Hydrocodone Home Detox
Oxycontin is a popular drug of abuse that falls in the opiate class that also contains heroin and morphine. Opiate drugs are used legitimately in the treatment of pain and are mainstays in that area. But, the same neuronal systems that alter pain also produce feelings of euphoria and well being, which lead to abuse and addiction. Tolerance occurs, and there is a significant withdrawal syndrome when the drugs are not taken. Opiates produce some unpleasant effects including nausea, vomiting, and sedation, particularly in people not addicted or not being treated for pain.
Introduced in 1995, OxyContin tablets slowly release their powerful opioid to promote steady comfort and a good night's sleep. Hailed as a wonder drug by patients and physicians, sales skyrocketed to more than 1 billion, greater even than those of Viagra. Originally targeted for cancer pain, OxyContin is now used increasingly for chronic pain from other causes. In 2000, however, reports of abuse skyrocketed with sensationalists articles full of grim details of high street values, violent robberies, and methods of abuse. These reports so terrified doctors, patients, pharmacists, and family members that legitimate OxyContin use (along with the proper use of other opioids) plummeted, signifying a major step backward in the war to decriminalize the legitimate treatment of authentic pain problems. An almost evangelical crusade to promote more aggressive treatment of pain has underestimated the determination of addicts to abuse drugs by any means. Once again, innocent sufferers with...
Schedule III Drugs Paregoric, methyprylon (Noludar) anabolic steroids, codeine and hydrocodone with aspirin or Tylenol, and some barbiturates have an abuse potential less than Schedules I and II drugs and currently have an accepted medical use in the United States. Abuse of these drugs may lead to moderate or low physical dependence and or high psychological dependence. Schedule IV Drugs Chloral hydrate (Noctec), ethchlorvynol (Placidyl), flu-razepam (Dalmane), pentazocine (Talwin), chlordiazepoxide (Librium), propoxyphene (Darvon), and diethylpropion (Tenuate), Equanil, Valium and Xanax have low abuse potential compared with Schedule III drugs and currently have an accepted medical use in the United States. Abuse of these drugs may lead to limited physical dependence and or psychological dependence. Schedule V Drugs Narcotic-atropine mixtures (Lomotil) and codeine mixtures (less than 200 mg) have a low potential for abuse relative to Schedule IV drugs and have a currently accepted...
Immediate release is somewhat misleading in that it means that the oxycodone is not imbedded in a slow-release matrix. It is most commonly used as needed for severe intermittent pain or for breakthrough pain, along with a long-acting opioid taken on a fixed schedule. Again, if rescue doses are consistently needed more than a few times daily, the dose of the long-acting ATC drug usually needs to be raised. For years oxycodone was only available in fixed combinations with aspirin (Percodan) or acetaminophen (Percocet). That's why it is still regarded by many as a weak opioid conventionally used to treat moderate pain. As such, patients taking oxycodone for moderate pain can keep using the same drug if the pain turns severe or for breakthrough pain. Another advantage is that its breakdown products (metabolites) appear to be much less of a problem than with other opioids.
Benzodiazepines, particularly clonazepam, can be used either alone or in combination with dopaminergic agents for RLS and for PLM disorder. Daytime sedation, tolerance, and loss of efficacy are the major problems encountered with these drugs. Opiates such as propoxyphene, codeine, and hydrocodone also reduce the unpleasant sensations and can be used alone or in combination with dopaminergic agents and benzodiazepines. y Clonidine, baclofen, carbamazepine, and gabapentin are sometimes helpful.
Butalbital mixtures, aspirin-acetaminophen-caffeine combinations, hydrocodone-acetaminophen combinations, all frequently overused medications, can be tapered by reducing the number of tablets per day by one per week. Tricyclics and topiramate fit this schedule nicely, increasing by one tablet per day per week. Tricyclics allow for dosage escalation by 10 mg per week and topiramate by 25 mg per week. Once again, a reasonable alternative is administration of onabotulinumtoxinA instead on day 1 and q 3 months thereafter.
Loss of the ankle reflex with sensory abnormalities indicates that the classic diabetic polyneuropathy is fully defined, with probable coexisting microangiopathy in the foot. Preventive foot care needs to be practiced to prevent skin breakdown. Patients should never walk barefooted because sharp objects penetrating the diabetic foot are often not perceived, leading to foot-threatening infections. The patient may require professional advice on footwear, orthotic devices, and toenail care. For symptomatic relief of nocturnal paresthesias, including charley horses, increasing doses of gabapentin or amitriptyline, with acetaminophen, or low-dose nonsteroidal anti-inflammatory drugs (NSAIDs) often provide some relief. The nutritional supplement aa-lipoic acid also can reduce neuropathic pain. New drugs such as duloxetine and pregabalin are approved for specific treatment of diabetic neuritis. Patients with these dyskinesias may require benzodiazepines or oxycodone,
Hydrocodone (Vicodin, Lorcet) Oxycodone OxyContin, OxyFast, About 70 of individuals will experience significant analgesia from 10 mg 70 kg of body weight of IV morphine or its equivalent.18 For severe pain in opiatenaive patients, a usual starting dose is 5 to 10 mg of morphine every 4 hours. In the initial stages of severe pain, medication should be given around the clock. Rescue doses should be made available for breakthrough pain in doses equivalent to 10 to 20 of the total daily opioid requirement and administered every 2 to 6 hours if needed. Alternatively 1 6 of the total daily dose or 1 3 of the 12-hourly dose might be used. Scheduled doses should be titrated based on the degree of pain. One method involves adjustment of the maintenance dose based on the total 24-hour rescue dose requirement. Alternatively, utilizing dose escalation, doses could be increased by 50 to 100 or 30 to 50 of the current dose, for those in severe and moderate pain, respectively. Once pain relief is...
In the context of this general endorsement of epidemiological field survey methods, some readers may be interested in whether occurrence of drug dependence can be measured surveillance of the routine administrative statistics of hospital or managed care organizations. Any evaluation of this type of surveillance brings an epidemiologist face to face with some of the traditional concerns of psychiatric epidemiology, such as the influence of ''nosocomial'' and ''threshold'' effects (e.g., see Anthony and Van Etten, 1995). The results of these effects include a familiar iceberg phenomenon cases identified in the administrative statistics may be no more than a small fraction of the total number of cases in a population (e.g., see Anthony, 1999, for an illustration of the ''iceberg'' phenomenon). With respect to the occurrence of dependence on prescribed Schedule II-III analgesic drugs such as morphine and oxycodone, it is difficult to inspect published evidence of the Boston Collaborative...
Propoxyphene Hydrocodone Oxycodone 4. Considered the strongest of the opioids conventionally used to treat moderate pain (mild or weak opioid) when a combination product is prescribed, but when prescribed alone (plain oxycodone), it is now considered an opioid conventionally used to treat severe pain (strong or potent opioid) (see Ch. 7).
The opioids exert their analgesic efficacy by stimulating opioid receptors (p, k, and 5) in the CNS. There is a wide variety of potencies among the opioids, with some used for moderate pain (codeine, hydrocodone, tramadol, and partial agonists) and others reserved for severe pain (morphine and hydromorphone). Pure agonists (morphine) bind to p-receptors to produce analgesia that increases with dose without a ceiling effect. Pure agonists are divided into three chemical classes, phenanthrenes or morphine-like, phenylpiperidine or meperidine-like, and diphenylheptane or methadone-like. Partial agonists antagonists (butorphanol, pentazocine, and nalbuphine) partially stimulate the p-receptor and antagonize the p-receptors. This activity results in reduced analgesic efficacy with a ceiling dose, reduced side effects at the K-receptor, psychotomimetic side effects due to K-receptor antagonism, and possible withdrawal symptoms in patients who are dependent on pure agonists.
There are currently six opioids suitable for long-term use morphine, oxycodone, fentanyl, oxymorphone, methadone, and levorphanol. The synthetic opiate agonist tramadol is an additional therapeutic option. Addiction medicine specialists may also use buprenorphine and butorphanol. There is no best opioid. Patients respond preferentially to some opioids, but not to others, which may make it necessary to try several different ones before finding the best drug for that patient (Table 15-1). Oxycontin is a time-release formula of the analgesic oxycodone and is an alternative to oral morphine
The short-acting opioids, such as codeine, hydrocodone (e.g. Vicodin, Norco), or oxycodone (e.g. Roxicodone, Percocet) are not usually used for long-term therapy because there will be wide swings in the blood levels, which leads to poor pain control and more side effects. Toxicity (liver or gastrointestinal) may occur with the use of short-acting opioids formulations containing other pain reducing medications (aspirin, acetaminophen, or ibuprofen). In those rare patients who do better with a short-acting opioid, they should be prescribed in a time-contingent manner. It is best to use a continuous release or long-acting opioid for long-term opioid analgesic therapy, although short-acting opioids should be available for breakthrough pain.
Larly in patients with painful symptoms. BZDRAs such as temazepam, clonazepam, zolpidem, and zaleplon effectively reduce arousals associated with PLMS in patients with RLS.49 Their main benefit is derived from improving sleep continuity in patients with RLS, particularly as adjunct treatment with other pharmacologic therapies. Opioids are effective for some patients' RLS symptoms, with oxycodone, pro-poxyphene, hydrocodone, and codeine being used most frequently. For both BZDRAs and opioids, caution should be used in the elderly, in patients who snore and are at risk for sleep apnea, and in patients with a history of substance abuse. Low iron levels frequently exacerbate RLS symptoms. Iron supplementation should be prescribed in patients who are iron-deficient. Iron supplementation in patients with serum ferritin concentrations of less than 50 mcg L improves RLS symptoms. Medications frequently used for RLS are shown in Table 41-3.
Hydrocodone (Vicodin) is the most frequently prescribed opioid in the United States. Oxycodone (Oxycontin) and hydrocodone are prescribed in the treatment of acute and chronic pain. Abusers of hydrocodone and oxycodone experience euphoria, relaxation, and sedation. Long-term use can result in tolerance. Abusers may overdose as they take increasing doses of the medication while pursuing euphoric sensations that they previously experienced. Overdoses may result in severe respiratory depression, hypotension, coma, and death. Recently, methadone, primarily diverted from prescriptions for chronic pain and not metha-done maintenance treatment, has been linked to increased opiate overdoses as well. Its relatively long onset of action and long half-life make methadone-naive individuals more prone to overdose as they seek a stronger high with escalating doses, which accumulate, causing overdose.
Opiates (also called narcotics) include heroin, an illicit substance, and such prescription medications as morphine, Demerol, codeine, fentanyl, and OxyContin (used to treat severe pain). Once in the bloodstream, opiates can have a variety of negative side effects labored breathing, nausea, vomiting, difficulty urinating, constipation, abdominal pain, dizziness, blood disorders, anxiety, mood changes, restlessness, and skin rashes.
A number of effective oral opioid preparations are available (Tables 5-4 and 5-5). If hydrocodone, 5 to 10 mg every 4 hours, is not adequate, oxycodone, 5 to 10 mg every 4 hours, should be used. Oral morphine beginning with 15 to 20 mg every 4 hours is usually the next step, but hydromorphone is a good alternative. The morphine dose should be titrated upward until analgesia lasts the full 4 hours, even if large doses are required. Hydrocodone (5 mg) + homatropine (1.5 mg) (Hycodan) Hydrocodone (5 mg) + acetaminophen (500 mg) (Vicodin) Oxycodone (5 mg) + aspirin (325 mg) (Percodan) Oxycodone (5 mg) + acetaminophen (325 mg) (Percocet) Oxycodone (5 mg 5 mL) (Roxicodone)
Although technically available as a single-entity drug (both in pill form and by intramuscular injection), by convention codeine is almost always prescribed in combination with acetaminophen (Tylenol or APAP) or aspirin, available under a variety of brand names, including those listed below. As indicated in the discussion of hydrocodone (below), the relative effectiveness, safety, and preferred dose for each combination product depends on how much of each medication is contained in a tablet or capsule.
Hydrocodone is most commonly prescribed in tablets containing 5 to 10 mg hydrocodone and 325 to 650 mg of acetaminophen. Although confusion may arise because it is available under such a large variety of trade names, the most important distinction relates to the two numbers that follow the hydrocodone and APAP, which indicate the dose of each drug contained in a single pill or capsule. The first number refers to the amount of hydrocodone (5 to 10 mg) and is important because it correlates with the preparation's potency or strength, while the second number is important because it describes the dose of APAP or acetaminophen and indicates how many tablets can be safely taken each day without excessive risks of liver injury. Brand names for hydrocodone APAP change constantly but currently include the following (tablets, unless indicated otherwise) Vicodin (5 500), Vicodin ES (7.5 750), Vicodin HP (10 660), Bancap HC (5 500) capsule, Hydrocet (5 500) capsule, Hy-phen (5 500), Co-Gesic (5...
In general, the pharmacotherapy of chronic neuropathic pain falls somewhere between art and witchcraft. Drugs should supplement cognitive and behavioral therapies and physical therapy with conditioning exercises. Non-steroidal anti-inflammatory drugs, aspirin, acetaminophen, tramodol, oxycodone or an equivalent opiate are for breakthrough pain in concert with any drug trial. N-of-1 experiments most often start with anticonvulsant or antidepressant medications, depending on the anticipated tolerance of side effects, followed by baclofen or by a sympatholytic agent when RSD is diagnosed. The clinician may try two different classes of drugs that act by similar putative mechanisms to amplify their effect or may try using drugs that have several different mechanisms of action. If pain seems to be triggered by noxious inputs, clonidine is worth trying. Muscle relaxants, benzodiazepines, antihistamines, L-tryptophan to raise serotonin levels, levodopa, calcium channel blockers,...
Prescription drugs including painkillers, sedatives and tranquilizers, and stimulants have been abused for many years. Drugs such as Valium, Xanax, Vicodin, OxyContin, and methadone show up frequently in ER emergency situations. In a National Survey more than six million Americans over the age of 12 stated they used prescription drugs for nonmedical uses.
Some patients may require minimal to mild conscious sedation during a procedure in the outpatient clinic setting. Use of a low-dose benzodiazepine, such as 1 to 2 mg of loraz-epam or 0.5 to 1 mg of alprazolam, may be appropriate for light conscious sedation. Sedation may also be accomplished with a dose of an oral opioid, such as hydrocodone or oxycodone. These patients should not operate a car or heavy machinery, and another person should provide their transportation. Use of an opioid in combination with a ben-zodiazepine may cause significant respiratory depression.