Oxycodone with Acetaminophen G H - a T a L E K C R I T N a R
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Medications to Treat Opioid Use Disorder Research Report
Research Report Revised Junio 2018 Medications to Treat Opioid Use Disorder Research Report Table of Contents Medications to Treat Opioid Use Disorder Research Report Overview How do medications to treat opioid use disorder work? How effective are medications to treat opioid use disorder? What are misconceptions about maintenance treatment? What is the treatment need versus the diversion risk for opioid use disorder treatment? What is the impact of medication for opioid use disorder treatment on HIV/HCV outcomes? How is opioid use disorder treated in the criminal justice system? Is medication to treat opioid use disorder available in the military? What treatment is available for pregnant mothers and their babies? How much does opioid treatment cost? Is naloxone accessible? References Page 1 Medications to Treat Opioid Use Disorder Research Report Discusses effective medications used to treat opioid use disorders: methadone, buprenorphine, and naltrexone. Overview An estimated 1.4 million people in the United States had a substance use disorder related to prescription opioids in 2019.1 However, only a fraction of people with prescription opioid use disorders receive tailored treatment (22 percent in 2019).1 Overdose deaths involving prescription opioids more than quadrupled from 1999 through 2016 followed by significant declines reported in both 2018 and 2019.2,3 Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy4,5 and increased spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.6 Effective prevention and treatment strategies exist for opioid misuse and use disorder but are highly underutilized across the United States. -
The Opioid Epidemic: What Labs Have to Do with It?
The Opioid Epidemic: What labs have to do with it? Ewa King, Ph.D. Associate Director of Health RIDOH State Health Laboratories Analysis. Answers. Action. www.aphl.org Overview • Overdose trends • Opioids and their effects • Analytical testing approaches • Toxicology laboratories Analysis. Answers. Action. www.aphl.org Opioid overdose crisis 1 Analysis. Answers. Action. www.aphl.org Opioid overdose crisis 2 Analysis. Answers. Action. www.aphl.org Opiates and Opioids • Opiates vs. Opioids • Opiates: Naturally occurring, derived from the poppy plant • Opioids: “Opiate-like” drugs in effects, not chemical structure Includes opiates • Narcotic analgesics • CNS depressants • DEA Schedule I or II controlled substances • Additive effect with other CNS depressant drugs Analysis. Answers. Action. www.aphl.org Efficacy of Opioids • How do opioids work? • Bind with opioid receptors • Brain, spinal cord, GI tract, and throughout the body • Pain, emotion, breathing, movement, and digestion Opioid Receptor Analysis. Answers. Action. www.aphl.org Effects of Opioids Physiological Psychological • Pain relief • Drowsiness/ sedation • Cough suppression • Mental confusion • GI motility • Loss of memory • Respiratory depression • Lethargy/ apathy • Pupillary constriction • Euphoria/ tranquility • Itching • Mood swings • Constipation • Depression • Dependence • Withdrawal • Dependence Analysis. Answers. Action. www.aphl.org Opiates 1 Opiates • Naturally occurring alkaloids Opium • Latex from the opium poppy plant Codeine: • Mild to moderate pain • Antitussive Morphine: • Severe pain • Metabolite of codeine and heroin Analysis. Answers. Action. www.aphl.org Opiates 2 Semi-synthetic Opiates: • Synthesized from a natural opiate Heroin: • Schedule I narcotic Hydrocodone (Vicodin): • Mild to moderate pain • Metabolizes to hydromorphone (Dilaudid) Oxycodone (Oxycontin/Percocet): • Moderate to severe pain • Metabolizes to oxymorphone (Opana) Analysis. Answers. Action. -
Quantitative Drug Test Menu Section 2
1 Guthrie Square, Sayre, PA 18840 Bill To: Client GMG Toxicology Laboratory Requisition Toll Free Phone (844) 617-4719 Insurance Request Date: _____/______/______ Medical Director: Hani Hojjati, MD Fax (570) 887-4729 Patient PATIENT INFORMATION (PLEASE PRINT IN BLACK INK) INSURANCE BILLING INFORMATION (PLEASE PRINT IN BLACK INK) Pt Last Name First M I PRIMARY Medicare Medicaid Other Ins. Self Spouse Child __ Subscriber Last Name First M Address Birth Date Sex M F Beneficiary/Member # Group # City Pt. SS# or MRN Claims Name and Address City ST ZIP ST ZIP Home Phone (Attach a copy of the patient's insurance card and information) SECONDARY Medicare Medicaid Other Ins. Self Spouse Child Employer Work Phone Subscriber Last Name First M Work Address City ST ZIP Beneficiary/Member # Group # __ CLIENT INFORMATION - REFERRING PHYSICIAN Claims Name and Address City ST ZIP Client Address: (Atttach a copy of the patient's insurance card and information) COLLECTION / REPORTING INFORMATION Copy to: FAX Results to __ CALL Results to Phone: Fax: Date Collected: Time Collected: AM PM Specimen Type: Urine Saliva Other ___________________ Physician Signature (legible - No Stamp) For Lab Use Only (Required for Medicare & Medicaid patient orders) Signed ABN Obtained Place Lab Label Here Contact Laboratory Medical Director (570-887-4719) with questions concerning medical necessity PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test thelaboratory will bill. The physician also understands he or she is required NOTICE to (1) submit ICD-10 diagnosis supported in the patient's medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN. -
Recommended Methods for the Identification and Analysis of Fentanyl and Its Analogues in Biological Specimens
Recommended methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Recommended Methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES UNITED NATIONS Vienna, 2017 Note Operating and experimental conditions are reproduced from the original reference materials, including unpublished methods, validated and used in selected national laboratories as per the list of references. A number of alternative conditions and substitution of named commercial products may provide comparable results in many cases. However, any modification has to be validated before it is integrated into laboratory routines. ST/NAR/53 Original language: English © United Nations, November 2017. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. Mention of names of firms and commercial products does not imply the endorse- ment of the United Nations. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Acknowledgements The Laboratory and Scientific Section of the UNODC (LSS, headed by Dr. Justice Tettey) wishes to express its appreciation and thanks to Dr. Barry Logan, Center for Forensic Science Research and Education, at the Fredric Rieders Family Founda- tion and NMS Labs, United States; Amanda L.A. -
Drug Fact Sheet: Oxycodone
Oxycodone WHAT IS OXYCODONE? What is its effect on the mind? Oxycodone is a semi-synthetic narcotic analgesic Euphoria and feelings of relaxation are the most and historically has been a popular drug of abuse common effects of oxycodone on the brain, which among the narcotic abusing population. explains its high potential for abuse. WHAT IS ITS ORIGIN? What is its effect on the body? Oxycodone is synthesized from thebaine, a Physiological effects of oxycodone include: constituent of the poppy plant. • Pain relief, sedation, respiratory depression, constipation, papillary constriction, and cough What are common street names? suppression. Extended or chronic use of oxycodone Common street names include: containing acetaminophen may cause severe liver • Hillbilly Heroin, Kicker, OC, Ox, Roxy, Perc, and Oxy damage What does it look like? What are its overdose effects? Oxycodone is marketed alone as OxyContin® in Overdose effects include: 10, 20, 40 and 80 mg extended-release tablets • Extreme drowsiness, muscle weakness, confusion, cold and other immediate-release capsules like 5 and clammy skin, pinpoint pupils, shallow breathing, mg OxyIR®. It is also marketed in combination slow heart rate, fainting, coma, and possible death products with aspirin such as Percodan® or acetaminophen such as Roxicet®. Which drugs cause similar effects? Drugs that cause similar effects to Oxycodone How is it abused? include: Oxycodone is abused orally or intravenously. • Opium, codeine, heroin, methadone, hydrocodone, The tablets are crushed and sniffed or dissolved fentanyl, and morphine in water and injected. Others heat a tablet that has been placed on a piece of foil then inhale the What is its legal status in the United States? vapors. -
The Opioid Crisis and the Black/African American Population: an Urgent Issue
THE OPIOID CRISIS AND THE BLACK/AFRICAN AMERICAN POPULATION: AN URGENT ISSUE THE OPIOID CRISIS AND THE BLACK/AFRICAN AMERICAN POPULATION: AN URGENT ISSUE U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Office of Behavioral Health Equity Table of Contents Introduction ...................................................................................................................................................... 3 i. Purpose of the Issue Brief ........................................................................................................................ 3 ii. Sources of Information ............................................................................................................................ 4 Opioids in Black/African American Communities: Context .................................................................. 4 i. What Do the National Data Show? ........................................................................................................ 4 ii. Routes to Opioid Misuse and Overdose Deaths: Pain Management, Illicit Drug Use, and Opioid Comorbidities in Black/African American Communities .................................................... 6 iii. Challenges to Prevention, Treatment, and Recovery .......................................................................... 7 Strategies to Address Opioid Misuse and OUD in Black/African American Communities ............ 9 i. Standard Treatment ................................................................................................................................ -
Phencyclidine: an Update
Phencyclidine: An Update U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse and Mental Health Administration Phencyclidine: An Update Editor: Doris H. Clouet, Ph.D. Division of Preclinical Research National Institute on Drug Abuse and New York State Division of Substance Abuse Services NIDA Research Monograph 64 1986 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administratlon National Institute on Drug Abuse 5600 Fishers Lane Rockville, Maryland 20657 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, DC 20402 NIDA Research Monographs are prepared by the research divisions of the National lnstitute on Drug Abuse and published by its Office of Science The primary objective of the series is to provide critical reviews of research problem areas and techniques, the content of state-of-the-art conferences, and integrative research reviews. its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisors MARTIN W. ADLER, Ph.D. SIDNEY COHEN, M.D. Temple University School of Medicine Los Angeles, California Philadelphia, Pennsylvania SYDNEY ARCHER, Ph.D. MARY L. JACOBSON Rensselaer Polytechnic lnstitute National Federation of Parents for Troy, New York Drug Free Youth RICHARD E. BELLEVILLE, Ph.D. Omaha, Nebraska NB Associates, Health Sciences Rockville, Maryland REESE T. JONES, M.D. KARST J. BESTEMAN Langley Porter Neuropsychiatric lnstitute Alcohol and Drug Problems Association San Francisco, California of North America Washington, D.C. DENISE KANDEL, Ph.D GILBERT J. BOTV N, Ph.D. College of Physicians and Surgeons of Cornell University Medical College Columbia University New York, New York New York, New York JOSEPH V. -
The Impact of Cannabis Access Laws on Opioid Prescribing
Journal of Health Economics 69 (2020) 102273 Contents lists available at ScienceDirect Journal of Health Economics j ournal homepage: www.elsevier.com/locate/econbase The impact of cannabis access laws on opioid prescribing a,∗ b c Benjamin J. McMichael , R. Lawrence Van Horn , W. Kip Viscusi a Assistant Professor of Law, University of Alabama School of Law, Box 870382, 101 Paul W. Bryant Drive East, Tuscaloosa, AL, 35487, United States b Associate Professor of Management and Law, Executive Director of Health Affairs, Owen Graduate School of Management, Vanderbilt University, 401 21st Avenue South, Nashville, TN, 37203, United States c University Distinguished Professor of Law, Economics, and Management, Vanderbilt University Law School. 131 21st Avenue South, Nashville, TN, 37203, United States a r a t i c l e i n f o b s t r a c t Article history: While recent research has shown that cannabis access laws can reduce the use of prescrip- Received 5 October 2018 tion opioids, the effect of these laws on opioid use is not well understood for all dimensions Received in revised form 17 July 2019 of use and for the general United States population. Analyzing a dataset of over 1.5 bil- Accepted 7 December 2019 lion individual opioid prescriptions between 2011 and 2018, which were aggregated to the Available online 14 December 2019 individual provider-year level, we find that recreational and medical cannabis access laws reduce the number of morphine milligram equivalents prescribed each year by 11.8 and 4.2 JEL classification: percent, respectively. These laws also reduce the total days’ supply of opioids prescribed, I180 the total number of patients receiving opioids, and the probability a provider prescribes K19 any opioids net of any offsetting effects. -
Drug Plasma Half-Life and Urine Detection Window | January 2019
500 Chipeta Way | Salt Lake City, UT 84108-1221 Phone: (800) 522-2787 | Fax: (801) 583-2712 www.aruplab.com | www.arupconsult.com DRUG PLASMA HALF-LIFE AND URINE DETECTION WINDOW | JANUARY 2019 URINE- PLASMA DRUG, DRUG METABOLITE(S)* COMMON TRADE AND STREET NAMES, NOTES DETECTION HALF-LIFEt WINDOWt STIMULANTS Benzedrine, dexedrine, Adderall, Vyvanse, speed; could be methamphetamine Amphetamine 7–34 hours 1–5 days metabolite; if so, typically < 30 percent of parent Cocaine Coke, crack; parent drug rarely observed due to short half-life 0.7–1.5 hours < 1 day Benzoylecgonine Cocaine metabolite 5.5–7.5 hours 1–2 days Desoxyn, methedrine, Vicks inhaler (D- and L-isomers not resolved; low concentrations Methamphetamine expected if the source is Vicks); selegeline (Atapryl, Carbex, Eldepryl, Zelapar) 6–17 hours 1–5 days metabolite Methylenedioxyamphetamine (MDA) MDA 11–17 hours 1–3 days Methylenedioxyethylamphetamine (MDEA) MDEA, MDE, Eve 6–11 hours 1–3 days Methylenedioxymethamphetamine (MDMA) MDMA, XTC, ecstasy, Molly 6–10 hours 1–3 days Methylphenidate Ritalin, Concerta, Focalin, Metadate, Methylin 1.4–4.2 hours < 1 day Ritalinic acid Methylphenidate metabolite 1.8–2.5 hours < 1 day Phentermine Adipex-P, Lomaira, Qsymia 19–24 hours 1–5 days OPIOIDS Buprenorphine Belbuca, Buprenex, Butrans, Suboxone, Subutex, Sublocade, Zubsolv 26–42 hours 1–7 days Norbuprenorphine, Glucuronides Buprenorphine metabolites 15–150 hours 1–14 days Included in many preparations; morphine metabolite; may be a contaminant if < 2 Codeine 1.9–3.9 hours 1–3 days percent of morphine Fentanyl Actiq, Duragesic, Fentora, Lazanda, Sublimaze, Subsys, Ionsys 3–12 hours 1–3 days Norfentanyl Fentanyl metabolite 9–10 hours 1–3 days Heroin Diacetylmorphine, dope, smack, dust; parent drug not detected. -
Oxycodone Acetaminophen
DETERMINING IF A PRESCRIPTION DRUG ABUSE PROBLEM EXISTS OPIOIDS: Answering “yes” to any of the following questions may indicate a problem with the use of pain medication: What You Need Are you using someone’s else’s prescription? to Know Are you obtaining drugs from an illicit source or by illegal means? Are you no longer using the drugs for the symptoms POSSIBLE CONSEQUENCES OF for which it was originally prescribed? OPIOID MISUSE OR ABUSE Are you lying about or hiding your use? Chronic use of opioids can result in tolerance for the drugs, which means that users must take higher doses Are you obtaining medications from multiple to achieve the same initial effects. Long-term use, if physicians. not taken as prescribed, can lead to physical dependence and addiction — the body adapts to the Have your friends, family members, or co-workers presence of the drug, and withdrawal symptoms occur expressed concern? if use is reduced TIPSor & WARNINGSstopped. Oxycodone Are you preoccupied about your medication, • If you are pregnant or expecting pregnancy, ask and Symptoms of withdrawalif taking oxycodone and acetaminopheninclude will restlessness, muscle focused on the next dose, and concerned about how have any side effects on your baby. and bone pain, insomnia, diarrhea, vomiting,Acetaminophen: cold you will obtain more drugs? Growing Threat of • Tell your doctor if you suffer from kidney (Endocet, Oxycet, Percocet, Magnacet, flashes with goosedisease, bumps liver disease, asthma, ("cold urinary retention, turkey"),Roxicet, Roxilox, and Tylox, Xolox) hypothyroidism, prostate enlargement, epilepsy, Do you fill your prescription sooner than would be involuntary leg movements.seizures, gall bladder disease, Addison’s Finally, disease, taking a large Prescription Drug COMMONsingle SIDE EFFECTSdose OF of an opioida head injury, or a history could of addiction. -
Emerging Drug Trends 2014
EMERGING DRUG TRENDS – 2014 Special Research Report • Regional Organized Crime Information Center Emerging Drug Trends Table of Contents Opioid Abuse .................................................... 2 By ROCIC Publications Specialist Jennifer Adkins Opiate Abuse .................................................... 7 © Regional Organized Crime Information Center Synthetic Cathinones ..................................... 13 ew drugs are emerging at an unprecedented rate as manufacturers Synthetic Cannabinoids ................................. 18 of “legal high” products use new chemicals to replace those that Phenethlyamines ............................................ 22 N Party Pills ...................................................27 are banned. These new chemicals take the place of heroin, morphine, and amphetamines. These drugs are highly accessible, touted as legal, Herbal Drugs ..............................................29 Sources of Information ...............................32 and perceived as safe. This Special Research Report was supported by Grant No. 2011-RS-CX-K007, awarded by the Bureau of Justice Assistance, Office of Justice Programs, U.S. However, despite the popularity in designer drugs and legal high Department of Justice. The Office of Justice Programs also coordinates the activi- ties of the Bureau of Justice Statistics, the National Institute of Justice, the Office of products, the abuse of heroin and prescription painkiller medication Juvenile Justice and Delinquency, and the Office for Victims of Crime. -
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.