover, three clients were able to successfully transition from welfare to competitive private sector employment. Preliminary data suggest that ECM may be an effective intervention strategy to help chronically unemployed methadone clients obtain and maintain employment. Qualitatively, clients reported that post employment intervention services such as motivational counseling, problem solving, and employer advocacy helped sustain employment.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
7/53. A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients.Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. In contrast, others claim the existence of significant problems.'Problematic drug use' includes the following definitions; addiction, abuse, physiological dependence and tolerance.We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs.The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.- - - - - - - - - - ranking = 4keywords = drug (Clic here for more details about this article) |
8/53. Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets.Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance. CASE SERIES: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. CONCLUSIONS: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
9/53. 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.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
10/53. Treatment of comorbid opiate addiction and attention-deficit hyperactivity disorder (residual type) with moclobemide: a case report.moclobemide is a specific and reversible monoamine oxidase-A (MAO-A) inhibitor. Studies show that it is an effective and well-tolerated treatment for attention-deficit hyperactivity disorder (ADHD). A number of reports suggest that ADHD may have a causal influence on the development of substance use disorders. The authors describe the use of moclobemide in a 27-year-old patient with comorbid opiate addiction and ADHD (residual type). The positive clinical response shown suggests that moclobemide may have a particular interest in the treatment of drug-dependent patients with current ADHD.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
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