DOCSLIB.ORG

Opioids Analgesics Consumption in Spain

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Opioids Analgesics Consumption in Spain Marta Molina, Noelia Llorens y Begoña Brime Government Delegation for the National Plan on Drugs Ministry of Health, Consumption and Social Welfare Opioids Lisbon, May 2019 28th, analgesics consumption in Spain Spanish Observatory on Drugs and Addictions National Consumption 01 DDD (Defined daily dose) per 1000 inhabitants per day 20 18 16 14 12 10 8 6 4 2 0 2010 2011 2012 2013 2014 2015 2016 2017 Opioids dihydrocodeine, morphine, hydromorphone, oxycodone Pethidine, fentanyl Dextropropoxyphene Pentazocine Buprenorphine dihydrocodeine or tramadol with non-opioid analgesics Tramadol, tilidine, dezocine, meptazinol and tapentadol Surveys National Consumption 02 Consumption prevalence. 15-64 years old population. Lifetime prevalence for analgesic opioids: 14.5% 0,5 1,3 1,4 1,5 1,6 Consumption prevalence (%) by sex 1,9 2,2 3,4 14,7 Last month 2,3 69,2 7,4 Last year 5,9 35,5 16,0 Lifetime 13,1 Hydromorphone Methadone Buprenorphine Pethidine Tapentadol Fentanyl Women Men Oxycodone Morphine Tramadol Dihydrocodeine Consumption characteristics 03 Last year consumption prevalence. 15-64 years old population would you dare to obtain them illegally No 98,2 Yes 1,8 Use with or without other 6,9 drugs 3,2 2,1 87,8 Opioids analgesics with alcohol Opioids analgesics with illegal drugs Opioids analgesics with alcohol and illegal drugs Opioids analgesics Consumption characteristics 04 Last year consumption prevalence. 15-64 years old population Reasons for using OA 1,3 0,5 10,0 Exact dose and timing Less time 15,0 Less dose Increased dose More time To counteract other drugs To get high 1,0 0,7 57,4 2,6 3,0 7,7 15,8 11,1 Acute pain After surgery Chronic pain To treat my pain because other medicines did not work To overcome the effects of other drugs OST 74,0 Ways of using OA Consumption 05 Doctor's prescription characteristics Last year consumption prevalence. 15- 64 years old population 98.3% OA availability 98,3 1,7 0.0% 1.7% Pharmacy without a doctor's prescription Friend or family Other ways Drug dealer Fake doctor's prescription Internet Other indicators Fentanyl 06 Number of people in DRD, TDI and Emergency rooms Treatment (45,788 number of people admitted to treatment) 70 66 Emergency rooms Mortality 44 28 25 19 20 15 12 8 6 5 6 6 2 1 4 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 * 2017 are preliminary figures Tramadol 07 Number of people in DRD, TDI and Emergency rooms Mortality 58 Treatment (45,788 number of people admitted to treatment) Emergency rooms 43 40 39 34 24 22 28 27 24 24 12 19 10 2 9 2009 2010 2011 2012 2013 2014 2015 2016 2016 Opioids analgesics Morphine, Fentanil, Pethidine, Tramadol, Buprenorphine, Dihydrocodeine, 08 Number of people in DRD, TDI and Emergency rooms Dextromethorphan, Hydromorphone, Oxycodone, Tapentadol Main Drug (treatment) Secondary drug (treatment) Emergency rooms Mortality (45,788 number of people admitted to treatment) 217 223 204 212 198 195 194 190 192 167 167 163 157 182 147 136 122 127 163 115 153 151 144 106 98 144 82 88 122 122 116 73 76 113 107 64 62 62 55 13459 53 138 98 59 50 46 44 76 75 54 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 * 2017 are preliminary figures Marta Molina, Noelia Llorens y Begoña Brime Government Delegation for the National Plan on Drugs Ministry of Health, Consumption and Social Welfare Lisbon, May 2019 28th, Thank you Spanish Observatory on Drugs and Addictions.
Load more

Recommended publications
  • Dezocine Exhibits Antihypersensitivity Activities in Neuropathy Through
    www.nature.com/scientificreports OPEN Dezocine exhibits antihypersensitivity activities in neuropathy through spinal Received: 09 November 2016 Accepted: 19 January 2017 μ-opioid receptor activation and Published: 23 February 2017 norepinephrine reuptake inhibition Yong-Xiang Wang1, Xiao-Fang Mao1, Teng-Fei Li1, Nian Gong1 & Ma-Zhong Zhang2 Dezocine is the number one opioid painkiller prescribed and sold in China, occupying 44% of the nation’s opioid analgesics market today and far ahead of the gold-standard morphine. We discovered the mechanisms underlying dezocine antihypersensitivity activity and assessed their implications to antihypersensitivity tolerance. Dezocine, given subcutaneously in spinal nerve-ligated neuropathic rats, time- and dose-dependently produced mechanical antiallodynia and thermal antihyperalgesia, significantly increased ipsilateral spinal norepinephrine and serotonin levels, and induced less antiallodynic tolerance than morphine. Its mechanical antiallodynia was partially (40% or 60%) and completely (100%) attenuated by spinal μ-opioid receptor (MOR) antagonism or norepinephrine depletion/α2-adrenoceptor antagonism and combined antagonism of MORs and α2-adenoceptors, respectively. In contrast, antagonism of spinal κ-opioid receptors (KORs) and δ-opioid receptors (DORs) or depletion of spinal serotonin did not significantly alter dezocine antiallodynia. In addition, dezocine- delayed antiallodynic tolerance was accelerated by spinal norepinephrine depletion/α2-adenoceptor antagonism. Thus dezocine produces antihypersensitivity activity through spinal MOR activation and norepinephrine reuptake inhibition (NRI), but apparently not through spinal KOR and DOR activation, serotonin reuptake inhibition or other mechanisms. Our findings reclassify dezocine as the first analgesic of the recently proposed MOR-NRI, and reveal its potential as an alternative to as well as concurrent use with morphine in treating pain.
    [Show full text]
  • A Review of Unique Opioids and Their Conversions
    A Review of Unique Opioids and Their Conversions Jacqueline Cleary, PharmD, BCACP Assistant Professor Albany College of Pharmacy and Health Sciences Adjunct Professor SAGE College of Nursing DISCLOSURES • Kaleo • Remitigate, LLC OBJECTIVES • Compare and contrast unique pharmacotherapy options for the treatment of chronic pain including: methadone, buprenoprhine, tapentadol, and tramadol • Select methadone, buprenorphine, tapentadol, or tramadol based on patient specific factors • Apply appropriate opioid conversion strategies to unique opioids • Understand opioid overdose risk surrounding opioid conversions and the use of unique opioids UNIQUE OPIOIDS METHADONE, BUPRENORPHINE, TRAMADOL, TAPENTADOL METHADONE My favorite drug because….? METHADONE- INDICATIONS • FDA labeled indications – (1) chronic pain (2) detoxification Oral soluble tablets for suspension NOT indicated for chronic pain treatment • Initial inpatient detoxification of opioids by a licensed trained provider with methadone and supportive care is appropriate • Methadone maintenance provider must have special credentialing and training as required by state Outpatient prescription must be for pain ONLY and say “for pain” on RX • Continuation of methadone maintenance from outside provider while patient is inpatient for another condition is appropriate http://cdn.atforum.com/wp-content/uploads/SAMHSA-2015-Guidelines-for-OTPs.pdf MECHANISM OF ACTION • Potent µ-opioid agonist • NMDA receptor antagonist • Norepinephrine reuptake inhibitor • Serotonin reuptake inhibitor ADVERSE EVENTS
    [Show full text]
  • Recommendations for Prescribing Analgesia on Discharge Following Surgery Or Acute Injury Information for Health Practitioners Preparing the Patient for Discharge
    Recommendations for prescribing analgesia on discharge following surgery or acute injury Information for health practitioners preparing the patient for discharge better health * better care * better value This booklet ‘Recommendations for prescribing analgesia on discharge following surgery or acute injury: Information for health practitioners preparing the patient for discharge’ is designed to be used in conjunction with the patient booklet titled ‘Pain relief medications following surgery and injury: Information for patients preparing for discharge’. Developed by the Analgesia Management Working Group (AMWG) and made available by the Western Australian Medication Safety Group (WAMSG). For more information on the WAMSG or this booklet go to website www.watag.org.au/wamsg Disclaimer: The information contained in this brochure has been produced as a guide only. It is not intended to be comprehensive and does not take the place of professional medical advice from your doctor, nurse or pharmacist. Contents Background 2 Recommendations for prescribing post-operative analgesia for pain following an acute injury or surgery 4 Precautions when prescribing opioids with other medications 6 Recommendations for prescribing discharge analgesia for pain following an acute injury or surgery 8 Paracetamol 8 Non-Steroidal Anti-inflammatory Drugs (NSAIDs) 8 Opioids 8 Communication to the primary care provider 10 Communication with the patient 10 Appendix 1 – Post-operative and post-intervention analgesia discharge checklist 11 Appendix 2 – Discharge analgesic plan 13 References 14 Recommendations for prescribing analgesia on discharge following surgery or acute injury | 1 Background The WA Medication Safety Group (WAMSG) has identified analgesia management post- surgery or acute injury (specifically managing and ceasing opioids), in the transition period from hospital to home, as a priority safety issue for patients and the community.
    [Show full text]
  • Supplemental Information
    REVIEW ARTICLE Supplemental Information SEARCH STRATEGIES 7. exp Congenital Abnormalities/ or remifentanil or sufentanil or 8. (defect or cleft or heart defect tapentadol or tramadol or heroin Database: Ovid MEDLINE(R) In- or nalmefene or naloxone or Process and Other Nonindexed or gastroschisis or cryptorchidism or atresia or congenital or clubfoot naltrexone).mp. Citations and Ovid MEDLINE(R), or renal or craniosynostosis or 4. 1 or 2 or 3 1946 to Present hypospadias or malformation or 5. exp pregnancy/or exp pregnancy spina bifida or neural tube defect). outcome/ mp. 1. exp Analgesics, Opioid/ 6. exp teratogenic agent/ 9. 5 or 6 or 7 or 8 2. (opioid* or opiate*).mp. 7. exp congenital disorder/ 10. 4 and 9 3. (alfentanil or alphaprodine or 11. Limit 10 to (English language and 8. (defect or cleft or heart defect buprenorphine or butorphanol humans) or gastroschisis or cryptorchidism or codeine or dezocine or or atresia or congenital or clubfoot dihydrocodeine or fentanyl or Database: Ovid Embase, 1988– or renal or craniosynostosis or hydrocodone or hydromorphone 2016, Week 7 hypospadias or malformation or or levomethadyl or levorphanol spina bifida or neural tube defect). or meperidine or methadone or mp. 1. exp opiate/ morphine or nalbuphine or opium 9. 5 or 6 or 7 or 8 or oxycodone or oxymorphone 2. (opioid* or opiate*).mp. or pentazocine or propoxyphene 10. 4 and 9 3. (alfentanil or alphaprodine or or remifentanil or sufentanil or buprenorphine or butorphanol 11. Limit 10 to (human and English tapentadol or tramadol or heroin or codeine or dezocine or language and (article or book or or nalmefene or naloxone or book series or conference paper dihydrocodeine or fentanyl or “ ” naltrexone).mp.
    [Show full text]
  • VHA/Dod CLINICAL PRACTICE GUIDELINE for the MANAGEMENT of POSTOPERATIVE PAIN
    VHA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF POSTOPERATIVE PAIN Veterans Health Administration Department of Defense Prepared by: THE MANAGEMENT OF POSTOPERATIVE PAIN Working Group with support from: The Office of Performance and Quality, VHA, Washington, DC & Quality Management Directorate, United States Army MEDCOM VERSION 1.2 JULY 2001/ UPDATE MAY 2002 VHA/DOD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF POSTOPERATIVE PAIN TABLE OF CONTENTS Version 1.2 Version 1.2 VHA/DoD Clinical Practice Guideline for the Management of Postoperative Pain TABLE OF CONTENTS INTRODUCTION A. ALGORITHM & ANNOTATIONS • Preoperative Pain Management.....................................................................................................1 • Postoperative Pain Management ...................................................................................................2 B. PAIN ASSESSMENT C. SITE-SPECIFIC PAIN MANAGEMENT • Summary Table: Site-Specific Pain Management Interventions ................................................1 • Head and Neck Surgery..................................................................................................................3 - Ophthalmic Surgery - Craniotomies Surgery - Radical Neck Surgery - Oral-maxillofacial • Thorax (Non-cardiac) Surgery.......................................................................................................9 - Thoracotomy - Mastectomy - Thoracoscopy • Thorax (Cardiac) Surgery............................................................................................................16
    [Show full text]
  • Codeine: the Facts Suzanne Nielsen Bpharm Phd MPS Codeine: Overview 1
    Codeine: The facts Suzanne Nielsen BPharm PhD MPS Codeine: overview 1. Codeine use in Australia 2. Characteristics of codeine dependence 3. Identifying codeine dependence 4. Treatment approaches (focus on primary care) 2 Codeine use in Australia Codeine (OTC) Tramadol Tapentadol Dextropropoxyphene Codeine (prescription) Oxycodone Morphine Methadone Hydromorphone Fentanyl Buprenorphine 0 5 10 15 20 Million packs Opioid pack sales (in millions) from: Degenhardt, Gisev, Cama, Nielsen, Larance and Bruno. The extent and predictors of pharmaceutical opioid utilisation in Australia. Pharmacoepidemiology and Drug Safety. (2016) 3 Codeine use in Australia • > 15 million packs OTC and 12 million prescribed • Highest codeine use in remote areas and low income areas 4 Codeine as an analgesic • Weak mu-opioid agonist • Analgesic effect predominantly through its metabolism to morphine via CYP2D6 enzyme • Considerable variable in metabolism between individuals (from poor to ultra-rapid metabolism) • Ultra-rapid metabolism opioid toxicity • Poor metabolism no analgesic effect Kirchheiner J et al. Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplication.Pharmacogenomics J. 2007 5 Codeine-related harm • Codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009 • Trebling of non-OST drug treatment presentations fpr codeine between 2002-2011 • Among people entering methadone and buprenorphine increasing numbers report codeine as the main drug • 2014 – 2.7% of cases (1287 people) • 2015 – 3.5% of cases (1676 people) • 2016 – 4.6% of cases (1562 people*) * missing data from Vic and ACT means actual number likely to be higher (>2000) Roxburgh et al (2015). Medical Journal of Australia.
    [Show full text]
  • Measures and CDS for Safer Opioid Prescribing: a Literature Review
    Measures and CDS for Safer Opioid Prescribing: A Literature Review Measures and CDS for Safer Opioid Prescribing: A Literature Review Executive Summary The U.S. opioid epidemic continues to pose significant challenges for patients, families, clinicians, and public health policy. Opioids are responsible for an estimated 315,000 deaths (from 1999 to 2016) and have caused 115 deaths per day.1 In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic a public health crisis.2 The total economic burden of opioid abuse in the United States has been estimated to be $78.5 billion per year.3 Although providing care for chronic opioid users is important, equally vital are efforts to prevent so-called opioid-naïve patients (patients with no history of opioid use) from developing regular opioid use, misuse, or abuse. However, much remains unclear regarding what role clinician prescribing habits play and what duration or dose of opioids may safely be prescribed without promoting long-term use.4,5 In 2013, ECRI Institute convened the Partnership for Health IT Patient Safety, and its component, single-topic-focused workgroups followed. For this subject, the Electronic Health Record Association (EHRA): Measures and Clinical Decision Support (CDS) for Safer Opioid Prescribing workgroup included members from the Healthcare Information and Management Systems Society (HIMSS) EHRA and the Partnership team. The project was oriented towards exploring methods to enable a synergistic cycle of performance measurement and identifying electronic health record (EHR)/health information technology (IT)–enabled approaches to support healthcare organizations’ ability to assess and measure opioid prescribing.
    [Show full text]
  • Original Article Preoperative Intravenous Administration Of
    Int J Clin Exp Med 2016;9(9):18451-18457 www.ijcem.com /ISSN:1940-5901/IJCEM0016462 Original Article Preoperative intravenous administration of dezocine for cesarean section under epidural anesthesia: effects on maternal well-being and neonatal outcome Keqiang He, Jianhui Pan, Liguo Hu, Ruiting Wang, Ling Hu Department of Anesthesia, Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China Received September 19, 2015; Accepted January 21, 2016; Epub September 15, 2016; Published September 30, 2016 Abstract: We evaluated the efficacy and safety of preoperative intravenous administration of dezocine for comfort- able birth by cesarean section under epidural anesthesia. Sixty primigravida women with full-term singletons un- derwent elective cesarean section, and were randomly divided into three groups. Patients in groups A and B were intravenously injected with 5 and 10 mg of dezocine, 10 min before skin incision, whereas patients in group C were intravenously injected with saline. We recorded data on visceral traction responses and intraoperative adverse reactions, such as nausea and vomiting. While the neonate was being delivered, the umbilical arterial and venous blood gas values were determined. The Apgar scores at 1, 5, and 10 min after delivery, as well as the Neurologic Adaptive and Capacity Score (NACS) at 15 min, 2 h, and 24 h, were recorded. The “fineness rate” required to relieve the traction reaction in group B was higher than that in group C (P < 0.05). The intraoperative Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores of groups A and B were lower than that of group C, and the time period that the intraoperative MOAA/S score was ≤ 4 points was longer in group B (P < 0.05).
    [Show full text]
  • Global Addiction & EUROPAD Joint Conference Diversion, Misuse and Trafficking of Methadone and Buprenorphine Dart RC
    Diversion, misuse and trafficking of methadone and buprenorphine Global Addiction Conference Richard C. Dart, MD, PhD Professor, University of Colorado Prescription Opioid Deaths are Rising Internationally United Kingdom Drug Related Deaths 2001 - 2011 Source: RADARS® System, Denver Health and Hospitals What is the RADARS® System? • History – 2006, Denver Health and Hospital Authority (DHHA) – Multiple pharmaceutical subscribers – Independent program – Denver Public Safety Net Hospital for 150 years – State sanctioned independent authority • Conflict of Interest Statement – None, other than running system for DHHA as noted above. 3 RADARS System Scientific Advisory Board Principal Investigators Substance Abuse Experts • Theodore J. Cicero, PhD • Herbert D. Kleber, MD Washington University at St. Louis Columbia University • Richard C. Dart, MD, PhD • Sidney Schnoll, MD, PhD Denver Health and Hospital Authority Pinney Associates • Hilary Surratt, PhD • George E. Woody, MD Nova Southeastern University University of Pennsylvania • Mark W. Parrino, MPA Epidemiology/Biostatistics American Association for the • Edgar Adams, ScD Treatment of Opioid Dependence Covance Law Enforcement • Nabarun Dasgupta, MPH • John Burke Founder – Epidemico National Association of Drug Diversion Investigators • Alvaro Muñoz, PhD Johns Hopkins University 4 Challenges of Prescription Drug Abuse Surveillance • Clandestine behavior • Geographical variability • Changes rapidly • Multiple age groups • Product specificity – 15 active pharmaceutial ingredients (API) •
    [Show full text]
  • The Cardiovascular Actions of Mu and Kappa Opioid Agonists In
    THE CARDIOVASCULAR ACTIONS OF MU AND KAPPA OPIOID AGONISTS IN VIVO AND IN VITRO. By Abimbola T. Omoniyi, BSc (Hons) A thesis submitted in accordance with the requirements of the University of Surrey for the Degree of Doctor of Philosophy. Department of Pharmacology, September 1998. Cornell University Medical College, New York, NY 10021, ProQuest Number: 27733163 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 27733163 Published by ProQuest LLC (2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106 - 1346 ACKNOWLEDGEMENTS I would like to thank God through whom all things are made possible. Many thanks to Dr. Hazel Szeto for funding this thesis. Heartfelt gratitude to Dr. Dunli Wu for his support, encouragement and for keeping me sane. I thoroughly enjoyed the funny stories, the relentless Viagra jokes and endless tales of the Chinese revolution! Thanks to Dr. Yi Soong for all her support and generous assistance and all that food! Thanks to Dr. Ian Kitchen and Dr. Susanna Hourani for making this a successful collaborative degree. Thanks to my family for all their support and belief in me.
    [Show full text]
  • PALEXIA IR Immediate Release Tablets
    PALEXIA® IR immediate release tablets Tapentadol (as hydrochloride) (Ta-pen-ta-dol) Consumer Medicine Information (CMI) WARNING Limitations of use PALEXIA® IR should only be used when your doctor decides that other treatment options are not able to effectively manage your pain or you cannot tolerate them. Hazardous and harmful use PALEXIA® IR poses risks of abuse, misuse and addiction which can lead to overdose and death. Your doctor will monitor you regularly during treatment. Life threatening respiratory depression PALEXIA® IR can cause life-threatening or fatal breathing problems (slow, shallow, unusual or no breathing), even when used as recommended. These problems can occur at any time during use, but the risk is higher when first starting PALEXIA® IR and after a dose increase, if you are older, or have an existing problem with your lungs. Your doctor will monitor you and change the dose as appropriate. Use of other medicines while using PALEXIA® IR Using PALEXIA® IR with other medicines that can make you feel drowsy such as sleeping tablets (e.g. benzodiazepines), other pain relievers, antihistamines, antidepressants, antipsychotics, gabapentinoids (e.g. gabapentin and pregabalin), cannabis and alcohol may result in severe drowsiness, decreased awareness, breathing problems, coma and death. Your doctor will minimise the dose and duration of use; and monitor you for signs and symptoms of breathing difficulties and sedation. You must not drink alcohol while using PALEXIA® IR. ® What is in this leaflet Keep this leaflet with the PALEXIA IR has been medicine. You may need to read prescribed for you. it again. This leaflet answers some common questions about Before you take ® ® PALEXIA IR.
    [Show full text]
  • Drug and Medication Classification Schedule
    KENTUCKY HORSE RACING COMMISSION UNIFORM DRUG, MEDICATION, AND SUBSTANCE CLASSIFICATION SCHEDULE KHRC 8-020-1 (11/2018) Class A drugs, medications, and substances are those (1) that have the highest potential to influence performance in the equine athlete, regardless of their approval by the United States Food and Drug Administration, or (2) that lack approval by the United States Food and Drug Administration but have pharmacologic effects similar to certain Class B drugs, medications, or substances that are approved by the United States Food and Drug Administration. Acecarbromal Bolasterone Cimaterol Divalproex Fluanisone Acetophenazine Boldione Citalopram Dixyrazine Fludiazepam Adinazolam Brimondine Cllibucaine Donepezil Flunitrazepam Alcuronium Bromazepam Clobazam Dopamine Fluopromazine Alfentanil Bromfenac Clocapramine Doxacurium Fluoresone Almotriptan Bromisovalum Clomethiazole Doxapram Fluoxetine Alphaprodine Bromocriptine Clomipramine Doxazosin Flupenthixol Alpidem Bromperidol Clonazepam Doxefazepam Flupirtine Alprazolam Brotizolam Clorazepate Doxepin Flurazepam Alprenolol Bufexamac Clormecaine Droperidol Fluspirilene Althesin Bupivacaine Clostebol Duloxetine Flutoprazepam Aminorex Buprenorphine Clothiapine Eletriptan Fluvoxamine Amisulpride Buspirone Clotiazepam Enalapril Formebolone Amitriptyline Bupropion Cloxazolam Enciprazine Fosinopril Amobarbital Butabartital Clozapine Endorphins Furzabol Amoxapine Butacaine Cobratoxin Enkephalins Galantamine Amperozide Butalbital Cocaine Ephedrine Gallamine Amphetamine Butanilicaine Codeine
    [Show full text]