Prolonged Percocet Abuse - Essay Example

Order 117676 Percocet Abuse Percocet is chemically prepared in combination of the narcotic i.e. oxycodone and acetaminophen. They are mixed with a view to fetching a synergistic influence on pain. Oxycodone entails the similar impact in form of effect and addiction. The Acetaminophen is also termed as Tylenol. The brand names of the pills containing such combination are Roxicet and Tylox. Such pills are available under different combinations like 25 mg oxycodone hydrochloride and 325 mg acetaminophen; 5 mg oxycodone hydrochloride and 325 mg acetaminophen; 7.5 mg oxycodone hydrochloride and 500 mg acetaminophen; 10 mg oxycodone hydrochloride and 650 mg acetaminophen. The abusers take the percocet in form of pills that for chewing and snorting after being crushed like cocaine. (Percocet information) The prolonged administering of narcotics particularly for continuous two to three weeks is vulnerable to addiction. Even the reasonable doses of some narcotics gradually lead to the fatal overdose. While enhancing the doses of narcotics, the person may initially feel restless and nauseous and then gradually goes towards loss of consciousness and abnormal breathing. It may also demonstrate withdrawal symptoms that may continue for months together. Sometimes percocet is also mixed with other drugs such as alcohol, antispasmodic drugs like Congentin, Bentyl, Donnatal, tranquilizers like Thorazine and mellaril, narcotic painkillers like Daryon and Demerol, sedatives like Phenobarbital and Seconal, to have enhanced influences. (Percocet information) The prescription of regulated substances at most of the cases appear to be the simplest and most effective method at times while the patient is effected by physical or emotional pain. However, in selected cases this strategy gives rise to the prescription drug abuse and hurt the patients. The concept of right use of medication differs with the different groups of physicians and differing societal beliefs and this makes the detection of prescription drug abuse really difficult. Particular mode of drug use leads to greater risk of harm than benefit. Such adoption manners among others incorporate increased adoption of a substance in absence of consultancy by the physicians, utilization of a substance for other than the definite medical conditions, persistent use of substance irrespective of adverse impacts and persistent efforts to obtain such substances. (Isaacson; Hopper; Alford; Parran, 2005) The real physical dependency on the drug cannot be called as drug abuse. Physical dependence indicates a pharmacologic condition that signifies sudden discontinuance of intake of some substances may give rise to symbolic withdrawal symptoms. Tolerance indicates a condition in that gradually increasing intake of substances is necessitated to have the similar impact. A prolonged treatment of a patient may demonstrate physical dependence or tolerance in form of a biological incident to the medication having no misuse or abuse. To illustrate a patient suffering from metastatic cancer administered with high doses of narcotics for pain relief turns to be physically dependence fetches severe withdrawal symptoms when discontinued suddenly. In such circumstances the patient is required to be convinced about the advantages of the drugs and about the difference between physical dependence and drug abuse. (Isaacson; Hopper; Alford; Parran, 2005) Conversely, there is indication of prescription drug abuse even in absence of any physical dependence on a substance. This circumstance may result while the administering of a substance is continual and still considerably interferes with the function. A substance can also be administered occasionally and in a dose not adequate to generate physical dependence, for reasons different than to take care of a defined medical complicacy. At last it is also significant to recognize that patients may be deterred from taking sufficient doses of a regulated substance for various kinds of reasons and be misinterpreted as having the problem of a drug abuse. The absence of a commonly adopted definition of a prescription drug abuse has given rise to confinements in epidemiologic research. Irrespective of the fact that many groups of medications are vulnerable to be abused physicians are mostly worried about the intentional abuse of prescription regulated substances. Instances of misuse are seen in case of prescription stimulants, sedatives, tranquilizers and analgesics. Prescription analgesics are considered to be most widely adopted prescription psychoactive medications next to tranquilizers, stimulants, and sedatives. A survey conducted by the National Household Survey on Drug Abuse brings out the magnitude of psychoactive medication misuse in the United States. As per the data relating to the year 2003, it has been estimated that about 6.3 million persons in the age group of 12 or more constituting about 2.7 percent of the population had adopted prescription psychotherapeutic medication without following appropriate medical procedure. (Isaacson; Hopper; Alford; Parran, 2005) It is seen that the pain relievers are most common drugs of abuse constituting the vulnerable population of 4.7 million, next to tranquilizers constituting about 1.8 million, stimulants 1.2 million and sedatives 0.3 million. The survey report indicated that more than 9 percent of high school seniors were found to have been used OxyContin, Vicodin, or Percocet during the previous year. In United States it has been found that women are 50 percent more vulnerable to be prescribed a regulated drug. Irrespective of the greater exposure of women to medications of abuse, rates of prescription drug misuse are almost equal for women and men. The survey for the period during 1990 to 1998 indicated that the number of non-medical use of opioid analgesic has enhanced by 181 percent constituting about 1.5 million populations as per the NHSDA. The emergency department attendance as a result of the administering of oxycodone hydrochloride has enhanced by 452 percent affecting 4069 cases during 1994 to 18409 cases during 2001. The trend with regard to tranquilizers is 132 percent, 90 percent for sedatives and 165 percent for stimulants during the same period. The physicians are liable to legal proceedings while recommending the regulated drugs and necessarily familiar with federal and state prescribed rules and regulations. (Isaacson; Hopper; Alford; Parran, 2005) Controlled substances are regarded as drugs having the potentialities for physical dependence, psychological dependence or both. The Food, Drug and Cosmetics Act empower the US Food and Drug Administration -- FDA to authenticated drugs to be safe and effective. The legal basis has been laid down by the Controlled Substances Act of 1970 which prescribes regulations of the use and accessibility to the controlled drugs. It categorized all the controlled drugs and groups under five schedules on the basis of the magnitude of medicinal potency, the prospective abuse, and comparative safety of the drug. Each of the schedules carries different legal prosecutions for illegal use. The Schedule I drugs include the drugs those have no acceptable medical application and are considered illegal other than accepted research applications. The drugs like Heroin, Marijuana, Lysergic Acid Diethylamide, and Mescaline have been grouped as Schedule I drug. The Schedule II, III, IV and V have authorized medical applications and diminishing prospective for abuse. The Schedule II drug includes the substances with confined quantities of regulated substances like acetaminophen with codeine or hydrocodone bitartrate, buprenorphine HCL like Buprenex, Subutex etc. It has been laid down that the Schedule II drugs are to be prescribed with a written prescription for not more than one month and refills are banned without a new prescription from the physician. In cases of Schedule III, IV and V medications as many as five refills are permitted. The Federation of State Medical Boards devises stipulations for state boards with regard to Use of Controlled Substances for the Treatment of Pain that was framed in 1998 and provides as a structure for the use of opioids in the management of chronic pain. (Isaacson; Hopper; Alford; Parran, 2005) The Federal Law entailing the five categorization of the schedules of controlled substances on the basis of the degree of control, the conditions of record the specific order forms and prescriptions necessitated and other controlled necessities all hovering on such classifications. Schedule I drugs have been classified to have high potential for abuse. Such type of drugs has no present medical application in the United States. It is not medically safe for use. The Schedule II drugs are found to be highly vulnerable for abuse. It has present medical applications in the United States. The abuse of such drugs has been seen in forms of severe impacts in form of psychological and physical dependence. The abuse of this drug may give rise to severe physical dependence or high psychological dependence. (Strauss, 2002) The schedule III drugs have the substances that have a potential for abuse but less than those drugs grouped under Schedules I and II. The substance has presently accepted medical application in the United States. The abuse of this drug may give rise to reasonable or low physical dependence or high psychological dependence. The schedule IV drugs are found to be of low potential for abuse in comparison to that of schedule III. This is presently found in the sphere of medical applications in US. The Schedule V drugs are incorporated in this schedule after being traced that the substance has a low vulnerability for abuse in comparison to that of the Schedule IV. This element has only scarce physical or psychological dependence. (Strauss, 2002) Various drugs exist, which are considered vulnerable due to attributes of mind and mood changing. This comes out of the drugs attained legitimately from one or more physicians or illegally from grey markets. It is not certain that drugs attained from the street markets may not have the elements in the proportion that the buyer expects it to be. However, the abusers took the prescription drugs prepared by pharmaceutical companies. When the drugs are taken in a conscious mind then only the user is able to understand the quantity of the dosage. Contrary to that the users of street drugs have no scope to recognize the magnitude of dosages they are taking. Likewise, prescription drugs have no impurities, while the street drugs may contain the different elements mingled with those entailing additional hazards. (Wilson; Kolander, 2003) Opiates are considered to be a significant group of pain control medications. However, any of the opiates like opium, heroin-diacetylmorphine, morphine, hydrocodone, Lortab, Lorcet, meperidine-Demerol, methlmorphine, hydromorphone - Dilaudid, fentanyl analogs, oxymorphone-percodan, oxycodone-OxyContin, Percocet, propoxyphene, etc. are vulnerable to be abused. It is a normal practice that the opiate abusers approach a physician for prescription of opiates and approach several doctors with the same complaint and obtain more doses of opiate for euphoric uses. The opiate intoxication exhibits varied symptoms like analgesia, miosis, facial flushing, itching, warmth, decelerated memory, slurred speech, diminished attention, euphoria or dysphoria, abdominal orgasm-like sensations, constipation, dry mouth, are-flexia, possible perceptual problems like hallucinations or illusions, possible respiratory suppression, hypotension, drowsiness, sedation, possible coma and death. (Doubleday; Albanese; Hubbard, 2002) The opioids are considered to be the most helpful elements for the pain alleviation due to their elementary agonistic influence on the opioidal receptors in the brain and spinal cord. However, the fact of psychological dependence alongwith aberrant drug-seeking attitude has largely confined the utilization of opioids only in administering of that category of the patients of cancer pain and the like. The short acting opioids like hydrocodone- Vicodin, Lortab and oxycodone-Percocet are commonly more abused than the long term opioids like methadone. The long acting opioids however, do not give rise to the central nervous system 'high' that the addict desires. However, at present there is much worry about the abuse potential and euphoric diversion of such agents. This is seen that even in case of the severe pain patients, surveys have revealed that physicians under-prescribe the opioids that involve doses not considered most advantageous, too irregular or for insufficient period of time. (Turk; Gatchel, 2002) The awareness of about the pharmacology of the drug application along with the complicated arena and dynamics of substance abuse is considered necessary for addiction practice. The pharmacology incorporates the pharmaceutics, pharmacokinetics and pharmacodynamics of drug utilization. Various drugs have varied impacts. The drugs like alcohol and sedative, hypnotic and anxiolytic drugs have tremendous influence on the central nervous system and act as depressants. The cocaine, amphetamines, nicotine, and caffeine all act as CNS stimulants. The analgesics like morphine, codeine, meperidine, oxycodone and heroin are categorized as opioids. LSD, PCP, peyote and mescaline are considered as hallucinogens. Marijuana is regarded the most widely abused drug in America. Inhalants, anabolic steroids and designer drugs are also seen to be abused. Presently the Americans made an expenditure of about $70 million per annum on herbal remedies. The addiction practitioners must understand as to the ways to acknowledge the indications of substance abuse particularly the stage of intoxication and withdrawal. (Rasmussen, 2000) The emerging media descriptions and data from the official surveys like National Household Survey on Drug Abuse indicate about an enhanced non-medical application of prescription drugs. It has become high time to examine whether such reports are result of growing medical application of the opioids in relation to the growing applications of opiate analgesics during the period 1990 to 1996. Joranson and his colleague's observed that while there is an increment in the application of opioid analgesics, there is no equi-proportionate increment in the rate of abuse. As a result of this the growing medical application of the opiate analgesics for the medical care of pain did not give rise to an increment in the opiate analgesic abuse. (Lowinson; Ruiz; Millman; Langrod, 2004) However, a survey at a later stage reveals a considerable increment in abuse of hydrocodone and oxycodone products ever since the period stressed upon by Joranson survey. Besides, the proportion of abuse relating to hydrocodone and oxycodone taking into consideration the availability remained comparatively constant from 194 to 1999 and it has depicted a disproportionate increment ever since the year 2000. This has been shown amidst the reports narrating a sharp increase in the fatal injuries relating to the OxyContin related drugs. Its relationship established with the increased methadone abuse and over dose fatalities after more than three decades of comparatively safer clinical use in treatment of opiate addiction has revealed embarrassing situations. The professionals concerned with more OxyContin abuse confronts with the situations of determining whether wide availability of OxyContin and the concerns of abuse and deaths giving rise to prescription of more methadone as pain relievers even without the prior exposure to the opioids. It is also to be found out as to whether the addicts or pain patients, who are actually the people dying from overdose. Whether the pain specialists or addiction experts, those lay emphasis on the prescription of methadone for such patients. (Lowinson; Ruiz; Millman; Langrod, 2004) The cost of heroin addiction has seen to be more severe next only to those of cocaine addiction amidst all the illicit drugs in terms of its high persistency and its linkage to the income generating crime and the spread of infectious diseases. Conversely, the opiate addiction however can fruitfully be taken care of with the help of substitution therapy. This in turn decreases the very urgency of devising a immunotherapy framework in respect of the heroin and the kinds of opiates and opioids those are comparatively more closely intersubstitutable supplementing the diacetylmorphine, monphine, oxycodone, hydrocodone, hydromorphone, meperidine and thefentanil compounds give rise to decrease the value of an immunotherapy aimed at only a single molecule. (Harwood; Myers, 2004) It has become highly essential to take the pain pills to take care of the severe pain occurring from the surgery accidents and some type of sufferings. However, most of the acute pains never continue for more than hours or days. Therefore, the patients require and use the pain pills only for short term. However, the administering of the opiate pain drugs for a longer period of time develops physiological dependence, however this can be taken care of by the physicians by methodologically and gradually withdrawing the patient from the drug use. The threat of addiction mostly come from the intensive misuse of such drugs by the older adults, particularly when those having the past trend of alcoholism. The withdrawal of opiates result in the symptoms of restlessness, dysphoric mood, joint and muscle aches, nausea, vomiting, diarrhea, fever and insomnia. The commonly prescribed opiates are Tylenol, Robitussin AC, Vicoden, Lortab, Demerol, Percodan and Percocet, Darvon and Talwin. (Hazelden; Colleran; Jay, 2002) The misuse of prescription drugs in the last years have warned the National Institute on Drug Abuse -- NIDA in escalating its study in two fields understanding the mechanisms those are inherent in strengthening, addictive and toxic attributes of the drugs and developing medications with less abuse prospective. Marijuana is considered to be the foremost illegitimate drug of abuse in the United States and the non-medical application of prescription medications like the pain relievers, tranquilizers, stimulants and sedatives are grouped under the second category. It is essential to observe the reason of such a high abuse of these medications and the mode of prevention of such abuse. (Kaplan, 2005) As per the recently published observations from the 2003 National Survey on Drug Use and Health, it has been estimated that about 6.3 million people that constitute the 2.7 percent of the population above the age of 12 presently seen to have used the psychotherapeutic drugs non-medically. It has been estimated that about 4.7 million apply pain relievers, 1.8 million apply tranquilizers, 1.2 million apply stimulants and 0.3 million apply sedatives. The radical growth in the application of the opioid painkillers is also a matter of deep concern for NIDA. It has been seen that there is a three fold growth in the abuse of such substances since 1995. The National Survey on Drug Use and Health researchers currently indicated that the number of Americans over the age of 12 years have reported having ever taken a prescription pain medication for recreational use enhanced from 29.6 million in 2002 to 31.2 million in 2003. The pain alleviators with statistically considerable enhancement in lifetime application incorporated such hydrocodone-combination substances as Vicodin, Lortab or Lorcet from 13.1 million to 15.7 million; the oxycodone combination elements like Percocet, Percodan or Tylox has increased from 9.7 million to 10.8 million, hydrocodone from 4.5 million to 5.7 million, etc. The 2003 Monitoring the Future Survey conducted to evaluate extent and perceptions of drug use among 8th, 10th and 12th grade students nationwide indicated that 10.5% of high school seniors had applied Vicodin for euphoric application during recent years and about 4.5% had utilized OxyContin. (Kaplan, 2005) The prescriptions medications like opioid analgesics, benzodiazepines or stimulants generate addiction due to the fact that all of them have a common feature that is they strive to enhance the concentration of dopamine. It has been indicated by Volkow that Methylphenidate-Ritalin, concerta, Metadate enhances the synaptic concentration of dopamine by banning the dopamine transporters. Volkow has been accredited to be the first researchers for using the positron emission tomography to inquire into the nature of acute brain variations in dopamine activity and the functional results of such variations in drug addicted subjects. Such studies have revealed that the part played by dopamine in the rewarding influences of drugs of abuse. The imaging research have indicated that the strengthening influences of drugs of abuse in humans calls upon the considerable and quick enhancement in dopamine that mimic but crosses the intensity and duration influenced by dopamine cell responding to circumstantial events like food, sex, social interaction. Besides, the imaging studies have also recorded an involvement of dopamine in motivation that appears to be encoded by fast as well as smooth dopamine enhancements. As the dopamine cells respond in reaction to the primary stimuli, the supra-physiological activation by drugs is prone to be experienced as considerably significant. It has been explained that dopamine function is remarkably disrupted in drug addicted individuals. There is a decrement in dopamine release and also in case of the dopamine D2 receptors in the striatum. Such a hypodopaminergic condition may give rise to deregulation of reward, motivation and inhibitory regulatory circuits. It has been seen that the possibility of an interaction of dopamine with a receptor is considerably diminished and the possibility of a person who is addicted to perceive a natural reinforcer like food or sex, as euphoric is radically influenced. The addicts may not be convinced for basic natural reinforcers. (Kaplan, 2005) Conversely, an addicted person will be motivated by the drug of abuse considered to be one of the basic variations that ignite the aberrant behavior that is the forcible attitude to administer with the drugs irrespective of the fact that serious consequences occur. NIDA adopted a multi-target approach that is associated with multiple projects. Such strategies incorporate improving medications to address the problem of addiction to opioid analgesics, improving the medications that can address the pain but have no abusive prospect and convincing the public and health care professionals about prescription drug abuse. NIDA has introduced an educational campaign to warn people and health care personnel on the most regularly abused drugs that have the prospective for abuse and also to make them available the sufficient resources from internet sources. Primarily, the addicted individuals are isolated into the utilization of drugs as the only mechanism by which they can leave the state of discomfort. However, by bringing them to Alchoholics Anonymous a theurapeutic intervention is infused, by so doing an alternative behavior other than the drug is provided to the person. Again the stresses related to the loss of control that they feel in contrast to their drug consumption. Therefore, these two elements are considered extremely significant in assisting the person addicted to overcome the force of taking drugs. (Kaplan, 2005) REFERENCES Doubleday, Abner P; Albanese, Robert P; Hubbard, John R.(2002)"Primary Care Medicine for Specialists and Non-Specialists: A Practitioner's Guide" Springer. Harwood, Henrick J; Myers, Tracy G. (2004) "New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions" National Academies Press. Hazelden, A; Colleran, Carol; Jay, Debra Erickson. (2002) "Aging and Addiction: Helping Older Adults Overcome Alcohol or Medication Dependence" Hazelden PES. Isaacson, Harry, J; Hopper, John A; Alford, Daniel P; Parran, Ted. (July, 2005) "Symposium on Addiction Prescription drug use and abuse Risk factors, red flags, and prevention strategies" Post Graduate Medicine. Vol: 118; No: 1; pp: 47-51. Kaplan, Arline. (July 2005) "NIDA Responds to Escalating Prescription Drug Abuse" Psychiatric Times. Vol: XXII; No: 8; pp: 62-65 Lowinson, Joyce H; Ruiz, Pedro; Millman, Robert B; Langrod, John G. (2004) "Substance Abuse: A Comprehensive Textbook" Lippincott Williams & Wilkins "Percocet information" Retrieved from http://www.clearhavencenter.com/substance-abuse-treatment-resources/percocet.php Accessed 23 March, 2006 Rasmussen, Sandra. (2000) "Addiction Treatment: Theory and Practice" Sage Publications Inc. Strauss, Steven. (2002) "Strauss's Federal Drug Laws and Examination Review" CRC Press. Turk, Dennis C; Gatchel, Robert J. (2002) "Psychological Approaches to Pain Management: A Practitioner's Handbook" Guilford Press Wilson, Richard W; Kolander, Cheryl. (2003) "Drug Abuse Prevention: A School and Community Partnership" Jones and Bartlett Publishers. Read More