Characterization of Prescription Opioid Abuse in the United States: Focus on Route of Administration.

Characterization of prescription opioid abuse in the United States: focus on route of administration.

J Pain Palliat Care Pharmacother. 2012 Dec; 26(4): 348-61
Kirsh K, Peppin J, Coleman J

Prescription opioids are prescribed increasingly for the management of chronic pain, and this has been accompanied by a dramatic rise in opioid-related abuse, addiction, and overdose deaths. Reports of abuse involving nonoral administration (e.g., snorting, injecting) of prescription opioids are increasing, although the epidemiology of oral versus nonoral abuse is not well understood. Available data indicate that oral abuse is far more common,with 72% to 97% of opioid abusers perferring oral administration. Factors associated with nonoral administration include longer duration of opioid abuse, male gender, and rural setting. Extended-release opioids, because of their relatively high drug load, may be attractive to experienced abusers seeking to manipulate the formulation to facilitate a rapid onset of effect. Putative abuse-deterrent formulations have been developed to decrease the likelihood or consequences of nonoral abuse. In addition, Risk Evaluation and Mitigation Strategies (REMS) are now required for prescribed extended-release/long-acting opioids by the US Food and Drug Administration, although their effectiveness in reducing the risk of abuse, addiction, and overdose has not been evaluated. Physicians should remain vigilant when prescribing opioids and should exercise appropriate patient selection, perform risk analysis and stratification, and maintain continuous patient monitoring to ensure the benefits outweigh these important risks. HubMed – addiction


Addiction, the Concept of Disorder, and Pathways to Harm: Comment on Levy.

Front Psychiatry. 2013; 4: 34
Wakefield JC

HubMed – addiction


Reversibility of myocardial hypertrophy 8 years after adrenal adenoma excision and drugs and alcohol addiction withdrawal.

BMJ Case Rep. 2013; 2013(may13_1):
Carboni GP

HubMed – addiction


Polydrug Abuse by Intravenous Use of Heroin and Tropicamide-Containing Eyedrops.

Clin Neuropharmacol. 2013 May/June; 36(3): 100-101
Spagnolo PA, Badiani A, Nencini P

BACKGROUND: Drug abuse is rarely limited to a single substance; polydrug use is the norm rather than the exception. In many cases, the misuse of potentially psychoactive substances can lead to serious intoxications and results in addictive behavior. CASE DESCRIPTION: A 22-year-old heroin-addicted woman presented in our clinic reporting a 2-year history of intravenous injection of an eyedrop solution containing 1% tropicamide, an antimuscarinic agent. She reported injecting tropicamide because it attenuated symptoms and signs of opiate withdrawal and it also has hallucinogenic and euphorigenic effects. Despite the large amounts (up to 1.5 g), the rapidity of injection, and the long-term use, tropicamide was relatively well tolerated, without life-threatening consequences.An outpatient detoxification program was performed without any sign or symptom caused by discontinuing tropicamide. CONCLUSIONS: The present case claims a role for pharmacological interactions, in addition to rewarding effects, in influencing drug association in polyabuse pattern.Moreover, this case underlines the need for physicians to be aware of the potential emergence of tropicamide as a drug of misuse, to prevent further harm. HubMed – addiction