heroin and Constipation

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.

Topics: Administration, Oral; Analgesics; Constipation; Delayed-Action Preparations; Drug Combinations; Heroin; Humans; Morphine; Morphine Dependence; Nausea; Neoplasms; Palliative Care; Respiratory Insufficiency

Topics: Administration, Oral; Constipation; Heroin; Humans; Morphine; Naloxone

Low plasma potassium level can cause muscle weakness, lassitude, constipation as well as rhabdomyolysis and arrhythmias, when severe. In muscle, low plasma potassium increases resting membrane potential (hyperpolarization) of myocytes that tend to make muscle more refractory to excitation, leading to muscle weakness. Hypokalemia can be associated with a myriad of causes including drugs of abuse. We present a case of hypokalemia and muscle weakness following use of cocaine and heroin.

Topics: Adult; Arrhythmias, Cardiac; Cocaine; Constipation; Female; Heroin; Humans; Hypokalemia; Muscle Weakness; Potassium; Quadriplegia; Rhabdomyolysis; Substance-Related Disorders

Methylnaltrexone, a peripheral opioid μ-receptor antagonist is licensed for subcutaneous administration for the treatment of severe opioid-induced constipation in adults. We describe the use of intravenous methylnaltrexone in a 3-year-old boy receiving a subcutaneous diamorphine infusion for palliation from widely metastatic alveolar rhabdomyosarcoma. The patient, who had not opened his bowels for 3 weeks despite use of regular conventional laxatives, was given a 150 mcg/kg dose via indwelling central venous catheter. Constipation was relieved within minutes of the injection. There were no side effects noted during or following injection, and no clinically apparent reduction in analgesia. Intravenous methylnaltrexone may provide a valuable additional treatment option in paediatric palliative care, especially for those with an oncological diagnosis, the majority of whom will have indwelling central venous access devices.

Topics: Administration, Intravenous; Analgesics, Opioid; Child, Preschool; Constipation; Heroin; Humans; Male; Naltrexone; Narcotic Antagonists; Palliative Care; Quaternary Ammonium Compounds

In four patients, a woman of 35 and men of 27, 38, and 22 years old, body-packer syndrome was diagnosed. Body-packer syndrome is seen in people concealing drugs in special containers within the body; this may lead to rupture with acute intoxication or to ileus. The clinical presentation can be very deceptive. An abdominal X-ray often reveals the packages. If there are no symptoms treatment is with mild laxatives, acute intoxication requires immediate laparotomy. One of the four patients died, the others recovered. Legally (Dutch law), the physician best delivers the drug to the police as a lost object, without revealing the patient's identity.

Topics: Adult; Cocaine; Constipation; Fatal Outcome; Female; Foreign Bodies; Heroin; Humans; Male; Radiography; Stomach Rupture; Syndrome

The smuggling of illicit drugs, either swallowed or inserted into the rectum or vagina, is gaining in popularity, particularly in view of the difficulty of its detection and the potentially large financial gains. Such contraband includes heroin (especially in Western Australia), cocaine, and marijuana and its derivatives. This practice is not without complications--drug intoxication, which may be fatal, and intestinal obstruction by foreign bodies have been reported. We review the cases of "body packing" reported in the literature and those detected in Western Australia over the past two years, and describe three cases of the ingestion of heroin-filled condoms, with resultant complications.

Topics: Adult; Australia; Constipation; Crime; Esophagus; Female; Foreign Bodies; Heroin; Humans; Legislation, Drug; Male; Stomach; Travel

Topics: Administration, Oral; Adult; Constipation; Erectile Dysfunction; Evaluation Studies as Topic; Female; Heroin; Hospitalization; Humans; Male; Methadone; Middle Aged; Morphine Dependence; Narcotics; Psychotherapy; Recurrence; Social Adjustment; Substance Withdrawal Syndrome; Sweating