Fighting the Opioid Epidemic: The Role of Providers and the Clinical Laboratory in Understanding Who is Vulnerable

Cover
Fighting the Opioid Epidemic
Copyright
Dedication
Preface
1. Crude Opium, Morphine, Codeine, and Heroin: Past and Present
	Introduction
	Opium Use: From Ancient Time to Modern Time
	Opium and Poppy Plants: Legal Issues
	Alkaloids Found in Opium
	Morphine
	Codeine and Thebaine
	Heroin
		Heroin Synthesis and Cutting of Heroin
		White versus Brown and Black Tar Heroin
		Heroin Laced with Fentanyl
		Heroin Pharmacokinetics
		Adverse Effects of Heroin
	Blood and Urine Levels of Heroin and ITS Metabolites
		Treatment of Heroin Overdose and Heroin Withdrawal
	Conclusions
	References
2. Prescription Opioids: An Overview
	Introduction
	History of Pain Management
	Opioid Receptors
	Prescription Opioids
		Opioid Prescription Pattern
	Morphine
	Codeine
		Oxycodone
	Hydrocodone
	Hydromorphone
	Oxymorphone
	Fentanyl
		Fentanyl Derivatives
	Methadone
	Meperidine
	Tramadol
	Tapentadol
	Buprenorphine
	Levorphanol
	Propoxyphene
	Effect of Sex, Age, Ethnicity, and Reanal and Hepatic Function on Certin Opioids
	Other Opioids
	Abuse-Deterrent Opioid Formulations
		Physical/Chemical Barrier Technology
		Combining an Opioid Drug with an Opioid Antagonist
		Incorporation of Aversive Ingredients
		Abuse-Deterrent Prodrug Formulation
		Novel Drug Delivery System
	Compliance With Prescription Opioid
	Conclusions
	References
3. Opioid Abuse and Opioid Epidemic
	Introduction
	Analgesic Ladder Proposed by the World Health Organization
	Other Guidelines in Pain Management
	Opioid Abuse and Opioid-Related Fatalities
	What Caused Opioid Epidemic?
		Heroin Laced With Fentanyl and Fatality
	Which Opioids Are Most Commonly Abused?
		Oxycodone Abuse
		Oxymorphone Abuse
		Hydrocodone or Hydromorphone Abuse
		Morphine or Codeine Abuse
		Fentanyl Abuse
		Other Abused Opioids
	Combined Abuse of Opioids, Other Drugs, and Alcohol: A Deadly Combination
	Prescription Monitoring
	Conclusions
	References
4. Genetic Factors Associated With Opioid Therapy and Opioid Addiction
	Introduction
	Substance Abuse Disorder: Role of Gene and Environment
	Drug-Metabolizing Enzymes
	CYP Family of Enzymes
		Polymorphism of CYP2D6
		Polymorphism of CYP2B6
		Polymorphism of CYP2C9
		Polymorphisms of Other CYP Isoenzymes
	Polymorphisms of CYP2D6 and Opioid Therapy
		CYP2D6 Gene Polymorphism and Codeine Therapy
		CYP2D6 Gene Polymorphism and Tramadol Therapy
		CYP2D6 Gene Polymorphism and Therapy with Oxycodone or Hydrocodone
			Methadone toxicity and pharmacogenetics issues
			Morphine and pharmacogenetic considerations
			Hydromorphone and pharmacogenomics
			Pharmacogenomics issues with fentanyl
	P-glycoprotein and Opioids
	Polymorphisms of Genes Coding Opioid Receptors and Opioid Therapy
		OPRM1 Gene Polymorphism and Addiction
	Dopaminergic System and Addiction
		Dopaminergic System and Opioid Addiction
	Other Neurotransmitter Pathways and Opioid Addiction
	Genetic Addiction Risk Score
	Epigenetic Issues
	Conclusions
	References
5. Environmental Factors Linked to Opioids, Drugs, and Alcohol Abuse
	Introduction
	Substance Abuse: A Psychiatric Disorder
	Fetal Exposure to Opioids
		Opioid Abuse in Pregnancy and Clinical Outcome
	Childhood Maltreatment and Increased Risk of Addiction
	Environmental Risk Factors for Adolescence
		Intimate Partner Violence and Addiction in Adolescents
		Peer Pressure and Addiction
		Yoga/Meditation Protects Adolescents and Adults From Substance Abuse
	Stress Increases Risk of Substance Abuse
		Stressful Life Events and Alcohol or Substance Abuse
		Happy Marriage, Religiosity, and Spirituality Protects People from Substance Abuse
	Personality Type, Mental Disorder and Risk for Substance Abuse
		Comorbid Substance Use Disorder and Personality Disorder
	Conclusions
	References
6. Poppy Seed Defense and Workplace Drug Testing: Does It Work in the Court?
	Introduction
	Differentiating Heroin Abuse From Poppy Seed Defense
		Morphine Levels Indicative of Heroin Abuse
		Acetylcodeine
		Papaverine and Metabolites
		ATM4G: a Biomarker of Heroin Abuse
	Opiate Content of Poppy Seeds
	Morphine and Codeine in Poppy Seed–Containing Foods
		Toxicity and Fatality after Drinking Poppy Tea
		Ethnic Poppy Seed Foods
		Consuming Raw Poppy Seeds
	Expected Morphine and Codeine Levels after Eating Poppy Seed–Containing Foods
		Degradation of Morphine During Food Processing
		High Morphine Levels After Eating Unprocessed Poppy Seeds
		Morphine Levels After Eating Poppy–Containing Foods
	Thebaine: a Marker of Poppy Seed Consumption
		Poppy Seed Defense: Does It Work at Court?
	Conclusions
	References
7. Drug Testing in Pain Management
	Introduction
	Commonly Tested Drugs
		Drug Testing: Analytical Issues
		Issues of Interferences in Immunoassay Screening Tests
		Drug Confirmation Using Mass Spectrometry
	Drug Testing in Pain Management
		Drugs Usually Tested in Pain Management Panel
	Urine Drug Testing in Pain Management
		Limitations of Pain Management Drug Testing Using Immunoassays
		Application of Mass Spectrometry for Pain Management
		Issues of Drug Metabolites in Drug Confirmation
		Case Report
		Case Report
		Case Report
	Issues of Specimen Adulteration
		Interpreting Urine Drug Testing Results in Pain Management
	Use of Oral Fluid for Pain Management Drug Testing
	Conclusions
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
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	L
	M
	N
	O
	P
	R
	S
	T
	U
	W
	Y
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