hydrocodone and Heroin-Dependence

Identification of external contamination is a challenge in hair analysis. This study investigates metabolite ratios of hydromorphone to morphine and hydrocodone to codeine as indicators to distinguish contamination from heroin use provided that hydromorphone/hydrocodone intake is excluded.. Hair samples after external contamination with street heroin proved to be negative for hydromorphone/hydrocodone. Hair samples from individuals with suspected street heroin use/contamination or opiate medication were analyzed for 6-monoacetylmorphine, morphine, acetylcodeine, codeine, hydromorphone and hydrocodone, and metabolite ratios of hydromorphone to morphine and hydrocodone to codeine were assessed. Hair samples from individuals with medicinal heroin/morphine/codeine use displayed significantly higher metabolite ratios than those with suspected street heroin use/contamination.. Hydromorphone/hydrocodone are solely formed during body passage. Thus, metabolite ratios can be used to distinguish morphine/heroin use from external contamination.

Topics: Analgesics, Opioid; Chromatography, Liquid; Female; Hair; Heroin; Heroin Dependence; Humans; Hydrocodone; Hydromorphone; Male; Morphine; Morphine Derivatives; Opiate Alkaloids; Substance Abuse Detection; Tandem Mass Spectrometry

The objectives of this medicolegal case report are the following: 1) to present details of a chronic pain patient (CPP) who was placed on chronic opioid analgesic therapy (COAT), and subsequently overdosed on multiple drugs, some of which were not prescribed by his COAT physician; 2) to present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation that COAT prescribing was the cause of death; and 3) based on these opinions, to develop some recommendations on how pain physicians can utilize the use of Controlled Substances Model Guidelines in order to protect the patient and themselves from such an occurrence.. This is a case report of a CPP treated by a pain physician.. Differences between the plaintiff's and defendant's expert's opinions are explained utilizing the Controlled Substances Model Guidelines.. Some CPPs may withhold information critical to their COAT treatment. Application of the Controlled Substances Model Guidelines and the newer Federation of State Medical Boards' policy on opioid prescribing can be helpful in improving patient care and may be helpful in protecting the physician medicolegally.

Topics: Adult; Analgesics, Opioid; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Diazepam; Doxepin; Drug Overdose; Female; Heroin Dependence; Humans; Hydrocodone; Malpractice; Methadone; Nordazepam; Pain; Pain Measurement; Practice Guidelines as Topic; Shoulder; Shoulder Injuries; Temazepam

40 heroin addicts of whom 20 were undergoing maintenance therapy with hydrocodone (Dicodid) and another 20 with methadone have been questioned by standardized interview regarding their previous history and present situation. With data on the history we examined how well heroin addicts succeed in getting away from criminality and prostitution and look for employment while undergoing drug maintenance therapy. We were also interested to learn whether reaching the aim depended on the maintenance medication, i.e. if hydrocodone is as appropriate as methadone for maintenance therapy. The inquiry showed a significant reduction of criminality and prostitution. The rate of employment was quite stable. The therapeutic successes, measured by employment, prostitution and criminality did not differ with medication by hydrocodone or methadone. Although the more reliable patients received hydrocodone and the less reliable methadone, they did not differ either in past history or in therapeutic success. We conclude that hydrocodone can be recommended for maintenance therapy of relatively reliable heroin addicts.

Topics: Adult; Crime; Demography; Employment; Female; Heroin Dependence; Humans; Hydrocodone; Male; Methadone; Sex Work; Socioeconomic Factors