Table 2: Common Opioid Analgesics Generic Name
Receptor Effects¹
Approximately Equivalent Dose (mg)
Duration of Analgesia (hours) 4
Maximum Efficacy
Oral: Parenteral Potency Ratio
Mu Delta Kappa
Morphine 2
+++
+
10
Low
4 to 5
High
Hydromorphone +++
1.5
Low
4 to 5
High
Oxymorphone
+++
1.5
Low
3 to 4
High
Methadone
+++
10
High
4 to 6
High
Meperidine
+++
60 to 100
Medium
2 to 4
High
Fentanyl
+++
0.1
Low
1 to 1.5
High
Sufentanil
+++
+
+
0.02
Parenteral only
1 to 1.5
High
Alfentanil
+++
Titrated
Parenteral only
0.25 to 0.75
High
Parenteral only
0.054
High
Remifentanil
+++
Titrated 3
Levorphanol
+++
2 to 3
High
4 to 5
High
Codeine
±
30 to 60
High
3 to 4
Low
Hydrocodone5
±
5 to 10
Medium
4 to 6
Moderate
++
4.5
Medium
3 to 4
Mod-High
Oxycodone 2,6
Pentazocine
±
+
30 to 50
Medium
3 to 4
Moderate
Nalbuphine
—
++
10
Parenteral only
3 to 6
High
Buprenorphine
±
— —
0.3
Low
4 to 8
High
Butorphanol
±
+++
2
Parenteral only
3 to 4
High
1 +++, ++, +, strong agonist; ±, partial agonist; —, antagonist. 2 Available in sustained-release forms, morphine (MS Contin); oxycodone (OxyContin). 3 Administered as an infusion at 0.025-0.2 mcg/kg/min. 4 Duration is dependent on a context-sensitive half-time of 3-4 minutes. 5 Available in tablets containing acetaminophen (Norco, Vicodin, Lortab, others). 6 Available in tablets containing acetaminophen (Percocet); aspirin (Percodan).
McGraw-Hill makes no representations or warranties as to the accuracy of any information contained in this Table 2, including any warranties of merchantability or fitness for a particular purpose. In no event shall McGraw-Hill have any liability to any party for special, incidental, tort, or consequential damages arising out of or in connection with Table 2. Note . From Katzung, B., & Masters, S. (2012). Basic and Clinical Pharmacology (12th ed.) (p. 545). New York: McGraw-Hill. © The McGraw-Hill Companies, Inc. Reprinted with permission. Drug combinations
parties, at which prescription drugs, stolen from the home medicine cabinet, are randomly mixed and taken by the handful (Levine, 2007; Contemporary Pediatrics, 2014). It is a concerning risky behavior that allows for the ability to get high without regard for the type of drug that is being ingested, often along with alcohol (Contemporary Pediatrics, 2014). Prescription drug abuse is a societal problem that will not magically go away. Careful prescribing of controlled substances and timely communication among healthcare practitioners can go a long way in alleviating the problem.
Prescription drug abuse often involves combinations of drugs intended to intensify the abuse experience. The best known combination is called the holy trinity , which includes an opioid, alprazolam (Xanax, Nivravam), and carisoprodol (Soma, Vanadom). Alprazolam is a BZD sedative, and carisoprodol is a muscle relaxant that is metabolized to form meprobamate, a CNS depressant. This mixture is much sought after by drug abusers and has been implicated in the overdose deaths of drug-naïve teenagers (Fudin, 2014; Seay, 2014). Compulsive seeking of alprazolam or carisoprodol, even in the absence of opioid seeking, should be monitored by practitioners. Teens have been reported to combine drugs at pharming or skittles Executive office efforts Evidence of the concern surrounding prescription drug abuse has been mounting in the past decades. Recognizing the seriousness of this epidemic and its impact on individuals and society, the U.S. government has invested attention and resources into its prevention and resolution. The government’s dedicated efforts can best be seen in the Executive Office of the
EFFORTS TO PREVENT NONMEDICAL USE OF PRESCRIPTION DRUGS
President of the United States, in which the Office of National Drug Control Policy (ONDCP) was established as a result of the Anti-Drug Abuse Act of 1988 (ONDCP, n.d.a). The ONDCP positions itself as a group that “works to reduce drug use and its consequences by leading and coordinating the development, implementation, and assessment of U.S. drug policy” (ONDCP,
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