Drug Withdrawal

In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management.Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients. The Cushman score was recorded on day 1, 2 and 3 to assess the severity of alcohol withdrawal. We searched for correlations between epidemiological, clinical and biological data and the Cushman score.The study population included 136 (74.7%) men and 46 (25.3%) women, mean age 47.6 ± 10.1 years. One hundred and eighteen patients (64.8%) were referred from a specialized outpatient clinic and 64 (35.2%) patients were referred from the emergency unit. The mean and median Cushman scores on day 1, 2 and 3 were: 5.1 and 5; 3.9 and 4; 2.3 and 2, respectively. Twenty patients (11.0%) and five patients (2.7%) had scores greater than or equal to 8 and greater than 12, respectively. The proportion of patients with Cushman score greater than or equal to 8 on day 1 was significantly greater in patients referred from the emergency unit than in those referred from a specialized outpatient clinic (p = 0.002). Mean alanine aminotransferase level on day 1 was significantly higher in patients with a score greater than or equal to 8 than in those who had a score less than 8 (112.1 ± 44.4 UI/L versus 78.4 ± 11.8 UI/L; p = 0.046). Referral via an emergency unit as well as an alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range were independent predictive factors for a Cushman score greater than or equal to 8.In conclusion, severe alcohol withdrawal (Cushman score ≥ 8) is significantly associated with initial management in an emergency unit and serum alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range. These predictors should be monitored in order to appropriately adapt the therapeutic schedule.Le nombre d’hospitalisations dans un service d’hépatogastroentérologie pour le sevrage d’une alcoolo-dépendance est important. Le but de cette étude, retrospective, était de déterminer les facteurs prédictifs d’un sevrage alcoolique sévère ou compliqué afin d’améliorer la prise en charge de ces malades. De juin 2002 à juin 2005, 182 malades ayant une alcoolo-dépendance selon la classification DSM-IV pris en charge dans le service pour sevrage ont été inclus dans cette étude. Tous les malades recevaient un protocole de sevrage identique. La gravité du sevrage alcoolique était évaluée par le score de Cushman à j1, j2 et j3. Les paramètres épidémiologiques et biologiques ont été comparés avec les valeurs du score de Cushman. Cent trente-six hommes (74,7 %) et 46 femmes (25,3 %) d’âge moyen 47,6 ± 10,1 ans ont été inclus. L’hospitalisation a été réalisée à partir d’une consultation d’alcoologie pour 118 malades (64,8 %) et par le biais des urgences pour 64 d’entre eux (35,2 %). La moyenne et la médiane du score de Cushman étaient à j1, j2 et j3, respectivement, de 5,1 et 5 ; 3,9 et 4 ; 2,3 et 2. Vingt malades (11,0 %) et cinq malades (2,7 %) avaient un score, respectivement, supérieur à 8 et supérieur ou égale à 12 à j1. La proportion de malades ayant un score supérieur ou égale à 8 à j1 était supérieure chez les malades venant des urgences que chez ceux issus de la consultation d’alcoologie (p = 0,002). Les malades dont le score était supérieur ou égale à 8 avaient un taux sérique moyen de l’alanine aminotransférase significativement plus élevé à j1 que ceux qui avaient un score inférieur à 8 (respectivement, 112,1 ± 44,4 UI/L versus 78,4 ± 11,8 UI/L ; p = 0,046). L’admission par le biais des urgences ainsi qu’un taux sérique de l’alanine aminotransférase supérieur à 1,5 fois la limite supérieure de la normale étaient les deux variables indépendantes prédictives d’un score de Cushman supérieur ou égale à 8. En conclusion, un syndrome de sevrage sévère lors d’une alcoolo-dépendance est significativement plus associé à une hospitalisation directe par le biais des urgences et à un taux sérique de l’alanine aminotransférase supérieur à 1,5 fois la limite supérieure de la normale. La présence de ces facteurs à l’admission du malade nécessite une surveillance accrue et une éventuelle adaptation de la prise en charge thérapeutique.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2016), within the past year 21.5 million individuals over the age of 12 suffer from addiction to various substances in America. The most commonly categorized substances, in their respective order of frequency of use, are as follows: alcohol, tobacco, cannabis, stimulants, hallucinogens, and opioids. Medical professionals attempting to effectively treat clients who suffer from either single or co-morbid substance abuse addiction may incorporate psychopharmacological aids in treatment. Anti-depressants, benzodiazepine, naltrexone, and methadone are just a few of the wide array of aids chosen as tools to assist addicts with ways to cope with drug withdrawal and detox as well as alcohol withdrawal and detox. Additionally, these psychopharmacological treatments assist the user in overcoming addiction. Despite their prevalence in substance abuse treatment, their incorporation into an individual’s treatment should be made on a case-by-case basis as each individual aid emanates its own unique set of strengths and weaknesses. This paper intends to elucidate a few popular, or widely implemented, psychopharmacological aids used in such treatments based on intended purpose, effectiveness, and supporting research. For the purpose of conciseness, a few will be evaluated within the parameters of drug withdrawal and detox, alcohol addiction, and heroin and opiate addiction. This paper should constrain the reader to seek further analysis of variant and covariant research on the wide array of alternative psychopharmacological aids and their intended uses.

The drug addicted characters in Irvine Welsh’s Trainspotting novels and Danny Boyle's film adaptations desperately seek to escape their Edinburgh environment through their use of heroin. Some may view their drug-taking as a display of inherent deviance or an attempt at self-destruction; instead, I view their consumption of opioids as a method for self-preservation in response to their societal alienation. In my thesis, I argue that this alienation stems from the predicaments plaguing Scotland’s population during the premiership of Margaret Thatcher. Thatcher’s administration prioritized the material desires of neoliberalism over the frequently suppressed principles of the welfare state. In this way, Thatcherism further oppressed Trainspotting’s underclass by pushing policies that often inspired adverse emotions in those who could not adapt, which I propose encouraged subsequent substance abuse as a method of self-preservation. Specifically, these policies contributed to deindustrialization, mass unemployment, uninhabitable housing conditions and an overall sense of deprivation and disenfranchisement among the Trainspotters. Largely devoid of the immediate option to improve their circumstances due to a lack of economic means and limitations related to their social statuses, the Trainspotters instead search for a superficial way out of these constricting circumstances. Already alienated from society, the characters in Welsh’s novels and Boyle’s films see in heroin an opportunity to reinforce their withdrawal as they live like ghosts in a state of ‘junkie limbo,’ a space that exists between full participation in Thatcherite society and total disengagement via death. Initially meant as a temporary anesthetic, opioids become a lifelong companion of the Trainspotters due to the painful nature of physical withdrawal and poor drug policies. Methadone, for instance, sustains the Trainspotters’ drug dependency while increasing the prevalence of an overdose, and continues to claim the lives of Scottish addicts left over from the ‘Trainspotting Generation.’ Utilizing the complete Trainspotting series as a key case study, with an added focus on the most recent text, Dead Men’s Trousers, and film, T2 Trainspotting, my thesis will contribute to the prior research done on the ‘Trainspotting Generation.’

1. Gentamicin was injected subcutaneously and intramuscularly into 5 groups of 10 laying hens and its concentration was determined in albumen, yolk and whole egg. 2. Groups 1 and 3 were intramuscularly injected with doses of 10 and 25 mg/kg while groups 2, 4 and 5 were subcutaneously injected with doses of 10, 25 and 50 mg/kg, respectively. 3. The final gentamicin concentration in albumen was measured on d 3 for groups 1 and 2; on d 4 for groups 3 and 4, and on d 5 for group 5. Concentrations in yolk and whole egg were measured on d 7, 10 and 12. 4. Gentamicin recovery was as follows: 2% in groups 1 and 2, 2. 5% in groups 3 and 4, and 3% in group 5. 5. Most of the residue ($90%) was recovered from the yolk.

The drug addicted characters in Irvine Welsh’s Trainspotting novels and Danny Boyle's film adaptations desperately seek to escape their Edinburgh environment through their use of heroin. Some may view their drug-taking as a display of inherent deviance or an attempt at self-destruction; instead, I view their consumption of opioids as a method for self-preservation in response to their societal alienation. In my thesis, I argue that this alienation stems from the predicaments plaguing Scotland’s population during the premiership of Margaret Thatcher. Thatcher’s administration prioritized the material desires of neoliberalism over the frequently suppressed principles of the welfare state. In this way, Thatcherism further oppressed Trainspotting’s underclass by pushing policies that often inspired adverse emotions in those who could not adapt, which I propose encouraged subsequent substance abuse as a method of self-preservation. Specifically, these policies contributed to deindust...

BACKGROUND:
As a legal drug, alcohol is commonly abused and it is estimated that 17 million adults in the United States suffer from alcohol use disorder. Heavy alcoholics can experience withdrawal symptoms including anxiety and mechanical allodynia that can facilitate relapse. The molecular mechanisms underlying this phenomenon are not well understood, which stifles development of new therapeutics. Here we investigate whether delta opioid receptors (DORs) play an active role in alcohol withdrawal-induced mechanical allodynia (AWiMA) and if DOR agonists may provide analgesic relief from AWiMA.
METHODS:
To study AWiMA, adult male wild-type and DOR knockout C57BL/6 mice were exposed to alcohol by a voluntary drinking model or oral gavage exposure model, which we developed and validated here. We also used the DOR-selective agonist TAN-67 and antagonist naltrindole to examine the involvement of DORs in AWiMA, which was measured using a von Frey model of mechanical allodynia.
RESULTS:
We created a robust model of alcohol withdrawal-induced anxiety and mechanical allodynia by orally gavaging mice with 3g/kg alcohol for three weeks. AWiMA was exacerbated and prolonged in DOR knockout mice as well as by pharmacological blockade of DORs compared to control mice. However, analgesia induced by TAN-67 was attenuated during withdrawal in alcohol-gavaged mice.
CONCLUSIONS:
DORs appear to play a protective role in the establishment of AWiMA. Our current results indicate that DORs could be targeted to prevent or reduce the development of AWiMA during alcohol use; however, DORs may be a less suitable target to treat AWiMA during active withdrawal.

Poor sociability and aggressive behavior are major clinical features of opiate use disorders that may contribute to the establishment and maintenance of these harmful diseases. The present study investigated the long-term effects of chronic morphine administration and withdrawal upon social and aggressive behavior as well as the interrelationship between these two behaviors. Thus, social behavior was measured in C57BL/6J male mice 7, 21, 35 and 49 days after cessation of escalating morphine doses (20–100 mg/kg, i.p.) administered during 6 consecutive days, using the three-chamber task for sociability (i.e., preference for an unfamiliar conspecific vs. an object) and social novelty preference (i.e., preference for a novel vs. a familiar conspecific). Moreover, aggressive biting behavior towards an unfamiliar conspecific was assessed throughout the three-chamber tests. Opiate withdrawal increased both social approach and aggressive biting behavior. Moreover, in morphine-withdrawn, but not in control, mice social approach and aggressive behavior followed a similar time-course and positively correlated one with each other, suggesting that social interest was mainly driven by aggressiveness. Aggressive biting behavior was still elevated 49 days after the last morphine administration, revealing that opiate withdrawal is followed by long-lasting aggressiveness. Throughout, opiate withdrawal did not affect social novelty preference, ruling out a role for olfactory or social discrimination dysfunction in the elevated social approach and aggressive behavior. The present findings of very long-lasting aggressive behavior and aggression-driven social approach in opiate-withdrawn mice might help understanding the behavioral and brain underpinnings of poor sociability and aggressiveness commonly observed in opiate use disorders patients.

Lamoure J.  Rationale of Combining More than One Antipsychotic in a LTC/Nursing Home Patient at Same Time . Canadian Healthcare Network ATE Panel. October, 2011. http://www.canadianhealthcarenetwork.ca/pharmacists/discussions/the-experts/mental-health