Naltrexone Case Study

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Morphine treats moderate-to-severe pain and is a Schedule 2 opioid. Although once available only as a rapidly acting formulation, long-acting products are now routinely prescribed to treat chronic pain. Morphine is the most prominent and active ingredient in opium. It was first extracted from opium some 200 years ago.
Morphine is as easy to abuse as heroin and carries the same risks as heroin. To reduce the potential for abuse, the newer product Embeda adds naltrexone to the formulation. Naltrexone will induce withdrawal symptoms if the product is chewed or injected. However, the vast majority of morphine products do not contain an abuse-deterrent medication.
Historical Note: Morphine was isolated from opium in 1805 and touted as a cure for
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It does not produce as powerful high as the more potent painkillers oxycodone, hydromorphone, and fentanyl.
Combinations
Hydrocodone is available as a stand-alone formulation (only hydrocodone) and in combination with acetaminophen, aspirin, and other non-opioid pain relievers.
Toxicity
Acetaminophen can be toxic to the liver (http://bit.ly/1d7c6C0). The risk of liver damage increases as the daily dose of acetaminophen increases. As tolerance to hydrocodone develops, addicts will use more of the hydrocodone-plus-acetaminophen product, exposing the liver to ever-greater amounts of acetaminophen. For most addicts, the worry for irreversible liver damage takes a distant backseat to getting high when addiction is in full control. Acetaminophen can also be toxic to the kidney.
Here are some important considerations:
• Acetaminophen is available in many over-the-counter and prescription products, including the original branded product Tylenol®.
• Acetaminophen taken in excessive amounts can cause acute liver failure (http://1.usa.gov/1I0Lno1). Emergency treatment is with the antidote N-acetylcysteine
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It is available as a long-acting formulation (OxyContin®) and in combination with other non-opioid analgesics, such as aspirin (Percodan®) and acetaminophen (Percocet®). All oxycodone formulations are Schedule 2.
Oxycodone is one of the most widely used and abused painkillers.
In 2010, OxyContin was reformulated to reduce (but not eliminate) the potential for abuse. When crushed and mixed with water, the product will “gum-up,” making it impossible to inject. The tablets are “crush resistant” making it difficult if not impossible to snort. However, oxycodone can still be abused by chewing and then swallowing several tabs at one time. Unfortunately, the risk of an overdose increases when oxycodone is abused in any manner.
Consequently, addicts are switching to easier to inject and snort opioids, such as oxymorphone, fentanyl, morphine, and, of course, heroin.
Using painkillers in any way other than as prescribed greatly increases the risk of an overdose.
Targiniq ER, a long-acting oxycodone formulation, contains the abuse-deterrent medication naloxone. If injected or snorted, naloxone will cause immediate and painful withdrawal symptoms, thereby reducing the potential for abuse. Many physicians feel that this is a step in the right direction to reduce the abuse potential of

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