Fighting the opioid epidemic : the role of providers and the clinical laboratory in understanding who is vulnerable

__Fighting the Opioid Epidemic: The Role of Providers and the Clinical Laboratory in Understanding Who Is Vulnerable__ covers the important aspects that are essential in fighting the opioid epidemic. This succinct reference highlights how the toxicology laboratory can play a vital role in fighting the opioid epidemic by implementing a robust system for drugs of abuse testing as well as drug testing in pain management patients. It targets health care professionals in a technical manner, discussing polymorphisms of important genes that may be associated with increased vulnerability of alcohol and drug addiction to an individual. 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 I L M N O P R S T U W Y Back Cover "Fighting the Opioid Epidemic: The Role of Providers and the Clinical Laboratory in Understanding Who Is Vulnerable covers the important aspects that are essential in fighting the opioid epidemic. This succinct reference highlights how the toxicology laboratory can play a vital role in fighting the opioid epidemic by implementing a robust system for drugs of abuse testing as well as drug testing in pain management patients. It targets health care professionals in a technical manner, discussing polymorphisms of important genes that may be associated with increased vulnerability of alcohol and drug addiction to an individual. Covers all important aspects of opioid abuse, including genetic and environmental factors Discusses pharmacology, toxicology and the pharmacogenomics related to opioid metabolism Presents genetic and environmental factors associated with those vulnerable to opioid addiction, as well as the pitfalls of drug testing in pain management."--Publisher