Codeine Abuse and Addiction

According to the World Health Organization and others, codeine is the most widely used opiate in the world.  It is one of the most effective orally-administered opioid analgesics.  It is about one-fifth the strength of morphine.  It is commonly mixed with other analgesics such as aspirin or acetaminophen, and in this combination it is listed as a Schedule III or V drug in the United States.

In the United States codeine is listed as a Schedule II controlled substance for products containing codeine alone or in a dose higher than 90 mg.

Beyond its analgesic effects, codeine's effects include euphoria, itching, nausea, vomiting, drowsiness, dry mouth, depression and constipation. Some people may also be allergic to codeine, with skin swelling and rashes.

Another side effect of codeine abuse is lack of sexual drive and increased complications with erectile dysfunction.

Tolerance to codeine develops with prolonged use, and this tolerance includes its therapeutic effects.  A potentially serious adverse drug reaction is respiratory depression and the potential for a fatal overdose.

Codeine is metabolized into morphine, and morphine can be passed through breast milk in potentially lethal amounts, fatally depressing the respiration of a breast fed baby.

Codeine is often used as a recreational drug, and has similar potential for abuse with other opiates such as oxycodone or hydrocodone.  In some countries cough syrups and tablets containing codeine are easily available without prescription.

Codeine is also available in a syrup with the anti-nausea medication promethazine (brand name Phenergan with Codeine). This medication is quickly becoming one of the most highly abused codeine preparations.

As with other opiate pain killers, chronic use of codeine can lead to physical dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops the medication.  Withdrawal symptoms include: drug craving, runny nose, yawning, sweating, insomnia, weakness, stomach cramps, nausea, vomiting, diarrhea, muscle spasms, chills, irritability, and pain.

Heroin addicts will take codeine to minimize the effects of heroin withdrawal, which will create additional withdrawal symptoms when codeine is no longer used.

To minimize withdrawal symptoms, long-term users should gradually reduce their codeine use through medical detox under the supervision of a doctor or addiction professional.

Adderall Abuse and Addiction

Adderall is the brand name of a stimulant drug made up of a proprietary blend of amphetamine and dextroamphetamine.  It is believed to work by increasing the neurotransmitters dopamine and norepinephrine in the brain.

The effects felt when using the drug include loss of fatigue, increased alertness and concentration, better cognitive ability, and heightened libido.  It is commonly prescribed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD), narcolepsy, and sometimes for depression.

Adderall is listed as a Schedule II drug under the Controlled Substances Act.  This means that it has a high potential for prescription drug abuse and drug addiction.

Prolonged use can lead to increased tolerance (needing more of the drug to achieve the same effect) and withdrawal (an intense craving for the drug along with physical and psychological distress) when use is stopped.  Continued use, especially over-use, can lead to the pathological conditions of drug abuse and drug dependence.

Extremely high doses, or high doses over a prolonged period of time, can result in a very serious condition known as amphetamine psychosis.

Adderral abuse and dependence often occurs when the drug is over-used for the treatment of commonly prescribed conditions such as fatigue, obesity, and depression.  Adderall has also become a favorite “study drug” in colleges and universities because of its ability to help the user focus their concentration and study for very long periods of time.

Many abusers were originally prescribed the drug for childhood ADHD, and then continued to use the drug in later life for reasons other than those for which it was prescribed, such as concentration, weight loss, and performance enhancement.

One study estimates that as many as 14% of college students abuse some form of ADHD drug like Adderall.

Withdrawal from chronic abuse of Adderall can include anxiety, depression, fatigue, excessive sleeping, increased anger and rage, and even psychosis and suicidal thoughts.  Physical effects can include heart palpitations, irregular heartbeat, uncontrollable tremors, sweating, and more serious cardiac symptoms.

As with most stimulants, users who take high doses of the drug over a prolonged period of time will eventually “crash.”

This occurs when their bodies and minds are simply too fatigued to continue, sometimes after days and even weeks of continuous use.  Heavy users will often turn to other drugs such as benzodiazepines, barbiturates, and even illegal opiates such as heroin, to help soothe the effects of withdrawal.

Treatment for chronic Adderall abuse or dependence often requires medical detoxification, a period of rehabilitation from the physical effects, a period of psychotherapeutic counseling to deal with the mental and emotional effects, and possible psychopharmacological treatment to assist in re-regulating the effects of disrupted brain function.

Chloral Hydrate Abuse and Addiction

Chloral hydrate is a sedative and hypnotic.  It is commonly prescribed for the short-term treatment of insomnia and as a sedative before minor medical or dental treatment.

It was largely displaced in the mid-20th century by barbiturates and then by benzodiazepines, but is still used as a recreational drug and as a so-called "date rape" drug.

Chloral hydrate is still used today as an ingredient in the veterinary anesthetic Equithesin, and as a sedative prior to EEG procedures because it is one of the few sedatives that does not suppress the nerve impulses recorded during the EEG.

Chloral hydrate is a Schedule IV controlled substance in the United States, and possession is illegal without a prescription.  Its quick acting sedative properties and its liquid gel capsule form, which makes it easy to pour into an alcoholic beverage, have sometimes led to its use as a so-called "date rape" drug.

Therapeutic doses work well for insomnia, becoming effective within 60 minutes.  Higher doses can depress respiration and blood pressure.  Long-term use creates a rapid development of tolerance to its effects as well as adverse physical effects including rashes, gastric discomfort and liver failure.

Overdose of chloral hydrate presents symptoms of confusion, convulsions, nausea and vomiting, severe drowsiness, slow and irregular breathing, cardiac arrhythmia, and possible coma.

Benzodiazepine Abuse and Addiction

A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring.  The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and made available in 1960 by Hoffmann–La Roche, which has also marketed diazepam (Valium) since 1963.

Benzodiazepines are commonly misused and are often taken in combination with other drugs of abuse.

Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) which results in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, muscle relaxant and amnesic effect.  These properties make benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures.

In general, benzodiazepines are safe for short term use, although cognitive impairments and paradoxical effects such as aggression or behavioral disinhibition occasionally occur.

Long-term use has adverse psychological and physical effects, decreasing effectiveness, physical dependence, and benzodiazepine withdrawal syndrome.

Benzodiazepines overdoses can cause dangerous deep unconsciousness.  However, they are much less toxic than barbiturates, and death rarely occurs when a benzodiazepine is the only drug taken.  When combined with other central nervous system depressants such as alcohol and opiates, the potential for toxicity increases.

The long-term adverse effects of benzodiazepines include a general deterioration in physical and mental health and tend to increase with time.

Adverse effects can include cognitive impairment such as feelings of turmoil, difficulty in thinking constructively, increased anxiety, and depression.  Behavioral problems also occur, such as loss of sex-drive, agoraphobia and social phobia, loss of interest in leisure pursuits and interests, and an inability to experience or express feelings.  An altered perception of self, environment and relationships may also occur.

The most frequent symptoms of withdrawal from benzodiazepines are insomnia, gastric problems, tremors, agitation, fearfulness, and muscle spasms.  Other effects include irritability, sweating, depersonalization, derealization, hypersensitivity to stimuli, depression, suicidal behavior, psychosis, seizures and delirium tremens.

Severe symptoms usually occur as a result of abrupt withdrawal, so medically supervised detoxification is recommended.

Approximately 10% of patients will experience a protracted withdrawal syndrome, which can last for many months or longer.  This phenomenon is known as "benzodiazepine withdrawal syndrome."  Symptoms do gradually lessen over time, eventually disappearing altogether.

Benzodiazepines are considered to be major drugs of abuse.

Benzodiazepines are used recreationally and by drug abusers, with abuse mostly limited to individuals who abuse other drugs.  Benzodiazepine abuse ranges from occasional binges on large doses, to chronic and compulsive drug abuse of high doses.  Mortality rates are higher among drug abusers that use benzodiazepines, particularly among heavy alcohol users.

Both long-term and short-term use have the potential to cause physical and psychological dependence and severe withdrawal symptoms.

Dependence and tolerance can also develop rapidly, with benzodiazepine withdrawal syndrome occurring after as little as three weeks of continuous use.  Withdrawal symptoms include depression, anxiety, panic attacks, and agoraphobia, among others.

Meridia Abuse and Addiction

Meridia (Sibutramine, Reductil and Sibutrex) is an appetite suppressant drug used primarily to treat obesity.  Safety concerns have led to suspension of sales in the United Kingdom and Europe, but it is still manufactured and sold in the United States.

Meridia is classified as a Schedule IV controlled substance in the United States due to is use as an anorectic and its over-prescription resulting in a number of abuse and addiction cases.

Meridia increases the risk of heart attack and stroke in people with a history of cardiovascular disease.  Symptoms of overuse or overdose include seizures, urniation problems, abnormal bruising or bleeding, jaundice, fever, rigors, chest pain, abnormal vision, dyspnea, and edema.

Other common side effects of Meridia include dry mouth, paradoxically increased appetite, nausea, upset stomach, constipation, trouble sleeping, dizziness, drowsiness, menstrual cramps/pain, headache, flushing, and joint and muscle pain.

Infrequent but serious side effects of Meridia include cardiac arrhythmia, severe mental/ or mood changes, restlessness, confusion, depression, and suicidal ideation.

Studies are ongoing into reports of sudden death, heart failure, renal failure, and gastrointestinal problems due to Meridia abuse.

The FDA has issued alerts and recalls for a number of dietary supplements that contain Sibutramine at concentrations twice the amount recommended for weight loss.   Related compounds such as Fen-Phen have been known to cause pulmonary hypertension, a rare but clinically significant problem.

Methylyn Abuse and Addiction

Methylyn (methylphenidate) is a psychostimulant drug approved for treatment of Attention Deficit Hyperactivity Disorder, Postural Orthostatic Tachycardia Syndrome, and narcolepsy.  It may also be prescribed for treatment-resistant cases of lethargy, depression, neural insult, obesity, and Obsessive Compulsive Disorder.

Methylphenidate belongs to the piperidine class of compounds, which increase the levels of dopamine and norepinephrine in the brain.  Methylphenidate is structurally similar to amphetamine, and its pharmacological effects are closely related to those of cocaine.

In the United States, Methylyn (methylphenidate) is classified as a Schedule II controlled substance, the designation used for substances that have a recognized medical value but present a high likelihood for abuse because of their addictive potential.

Methylyn is approved by the FDA for the treatment of Attention Deficit hyperactivity disorder because of its effects of increasing or maintaining alertness, combating fatigue, and improving attention.  The long term effects of methylphenidate on the developing brain are unknown, and it is not approved for children under six years of age.

Methylphenidate has shown some benefits as a replacement therapy for methamphetamine addiction.  Methylphenidate and amphetamine have also been investigated as a chemical replacement for the treatment of cocaine dependence, in the same way that methadone is used as a replacement for heroin.  Methylphenidate is actually more potent than cocaine in its effect on dopamine transporters.

Methylphenidate has a high potential for drug abuse and drug dependence due to its pharmacological similarity to cocaine and amphetamine.

Methylphenidate abuse is higher among college students compared to non-college attending young adults.  College students abuse methylphenidate as a so-called "study drug" to improve concentration or stay awake.  Methylphenidate has been dubbed "kiddie coke" due to its low price and high availability among young people.  It is one of the top ten stolen prescription drugs in the United States.

Increased alcohol consumption due to abuse of stimulants such as Methylyn has additional negative effects on the health, particularly in young adult abusers.

Methylyn long term use, and use in high doses, has been associated with higher levels of psychiatric admissions, drug dependence, paranoia, schizophrenia and psychosis.  Psychotic symptoms from Mehyphenidate can include hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, euphoria, grandiosity, paranoid delusions, confusion, and increased aggression.

Tolerance may occur with long-term use of methylphenidate, including cross tolerance with other stimulants such as amphetamines and cocaine.

Withdrawal symptoms of methylphenidate can include psychosis, depression, irritability and a temporary worsening of the original symptoms for which the drug was prescribed, known as rebound.

Meprobamate Abuse and Addiction

Meprobamate (brand name Miltown, Equanil and Meprospan) is a an anti-anxiety drug that was once the best-selling minor tranquilizer in the United States.  It has largely been replaced by benzodiazepines such as Valium, Librium, and Xanax.

Meprobamate is a Schedule IV drug under the Convention on Psychotropic Substances.

Symptoms of Meprobamate overdose include drowsiness, unresponsiveness, loss of muscle control, severe impairment or cessation of breathing, coma, and shock.

Death has been reported with ingestion of as little as 12 grams of Meprobamate.

Prolonged use of Meprobamate can lead to physical dependence and has a life-threatening abstinence syndrome similar to alcohol and barbiturates.  Sudden abstinence from Meprobamate can lead to severe reactions including insomnia, vomiting, tremor, muscle twitching and overt anxiety in the first 3 to 4 days.

Acute psychotic reactions and hallucinations resembling delirium tremens have been noticed in severe cases of Mebrobamate abuse.

Medically supervised detoxification (detox) followed by psychosocial treatment is highly recommended in cases of long-term Mebprobamate abuse and dependence.

Interventionists

The following is a list of Interventionists we have worked with.

Summit Malibu does not endorse or recommend one interventionist over another, but is providing this list as a starting point in your search for the right Interventionist.

As part of the Intervention process, the client and their Interventionist must be free to choose the correct next step in their recovery regardless of any affiliation, stated or implied.

• Pat Moomey, BRI-I
  • Board Registered Interventionist (BRI-I) with the Association of Intervention Specialist Credentialing Board (AISCB), Certified Addiction Treatment Counselor, and Certified Recovery Coach.
• Dallas Taylor, CAS, BRI-II
  • Board Registered Interventionist (BRI-II) with the Association of Intervention Specialist Credentialing Board (AISCB), Certified Addiction Counselor with the American Academy of Health Care Providers in the Addictive Disorders.

Meperidine Abuse and Addiction

Meperdine (Demerol, Pethedine, Lidol, Pethanol, Alodan and Dispadol) is a fast-acting opioid analgesic drug used for the treatment of moderate to severe pain.  It is most commonly known by its brand name, Demerol.  It is administered in tablets, syrup or by intramuscular or intravenous injection.

Meperidine causes users to experience marked euphoria because it triggers the brain's pleasure centers while it blocks pain.

Meperidine's effects are felt a few minutes after ingestion and last from two to four hours.  Meperidine’s effects are similar to morphine, but with sedation, respiratory depression, and euphoria less intense than morphine.  Nausea and vomiting are common with oral use but less likely when administered by injection.

For much of the 20th century Meperidine was the opioid of choice for many physicians.

Meperidine was considered to be safer and to carry less risk of addictionthan Morphine.  It was also thought to be superior in treating pain due to its antispasmodic effects.  Physicians now consider Meperidine to be no more effective than Morphine in treating pain. In addition, its low potency, short duration, and toxicity has caused it to lose popularity in recent years.

Meperidine toxicity can result in seizures, delirium, and other serious neuropsychological effects.

The side effects of Meperidine are similar to those of other opiods: nausea, vomiting, sedation, dizziness, urinary retention and constipation. Meperidine overdose can cause muscle flaccidity, respiratory depression, cold and clammy skin, hypotension, and coma.

Fatalities have occurred with both oral and intravenous Meperidine overdose.

Serotonin syndrome, a potentially life-threatening build up of excess serotonin in the brain, has occurred in patients taking Meperidine during antidepressant therapy or with selective serotonon reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MOIs).

Despite being structurally distinct from Morphine and related opiates, Meperidine's effects on opiate receptors in the brain are similar to those of morphine.

The major hazard of Demerol is respiratory depression, but other risks include circulatory depression, respiratory arrest, shock, and cardiac arrest.

Physical tolerance and psychological dependence can develop, especially with excessive doses or long-term use.  Stopping usage abruptly after prolonged or high dosage can result in extreme fatigue and mental depression.

Medially supervised detoxification is highly recommended when experiencing Meperidine withdrawal.

Severity of withdrawal symptoms is directly related to the amount of Meperidine taken and the length of time it has been taken.  Dependence can develop after even a few weeks of regular use.  Treatment will ultimately depend on the degree of addiction.

Lomotil Abuse and Addiction

Lomotil is the brand name of diphenoxylate, an anti-diarrheal that is chemically related to the narcotic drug meperidine (aka Demerol).  It works by slowing down the movement of the intestines.  It is often combined with Atropine, which reduces spasms in the bladder, stomach and intestines.

Lomotil and Atropine are generally safe in short-term use and with recommended dosage, but long-term use may present problems of dependence.

Lomotil abuse can cause side effects including dry mouth, headache, constipation, blurred vision, drowsiness and dizziness.  Because of these efects, Lomotil shouldn't be used by motorists or operators of machinery.

Symptoms of Lomatil overdose can take up to 12 hours to appear.

Overdose is common among drug abusers, possibly because of its relatively mild initial effects that may cause them to take additional amounts to feel the desired effects.  Symptoms of Lomatil overdose include convulsions, respiratory depression, dilated eye pupils, rapid side-to-side eye movements, flushed skin, constipation, nausea, vomiting, tachycardia, drowsiness, coma and hallucinations.

Treatment of Lomotil overdose must begin immediately after diagnosis and may include the following: emesis (induced vomiting), gastric lavage, ingestion of activated charcoal, laxative and a counteracting medication such as a narcotic neutralizer.

Recovery from Lomatil overdose usually occurs within 24 to 48 hours, but children and young adults are at risk of a very poor outcome and must be kept for observation.

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