Sharing a Novel Experience of Treating Addiction to Opium and Derivatives with only Ayurvedic Approach- A Case Series

Introduction: Opium and its derivative addiction are one of the most prevalent addictions in western Rajasthan, because it is easily available and is being used openly in social programs as the culture of the same. In western Rajasthan, mainly Doda poppy, opium milk, smack, tramadol, etc. are major forms of opium-derived addictions. Withdrawal symptoms such as nausea, vomiting, diarrhea, chills, body ache, sleeplessness and flu-like symptoms begin, these symptoms can grow severe enough to necessitate emergency medical attention, and in extreme situations, they might have life-threatening consequences for the user as a result of respiration depression, and pupil dilation in the later stages. The assessment was based on Clinical Opiate Withdrawal Scale (cows) before and after the treatment. Intervention: Efforts have been applied to depict 8 cases of opium addiction in form of series who have been treated with Ahiphenmochanadi vati in the dose of 250 mg twice a day and Sameergaja kerari rasa in the tapering method (Padanshika Krama) starting with the dose of 375 mg along with panchakarma procedures, Shirodhara with til tail, Abhayanga, and Swedana with Mahanarayan Tail and Dashmool kwath respectively for a period of 1 month. Reduction in cows scale was observed, about 75-80% of symptoms subsided in all cases and the results have been reported very encouraging within a period of twenty to thirty days. Conclusion: Altogether, multimodal Ayurveda treatment can be an effective and safe solution for smack addictions.

Effect of opium addiction on postoperative arrhythmia among patients undergoing cabg operation on cardiopulmonary bypass

Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.

Identification of major bioactive components and their metabolites in rat plasma after oral administration of Zhikebao tablet by UHPLC-QTOF-MS / 药学学报

An ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) method was established to identify the metabolites in rat plasma after oral administration of Zhikebao tablets. The high-resolution mass spectrometer was operated in positive and negative ion mode, respectively. First, full-scan was applied, which was dependent on a multiple mass defect filter (MMDF) combined with dynamic background subtraction (DBS). These were utilized to trigger the information dependent acquisition (IDA) function in the experiment. For the IDA criteria, the eight most intense candidate ions of per cycle were selected to do a product ion scan. Then Metabolite Pilot 2.0 software was utilized to load data to seek possible metabolites. The analytical models employed by Metabolite pilot 2.0 were established for representative compounds of the Papaveris Pericarpium and licorice in Zhikebao tablet. Finally, metabolites were identified according to accurate mass measurement and retention time. 38 components from the rat plasma after oral administration of the drug have been found, including 5 prototype opium alkaloids, liquiritin, glycyrrhizic acid and 31 relative metabolites. The metabolic transformation of Zhikebao tablet in rats was mainly induced by glucuronidation, sulfation, methylation, amine to carboxylic acid, hydrolysis and so on. In this paper, the metabolites of the main active components of Zhikebao tablet were tentatively identified, and the metabolic pathway was compared with that of single chemical drugs. Moreover, it laid the fundamental elucidation of further metabolism study of Zhikebao tablet or other compound traditional Chinese medicine preparations which containing Papaveris Pericarpium or licorice.

Double-blind evaluation of homeopathy on cocaine craving: a randomized controlled pilot study / 中西医结合学报

<p><b>BACKGROUND</b>Brazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment.</p><p><b>OBJECTIVE</b>This study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting.</p><p><b>DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS</b>A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group).</p><p><b>MAIN OUTCOME MEASURES</b>The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups.</p><p><b>RESULTS</b>The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients' appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41).</p><p><b>CONCLUSIONS</b>A psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.</p><p><b>TRIAL REGISTRATION</b>RBR-2xzcwz (http://www.ensaiosclinicos.gov.br).</p>

The medieval Persian manuscript of Afyunieh: the first individual treatise on the opium and addiction in history / 中西医结合学报

According to historical evidence, the abuse of opium has been reported all over the globe-specifically throughout Eastern nations-since the sixteenth century. Before that, opium had mostly been applied as medication. Reference has been made in traditional Persian medical literature to the method of cultivation, properties, side effects and toxicity. In sixteenth century Iran, during the reign of the Safavids, opium abuse began. It was from then that prominent Persian scholars started to think of solutions to this societal problem. One of the most famous scholars was Imad al-Din Mahmud ibn Mas'ud Shirazi, who composed a book concerning addiction-Afyunieh, a comprehensive book on the topic of opium and all issues of opium. Furthermore, he recommended methods for reducing opium dose as well as substitution with other medications that had a narrower range of side effects, in order to eradicate dependency upon opium and opium-derived materials. This is most likely the first book that comprehensively addressed opium and discussed drug rehabilitation methodology, in traditional Persian medical literature. In this historical review, the authors have introduced the book Afyunieh, which presents methods for treating addiction to and giving up opium; the text comprises a synthesis of the author's opinions, professional experience and references to the work of other famous physicians.

Narratology and History in Amitav Ghosh’s River of Smoke.

Amitav Ghosh‟s novel River of Smoke belongs to the genere of the historical novel. With the help of different narrative strategies, Amitav Ghosh in this novel has re-written history that covers the period of opium trade in Canton, in 1838. The story is about the struggle of Manchu Empire against the British Empire who made war on China in the name of free trade. Ghosh has re-inventing past through using different narratological devices while presenting the personal history with nation‟s history. He uses memory, interior monologue, stream of consciousness, authentic and official voices of historical personals , original documentation ,edicts, Canton journals, Hukamnamas , proclamations, translators, letters, painting and drawings etc. to present opium war period in Canton . The novel moves in flash back in non- chronological order. There are analeptic movements, embedded stories, characterized by fragmented sequences, ellipsis, digression and jumbled chronology. The narrative is presented through third person omnipresent narrator along with first person character narrator. The point of views from which the story is told keeps on changing. Different perspectives of the colonized, the downtrodden, the oppressed, the sufferers, the marginals, of the colonizers and real historical persona present vivid account of the period. This shifting focalization also helps to present vividly the history of opium war period in Canton.

Unaccustomed exertion and opiate consumption leading to acute renal failure in a healthy male.

A 38 year old male presented with stupor and acute renal failure (ARF) following opium consumption and a protracted excursion on foot to a holy shrine situated at altitude of 4329 m above sea level. The finding of dark colored urine, myoglobinuria and a markedly elevated serum creatinine phosphokinase level supported the diagnosis of rhabdomyolysis. The patient had a rapid and complete recovery following fluid resuscitation and haemodialysis.

Morfina intratecal como analgésico postoperatorio en la corrección quirúrgica de escoliosis / Intratecal morphine as a preoperative analgesic in the surgical correction of scoliosis

Introducción: la escoliosis, entidad frecuente en Cuba, es fuente de preocupación e investigación por su repercusión estética y afecciones funcionales que produce. Su tratamiento definitivo es quirúrgico y el dolor es una molestia significativa para estos pacientes en el postoperatorio. Objetivos: caracterizar el desempeño de la morfina intratecal como analgésico postoperatorio en la corrección quirúrgica de escoliosis. Métodos: análisis del dolor postoperatorio de 24 pacientes portadores de escoliosis idiopática con curvaturas mayores o iguales a 40 grados divididos en un grupo «Estudio¼ receptor de morfina intratecal y un grupo «Control¼ con tratamiento convencional. Análisis estadístico con la prueba t, ANOVA, Chi-cuadrado, Odds Ratio y Correlación Lineal de Spearman con un nivel de significación de 5 %. Resultados: ambos grupos no exhibieron diferencias estadísticamente significativas respecto a edad, sexo, peso corporal, estado físico ASA, grado de escoliosis y tiempo quirúrgico pero difirieron significativamente en la analgesia de rescate requerida en la totalidad de los controles y en menos de la mitad del grupo Estudio. Solo un paciente del grupo Estudio no presentó efectos adversos atribuibles a la morfina. Los dos grupos revelaron diferencias estadísticamente significativas en relación al dolor postoperatorio a las 3, 6, 12 y 48 horas, no así a las 24 horas. Conclusiones la morfina intratecal fue altamente efectiva para disminuir el dolor postoperatorio con desempeño superior al tratamiento convencional. La incidencia y severidad de los efectos colaterales fueron aceptables y fácilmente controlables, no se presentó ninguna complicación.

Introduction: scoliosis, a frequent entity in Cuba, is a source of concern and research due to the esthetic repercussion and functional affections that produces. Surgery is the definite treatment and the pain is a significant bother for patients in postoperative. Objective: to characterize the behavior of intratecal morphine as a postoperative analgesic in the surgical correction of scoliosis. . Methods: analysis of postoperative pain in 24 patients who suffer from idiopathic scoliosis with main curvatures or equal to 40 degrees divided into a study group as a receptor of intratecal morphine and a control group with a conventional treatment. Statistical analysis with the T test , ANOVA, Chi-squared, Odds Ratio and Linear Correlation of Spearman with a level of significance of 5 %. . Results: both groups did not show significant statistical differences as to age, sex. body weight, ASA physical conditions, degree of scoliosis and surgical time but they differed significantly in the rescue analgesia in all controls and in less than the half of the study group. Only one patient of the group study did not show side effects attributed to morphine. Both groups revealed statistical differences in relation to postoperative pain at 3, 6, 12 y 48 hours, but not at 24 hours. Conclusions: intratecal morphine was effective to reduce postoperative pain with a higher behavior to conventional treatment. Incidence and severity of side effects were acceptable and easily controllable, there was no complication.

Receptores opioides até o contexto atual / Opioid receptors to date

JUSTIFICATIVA E OBJETIVOS: Devido à finalidade do ambulatório e os fármacos utilizados rotineiramente, o objetivo deste estudo foi rever e atualizar os conhecimentos sobre os receptores opioides e como complemento de estudo após palestra apresentada aos integrantes da equipe. CONTEÚDO: Foram revisados desde os aspectos históricos até os conhecimentos mais recentes sobre receptores opioides, descritos seus subtipos e mecanismos de ação. Para tal, foram consultadas referências indexadas pelo Pubmed. CONCLUSÃO: Com os dados presentes na literatura atual, concluiu-se que ainda existe muito a ser pesquisado sobre o tópico, visando medicações mais seguras e novas técnicas biomoleculares ainda são necessárias.

BACKGROUND AND OBJECTIVES: Due to the objective of the outpatient setting and to routinely used drugs, this study aimed at reviewing and updating the knowledge about opioid receptors and worked as a study complement after a lecture presented to team members. CONTENTS: We have reviewed from historical aspects to most recent developments about opioid receptors, in addition to describing subtypes and action mechanisms. For such, Pubmed-indexed references were queried. CONCLUSION: After reviewing current literature data, we have concluded that there is still a lot to be researched about the topic, aiming at safer drugs, and new biomolecular techniques are still needed.

Relationship between Opium Abuse and Severity of Depression in Type 2 Diabetic Patients

BACKGROUND: Opium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients. METHODS: In this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria. RESULTS: The mean depression score was higher in the opium abuse group than in the non-abuser group (29.27+/-1.44 vs. 18.29+/-1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001). CONCLUSION: Depression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.

Study On Harmful Effects Of Opium On Liver And Lungs In Chronic Opium Addicts Of Western Rajasthan.

Background: Today opium dependence is widely prevalent in certain states of India, especially Rajasthan, Punjab, Haryana, Madhya Pradesh (MP) etc. In rural areas of western Rajasthan crude opium is consumed with a social acceptance by a notable proportion (8.0%) of adult male population. Later on they become addicted to it. Objective: to observe the changes in some liver and lung function parameters in opium addicted subjects of Barmer city of Western Rajasthan. Methods:The present study was conducted in district hospital of Barmer, Rajasthan. Total fifty (50) adult male subjects with age ranged from 30 to 50 years were participated in this study. Among them 25 were opium addicted and were considered as study group (Group B) and another 25 apparently healthy adult male of same age group were designated as control group (Group A). Opium addicts were consuming about 5–11 gm/day opium for >2 years. Then liver function tests were evaluated by estimating serum aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase and lung function tests by measuring FVC, FEV1 , FEV1/FVC% , PEF, FEF 25-75% of both the groups. Results: In this study AST, ALT and alkaline phosphatase levels were found significantly (p<.05) higher in group B as compared to those of group A. Again, FVC, FEV1, FEV1/ FVC were significantly (p<.05) lower in group B as compared to those of group A. PEF (L/sec) and FEF25-75% were also significantly (p<0.001) lower in group B as compared to those of group A. Conclusion: it is concluded that chronic long term use of opium, increases the risk of hepatic and pulmonary damage.

William Wilkie Collins: la medicina como un medio para enriquecer la creación de la literatura de ficción / William Wilkie Collins: Medicine as an aid for enriching the creation of fiction literature

William Wilkie Collins (WWC) is a well-known prolific and innovator English writer of the Victorian age. After 150 years he is still being extensively read and all his main works are translated into Spanish. Furthermore, WWC has been acclaimed by famous writers such as JL Borges and TS Eliot as one of the best story-tellers of all times, and a master of the complexities of the plot of stories. WWC mentioned on his works many innovator aspects of medicine, demonstrating an uncanny power of observation and real interest in science. Notoriously, WWC described posttraumatic epilepsy, the clinical effects of opium, the introduction of people with sensorial deficits, such as blindness and deafness, as main figures in his novels. WWC also showed an interest in the management of mental disorders and the use of music as a potential therapy. In this review, we comment these interesting aspects of the creative work of this genius of the fiction literature.

Characteristic of SCL-90 in detoxification addicts in reeducation center / 中国康复理论与实践

@#ObjectiveTo investigate the Character of Symptom Checklist 90 (SCL-90) in detoxification addicts in reeducation center.Methods100 detoxification addicts in reeducation center were evaluated.ResultsThe results showed that the mean scores of all factors in detoxification addicts were higher than those of normal population, and there was difference between different drug dependence addicts.ConclusionThe detoxification addicts shows serious psychological disorders.

Analysis of Opium Analgesics Used in Advanced Cancer Patients in Four Cities During the Period 1998～2000 / 中国药房

OBJECTIVE:To investigate the situation of opium analgesics used for advanced cancer patients in recent 3 years and its future trend METHODS:The sales volume of morphine,fentanyl and pethidine sold in four cities was analysed RESULTS:Morphine which conformed to the first treatment principle in late cancer ache recommended by WHO occupied the first place in amount of consumption The largest quantity of opium analgesics consumption was in Shanghai and Guangzhou,which represented the situation of these drugs used in the developed districts of China CONCLUSION:There arebroad prospects in opium analgesics in controlling cancer ache

Effects of narcotics on adenyl cyclase and phosphodiesterase activity in rabbit bronchial smooth muscle / 中华麻醉学杂志

The effects of morphine, pethidine and fentanyl on adenyl cyclase (AC) and phospho- diesterases (PDE) in rabbit bronchial smooth muscle were examined in vitro. The results were as follows: morphine could inhibit the activity of AC which was decreased from 15. 9911 ? 0. 8597u to 15.0463?0. 7989u, P

Relationship between analgesic effect of total alkaloids in Papaver nudicaule and prostaglandins with opium receptors / 中草药

Objective To study the relationship between analgesic effect of total alkaloids in Papaver nudicaule(TAPN) and prostaglandins(PGs) with opium receptors.Methods The analgesic effect of TAPN was studied by hot-plate, writhing,electric-evoked methods of mice.The analgesic mechanisms of TAPN and PGs with opium receptors were studied by the writhing numbers induced by different substances(Ach,AA,MgSO_4),the PGE_2 level in celiac fluid in mice after treated by AA writhing test and the antagonistic experiment of Naloxone.Results The inhibitory effect of TAPN on the writhing induced by Ach and AA in mice was stronger than that induced by MgSO_4.TAPN could also lower the PGE_2 level in celiac fluid.In the antagonistic experiment of Naloxone,no antagonism to the analgesic effect of TAPN had been found by ip or icv Naloxone.Conclusion It may be the mainly peripheral analgesic mechanism that TAPN could lower the PGE_2 level in celiac fluid.Its central analgesic mechanisms are not related to opium receptors.