be a sterile liquid capable of complete absorption or it will irritate the tissues. Although the subcutaneous injection may be given in almost any area of the body, the usual sites are the lateral (outer) aspect of the upper arms and the anterior (front) of the thighs. 2. Intramuscular : The drug is injected into a muscle, usually in the buttocks, sometimes in the upper arm or the thigh. The needle is inserted, at right angle to the skin, through the skin and subcutaneous tissue into the underlying muscle. This method gives more rapid absorption of the drug than subcutaneous injection gives. 3. Intravenous : Drugs administered by vein act very rapidly, because the whole dose passes directly into the blood stream. A comparatively small amount of sterile solution is given by intravenous injection; large amounts, administered drop by drop, are given by intravenous infusion. The usual site of injection is into the median basilic or median cephalic vein at the bend of the elbow. Intravenous injection is used when the drug is too irritating to be injected into other tissues, when immediate action is necessary, or when circulation is so poor that absorption from other tissue would be retarded. The IV administration of drugs is the responsibility of a medical officer; it is not a routine procedure performed by nurses or nonprofessional nursing personnel. When so performed, it must be in accordance with local policy directives. 4. Intradermal : The drug is injected into the upper layers of skin, rather than under the skin as in a subcutaneous injection. Minute amounts (0.1 ml. and less) are given intradermally, usually to test for drug sensitivity before administering larger amounts by other methods. Absorption from intradermal injection is slow. The medial (inner) surface of the forearm is the site most frequently used. 5. Intraspinal (intrathecal) : Drugs injected into the spinal canal are usually injected into the subarachnoid space. Some anti-infective drugs as well as spinal anesthesia are administered in this manner. The technique is the same as that required for lumbar puncture. 6. Other : Drugs may also be injected into the peritoneum (intraperitoneal), into the heart muscle (intracardiac), into bone (intraosseous) and into joints (intrasynovial). Categories of opioids CDC looks at four categories of opioids: 1. Natural opioid analgesics : Including morphine and codeine, and semi-synthetic opioid analgesics, including drugs such as oxycodone, hydrocodone, hydromorphone and oxymorphone. 2. Methadone : A synthetic opioid. 3. Synthetic opioid analgesics : Other than methadone, including drugs such as tramadol and fentanyl. Fentanyl is a synthetic opioid that is legally made as a pharmaceutical drug to treat pain, or illegally made as a non-prescription drug and is increasingly used to intensify the effects (or “high”) of other drugs, such as heroin. This drug is often mixed with other opioids, unbeknownst to the user, and is extremely powerful. 4. Heroin : An illicit (illegally-made) opioid synthesized from morphine that can be a white or brown powder, or a black sticky substance. (CDC, 2017)
drug is administered. The common methods of internal administration are: A. Oral : The most common way to give a medicine is by mouth, either in solid or liquid form. Giving a drug by mouth is the simplest way; it requires no special apparatus, it is painless, and absorption takes place in a natural manner. Furthermore, if a patient is sensitive to the drug, the stomach can be washed out or the patient can induce vomiting to prevent further absorption. B. Sublingual : A limited number of drugs are administered by placing a tablet or drop under the tongue. The drug is held there until absorbed. It is not swallowed, and a drink must not be taken until it has been absorbed. The resulting action of drugs is rapid. (The drug most commonly used sublingually is nitroglycerine). C. Rectal : Medications are given by rectum for the purpose of evacuating the colon, for local treatment of a diseased rectum or colon, and for general absorption. To induce a bowel movement, drugs may be given by an enema. Irrigations may be used to medicate the mucous membrane of the rectum or colon. Rectal suppositories also are frequently used. Another method by which substances are administered through the rectum is proctoclysis. Fluid is allowed to run into the rectum slowly, drop by drop, so that it is absorbed and does not enlarge the rectum. The disadvantages of rectal administration are the uncertainty of absorption and the chance that the drug may be expelled. D. Inhalation : Medications are administered by inhaling them into the lungs. This may be done by inhalation of aqueous preparations such as medicated steam, sprays and aerosols. Drugs given by inhalation include various preparations for respiratory infections and diseases, medicinal gases such as oxygen, and certain general anesthetics. Oily preparations are not given by inhalation since the oil would damage lung tissue. E. Injection : Drugs given by injection are administered with a sterile needle and syringe; injection methods are also referred to as parenteral (beside the intestine). A sterile injection method is used when rapid action by the drug is desired, when the drug might be destroyed by digestive juices or vomited if given by mouth, or when the patient is unconscious or injured so that he cannot take the medication orally. 1. Subcutaneous (hypodermic) : The drug is injected by syringe and needle into the tissue just beneath the skin. A preparation for subcutaneous use must The opioid epidemic Many individuals with an opioid use disorder began using prescription opioids to treat moderate to severe pain after surgery or injury. Even when taken as prescribed, individuals may suffer from adverse side effects and may develop an opioid use disorder. According to a 2017 report from the Center for Disease Control and Prevention, the United States is in the midst of an opioid overdose epidemic that includes prescription opioids, heroin and fentanyl. In 2017 a record number of 64,000 people died from opioid overdose. Forty percent of all opioid overdose deaths involve a prescription opioid, with 90 to 100 Americans dying every day from an opioid overdose (CDC, 2018).
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