University of Groningen Stereoselectivity in the Hepatic Metabolism and Transport of Quaternary Drugs of the Morphinan Type Lant
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DEMAND REDUCTION a Glossary of Terms
UNITED NATIONS PUBLICATION Sales No. E.00.XI.9 ISBN: 92-1-148129-5 ACKNOWLEDGEMENTS This document was prepared by the: United Nations International Drug Control Programme (UNDCP), Vienna, Austria, in consultation with the Commonwealth of Health and Aged Care, Australia, and the informal international reference group. ii Contents Page Foreword . xi Demand reduction: A glossary of terms . 1 Abstinence . 1 Abuse . 1 Abuse liability . 2 Action research . 2 Addiction, addict . 2 Administration (method of) . 3 Adverse drug reaction . 4 Advice services . 4 Advocacy . 4 Agonist . 4 AIDS . 5 Al-Anon . 5 Alcohol . 5 Alcoholics Anonymous (AA) . 6 Alternatives to drug use . 6 Amfetamine . 6 Amotivational syndrome . 6 Amphetamine . 6 Amyl nitrate . 8 Analgesic . 8 iii Page Antagonist . 8 Anti-anxiety drug . 8 Antidepressant . 8 Backloading . 9 Bad trip . 9 Barbiturate . 9 Benzodiazepine . 10 Blood-borne virus . 10 Brief intervention . 11 Buprenorphine . 11 Caffeine . 12 Cannabis . 12 Chasing . 13 Cocaine . 13 Coca leaves . 14 Coca paste . 14 Cold turkey . 14 Community empowerment . 15 Co-morbidity . 15 Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control (CMO) . 15 Controlled substance . 15 Counselling and psychotherapy . 16 Court diversion . 16 Crash . 16 Cross-dependence . 17 Cross-tolerance . 17 Custody diversion . 17 Dance drug . 18 Decriminalization or depenalization . 18 Demand . 18 iv Page Demand reduction . 19 Dependence, dependence syndrome . 19 Dependence liability . 20 Depressant . 20 Designer drug . 20 Detoxification . 20 Diacetylmorphine/Diamorphine . 21 Diuretic . 21 Drug . 21 Drug abuse . 22 Drug abuse-related harm . 22 Drug abuse-related problem . 22 Drug policy . 23 Drug seeking . 23 Drug substitution . 23 Drug testing . 24 Drug use . -
Drugs of Abuseon September Archived 13-10048 No
U.S. DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WWW.DEA.GOV 9, 2014 on September archived 13-10048 No. v. Stewart, in U.S. cited Drugs of2011 Abuse EDITION A DEA RESOURCE GUIDE V. Narcotics WHAT ARE NARCOTICS? Also known as “opioids,” the term "narcotic" comes from the Greek word for “stupor” and originally referred to a variety of substances that dulled the senses and relieved pain. Though some people still refer to all drugs as “narcot- ics,” today “narcotic” refers to opium, opium derivatives, and their semi-synthetic substitutes. A more current term for these drugs, with less uncertainty regarding its meaning, is “opioid.” Examples include the illicit drug heroin and pharmaceutical drugs like OxyContin®, Vicodin®, codeine, morphine, methadone and fentanyl. WHAT IS THEIR ORIGIN? The poppy papaver somniferum is the source for all natural opioids, whereas synthetic opioids are made entirely in a lab and include meperidine, fentanyl, and methadone. Semi-synthetic opioids are synthesized from naturally occurring opium products, such as morphine and codeine, and include heroin, oxycodone, hydrocodone, and hydromorphone. Teens can obtain narcotics from friends, family members, medicine cabinets, pharmacies, nursing 2014 homes, hospitals, hospices, doctors, and the Internet. 9, on September archived 13-10048 No. v. Stewart, in U.S. cited What are common street names? Street names for various narcotics/opioids include: ➔ Hillbilly Heroin, Lean or Purple Drank, OC, Ox, Oxy, Oxycotton, Sippin Syrup What are their forms? Narcotics/opioids come in various forms including: ➔ T ablets, capsules, skin patches, powder, chunks in varying colors (from white to shades of brown and black), liquid form for oral use and injection, syrups, suppositories, lollipops How are they abused? ➔ Narcotics/opioids can be swallowed, smoked, sniffed, or injected. -
Proposal for Reclassification of Cough Medicines Containing Dextromethorphan, Opium Tincture, Squill Oxymel and Pholcodine to Restricted Medicines
Proposal for reclassification of cough medicines containing dextromethorphan, opium tincture, squill oxymel and pholcodine to restricted medicines Purpose Medsafe has recently been alerted to instances of abuse of cough medicines containing dextromethorphan. Concern was raised over the easy availability of opioid (and opioid-like) cough medicines which can be bought at a pharmacy or supermarket without healthcare professional supervision. Dextromethorphan is a substance that does not belong to the opioid family but has a chemical structure closely resembling the opioids. Dextromethorphan has a history of abuse in New Zealand and other countries. There are also other cough medicines available as pharmacy medicines which have been noted as at least having a potential for abuse, for example cough medicines containing pholcodine and Gees linctus which contains anhydrous morphine. Pholcodine and anhydrous morphine are both opioids. Medsafe therefore requests that Medicines Classification Committee (MCC) considers reclassification of dextromethorphan, opium tincture, squill oxymel and pholcodine containing products to Pharmacist-Only (restricted) medicines. Medsafe considers that a reclassification to restricted medicine balances a need for better supervision whilst maintaining access for those who benefit from using these medicines. Background Dextromethorphan and misuse (1) Dextromethorphan (DXM) is the D- isomer of the codeine synthetic analogue, levorphanol. DXM also structurally resembles ketamine and phenycycline which are dissociative agents, meaning that they can be used to incite a type of general anesthesia characterized by analgesia and amnesia with minimal effect on respiratory function. DXM is an opioid, but because of its stereochemistry, DXM and its metabolites do not bind to the mu and delta opioid receptors, thus avoiding classic opioid toxicity. -
Urine Drug Toxicology and Pain Management Testing
Urine Drug Toxicology and Pain Management Testing Kara Lynch, PhD, DABCC University of California San Francisco San Francisco, CA Learning Objectives • Describe what chronic pain is, who is affected and how they are commonly treated • Explain the common methodologies used in pain management testing • Interpret urine drug testing results • Create protocols to minimize the occurrence of false positive or false negative results Pain – definition and types • Pain - an unpleasant sensory and emotional experience associated with actual or potential tissue damage • Chronic pain - pain that extends beyond the expected period of healing • Nociceptive Pain – Pain caused by tissue injury – Stimulus-evoked, high intensity – Opioid sensitive • Neuropathic Pain – Caused by nerve injury – Spontaneous activity – Develops in days or month – Opioid insensitive Chronic Pain Patients • Arthritis • Fibromyalgia – Osteoarthritis • Headaches – Rheumatoid arthritis – Migraine – Gout – Tension • Cancer – Cluster • Chronic non-cancer pain • Myofascial pain • Central pain syndrome • Neuropathic pain – CNS damage – Diabetic Peripheral – Multiple Sclerosis Neuropathy – Parkinson’s disease – Postherpetic neuralgia • Chronic abnominal pain • Neck and Back Pain – Intestinal obstructions Chronic Pain Medications • Opiates • Synthetic opioids – Codeine – Fentanyl – Morphine – Methadone • Semi-synthetic opioids – Meperidine – Oxymorphone – Tramadol – Oxycodone – Propoxyphene – Hydromorphone – Levorphanol – Hydrocodone – Tapentadol – Buprenorphine • Anticonvulsant • Muscle -
Dextrorphan Binds to Opioid Receptors in Guinea-Pig Brain Membranes And
Proc. Natl. Acad. Sci. USA Vol. 87, pp. 1629-1632, March 1990 Pharmacology Dextrorphan binds to opioid receptors in guinea-pig brain membranes and is an antagonist at opioid receptors in myenteric plexus (binding/guinea-pig ileum/levorphanol/stereoselectivity) AVRAM GOLDSTEIN AND ASHA NAIDU Department of Pharmacology, Stanford University, Stanford, CA 94305 Contributed by Avram Goldstein, December 11, 1989 ABSTRACT Dextrorphan (+)-tartrate, purified by re- LaRoche); [D-Ala,MePhe4,Gly-ol5]enkephalin (DAGO; Pe- peated crystallization to remove all traces of the enantiomer ninsula Laboratories) (2); trans-3,4-dichloro-N-methyl- levorphanol, binds to IL, 6, and K sites on guinea-pig brain N-[2-(1-pyrrolidinyl)cyclohexyl]benzeneacetamide methane- membranes with lower affinities (by a factor of400-3200) than sulfonate (U50,488; Upjohn) (3); (-)-naloxone hydrochloride levorphanol. In the guinea-pig ileum myenteric plexus longi- (NAL; Endo Laboratories, New York); normorphine hydro- tudinal muscle preparation (GPI), dextrorphan, at 100-200 chloride (NOR) and (+)-naloxone hydrochloride (National ,uM, inhibits the electrically stimulated twitch, but this action Institute on Drug Abuse); N-methyl-D-aspartic acid (NMDA), is not blocked or reversed by naloxone; both (+)- and (-)- aminophosphonovalerate, norepinephrine (levarterenol), at- naloxone produce similar non-opioid twitch inhibition at com- ropine, and eserine (physostigmine) (Sigma). parable concentrations. At 10-20 jaM, dextrorphan' blocks and Preparation ofDEXp. [3H]LEV (Ro 1-5431/701, Hoffmann- reverses the twitch inhibition due to ,u and KWagonists, but the LaRoche; 17.4 Ci/mmol; 1 Ci = 37 GBq) was purified' by blockade can be overcome only partially by increasing the preparative reversed-phase HPLC (Waters, C18 AgBondaPak, agonist concentration. -
Neurolept Anaesthesia: a Comparison with a Conventional Technique for Major Surgery*
NEUROLEPT ANAESTHESIA: A COMPARISON WITH A CONVENTIONAL TECHNIQUE FOR MAJOR SURGERY* S. A. McDOWELL,M.B., F./~.A.I~.C.S. AND J. W. DUNDEE, 1VI.D.,PH.D., F.F.A.H.C.S. IN THE PAST DECADE, the term "neuroleptic" has been increasingly used to describe the effects of certain drugs on the central nervous system. It is usually used to signify the production of tranquillity and mental detachment, without a marked soporific effect. If a narcotic analgesic is used in combination with a neuroleptic drug, then a state of neurolept-analgesia is produced and if, in this state, a hypnotic is added to produce sleep, the result is neurolept anaesthesia (NLA). Since the introduction of this form of anaesthesia by De Castro and Mundeleer 1 a great variety of techniques of NLA have been described and many claims made for its advantages over more conventional forms of anaesthesia. 2-6 Among these are: (a) stability of the cardiovascular system, making it particularly suited for the poor-risk patient. (b) profound analgesia, which extends into the postoperative period and results in comfort for the patient and ease of management. (e) little postoperative nausea and vomiting. (d) rapid recovery of consciousness with good tolerance of endotraeheal tubes and patient cooperation. In spite of these advantages, neuroleptanaesthesia has not found acceptance with all workers 7 and recently, the usefulness of the drugs used in NLA has been ques- tioned by workers from this department, s,9 The neuroleptic drug commonly used in this form of anaesthesia is droperidol and it is usually given in conjunction with the analgesic fentanyl. -
Levorphanol Use: Past, Present and Future
Postgraduate Medicine ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20 Levorphanol Use: Past, Present and Future Jeffrey Gudin, Jeffrey Fudin & Srinivas Nalamachu To cite this article: Jeffrey Gudin, Jeffrey Fudin & Srinivas Nalamachu (2015): Levorphanol Use: Past, Present and Future, Postgraduate Medicine, DOI: 10.1080/00325481.2016.1128308 To link to this article: http://dx.doi.org/10.1080/00325481.2016.1128308 Accepted author version posted online: 03 Dec 2015. Submit your article to this journal View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Jeffrey Fudin] Date: 03 December 2015, At: 20:32 Publisher: Taylor & Francis Journal: Postgraduate Medicine DOI: 10.1080/00325481.2016.1128308 Levorphanol Use: Past, Present and Future Authors: Jeffrey Gudin1, Jeffrey Fudin2, and Srinivas Nalamachu3 Affiliations: 1Director, Pain Management and Palliative Care, Englewood Hospital and Medical Center, Englewood, NJ, and Clinical Instructor, Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY. 2Adjunct Associate Professor, Albany College of Pharmacy and Health Sciences and also Western New England University College of Pharmacy Director, PGY2 Pain Residency and Clinical Pharmacy, Specialist, Pain Management Stratton VA Medical Center, Albany, NY 3President and Medical Director, International Clinical Research Institute, Overland Park, KS, and Adjunct Associate Professor, Temple University School of Medicine, Downloaded by [Jeffrey Fudin] at 20:32 03 December 2015 Philadelphia, PA. Running Title: Levorphanol Use: Past, Present and Future Corresponding Author Srinivas Nalamachu Srinivas R. Nalamachu MD International Clinical Research Institute, Inc. -
Chronic Pain Levorphanol Methadone and the N Methyl D Aspartate
JPM-2009-0105-Letter to the Editor_1P.3d 07/21/09 2:53pm Page 1 JPM-2009-0105-Letter to the Editor_1P JOURNAL OF PALLIATIVE MEDICINE Volume 12, Number 9, 2009 Letter to the Editor ª Mary Ann Liebert, Inc. DOI: 10.1089=jpm.2009.0105 Chronic Pain: Levorphanol, Methadone, and the N-Methyl-d-Aspartate Receptor Dear Editor: patients, whose pain score was reduced to a score of 4 to 5. The Not every clinician is in a position to undertake controlled overall response rate to treatment with methadone ap- trials to advance the science and practice of medicine. Even proached 75%. The pain relief provided by levorphanol was researchers in academic institutions are subject to problems quite similar to that from methadone. Of the 73 patients who with funding the cost of studies. End-of-life care, which is received levorphanol, 35 had an excellent response and 14 increasingly provided in the home, is beset with ethical and experienced fair relief. The overall response rate to levor- logistical problems regarding the use of evidence-based prin- phanol was 70%. ciples to study patients. Physicians practicing in home hos- Levorphanol is a m- and k-receptor agonist and an NMDA pice settings are in a much different environment than those receptor antagonist. With respect to effectiveness and adverse- who work in hospitals and teaching institutions, and studies effect profile, it is much like hydromorphone but offers these in those locations may not be comparable. important advantages: Levorphanol relieves neuropathic If a concept, new or old, is attractive to a physician because pain, and 1 dose is effective for 6, 8, or 12 hours as opposed to it may improve the care of patients and if a controlled trial is the 3 to 4 hours of relief afforded by hydromorphone. -
Laws 2021, LB236, § 4
LB236 LB236 2021 2021 LEGISLATIVE BILL 236 Approved by the Governor May 26, 2021 Introduced by Brewer, 43; Clements, 2; Erdman, 47; Slama, 1; Lindstrom, 18; Murman, 38; Halloran, 33; Hansen, B., 16; McDonnell, 5; Briese, 41; Lowe, 37; Groene, 42; Sanders, 45; Bostelman, 23; Albrecht, 17; Dorn, 30; Linehan, 39; Friesen, 34; Aguilar, 35; Gragert, 40; Kolterman, 24; Williams, 36; Brandt, 32. A BILL FOR AN ACT relating to law; to amend sections 28-1202 and 69-2436, Reissue Revised Statutes of Nebraska, and sections 28-401 and 28-405, Revised Statutes Cumulative Supplement, 2020; to redefine terms, change drug schedules, and adopt federal drug provisions under the Uniform Controlled Substances Act; to provide an exception to the offense of carrying a concealed weapon as prescribed; to define a term; to change provisions relating to renewal of a permit to carry a concealed handgun; to provide a duty for the Nebraska State Patrol; to eliminate an obsolete provision; to harmonize provisions; and to repeal the original sections. Be it enacted by the people of the State of Nebraska, Section 1. Section 28-401, Revised Statutes Cumulative Supplement, 2020, is amended to read: 28-401 As used in the Uniform Controlled Substances Act, unless the context otherwise requires: (1) Administer means to directly apply a controlled substance by injection, inhalation, ingestion, or any other means to the body of a patient or research subject; (2) Agent means an authorized person who acts on behalf of or at the direction of another person but does not include a common or contract carrier, public warehouse keeper, or employee of a carrier or warehouse keeper; (3) Administration means the Drug Enforcement Administration of the United States Department of Justice; (4) Controlled substance means a drug, biological, substance, or immediate precursor in Schedules I through V of section 28-405. -
Levorphanol: the Forgotten Opioid
Support Care Cancer (2007) 15: 259–264 DOI 10.1007/s00520-006-0146-2 REVIEW ARTICLE Eric Prommer Levorphanol: the forgotten opioid Abstract Background: Levorphanol Similar to morphine, levorphanol Received: 8 June 2006 Accepted: 17 August 2006 (levo-3-hydroxy-N-methylmorphinan) undergoes glucuronidation in the liver, Published online: 13 October 2006 is a strong opioid that is the only and the glucuronidated products are # Springer-Verlag 2006 available opioid agonist of the excreted in the kidney. Levorphanol morphinan series. Levorphanol was can be given orally, intravenously, and originally synthesized as a pharmaco- subcutaneously. Objective: This logical alternative to morphine more article reviews the pharmacodynamics, than 40 years ago. It is considered a pharmacology, and clinical efficacy step-3 opioid by the World Health for this often overlooked step-3 opioid. Organization (WHO) and has a greater Conclusion: The long half-life of potency than morphine. Analgesia the drug increases the potential for E. Prommer (*) VIP Palliative Care Program, produced by levorphanol is mediated drug accumulation. Levorphanol Greater Los Angeles Healthcare, via its interactions with μ, δ,andκ has clinical efficacy in neuropathic Division of Hematology/Oncology, opioid receptors. Levorphanol is also pain. UCLA School of Medicine, an N-methyl-D-aspartate (NMDA) 11301 Wilshire 111-H, receptor antagonist. There is evidence Los Angeles, CA, USA e-mail: [email protected] that levorphanol may inhibit uptake Keywords Pain . Levorphanol . Tel.: +1310-478-3711 of norepinephrine and serotonin. Opioids . NMDA . Glucuronidation Introduction and it is important that clinicians not forget that this is an option for moderate to strong pain. -
Coash, 27; Dubas, 34; Friend, 10; Mcgill, 26; Pirsch, 4; Rogert, 16; Wallman, 30; Giese, 17
LB 123 LB 123 LEGISLATIVE BILL 123 Approved by the Governor February 26, 2009 Introduced by Karpisek, 32; Christensen, 44; Coash, 27; Dubas, 34; Friend, 10; McGill, 26; Pirsch, 4; Rogert, 16; Wallman, 30; Giese, 17. FOR AN ACT relating to the Uniform Controlled Substances Act; to amend section 28-405, Reissue Revised Statutes of Nebraska; to regulate Salvia divinorum or Salvinorin A; and to repeal the original section. Be it enacted by the people of the State of Nebraska, Section 1. Section 28-405, Reissue Revised Statutes of Nebraska, is amended to read: 28-405 The following are the schedules of controlled substances referred to in the Uniform Controlled Substances Act: Schedule I (a) Any of the following opiates, including their isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, unless specifically excepted, whenever the existence of such isomers, esters, ethers, and salts is possible within the specific chemical designation: (1) Acetylmethadol; (2) Allylprodine; (3) Alphacetylmethadol, except levo-alphacetylmethadol which is also known as levo-alpha-acetylmethadol, levomethadyl acetate, and LAAM; (4) Alphameprodine; (5) Alphamethadol; (6) Benzethidine; (7) Betacetylmethadol; (8) Betameprodine; (9) Betamethadol; (10) Betaprodine; (11) Clonitazene; (12) Dextromoramide; (13) Difenoxin; (14) Diampromide; (15) Diethylthiambutene; (16) Dimenoxadol; (17) Dimepheptanol; (18) Dimethylthiambutene; (19) Dioxaphetyl butyrate; (20) Dipipanone; (21) Ethylmethylthiambutene; (22) Etonitazene; (23) Etoxeridine; (24) Furethidine; -
Separation, Quantification and Control of Enatiomers of the Key Starting Material of Dextromethorphan Hydrobromide
Journal of Applied Pharmaceutical Science Vol. 8(08), pp 032-038, August, 2018 Available online at http://www.japsonline.com DOI: 10.7324/JAPS.2018.8805 ISSN 2231-3354 Separation, Quantification and Control of Enatiomers of the Key Starting Material of Dextromethorphan Hydrobromide Ajit Anerao*, Vishal Solase, Amol More, Nitin Pradhan R&D Centre (API), Wanbury Ltd., EL-16, TTC Industrial Estate, Mahape, Navi Mumbai 400710, India. ARTICLE INFO ABSTRACT Article history: Objective: Enantiomeric resolution of racemic 1-(4-Methoxybenzyl)-1,2,3,4,5,6,7,8-octahydroisoquinoline, a key Received on: 16/05/2018 starting material in the synthesis of the antitussive agent dextromethorphan hydrobromide. Material and method: Accepted on: 11/07/2018 Chiral liquid chromatographic method is developed and enantiomers are resolved on a Chiralpak ID-3 column using Available online: 31/08/2018 gradient mode of elution. Mobile phase A and B containing a mixture of 0.1% diethylamine in acetonitrile and 0.1% diethylamine in methanol respectively are optimized with the timed programme. The flow rate is 1.0 mL/minute and the column temperature was maintained at 40°C. Ultraviolet detection was performed at 280 nm wavelength and Key words: the injection volume was 20 μL. Results: The resolution between the enantiomers is found to be more than 2.5. The HPLC; chiral purity; developed method is extensively validated and proved to be robust. The limit of detection and limit of quantification dextromethorphan; of unwanted (R)-enantiomer is found to be 0.0075% and 0.025% with respect to test concentration, respectively. The development; validation.