WARNING: This page may not be appropriate for all audiences due to the explicit sexual and narcotic imagery, and the colloquial language employed to raise awareness of the experiences associated with the chronic pain relief of HIV/AIDS patients.
The Universal Declaration of Human Rights, December 10, 1948
No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.
"Dr Benway's Patient: William S. Burroughs (1914-1997)" by Tim Barrus
the morphine hour (1/18/2011)
and my numbness dreaming of the slow plow/
rides the jackknife in pursuit of dragons/
chasing lightning as it hits the ground/
the world weeping in the dust/
chaos leaking from the eyeballs/
no boundaries gathered for the flight from winter’s leaking streaked in lines upon the sky/
all my hammered names/
in rooms upon whose dangerous beds our second selves bring their own sullen memories of death/
to what is now a finely-tuned stringed instrument of bones and salt/
which is half of dying ruined like a whisper pushing the dark away in the silences of graves among the summer’s leaves/
the morphine hour (1/06/2011)
so you have washed yourself with mud again/
the housedog is the poppy plant/ it’s the best they have to offer/
the solution from your veins distilled/
2:am thumbs up god himself creeps his grief through pain/
fentanyl, fentanil, sublimaze, actiq, durogesic, duragesic, fentora, onsolis, iInstany, dilaudid, oxycontin,
my favorite is actiq; whose witchery breaks the rims of memory,
into softer wheels sitting in the silences of sadomechanisms,
the masochist’s deceit that the strongbox can easily be plundered/
the plundering will be of you and any number of your other selves/
the edge of nighttime’s fence/ vibrates doorframes of my tomb of mud and stones
and small deceptions, whirl over and around the rain-soaked grass/
a stir of wonders with the plastic lightness of a blowing grocery bag/
the wandering pill-to-pill/ and mud again, shines the summits of a rapture/
sleepwalks among the bones up and down the walls painted with the demon’s face/
such threads of veins have been gnawed on by the bodies of a fertile land
now entangled with the voices of the talking to the lesser saints/
the awfulness of sorrow and the vanishing of the bleeding doors to sleep/
how hard they close with a clang
just as the sun licks the horizon gently with its numb the mud again and melancholy tongue/
inside the morphine cage (12/16/09)
you stand alone at the window/
your mind racing like the thunder from a train/
subordinate whatever balance that you can/
every self-help guru says so/
the morphine leaving you/
the night alive with rhythm/
the paralytic insects feeding on your skull's dominion/
you eunuch/ mister poppy has you now/
obliquity has got herself between you and the lives down there/
you would see behind the curtains if you had curtains/
what you have is gravity holding you steadfast in this disembodied corpse you live in/
your dark hallways haunted by the dead march/
decimated physical insensibility/
mister poppy was a hushed solemnity/
rides your veins like the glowworm/
they say a horror movie will play tonight/
but you already knew that/ the gathering of your shadows is an affirmation of contempt/
disposed to doubt/ through the glass of comprehension/
deep inside the land of cage/
mister poppy was a gypsy/
whose latitude and longitude came from a prebiblical stammering/
you and the binder's cord/
pothooks and seduction when the dishes are all done/
you're up all night anyway/
with the witchery of rain and snow/
the people on the sidewalk seem to trudge along/
the vernacular of everything ascendent/
but mister poppy loves you/
drenched and overflowing/
exuberant and even yet a swarm/
not unlike the cat who prowls through the hollow din falling from the sky/
what you really are is famished/
but exactly how do you propose to eat like this/
reaching for the blight of reclamation/
up here on the precipice/
where the light falls in/
mister poppy's watchdog/
proof that breathless speed is now inert/
and snow has covered up defiance with the bended knee of words/
Chronic Pain Relief
What is an opioid?
Opioids are among the world's oldest known drugs; commonly used for its therapeutic benefits since pre-recorded history. The analgesic (painkiller) effects of opioids are due to decreased perception of pain, decreased reaction to pain as well as increased pain tolerance.
An opioid is a chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract. The receptors in these organ systems mediate both the beneficial effects and the side effects of opioids. **Patients taking opioids regularly for pain relief, rapidly build up a tolerance to the side-effect of respiratory depression, so that it is not a clinical problem.
Although the term Opiate is often used as a synonym for opioid, the term opiate is properly limited to only the natural alkaloids found in the resin of the opium poppy (Papaver Somniferum).
Opium is a naturally occurring substance that is extracted from the seedpod of the opium poppy. Morphine is the principal component of opium. Heroin is produced from morphine. There are a lot of other “opiates” that are available as prescription medication, which are legal, rapidly acting and addictive. For instance, Morphine, Codeine, Hydrocodone, Oxycodone, Methadone, Fentanyl, Mepridine…
Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. It is a schedule II prescription drug.
In its prescription form, fentanyl is known as Actiq, Duragesic, and Sublimaze. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.
Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain's reward areas, producing a state of euphoria and relaxation.
Medications called opiate receptor antagonists act by blocking the effects of opiate drugs. Naloxone is one such antagonist. Overdoses of fentanyl should be treated immediately with an opiate antagonist.
When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. However, the type of fentanyl associated with recent overdoses was produced in clandestine laboratories and mixed with (or substituted for) heroin in a powder form.
Mixing fentanyl with street-sold heroin or cocaine markedly amplifies their potency and potential dangers. Effects include: euphoria, drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, tolerance, and addiction.
NOTE: There have been several fentanyl patch recalls over the years. The recalls have covered the brand name Duragesic fentanyl patches, as well as generic patches made by Sandoz, Actavis, and Watson. http://www.onlinelawyersource.com/fentanyl/patch/Fentanyl
Constipation; diarrhea; dizziness; drowsiness; dry mouth; exaggerated sense of well-being; headache; indigestion; loss of appetite; nausea; nervousness or anxiety; mild redness, swelling, or discomfort at the skin application site; sleeplessness; stomach pain or discomfort; sweating; vomiting.
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; coughing up blood; difficulty urinating; difficulty talking, thinking, or walking; difficult, shallow, or slow breathing; excessive dizziness or drowsiness; fainting; fast, slow, or irregular heartbeat; fatigue; fever; flu-like symptoms (eg, headache, muscle aches, tiredness); hallucinations; mood or mental changes (eg, anxiety, agitation, depression); memory loss; muscle rigidity; numbness or tingling; persistent sore throat; seizures; shortness of breath; tremor; vision problems; weakness .
source for above: http://www.drugs.com/sfx/fentanyl-side-effects.htmlSide
Nervous system side effects have included mental and respiratory depression (particularly in the elderly), stupor, delirium, somnolence, and dysphoria. Muscle rigidity (involving the respiratory musculature including the glottis) may also occur and further aggravate the respiratory depression associated with fentanyl therapy. Myoclonus has been reported with the use of transdermal therapy. A case of severe hemiplegic migraine attack precipitated by fentayl sedation has also been reported.
Cases of seizures have occasionally been reported, but some investigators have suggested that the seizure-like events reported may have been episodes of fentanyl induced-rigidity Cardiovascular
Cardiovascular side effects have included hypotension, bradycardia, and arrhythmias rarely.
One report has suggested that epidural fentanyl may mask the pain of myocardial ischemia in patients treated with fentanyl for other reasons. Another report has suggested that QTc interval prolongation may occur in some patients receiving the related narcotic sufentanil. Another report has implicated fentanyl as a potential cause of pulsus alternans in a patient with aortic stenosis and congestive heart failure.
Nevertheless, fentanyl has been advocated by some as a satisfactory agent for coronary artery surgery.
Gastrointestinal side effects including nausea, vomiting, and constipation have been reported to have occurred commonly. Dental decay of varying severity including dental caries, tooth loss, and gum line erosion have been reported. Choledochoduodenal sphincter spasm has been reported rarely.
Respiratory side effects have included respiratory depression which has been frequently observed with fentanyl therapy and one case of acute noncardiogenic pulmonary edema. Coughing has been reported following fentanyl administration for anesthesia induction.
Genitourinary side effects including urinary retention have been reported for other narcotic analgesics. A case of priapism has been associated with fentanyl anesthesia.
Dermatologic side effects have included pruritus which has been reported frequently. Localized rashes (associated with the use of transdermal fentanyl patches) and, less commonly, systemic rashes have also been reported.
Hypersensitivity side effects including anaphylaxis have been reported rarely.
Abnormal Body Sensations
Certain patients can begin to experience abnormal body sensations as a side effect of fentanyl transdermal use. Sensations of tingling, burning, pain or numbness can develop in the hands or feel of an affected patient, which may contribute to periods of muscle or body weakness. Involuntary body spasms (shaking) can also occur in certain patients during treatment.
Fentanyl transdermal patch users can develop stomach upset side effects, explains Drugs.com. A patient may feel nauseous or begin to vomit. Bowel movement changes, such as diarrhea or constipation, may occur in conjunction with indigestion, heartburn, hiccups, dry mouth, or abdominal cramping or bloating. These stomach-related side effects can cause a decrease in appetite in some patients.
Sleeping problems can develop during treatment with fentanyl transdermal patch. A patient may struggle to fall asleep or stay asleep throughout the night, warns Medline Plus. Difficulty sleeping can contribute to increased daytime fatigue, which can affect a patient's ability to remain active and alert throughout the day.
Fentanyl transdermal patch use can lead to difficulty urinating, explains the Mayo Clinic. A patient may notice that the amount or frequency of urination significantly decreases.
Application Site Reaction
An application site reaction can occur as a side effect of fentanyl tansdermal patch use. The skin at the site of patch application can appear red, irritated or inflamed, and may begin to itch. Severe skin reactions, such as the appearance of blisters at the patch application site, should be reported to a doctor immediately.
Severe, life-threatening breathing difficulties have been reported in certain patients who use the patch, warns the Food and Drug Administration. Patients who have a history of asthma, chronic obstructive pulmonary disease (COPD) or other lung-related diseases should share this information with a physician before beginning treatment with this medication. Seek emergency medical care if side effects such as breathing difficulties, heart rate abnormalities, dizziness, confusion or loss of consciousness occur while using the fentanyl transdermal patch.
The use of fentanyl transdermal patch can be habit-forming. To prevent the side effects associated with fentanyl dependence, only use this medication exactly as prescribed by a doctor.
Read more: http://www.livestrong.com/article/114539-fentanyl-transdermal-patch-side-effects/#ixzz1AfpSx51z
The hemolysis observed may have been related to rapid injection of large volumes of hypotonic fentanyl solution. The authors therefore recommend slower injection rates and/or mixture in isotonic fluid.
Hematologic side effects have included one study which suggested that a small amount of hemolysis (of uncertain clinical significance) may occur in patients treated with fentanyl.
Immunologic side effects including a case of recurrent herpes simplex infection have been reported following epidural administration of fentanyl. Intravenous fentanyl has been reported to increase natural killer cell cytotoxicity and circulating CD16+ lymphocyte levels.
Metabolic side effects including a case of syndrome of inappropriate antidiuretic hormone have been reported. .http://www.drugs.com/sfx/fentanyl-side-effects.htmlFentanyl fentanylpatches may lead to death
In response to these Fentanyl death reports, the FDA has published a number of important facts about Fentanyl. The objective of these safety reports is to educate physicians and patients in hopes of reducing the risk of fatal Fentanyl overdoses. In order to avoid a Fentanyl overdose and other adverse drug reactions, the only patients that should be prescribed Fentanyl are those currently taking other prescription narcotics who also suffer long term consistent pain that is not well managed with shorter-acting opioids. It is also imperative that patients safely store, use, and dispose of Fentanyl patches exactly as directed.
There are many factors that can increase a patient’s risk of suffering an adverse drug reaction including fatal Fentanyl overdose. Concurrent use of other medications that affect brain functioning or the way in which Fentanyl is broken down in the body may elevate Fentanyl levels in the body or increase the drug’s effect. The consumption of alcoholic beverages may have a similar effect. Patients who are exposed to heat or experience an increase in body temperature are also at a greater risk of adverse Fentanyl effects. http://www.onlinelawyersource.com/fentanyl/patch/Fentanyl
Duragesic and Durogesic
Duragesic and Durogesic are trade names of fentanyl transdermal therapeutic systems, and are used for relief of moderate to severe pain. Since Duragesic and Durogesic release Fentanyl, a potent, opioid, slowly through the skin, one patch may provide 72 hours of pain relief. Its initial onset after a patch has been applied is roughly 8–12 hours under normal conditions, thus Duragesic patches are often prescribed with another opioid (such as morphine sulfate) to handle breakthrough pain.
Duragesic is manufactured by ALZA Corporation and marketed by Janssen Pharmaceutica (both subsidiaries of Johnson & Johnson). From June 2002 - June 2003, Duragesic sales totaled over one billion.
Pain clinic physicians who prescribe Duragesic may also recommend dextromethorphan, a non-prescription cough syrup, as it helps opioids work better and help with withdrawal symptoms felt during patch change over time.
As of July 2009, construction of the Duragesic patch had been changed from the problematic gel pouch and membrane design to "a drug-in-adhesive matrix designed formulation," to eliminate the possibility of leakage and leakage-related accidental overdosing.
Onsolis is a mouth patch, and it isn’t supposed to be used as a substitute for the Duragesic patch or the other generic fentanyl patches.
In July 2009 the U.S. Food and Drug Administration formally approved Onsolis, Raleigh-based BDSI's mouth patch that delivers the painkilling drug fentanyl to cancer patients suffering severe “breakthrough pain” that doesn't respond to other medications.
Onsolis is manufactured by Veva Drug Delivery Systems of Florida and marketed under license from BDSI (Nasdaq: BDSI) by Meda Pharmaceuticals. With FDA approval of Onsolis, BDSI is due about $27 million in milestone payments, which Sirgo said would be directed to the company's drug pipeline.
The company also is developing the product BEMA Buprenorphine, a form of painkilling drug buprenorphine that is often given intravenously to treat chronic pain. Like Onsolis, the product uses the company's BEMA technology, which delivers drugs through mucous membranes in the mouth via a small patch.
Hydromorphone, a more common synonym for dihydromorphinone and dimorphone, commonly a hydrochloride (trade names Palladone, Dilaudid, and numerous others) is a potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, and therefore a semi-synthetic drug. It is, in medical terms, an opioid analgesic and, in legal terms, a narcotic.
Hydromorphone is known in various countries around the world by the trade names Hydal, Sophidone, Hydrostat Hydromorfan, Hydromorphan, Laudicon,
Hymorphan, Opidol, Palladone and others (warning: the brand names are inconsistent from country to country). An extended-release version of hydromorphone called Palladone was available for a short time in the United States before being voluntarily withdrawn from the market after a July 2005 FDA advisory warned of a high overdose potential when taken with alcohol. As of March 2010, it is still available in the United Kingdom under the brand name Palladone SR, and in most other European countries.
Another extended-release version called Hydromorph Contin, manufactured as controlled-release capsules, continues to be produced and distributed in Canada by Purdue Pharma Inc. of Pickering, Ontario. The newest extended-release preparation (and the first to last 24 hours - see below) is Jurnista, made by Janssen-Cilag. In addition to Purdue-Frederick and Janssen-Cilag, manufacturers of hydromorphone products include Knoll, Abbott, Endo, Mallinckrodt, Merck, Mundipharma, and Lannacher, among others.
Dilaudid Side Effects
Warnings: Dilaudid is a very addictive narcotic. Individuals can form an addiction to Dilaudid within days. Addiction can result in restlessness and nausea and may progress to loss of consciousness and abnormal breathing. Other risks include withdrawal symptoms lasting several months. Overdose may result in stupor, circulatory collapse, cold clammy skin, respiratory depression, coma, cardiac arrest and/or hypertension.
The major hazards of Dilaudid ORAL LIQUID and Dilaudid TABLETS include respiratory depression and apnea. To a lesser degree, circulatory depression, respiratory arrest, shock and cardiac arrest have occurred.
The most frequently observed adverse effects are light-headedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain
General and CNS
Weakness, headache, agitation, tremor, uncoordinated muscle movements, alterations of mood (nervousness, apprehension, depression, floating feelings, dreams), muscle rigidity, paresthesia, muscle tremor, blurred vision, nystagmus, diplopia and miosis, transient hallucinations and disorientation, visual disturbances, insomnia, increased intracranial pressure
Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension
Bronchospasm and laryngospasm
Constipation, biliary tract spasm, ileus, anorexia, diarrhea, cramps, taste alteration
Urinary retention or hesitancy, antidiuretic effects
Urticaria, other skin rashes, diaphoresisSide Effects by Body System
Nervous system side effects have included mental depression, respiratory depression (which is sometimes fatal), stupor, delirium, somnolence, agitation, increased intracranial pressure, and dysphoria. Myoclonus has also been reported.
Opiates may result in psychotic symptoms in some patients.
Other side effects have included withdrawal symptoms which have occurred following either abrupt cessation or fast tapering of narcotic analgesics and have included agitation, restlessness, anxiety, insomnia, tremor, abdominal cramps, blurred vision, vomiting, and sweating.
Cardiovascular side effects have occurred rarely and have included hypotension, shock, and arrhythmias.
Gastrointestinal side effects have included constipation, nausea, vomiting, biliary tract spasm, and dry mouth.
Dermatologic side effects including rashes and systemic contact dermatitis have been reported rarely.
Narcotic-induced rashes may be related to direct stimulation of histamine release.
Local side effects have included redness, swelling and pain which develop at the site of subcutaneous injection of hydromorphone. Two cases of fatal neurologic events have been reported following intravenous injection of hydromorphone. In one case, a known intravenous drug abuser injected two melted hydromorphone suppositories into the right antecubital vein and suffered a stroke. In the other, a known intravenous drug abuser injected ground hydromorphone tablets and presented in an akinetic mute state and later died.
Genitourinary side effects including urinary retention have been reported for other narcotic analgesics.
source to above: http://www.drugs.com/sfx/dilaudid-side-effects.html
Anorexia , anxiety, constipation, dizziness, drowsiness, hallucinations, impaired physical performance, mental impairment, mood changes, nausea, pain at the injection site, restlessness, sedation, skin rash or itching, sluggishness, somnolence, tissue irritation. Also, but less commonly - Agitation, blurred vision, breathing difficulties, chills, cramps, diarrhoea, difficulty urinating, disorientation, dizziness, double vision, dry mouth, exaggerated feelings of depression or well-being, fainting, flushing, hallucinations, headache, increased pressure in the head, insomnia, involuntary eye movements, irregular heartbeat, itching, light-headedness, loss of appetite, low or high blood pressure, muscle rigidity or tremor, muscle spasms of the throat or air passages, palpitations, rashes, sweating, taste changes, tingling or numbness, tremor.
source to above: http://www.rsdalert.co.uk/drugs/Dilaudid.htmThere
good info http://www.ehealthme.com/q/dilaudid-side-effects-drug-interactionsAnorexia
There are 101 ratings for the drug: DILAUDID in the Askapatient database.
Read more at http://www.askapatient.com/viewrating.asp?drug=19891&name=DILAUDID&ktrack=kcplink
Dilaudid (Hydromorphone) - Adverse Event Reports - Death http://www.druglib.com/adverse-reactions_side-effects/dilaudid/seriousness_death/
Oxycodone / OxyContin
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine.
OxyContin is the brand name of a time-release formula of oxycodone produced by the pharmaceutical company Purdue Pharma (the manufacturing rights to time-released generic oxycodone are under dispute). It was approved by the U.S. Food and Drug Administration in 1995 and first introduced to the U.S. market in 1996.
By 2001, OxyContin was the best-selling non-generic narcotic pain reliever in the U.S.; 2008 sales in the U.S. totaled $2.5 billion. An analysis of data from the U.S. Drug Enforcement Administration found that retail sales of oxycodone "jumped nearly six-fold between 1997 and 2005." Mundipharma distributes OxyContin in Australia, China and Europe. Beginning in 2010, the brand name OxyContin by Purdue was reformulated to prevent the misuse and abuse of the tablets.
** Critics have accused Purdue Pharma of putting profits ahead of public interest by applying "significant political pressure" to attempt to reverse South Carolina's requiring prior approval before a person with Medicaid can receive the drug. In May 2007 Purdue Pharma and three of its top executives pleaded guilty in a Virginia federal court to charges that they misbranded OxyContin, and were ordered to pay $634 million in fines for felony and misdemeanor misbranding.
**The slang term hillbilly heroin for OxyContin refers to the occurrence of the "earliest reported cases of Oxycontin abuse" in the U.S. in rural areas such as Appalachia.
What are its short-term effects?
The most serious risk associated with opioids, including OxyContin, is respiratory depression — slowed breathing. Common opioid side effects are constipation, nausea, sedation, dizziness, vomiting, headache, dry mouth, sweating, mood changes, flushing, loss of appetite, and weakness. Taking a large single dose of an opioid could cause severe respiratory depression — slowed or difficulty breathing that can lead to death.
What are its long-term effects?
Chronic use of opioids can result in tolerance for the drugs, which means that users must take higher doses to achieve the same initial effects. Long-term use also can lead to physical dependence and addiction — the body adapts to the presence of the drug, and withdrawal symptoms occur if use is reduced or stopped. Taken exactly as prescribed, opioids can be used to manage pain effectively.http://www.drugfree.org/drug-guide/oxycontinLong-Term Damage
While most painkillers have short-term unwanted effects, others can have serious and long-lasting harm if they tend to be overused. Oxycontin and hearing loss are carefully related because of this truth. The toxins from the medication can have a very bad impact on the central nervous system of the body, that is made up of the brain and spinal cord. The auditory lack of feeling the comes from the hearing to the auditory part of the mind, carrying seems through the outside world to the brain to become prepared as well as noticed.
When the oral lack of feeling is actually damaged, the result is really a loss of listening to slightly, or nearly completely. It's believed that Oxycontin can cause hearing problems if it's overdosed. Current press speculates that talk show web host Rush Limbaugh dropped a great deal of their hearing due to his substance abuse of Vicodin as well as Oxycontin, therefore furthering the tie up between Oxycontin and hearing loss.
The most commonly reported effects include euphoria, memory loss, constipation, fatigue, dizziness, nausea, lightheadedness, headache, dry mouth, anxiety, pruritus, and diaphoresis. It has also been claimed to cause dimness in vision due to miosis. Some patients have also experienced loss of appetite, nervousness, abdominal pain, diarrhea, ischuria, dyspnea, and hiccups, although these symptoms appear in less than 5% of patients taking oxycodone. Rarely, the drug can cause impotence, enlarged prostate gland, and decreased testosterone secretion. Compared to morphine, oxycodone causes less respiratory depression, sedation, pruritus, nausea, and euphoria. As a result, it is generally better tolerated than morphine.
In high doses, overdoses, or in patients not tolerant to opiates, oxycodone can cause shallow breathing, bradycardia, cold, clammy skin, apnea, hypotension, miosis (pupil constriction), circulatory collapse, respiratory arrest, and death.
Withdrawal related side effects
There is a high risk of experiencing severe withdrawal symptoms if a patient discontinues oxycodone abruptly. Therefore therapy should be gradually discontinued rather than abruptly discontinued. People who use oxycodone in a hazardous or harmful fashion are at even higher risk of severe withdrawal symptoms as they tend to use higher than prescribed doses. The symptoms of oxycodone withdrawal are the same as for other opiate based painkillers and may include "anxiety, nausea, insomnia, muscle pain, muscle weakness, fevers, and other flu like symptoms."
Withdrawal symptoms have also been reported in newborns whose mothers had been either injecting or orally taking oxycodone during pregnancy.
Today, heroin's link with violent crime and the transfer of HIV among users who share needles, added to its' highly addictive nature, has resulted in much social fear associated with this drug.
Some street terms for Heroin:
Big H, Boy, Capital H, China White, Chiva, Dead on arrival, Diesel, Dope, Eighth, Good H, H, Hell Dust, Horse, Junk Mexican Horse, Mud, Poppy, Smack, Thunder, Train White Junk, Brother, Chick, Harry Jones, Judas, Black Pearl, Blanco, and many more
The appearance of heroin can vary dramatically. In the USA for instance:
In the eastern United States, heroin generally is sold as a powder that is white (or off-white) in color (generally, the purer the heroin the whiter the color, because variations in color result from the presence of impurities.)
In the western United States, most of the heroin available is a solid substance that is black in color. This type of heroin, known as black tar, may be sticky (like tar) or hard to the touch. Powdered heroin that is a dirty brown color also is sold in the western United States.
UCSF researchers have found that use of black tar heroin by injection drug users in West Coast cities accounts for a dramatically lower percentage of IDUs in these locations who are infected with HIV. The finding is based on comparison to East Coast cities, where powder heroin is commonly used.
In cities west of the Mississippi, black tar heroin - a dark, gummy, resinous substance from Mexico - is the type of heroin predominately available.
On the East Coast, white and light brown powder heroin from South Asia and South America is the type predominately available.
Study findings showed the percentage of IDUs infected with HIV was sharply lower in cities where black tar heroin use predominated compared to cities where powder heroin use predominated, a pattern that was not mirrored in the percentages of HIV-infected gay men.
In addition, black tar heroin clogs syringes, they note. Frequent rinsing and flushing is required, reducing the amount of residual blood and HIV virus present.
Heroin is a Scheduled 1 drug in the United States, Canada, and Norway. In both U.K. and New Zealand heroin is a Class A, and in U.K. it is also a Schedule II.
Some countries, such as UK and Switzerland, prescribe heroin to addicts to slowly wean them off of it. These countries have led others such as Canada, Germany, and Australia to test the prescription programs of heroin.
Heroin is controlled in Australia. It was listed in Schedule I of the Narcotic Drugs Act of 1967. It is unclear whether the control system has changed since then.
In Brazil heroin is listed as a controlled substance, making production, distribution, or possession illegal.
In Finland Heroin is a controlled substance, making production, distribution, and possession illegal without a license.
In Germany in May 2009, it became legal to prescribe heroin to addicts over 23 years old, who have been addicted for at least 5 years and tried 2 other therapies to get off heroin.
In Norway Heroin is Schedule I and it is illegal to buy or possess heroin without a special license. There have been some projects to establish "needle rooms" in Norway by the government, where heroin addicts are allowed to get fresh needles for injecting heroin, but the chemical is still Schedule I.
In Portugal effective from July 2001, personal use of heroin was decriminalized by Law 30/2000. Possession of less than 1 g is not regarded as a criminal offense, though the substance is liable to be seized and the possessor can be referred to mandatory treatment. Sale, or possession of quantities greater than the personal possession limit, are criminal offenses punishable by jail time.
In Switzerland Heroin is legally available for addicts under an ongoing experiment.
Opioid-peptides that are produced in the body include:
Phenanthrenes naturally occurring in opium:
Preparations of mixed opium alkaloids, including papaveretum, are still occasionally used.
Levomethadyl Acetate (LAAM)
Loperamide (used for diarrhoea, does not cross the blood-brain barrier)
Dezocine - agonist/antagonist
Pentazocine - agonist/antagonist
Buprenorphine - partial agonist
Butorphanol - agonist/antagonist
Nalbuphine - agonist/antagonist
Opioid antagonists (to counter the effects of opioids)
Back pain; cough; darkened skin color on the palms of hands or soles of feet; diarrhea; dizziness; drowsiness; gas or indigestion; headache; loss of appetite; mild stomach pain; muscle or joint aches; nausea; skin discoloration (small spots or freckles); stomach upset; strange dreams; stuffy or runny nose; tiredness; trouble concentrating; trouble sleeping; vomiting.
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bone pain; change in personality; chest pain; confusion; decreased coordination; delusions; fever, chills, or persistent sore throat; hallucinations; memory loss; mental, mood, or behavior changes (eg, abnormal thoughts, agitation, depression, paranoia); muscle pain or weakness; numbness, burning, pain, or tingling of the hands, feet, or skin; red, swollen, blistered, or peeling skin; seizures; severe or persistent stomach pain, nausea, or vomiting; shortness of breath; suicidal thoughts or actions; symptoms of kidney problems (eg, increased or decreased urination, increased thirst); symptoms of lactic acidosis (eg, unusual weakness or tiredness; unusual muscle pain; fast or difficult breathing; stomach pain with nausea and vomiting; feeling cold, especially in the arms and legs; dizziness or lightheadedness; fast or irregular heartbeat); symptoms of liver problems (eg, yellowing of the skin or eyes; dark urine; pale stools; persistent loss of appetite).
source for above: http://www.drugs.com/sfx/atripla-side-effects.html
Serious side effects associated with the use of Atripla include:
* Severe depression
* Angry behavior
* Strange thoughts
* Difficulty sleeping or concentrating
* Unusual dreams, hallucinations
* Kidney or liver problems
* Bone changes
Seek immediate medical attention at the onset of any side effects of Atripla.
Common side effects of Atripla include:
* Upset stomach
* Skin discoloration
* Changes in body fat
source for above: http://www.drugwatch.com/atripla/side-effects.php
some important links below:
Morphine and remifentanil and their effects on dreams, nightmares and hallucinations in critically ill patients
M Lane, A Serrano, S Walters and GR Park
The John Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge CB2 5EG, UK
from 23rd International Symposium on Intensive Care and Emergency Medicine
Brussels, Belgium. 18–21 March 2003
Critical Care 2003, 7(Suppl 2):P097doi:10.1186/cc1986
Published 3 March 2003
Dreaming, nightmares and hallucinations are common in the critically ill and have many causes. These may lead to serious adverse psychological sequelae such as post-traumatic stress disorder. The type of sedation and analgesia used to make patients comfortable may influence this. Morphine causes dreams because of its μ-agonist effects. It is unknown if the new highly lipophilic and potent opioid remifentanil is different.
We studied the influence of sedative practice on many variables over an 8 month period in 2002. During the first period of 12 weeks, 'conventional' sedative and analgesic techniques were used where midazolam and propofol were titrated to make the patient comfortable and analgesics added. Over the next 2 months we developed guidelines for the use of remifentanil relieving pain first and adding hypnotics only if needed. The final 12 weeks involved using remifentanil as the major sedative agent in the ICU, as part of an analgesia-based regimen. As part of the followup in the first 4 days after discharge all patients are asked whether they had any dreams, nightmares or hallucinations and, if so, were they distressing?
In the first 12 weeks, 47 patients were followed up and 20 (42%) of them experienced dreams or hallucinations, 13 (65%) did find the experience distressing. These patients all received morphine in combination with midazolam and propofol. In the final 12 weeks, 57 patients were seen and 28 (49%) of them experienced dreams or hallucinations and 16 patients (57%) found them unpleasant or distressing. Morphine (12), remifentanil (12), propofol (9) and midazolam (2) were given to 26/28. Two patients received no sedative or analgesic drugs.
This study shows that the use of potent opioids, such as remifentanil, does not increase the risk of dreaming. Some patients have distressing dreams despite having had no hypnotic or analgesic drugs.
Conflict of interest statement
This study was sponsored by Elan Pharma Ltd and GSK Ltd.
We thank the medical and nursing staff of the ICU for their invaluable contribution to this study.