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.

Methadone: New CRC Report Dispels Some Myths about Addiction Treatment

Last modified: July 29, 2013 07:20:46 AM

For those who help rehabilitate heroin addicts or are the friends and relatives of an opiate addict who has decided to attempt treatment or is currently in a treatment program, there has been some encouraging news from the medical community dispelling some myths about the use of methadone as a therapeutic tool.

According to doctors and experts at a methadone treatment center in the U.S., the Centers for Disease Control and Prevention in the U.S. have been noting and recording a decrease in the number of methadone overdose deaths.  Their report also dispels the myths and negativity that come part and parcel with the use of methadone as a treatment for heroin (or any other opiate) addiction.

Research, which has been done continuously on the subject for over 60 years, shows that the use of methadone can be effective in treating opiate addiction.  New medications such as suboxone are also looking like they may be effective tools in addiction treatment.  The CDC report emphasizes that almost all the deaths caused by methadone overdose were due to its use by chronic pain sufferers as a painkiller, not due to its use to treat those addicted to heroin.  Methadone use in an addiction clinic is strictly regulated in most areas, and almost impossible for an addict to abuse as access is also severely restricted, administered only by highly qualified doctors and nurses.

The report does show some evidence that methadone treatment can work  and former heroin addicts who take methadone will not go back to the illegal street drugs.  The report offers shows that addicts can go back to a fulfilling lifestyle with employment, reuniting with friends and family, and much improved physical and mental health.

The CDC report also gives evidence that methadone treatment is not simply substituting one drug for another.  Methadone is a prescription medication administered by doctors for therapeutic uses and the improvement of health.  One can become physically dependent on methadone after a period of prolonged use; it does not provide the “highs” characteristic of opiates.  It also does not cause addiction, nor does it cause the characteristic behaviors associated with opiate addiction.

Mark Jorrisch, M.D. and Cary Kaplin, MRC, LCAC from the Methadone and Opiate Rehabilitation and Education Center of Kentucky further state in a letter to the Louisville Courier-Journal that while they do not want to give the impression that methadone use in inexperienced hands is safe, methadone can work as one of the many tools to manage addiction and has been helping heroin addicts recover in treatment centers for over sixty years.  The CDC’s report should dispel some of the public misconceptions surrounding the use of methadone in the battle against opiate addiction.

Drug and Alcohol Addiction: The Enabler

Last modified: July 29, 2013 07:23:39 AM

Drug addiction and alcohol addiction not only hurt those addicted, they hurt the addicts’ families and friends in ways that can be completely devastating emotionally, mentally, and financially.  The people who get hurt the most are often those who are closest to and love the addict unconditionally, and end up enabling the addict’s substance abuse rather than risk their anger or displeasure.

An enabler is someone who is in denial about the addict’s problem and unreasonably hopes that the problem will somehow just go away.  An addict makes an enormous amount of demands on their enabler and feels entitled to expect the enabler to drop everything to “help them out” one last time; however the demands and neediness are limitless and endless.  The enabler will always give way in order not to anger their loved one who is an addict or lose their love.  The manipulation is constant and grows with the addiction; the enabler, by constantly agreeing or doing what the addict wants, only sweeps the problem under the rug; the increasing denial goes hand-in-hand with the increasing substance abuse of the addict.  An enabler often has just as many emotional and mental problems as the addict, and the addict cannot recover if an enabler refuses to deal with his or her own issues with co-dependency.

Enablers lie, provide alibis, complete tasks, make excuses and will cover up for an addict so that the addict needn’t take responsibility and suffer the consequences of his or her actions.  Enablers rationalize the substance abuse, coming up with reasons why the drug or alcohol abuse is understandable or even acceptable.  “But no one has given him a chance in life” or “well, he’s had hard times,” or “she’s just ended a long relationship and needs a crutch to get through the day” are common refrains heard from enablers who refuse to see the seriousness of the abuse.  Enablers will also give addicts untold sums of money to feed the addiction so that the enabler doesn’t suffer the addict’s ire.  Enablers will go so far as to get loans for the addict and can get into crippling amounts of debt rather than lose the addict’s love.

Enablers withdraw from the addict emotionally or even physically, avoiding contact, hoping that this may encourage the addict to stop his or her destructive behaviour.  Enablers will also blame and get upset with the addict for the failure to stop the substance abuse.  An enabler will try to control and be responsible for the addict, who they themselves have made irresponsible by making excuses , etc., for them, by attempting to cut the supply, limiting it, or throwing it out.

Enablers also threaten that the addict will suffer the consequences of his or her actions, but never follow through and continue the enabling behaviour, further feeding the addict’s problems.

The enabler is addicted to rescuing the addict; both will deny that there is a problem and both parties will sink deeper and deeper into their destructive habits.  The only way that a person can recover from alcohol or drug addiction is for both parties to get the help they desperately need to deal with their emotional and mental issues.

Doctor Loses License to Prescribe, Retains License to Practice

Last modified: July 24, 2013 01:08:05 AM

How much pain is too much pain? When is it illegal for a physician to give patients prescription to pain relieving medication with high potential for abuse and addiction? These questions were raised in the wake of the raid on a Los Angeles physician’s clinics.

The outcome?

Dr. Andrew Sun may have lost his license to prescribe controlled substances, but no legal charges can be filed against him. The Drug Enforcement Administration released this information in a statement after it raided the office of the Los Angeles County doctor.

Doctor, Doctor, I Am Sick

Dr. Sun, 76, of La Mirada surrendered his license after a search of his clinics in East Los Angeles and home in San Gabriel. The search is a joint effort of the DEA, the California Medical Board, the state’s Department of Healthcare Services, and the Internal Revenue Service. Continue Reading