Opioid Drugs: A Comparative Survey of Therapeutic and "Street" Use

Abstract

Findings suggest that CNCP patients prescribed strong opioid analgesics derive more benefit than harm.

Analysis of opioid efficacy, tolerance, addiction and dependence from cell culture to human

“…Dose escalation in human pain patients receiving chronic opioid therapy is well established (Collett, 1998;Tobias, 2000), although many patients maintain a relatively consistent dose for months once a therapeutic dose is achieved (Cowan et al, 2001;Farrar et al, 2010). Dose escalation is a common occurrence for illicit opioid users (Cowan et al, 2001), and anecdotal reports of complete tolerance to doses of morphine up to approximately 500-fold the normal dose in single infusions in human addicts have been documented (Jaffe, 1985).…”

“…As described above, this is evident at both the behavioural and cellular level. Although the long-term use of opioids to treat chronic pain suggests that pain may interfere with the development of tolerance to opioids in humans (Cowan et al, 2001;Portenoy et al, 2007), data derived from both animals and drug abusers demonstrate that tolerance is a real potential problem with opioid use. The two most interesting findings are that different signalling mechanisms may contribute to tolerance to different opioids and the magnitude of tolerance is less with high-compared with low-efficacy m-opioid receptor agonists in animal studies.…”

“…Dose escalation is a common occurrence for illicit opioid users (Cowan et al, 2001), and anecdotal reports of complete tolerance to doses of morphine up to approximately 500-fold the normal dose in single infusions in human addicts have been documented (Jaffe, 1985). The magnitude of tolerance is more difficult to ascertain in chronic pain patients.…”

“…Clinically, more than 10-fold dose escalations of opioid dose in chronic pain management are common (Buntin-Mushock et al, 2005) and yet, many studies show that relatively stable doses of opioids can provide pain relief for weeks or years (Eisenberg et al, 2005;Farrar et al, 2010). Addiction as defined by the compulsive, harmful use criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition is common among recreational opioid users, but relatively rare in chronic pain patients (Cowan et al, 2001). Conservative estimates of patients prescribed longterm opioids who develop some sort of addictive disorder range from 2-6% (Fields, 2007) although both lower and higher rates have been reported (Ballantyne and LaForge, 2007;Noble et al, 2010).…”

The Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Patients with Chronic, Non-Malignant Pain who are Maintained on Sublingual Buprenorphine/Naloxone

“…Despite their medical utility, many opioid analgesics including morphine, hydrocodone, hydromorphone, fentanyl, and oxycodone have significant abuse liability (Comer et al, 2008;Walsh et al, 2008;Zacny and Lichtor, 2008). Aberrant opioid use behaviors among patients with pain include: obtaining prescriptions from multiple prescribers, forging prescriptions, 'borrowing' or stealing opioids, aggressively seeking more medication from physicians, and escalating doses without the physician's knowledge (Cowan et al, 2001;Martell et al, 2007;Passik et al, 2006). The exact prevalence of opioid abuse among patients with chronic pain is difficult to determine, although two studies conducted in the United States estimated that over 40% of patients with chronic pain exhibited aberrant drug-related behavior (Katz et al, 2003;Passik et al, 2006).…”