Legal Intoxication: What Prescriptions Are Being Abused Now?
Legal Intoxication: What Prescriptions Are Being Abused Now?
Legal Intoxication: What Prescriptions Are Being Abused Now?
What prescriptions
are being abused now?
Disclosure Statement
1
Objectives
A. Carbidopa/levodopa (Sinemet)
B. Gabapentin (Neurontin)
C. Buproprion (Wellbutrin)
D. Atenolol (Tenormin)
E. Fexofenadine (Allegra)
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Question 2: Which medication would you
choose?
A. Fluoxetine (Prozac)
B. Paroxetine (Paxil)
C. Phenelzine (Nardil)
D. Quetiapine (Seroquel)
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For Another CE: Known Abusive Medications
• Amphetamines: alone or with other meds
• Benzodiazepines: alone or with other meds
• Dextromethorphan: alone or with other meds
• Diphenhydramine: all routes, ‘dirty high’, preferably
before other meds (increase high)
• Ketamine: alone or with other meds
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Where Do They Learn?
• www.bluelight.org
• Wikipedia, treato.com
Carbidopa/levodopa + Cocaine
http://www.bluelight.org
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Gabapentin
• Combo: oxy, etoh, naproxen (? increased
bioavailability), propranolol, mirtazapine,
buprenorphine, caffeine
• Ø rectal or IV potential
Beta-Blockers
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Diltiazem: With Other Substances
• Suboxone
• Morphine
• Cocaine
Bupropion
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Paroxetine vs Fluoxetine
www.bluelight.org
Quetiapine
8
Monoamine Oxidase Inhibitors (MAOI’s)
Anticholinergics
• Mild euphoria
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GI Medications
• Omeprazole
• Famotidine
• Ranitidine
• Cimetidine
Cimetidine
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Loperamide
• Prevent withdrawal
• Be able to work
Miscellaneous
• Levetiracetam + methylphenidate
• Lamotrigine
• ADHD/ADD meds
Jena, A.B., Goldman, D.P., Foster, S.E., Califano, J.A.. (2011). Prescription Medication Abuse and Illegitimate Internet-Based Pharmacies. Annals
of Internal Medicine, 155, 848-850. Retrieved Feb 5, 2012, from OVID database.
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CYP450 Action
http://www.bluelight.org
Grapefruit Juice
http://www.bluelight.org
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Kratom
• Food supplement
• Sold on the internet, and stores
• Best if taken orally
• Best abused if mostly opiate naïve
• Addiction potential
http://www.narconon.org/drug-abuse/kratom-effects.html
https://en.wikipedia.org/wiki/Mitragyna_speciosa
http://www.bluelight.org
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Signs
Pmp Correctly
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Potential Prevention
Potential Prevention
• Research
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Other Supplements
A. Carbidopa/levodopa (Sinemet)
B. Gabapentin (Neurontin)
C. Buproprion (Wellbutrin)
D. Atenolol (Tenormin)
E. Fexofenadine (Allegra)
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Question 2: Which medication would you
choose?
A. Fluoxetine (Prozac)
B. Paroxetine (Paxil)
C. Phenelzine (Nardil)
D. Quetiapine (Seroquel)
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Thank you!!
The End
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Additional Information
http://www.bluelight.org
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Gabapentin Abuse
• Max benefit: solid meal before, wash down with acidic
drink, fresh squeezed lemon in water = winner, +
naproxen further incr bioavail. Dose >900mg=wasteful,
more you take=less absorb, space doses by ~1-2 hrs, this
particular and lovable med takes 1+ hr to reach peak
effect
• When 1st started taking, was my wife's, only kept filling rx
for me; was bad opiate addict then, always dosed 1800-
3600 mg at a time x 3-4 days til script gone, then I’d look
to score something else, she now gets 4500 mg/day! we
now only get rx cause I’m totally off opiates & all else,
previous dose doesn't do anything for me 3 1/2 weeks
later, so for someone w/apparently high tolerance, need to
dose for at least mellow affect? any advice would be
greatly appreciated!
://www.bluelight.org
With suboxone am a believer, amazing potentiator of buprenorphine! Not only almost doubles
subjective dose feeling but extends effects.Took 1mg of sub sl yesterday 6p, is now 10:30 a,
still feel strongly + last night slept like a baby when usually suffer from insomnia. W/out using
cimetidine, 2 mg suboxone barely holds me, keeps me well, + would not be feeling it next day.
Dosing schedule:1 hr before su -600 mg cimetidine, then dose sub, then every 6 hrs after 400
mg cimetidine until I no longer feel the sub, usually sometime after the 24 hr mark. Still well;
just no longer conciously feel the sub. Big money saver with cost of suboxone: 50 tabs of 200
mg cimetidine < $5. Even if have tried cimetidine with other opiates, try with sub, you might be
like me and able to get double the mileage out of your sub..
Recently trying to lower my suboxone maint dose to conserve my stash. Prescribed 3mg a
day; I insufflate my pills, not to get high, but find it most effective road for me. Taking 4mg
recently, ran a little low on my stash, I have begun to taper. To 3 mg three days ago and
feeling crappy. Achey/depressed below 4 mg & has always been the case (on sub maint for 4-
5 yrs, attempted to stop multiple times). 9 am took 800 mg cimetidine 1 hr before insufflating 2
mg sub, and now at 4:30 pm while I am writing this, I still feel better than I have the past few
days at 3 mg. Also took 5 hr energy shot a few hrs ago. I read somewhere they help potentiate
suboxone because of the caffeine and vitamin b. Update: again I am totally blown away by
how well this works! It has allowed me to take half my normal dose and literally be well enough
to make it 48 hours without redosing. Granted I didn't feel fantastic day two, but it certainly
made conserving my stash so much more pain free than what I've experienced the numerous
other times I have ran low at the end of the month. Anyways, I am amazed at how well this
worked. Tomorrow I will try this without the 5 hour energy shot and see if it works as well.
Cheers to the OP for tipping me off about this! I have tried literally everything to lower my dose
without suffering from horrible depression. (plugging, alcohol solution, white grapefruit juice,
etc.
://www.bluelight.org
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-Loperamide: taking for almost 2yrs whenever I run out of my monthly MSIR rx prescribed to me for chronic
back pain. Believe it or not, I'm not your typical junkie who began using drugs at young age to cope; was a "good
boy" until began experiencing nightmare known as chronic pain. I hope none of you ever have to experience it if
you aren't already; it'll flip your world upside-down.
-If I take around 70 tabs loperamide it DOES stop all of MY withdrawals for roughly 20 hrs and gives me a
decent albeit "dirty" buzz x several hrs. Contrary to popular belief, does NOT constipate ME for an eternity.
Takes roughly 1-2 hrs for loperamide to take effect. Have been taking opiates almost every day for 4 yrs.
Tagamet tabs (200mg/ tab)..1g (5 tabs) ORAL, Loperamide tabs (2mg/tab)... 160mg (80 tabs) ORAL
3am, picked up soda, thought about Tagamet to experiment. Generics $5/60 tabs. Brand about $8 for 30 tabs.
3:15am -Took 1g (5 tabs) in my truck before leaving. Feeling optimistic about it, not expecting anything major.
3:30am -Decided to eat before dosing loperamide. Most say to wait 45 min-hr before loperamide for best result
4:15am - Dosed 80mg (40 tabs) of loperamide after pizza. Remember to dose according to YOUR tolerance
5:15am - Feeling the same as before; nothing worth writing about
6:15am - Took additional 80mg (40 tabs) to see if get me anywhere. Normally take that daily to stave off
w/drawal to function at work. Sounds crazy but more common than you think; can become dependent on
loperamide; I experience horrible withdrawals roughly 24hrs after dosing. Remember dose to YOUR tolerance!
-Lamictal: Been taking sub for maint for > 1 ½ yr, for me is godsend. Won't go in whole history, suffice to say a
heroin addict on/off for long time. When started sub was taking 8-12mg/day, felt absolutely *nothing* no matter
how much took (up to 24mg) or in what manner (tried snorting=nothing). Then about 3 m into sub treatment my
doctor put me on Lamictal -mood stabilizer - and I immediately Noticed it's potentiator effects. now I take 8mg
of sub in morn and 8mg at night and about 75-100mg of the Lamictal with each dose. it's a bit strange because
it's not 100% of the time and it's not always the same strength but probably 75% of the time I *do* get high - not
a lot, and the euphoria only lasts for maybe an hour, but nonetheless - it's definitely there.
-I find that if I take too much of both I get drowsy and I nod - but without the raging euphoria we all know so
well so it's kind of pointless. best I can compare it to is when I didn't have a habit and I would eat a bunch of
codeine, a nice opiate buzz but nothing overwhelming.
I haven't tried the Cimetidine as of yet but I'm off to the pharmacy now so I'll let y'all know how that works out.
://www.bluelight.org
References
• Affaticati, A., Gerra, M.L., Amerio, A., Inglese, M., Antonioni, M.C., et al (2015,
December). The Controversial Case of Biperiden From Prescription Drug to Drug of
Abuse. Journal of Clinical Psychopharmacology, 35 (6), 749-750. Retrieved Aug 20,
2017, from OVID database.
• Baker, J.S., Graham, M., Davies, B. (2006, July). Gym users and abuse of prescription
drugs. Journal of the Royal Society of Medicine, 99, 331-332. Retrieved Jul 30, 2017,
from OVID database.
• Maier, L., Schaub, M.P. (2015). The Use of Prescription Drugs and Drugs of Abuse for
Neuroenhancement in Europe Not Widespread But a Reality. European Psychologist,
20 (3), 155-166. Retrieved Feb 5, 2012, from OVID database.
• Jewell, C.E., Tomlinson, J., Weaver, M. (2011). Identification and Management of
Prescription Opioid Abuse in Hospitalized Patients. Journal of Addictions Nursing, 22,
32-38. Retrieved Feb 5, 2012, from OVID database.
• Jena, A.B., Goldman, D.P., Foster, S.E., Califano, J.A.. (2011). Prescription Medication
Abuse and Illegitimate Internet-Based Pharmacies. Annals of Internal Medicine, 155,
848-850. Retrieved Feb 5, 2012, from OVID database.
• Cai, R., Crane, E., Poneleit, K., Paulozzi, L. (2010, June 10). Emergency Department
Visits Involving Nonmedical Use of Selected Prescription Drugs – United States, 2004-
2008. Centers for Disease Control and Prevention MMWR Morbidity and Mortality
Weekly Report, 59 (23), 705-709. Retrieved Feb 5, 2012, from OVID database.
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References
• Cooper, R. (2013). Over-the-counter medicine abuse – a review of literature. Journal of
Substance Use, 18 (2), 82-107. Retrieved Feb 5, 2012 from OVID database.
• Lessenger, J.E., Feinberg, S.D. (2008, January-February). Abuse of Prescription and
Over-the-Counter Medications. Journal of American Board of Family Medicine, 21, 45-
54. Retrieved Feb 5, 2012 from OVID database.
• Levine, D. (2007). ‘Pharming’: the abuse of prescription and over-the-counter drugs in
teens. Current Opinion in Pediatrics, 19, 270-274. Retrieved Feb 5, 2012 from OVID
database.
• Worley, J.. (2014, July/September). Identification and Management of Prescription Drug
Abuse in Pregnancy. The Journal of Perinatal & Neonatal Nursing, 28 (3), 196-203.
Retrieved Feb 5, 2012 from OVID database.
• Goldsworthy, R.C., Schwartz, N.C., Mayhorn, C.B. (2008). Beyond Abuse and
Exposure: Framing the Impact of Prescription-Medication Sharing. American Journal of
Public Health, 98, 1115-1121. Retrieved Feb 5, 2012 from OVID database.
• http://www.bluelight.org
• FDA (2011, August 12). Strategies to Reduce Medication Errors: Working to Improve
Medication Safety. Retrieved from FDA website
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm
• https://www.statnews.com/2017/07/06/gabapentin-opioid-abuse/
• http://www.narconon.org/drug-abuse/kratom-effects.html
• https://en.wikipedia.org/wiki/Mitragyna_speciosa
References
The following links from Erowid may be interesting for
you and display education provided to users of such
sites:
• https://erowid.org/chemicals/opiates/opiates_info3.sht
ml
• https://erowid.org/psychoactives/testing/testing_faq.s
html
• https://erowid.org/experiences/exp.php?ID=83751
• https://erowid.org/chemicals/opiates/opiates_mcderm
otts_guide.shtml
• https://erowid.org/experiences/exp.php?ID=75597
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