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(2)

Table 1.

Types of

opioid

receptors and their

activity*

Receptor

Activity

mu-1

Supraspinal analgesia

Prolactin release

Catalepsy

Cardiovascular effects

Miosis

Physical dependence

Indifference to environmental stimulus

mu-2

Respiratory depression

Dopamine turnover

Feeding

Cardiovascular effects

Possible growth hormone release

Delta

Modulate mu receptor activity

Spinal analgesia

Dopamine turnover

Possible growth hormone release

Kappa

Spinal analgesia

Inhibit antidiuretic hormone release

Sedation

Miosis

Possible respiratory depression

Dysphoria

Sigmat

Dysphoria

Hallucinations

Hypertonia

*Other

opioid subtypes exist, such as kappa-1, kappa-2, and

kappa-3. Each receptor subtype may be associated with

dis-tinct effects. Much of our knowledge of receptor subtypes

comes from work performed on nonhuman species.

tBinding to the sigma receptor is not antagonized by

nalox-one. Furthermore, in light of the kappa-mediated dysphoria,

many authorities no longer consider the sigma receptor as

an opiate receptor.

(3)

Table 2.

Characteristics of addiction

* Use of a drug in excessively high amounts or for a

time longer than intended

* Intoxication not uncommon, symptoms of

with-drawal when not administered

* Drug limits personal or work schedule

* Use of drug persists despite work-related or

per-sonal health-related problems

* Large amount of time and resources used to obtain

the drug

* Lack of success in attempts to reduce the use of

the drug

* Evidence of diminishing effect of a given dose

(tolerance)

* Use of the drug specifically to avoid the symptoms

of withdrawal

Table 3.

Comorbid conditions often observed in

the person addicted to opioids

Malnutrition

Hepatitis

Acquired immune deficiency syndrome*

Tetanus

Endocarditis

Pulmonary embolization and infarction

Superficial skin abscesses and infections

Cellulitis

Thrombophlebitis and septic thrombophlebitis

Adrenal gland dysfunction

Positive serologic test results

Aspiration pneumonitis

Cigarette abuse with chronic obstructive lung disease

Ventilation-perfusion mismatch

*There is no specific or documented increased risk of

anes-thesia for patients with the acquired immune deficiency

syn-drome. However anesthesia-related risk in the presence of

human immunodeficiency virus has not been well studied,

and any conclusions are premature at best.

(4)

i n ti {Choi to . L.. though the

.li

time tnf fence C4; hid dii ti repetition

taking, the pers lc :theta bi ter tai p 4 au tauswn

control its

use.

Compulsive, over a 4LL_. ,

tremors

, dx ra

'voluntary use of the oproid

OOMM

i t +ctale na ea can

.,Claim

they

-lcae' tddi

r pain control

during

:a pre4ios

,.Although some biological ch ge i t ificat i _ r provide

vau

wised

°xs rtu xt d al fray a i6id-de nden state

sothat

single analgesic dose-of morphi ,1 . .z. .... p

-w

p

t

is .. ,, 1,.

"'Ally

no evidence that p roprxa severity the wxthdra al

symptoms

and their

= v i t a l use of opioids to .relieve .} w: at d med ' compli o s are- m r zed,

;addiction. d all r,,a ch rams offer

follow -UP

to minimize

the rte mid of relapse

MUdrawax

A traditions! form of 'pharmacological

assisted

Ian -addicted person f ni the ; r nth mplisfied with' the use of

me

AI

h

fl .,rive drug will precipitate a

+n

dra

l syridr

a s

66e

deter fi tzntx. l rt thx apps Y a lon :acting

"' th

another.

wa

synd _Bar, xn vod idid thj at herox ri idine

for

or a shorter th' . acts:.':e=

0% MP.

s, p pe o er pr

hol, and opioids.ea

h have

t 'r ch erish sor

on

op o d), and the dose is aduaily tay mot'

tb traw of syn A ry; z ed. Methadone is marketed under the grade

Our percepts name Dolophine and has a plasma half-life

of

ap-gar. h may= roximately

'30

he tors. Long-term success rates

media'represetttat1on Curd- s. Y seem quite va i ble- rith conventional approaches;

calla ,the with I 1 po

, , rt success rates are

low

and. dropout rates

v y

severe

h

5'4 *14;

q rte h

h.l

Interpretation of these reports: must

n a ona txc . k o .ledge often ark>an dam ;: involve:

jar MC" TMU

131"Wal

,, : "m ,gi p aIgnMont d_ l zg .y

experience treating .addic " their ,Sub* it rns of s ess..

aer pl n t t 14 is akin t, o-a a l eth rlt .a ethad a der

t, ache with unreient 4-gi n 1 a tive# was approved for use'in the United States

p .

t

# '= . ,

v

ngr ma f ilk th r

.

ethadone t ass{an

alterna

n

$anal account tV rdte: tive to ethadone and

dict''is,'acute aware oaf 'his sur lie adm n inter d on alternate days, which. may

pro :ate at it

y

'xnpvtng

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pe6o

s eexn, .r _{a#io n. Famjlia.r, alxjeel}

Ii anc ,

Ex

rien _{with the drug xs growxng, .al,:}

Hof

W

sign ficant n urea' nd even resp rat ory der

\qA f s ions ex l , ~ 4 on art :associated

with

its use

(:Gil

Fanciullo.

stelf , d t ,PaainC1iaic, rtmouth .H hcock

luenced ' the c edical-Center, persoual.communication,

aver-b s try; ore ece .d a P1*brup} C .7 tQ t me J. , ch

lr. \ s 11 \ 1 $ 1 1 I^ ' l i "*"A lfi+';T+ l j .7 'ti7ll

cr*vixtg mire

.*:rapid

or ult pi l detoxification has

he

pic

-11 \I

a _ p1tl t erg arnoted' usingapjoid antagoni is such as naloxane

o + altr cane: e oa is ra detc .. xu eat, g p ication tc

le, fb s cxcc rs

et

generally.:

rip

xn 4 " . k n , .. , Iles.

x

minimize' u off the t

opportunitY

one for tuaintenanc

for relypse, continued e, and appro-IV

-cen i t I prigte psyche follvwTup. Genera! anesthesia,

Tie . opioi de e e e cif ry deep sedation, inc rpo rated

drr -enga in a i 1 app a es to make' the patient

insensi-r ho i almost'nl ys ' a 4 ,; a Ir h xtn:the vie v intoleralrl e sympto s a.

aci-ti of the'; cravin h .gat :w ica 't or ul tra p

id

d, tc adfiea ion.. In

the

ff

the

craving canto nce of

opoid

addiction, the

administration

l our ure val p

an-

acute w drawal

(5)

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(6)

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(7)

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(11)

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(8)

Cruises

Tours

Family

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Honey.moons

Ivel

222 South Prospect Avenue Park Ridge, IL * 60068-4001