Archives for August 2013

Opioid–Induced Neurotoxicity

Last modified: August 10, 2013 12:05:46 PM

Opioid-induced neurotoxicity

Opioid-induced neurotoxicity is when a drug based on the natural or synthetic alkaloid of the opium poppy (Papaver somniferum) becomes poisonous and starts to destroy or damage the nerve tissue of the person who has ingested it.  While neurotoxicity caused by opioid ingestion is rare, it can occur in palliative care situations or in situations where a person is taking prescribed medication for non-medicinal purposes.

Opioid-induced neurotoxicity can occur with any type of opioid; however, it is more likely to occur when the opioid used contains active metabolites which are created when the opioid is processed by the liver.  The kidneys then attempt to excrete the metabolites, but the metabolites may build up due to a decrease in kidney function or dehydration.

Opioid medications that contain these metabolites include meperedine, morphine, codeine, and hydromorphone.

While Oxycodone also contains metabolites, research at the present time has not been able to determine if its specific metabolites can provoke neurotoxicity.  Another common cause of neurotoxicity is a sudden increase in opioid medication to treat symptoms such as breathlessness or pain.

The onset of neurotoxicity can occur a few days after the start of opioid-based treatment or after increasing the medication dose to a level where metabolites can build up.  Things that can increase the likelihood of developing neurotoxicity are dehydration, drugs that work to depress the central nervous system, and infection of any sort.  Symptoms of opioid-induced neurotoxicity syndrome are varied and may occur individually or at the same time; oftentimes the symptoms may be misdiagnosed.  The symptoms can include:

  • Seizures, involuntary muscle twitching and spasms
  • Confusion, disorientation, hallucinations
  • Decrease in consciousness level
  • Hyperalgesia, or a painful reaction to non-painful stimuli
  • Pain becoming generalized all over the body
  • Drowsiness.

Treatment varies due to the cause of the opioid-induced neurotoxicity.  If dehydration is a contributing factor, then intravenous fluid should work to eliminate the neurotoxicity.  If the syndrome is caused by a decrease in kidney function, a reduction in the amount of opioid medicine will usually result in a reversal of the syndrome.  If neurotoxicity occurs because of a sudden, dramatic increase in opioid dosage, reducing the dose or rotating to a different opioid-based medication will resolve the neurotoxicity issue.

Basically, opioid neurotoxicity is managed by re-hydrating a patient and rotating medications:  a patient who had been receiving a regular opioid dose for more than two weeks and has not developed neurotoxicity is unlikely to develop it unless infection, dehydration or reduced kidney function occur.  Opioids should never be discontinued in the treatment of severe pain and shortness of breath, especially for patients in palliative care.

Sid Vicious: The Violent Life of an Addict

Last modified: August 8, 2013 02:59:20 AM

Sid Vicious, punk icon of the 1970’s.

Sid Vicious, born John Simon Ritchie in London, England on May 10, 1957, shot to fame in the mid-to-late 1970’s as the bass player for the leading punk band at the time, the Sex Pistols.  However, what is might be remembered for most today is the fact that his music career disintegrated before his eyes due to his escalating drug abuse which led to the death of his girlfriend Nancy Spungeon in 1979 under violent circumstances and his own death a few months later in 1980.

Vicious, in 1977, was brought into the Sex Pistols by manager Malcolm McLaren as a replacement for bassist Glen Matlock.  Although Vicious couldn’t play bass, (and by most accounts never did learn how to play properly), McLaren thought that his spiky hair, self-destructive tendencies, bad attitude and slovenly appearance would resonate with the masses of disaffected youth that were in the United Kingdom at the time.    The Sex Pistols played fast-paced songs that were short in duration and expressed anger and frustration about the economic and social problems of the time and were already something of a sensation.  However, once Vicious was on board, the band’s popularity simply exploded, especially with the release of “God Save the Queen” in which Queen Elizabeth II was insulted.

The same year that “God Save the Queen” was released, Vicious met Nancy Spungeon and the two, from the moment they met, were never apart.  Vicious’ band mates claim that Spungeon was responsible for Vicious’ rapidly escalating drug abuse; in fact, Spungeon accompanied them on their tour of the United States.  The amount of drugs both Vicious and Spungeon were consuming caused the Sex Pistols to disintegrate, and before even ten shows were performed, the Sex Pistols split up.

Vicious and Spungeon moved to the Chelsea hotel in New York City; Spungeon became his manager and did manage to get him a few shows, however his performance was below even mediocre standards as he was intoxicated with drug cocktails most of the time.  While the pair did try to get clean, they ended up even more addicted than ever, and their existence became dedicated to feeding their drug habits.  Reports say that both were addicted to and actively consuming heroin, barbiturates, a synthetic form of morphine, and other substances.

In a drug induced haze on October 12, 1979, Nancy Spungeon had been found in their Chelsea hotel room, dead from a stab wound to her abdomen, and Vicious was found wandering in the hotel.  He confessed to killing her although he couldn’t remember what had happened.  He was charged with second-degree murder.

Vicious was released on bail a few days later, and attempted to commit suicide.  He got into a fight in a bar, and was put back into prison for seven weeks, during which time he became clean.  He was released on February 1, 1980, and at a party celebrating his release, he overdosed on heroin and was found dead the next morning by his girlfriend.  Originally it was said it was his mother who gave him the fatal dose of drugs as a gift to celebrate his release from jail. However, in 2009  Peter Gravelle finally came clean and said that it was him who handed his friend Sid Vicious, his last half-gram of heroin.

If you or someone you care about is having problems with substance abuse, call a professional medical expert who can help you on the path to sobriety today.

Opiate Addiction and Relapse Prevention

Last modified: September 16, 2013 10:19:41 AM

Relapses occur on the road to addiction recovery

Opiate addiction is a very strong disease and recovery is not something instantaneous; sobriety is a process that has its ups and downs, and relapses are painful bumps in the recovery road that can sometimes occur.  A person who is trying to kick a opiate habit must not get discouraged if a relapse does occur; a relapse does not mean total failure and full recovery is still possible.  As the saying goes, if you fall off the wagon, dust yourself off and get right back on again.

However, this does not mean that relapses are inevitable.  Relapses can be prevented if certain steps are taken and if certain behaviors are changed.  Here is some advice from the famed Mayo Clinic of the U.S. that can help you prevent a relapse.

  1. Do not go into high-risk situations.  If all of your friends happen to be people that you used to take drugs with and are all still using, make new friends who don’t use drugs.  Hanging out with the old crowd will make you susceptible to peer pressure and you might actually feel a physical craving for the drug (dependency).  Similarly, don’t go to places where you used to take drugs and find new, drug-free places to go.  You might miss your old crowd and familiar surroundings, but your health is more important.  Soon you’ll be enjoying your new friends and environment so much, you won’t miss your former pals.  However, do be supportive of former friends who have also given up the habit.
  2. Keep seeing your psychotherapist/ attending meetings.  One of the best ways to prevent a relapse is to stick to your treatment plan and attend regular therapy sessions or AA-style meetings.  While you might feel that you have fully recovered and don’t need any more help, studies show that those who continue their therapy after rehab on a regular basis are far less likely to relapse.
  3. Speak to your doctor or therapist immediately if you feel strong urges to use again.   You may be directed to further treatment to help you deal with your cravings.  If you are prescribed certain medication, make sure you follow the doctor’s orders to the letter; the medication you’ve been given might help suppress cravings.
  4. Contact your doctor or therapist immediately if you do start using the drug again.  Your doctor or therapist may put you back into rehab so that you can get on the right track again.  While a relapse is disappointing, it does not mean that you cannot make a full recovery, so try again; remember that many people have been able to achieve sobriety and lead productive, happy lives after an addiction, but it may have taken them several attempts.