Demerol Addiction

Demerol Addiction

Demerol AddictionDemerol has been around since the 1930s, and it is the granddaddy of opioid painkiller prescription addictions. Even as late as the mid-1980s, it was still one of the most commonly prescribed painkillers because it was supposed to be safer and less addictive than morphine. That turned out to be wrong. By the 1950s, many in the medical community were addicted to Demerol. Elvis Presley and Jerry Lee Lewis were among the thousands abusing it in the 1960s and 1970s, and one of Bobby Kennedy’s sons died from it in 1984. Michael Jackson wrote a song in 1997 about his Demerol addiction called “Morphine,” with the sad lyrics — “Oh God, he’s taking Demerol … Today he’s taking twice as much.”

Since about 2000, addictions to prescription narcotics like Demerol have increased by 500%, and they now outnumber additions to cocaine, heroin and others combined. Demerol is not as trendy as OxyContin or Fentanyl, and it may be in slight decline as a first choice among addicts, but it’s still on the government’s list of most abused opioid painkillers, partly because it is extremely fast-acting. It still contributes to the problems of more than 80,000 people who enter treatment every year for prescription painkillers and the more than 14.5 million Americans who are abusing them.

Demerol has a few more risks and dangers associated with it when compared with other narcotic painkillers. People who used meperidine made in kitchen labs developed a form of Parkinson’s Disease. These so-called “frozen people” now experience nerve damage and symptoms like tremors and slowed movement that are permanent and irreversible. Demerol also puts some people at risk for seizure disorders. Demerol probably causes over 200 deaths a year because of certain rare reactions and serotonin syndromes, which are not associated with other opioid painkillers.

What Is Demerol?

The main ingredient in Demerol is meperidine, a synthetic narcotic made entirely from manmade chemicals in laboratories. The scientific name for meperidine is 4-Piperidinecarboxylic acid, 1-methyl-4-phenyl-, ethyl ester, hydrochloride. The molecular formula is C15H21NO2

Meperidine is classified as a Schedule II Controlled Substance, along with other prescription opioids like oxycodone, hydrocodone and fentanyl. Unlike Schedule I drugs, Schedule II Controlled Substances have medicinal uses, but they are highly regulated because they are so additive. Meperidine is similar to morphine but not as strong. Between 60mg and 80 mg meperidine is about equal to 10 mg of morphine.

The main effect of meperidine is pain relief and relaxation (sedation).

The medical uses for Demerol and other meperidine products are to relieve severe and moderate pain, to suppress cough, to stop diarrhea, to support anesthesia before surgery, and to kill pain during childbirth. Doctors are not supposed to prescribe it for chronic pain because of the dangers of addiction and seizures.

Demerol comes as white, round convex pills in 50mg and 100mg form. Both have a stylized W logo on one side. The 50mg say D 35 on the other side, and the 100mg say D 37. The manufacturer is Sanofi US.

Meperidine products also come as banana-flavored syrups and injectable liquids, and are available in generic forms.

The usual dosage is 50 to 150mg every four hours.

Demerol does not work in the same way that other opiate pain killers do. Instead of blocking nerves that transmit pain in the spinal cord and central nervous system, Demerol “tricks” the brain into replacing feelings of pain with pleasure.

Common but not harmful side effects are drowsiness, nausea, constipation, sedation, feelings of calmness, and vomiting. Some people experience anxiety, confusion, problems with vision, headaches, dry mouth, irritability, and weakness.

Special Risks Associated With Demerol

On March 5, 1984, a college student named Libby Zion died after she was given Demerol in IV form. Doctors restrained her after she thrashed around and tried to pull out her IV. Zion had been taking an antidepressant that interacted with Demerol and raised her levels of serotonin too high. There are over 7,000 such cases and 100 deaths every year from serotonin syndrome, and Demerol is involved in some. Symptoms of serotonin syndrome are tremor, high blood pressure, anxiety, agitation, confusion, irritability, muscle spasms and rigidity, fever, sweating, and fast heartbeat.

Demerol can also cause another unpredictable and sometimes fatal reaction that occurs up to 14 days after you take the drug. This reaction is probably due to hyperphenylalaninemia, which is an elevation of a protein building block called phenylalanine. Symptoms are coma, severe respiratory depression, low blood pressure, and blue color to the skin resulting from low oxygen levels. Some people experience convulsions, agitation, fever and irregular heartbeat. Virtually everyone with this reaction took Demerol or other meperidine products.

Some people are allergic to Demerol and develop hives, rashes, wheals over the injection site, flushing, sweating, and even life-threatening difficulty in breathing. Other adverse reactions include weakness, agitation, dizziness, tremors, twitching, convulsions, visual disturbances, dry mouth, constipation, flushing, irregular heartbeat, heart palpitations, and low blood pressure.

Because severe and even fatal reactions can occur the first time a patient uses Demerol, physicians are advised to prescribe the drug in very small amounts at first, and to avoid drug interactions. Demerol has what physicians call a narrow therapeutic index, especially in combination with other drugs. This means that just a little bit too much Demerol can cause serious problems. Some experts believe Demerol should be taken off the market as there are more effective and less dangerous painkillers. Because of all its risks, it is rarely prescribed to patients over 65 years old.

Drug Interactions

Demerol interacts with hundreds of drugs, sometimes fatally. It should not be used with any drug that depresses the central nervous system or slows breathing, including antidepressants, antipsychotics, sedatives, sleeping pills, alcohol, MAO inhibitors (fatal interaction), certain street drugs, and medications for mental illness, anxiety, pain or nausea. Demerol in combination with any of these drugs can slow the breathing to the point of coma or even death. Acyclovir, Cimetidine, and Phenytoin are drugs that can increase the effects of Demerol or reduce its clearance from the human body.

Demerol should not be taken by people with histories of alcoholism or drug abuse because of its highly addictive quality. It should not be taken by people with head injuries because the drug could elevate fluids in the head to dangerous levels. It should not be taken by people with curvature of the spine that results in respiratory depression or any other condition that slows breathing. People with the following conditions also should not take Demerol: Addison’s disease or tumors on the adrenal glands, sickle cell anemia, chronic obstructive pulmonary disease, mental illness, urinary problems, heart rhythm problems, liver or kidney diseases, seizure disorders, hypothyroidism, enlarged prostate, low blood pressure or low blood volume.

Demerol Overdoses

It is relatively easy to overdose on Demerol. Symptoms can be very slow breathing, or stoppage of breathing, shallow breathing, slow or labored breathing, death rattle, convulsions, weakness, lightheadedness, fatigue, twitching muscles, blue finger nails and lips, cold clammy skin, drowsiness, weak pulse and low blood pressure. A person with these symptoms should go to an emergency room immediately. The usual treatment is to administer an opiate antagonist like naloxone to reverse the effects of Demerol, to administer fluids intravenously, and to wash out the stomach. Some people will require breathing tubes.

Demerol Addictions

Demerol addiction has the usual components of physical dependency, tolerance, and drug seeking behaviors. Physical dependency means you will develop an unpleasant withdrawal syndrome whenever you stop taking Demerol and have to keep taking the drug in order to just feel normal. Tolerance means you need to increase the amounts of Demerol you take in order to get the same effects. Drug seeking behaviors can include “doctor shopping,” refusal to undergo physical examinations when you try to obtain more Demerol, “losing” your prescriptions, tampering with the pills to increase their effects, and so forth.

Demerol addiction may have indirectly cost Michael Jackson his life. When he quit taking the drug, he may have developed such severe insomnia that he become dependent on Propofol to sleep, an anesthesia that is only supposed to be used during surgical procedures.

If you say yes to one or more of these questions, you may be addicted to Demerol.

  • Do you need Demerol just to feel normal?
  • Do you take Demerol when you are angry or upset?
  • Are your family and friends complaining that you are moody and withdrawn? If they know about your Demerol abuse, do they criticize you and urge you to get help?
  • Have you tried to quit Demerol and failed?
  • Do you use Demerol in combination with other opiate painkillers or alcohol?
  • Are you constipated, and do you have trouble falling asleep unless you take Demerol or other drugs?
  • Do you crush, chew, snort, or inject Demerol to enhance its effects?
  • Does your abuse of Demerol interfere with your ability to meet your obligations at work or school?
  • Do you feel guilty about your drug use?
  • Do you feel that your drug use is out of control?
  • Do you feel that you are missing out on having a full life because of Demerol?
  • Do you realize that your use of Demerol is causing you health problems and put you at physical risk when you drive, and yet you continue to abuse it?
  • Are you engaging in the illegal activities, such as lying to a doctor or paying street dealers, in order to obtain Demerol or other drugs?

Demerol Withdrawal

Because it is one of the oldest legal painkillers and because it is considered not as strong as some of the others, addicts can underestimate the power of Demerol. Depending on the amounts used and how long the drug was abused, the Demerol withdrawal syndrome can be just as miserable as that of any other opioid, including heroin. The withdrawal symptoms will also depend on individual factors such as the age and weight of the patient. Most people abuse Demerol along with alcohol and other drugs, both legal and illegal, and that can be another factor in their recoveries.

These symptoms will start within four to five hours after the last Demerol and can last up to ten days. Demerol withdrawal can feel like a bad case of flu, and may include restlessness, yawning, sweating, stuffy nose, chills, and dilated pupils. Later symptoms might be irritability, anxiety, backache, joint and muscle pain, weakness, cramps, upset stomach, insomnia, loss of appetite, diarrhea, vomiting, and increases in blood pressure and rates of breathing and heartbeat. It is best and usually necessary to withdraw from Demerol under a physician’s care.

Demerol Addiction Treatment

If you enter a residential treatment center for Demerol addiction, your protocol will be similar to that for any other opioid or opioid painkiller. Certain medications can be helpful, such as buphrenorphine, a man-made opiate. Long- or short-acting opiate blockers such as naltrexone or naloxone can be prescribed after detoxification is complete.

The vast majority of people who enter Demerol addiction treatment will have comorbidities, which are psychiatric problems that contribute to but do not necessarily cause the addiction. Typical comorbidities are eating disorders, anxiety, childhood trauma, bipolar disorder, attention deficit disorder, borderline personality, and more. Once you enter a residential treatment center, a psychologist or psychiatrist can perform an examination and diagnose such a comorbidity, which must be treated within a separate protocol of counseling and medication.

Residential treatment centers usually offer classes in art, drama, music, and sometimes animal husbandry in order to help people become more in touch with their emotions. Journaling can also be helpful. Physical activities such as sports and outdoor recreation, as well classes in nutrition, can help people regain their physical health. Psychological counseling, both on the individual, couples, and family levels, is always a key component of recovery. You may also attend classes to better understand drug addiction and to learn techniques that will be helpful in handling situations and people that will encourage you to reuse drugs once you return to your usual environment.

A good residential treatment center will offer an extensive aftercare program to help you adjust to life without drugs. You will need to find new friends and new ways to relax in order to remain drug-free. Many people make major life changes, such as divorce or finding new careers, after residential treatment for drug addiction.

Source:

Eisendrath SJ, Goldman B, Douglas J, et al. Meperidine-induced delirium. Am J Psychiatry 1987;144:1062–5.

Rasor, Robert (MD). Addiction to Meperidine (Demerol). The Journal of the American Medical Association, 1955:157(8) pg. 654-657.

“Presley’s Doctor on Trial Over Prescriptions,” the New York Times, September 30, 1981.

Stuart, Reginald. “Three Drugs Are Blamed in Kennedy Death,” the New York Times, May 17, 1984.

Jaffe, Adi (Phd). “All About Addiction,” Psychology Today, April 6, 2010.

“Commonly Abused Prescription Drug Chart, Revised October 2011,” National Institute on Drug Abuse, see http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-prescription-drugs-chart

Jaffe, Adi Phd. “All About Addiction,” Psychology Today, April 6, 2010.

Prescription Medications: Misuse, Abuse, Dependence and Addiction, pamphlet from the U.S.  Substance Abuse and Mental Health Administration, see http://www.kap.samhsa.gov/products/manuals/advisory/pdfs/Prescription-Meds.pdf

Meperidine,  Drug Descriptions, LAAM, DEA Briefs and Background, see www.justice.gov/dea/concern/laam.html

Meperidine, Drugs.com, Drug Information Online, see http://www.drugs.com/pro/meperidine.html

Demerol/Meperidine, Pamphlet from the Federal Drug Administration, see http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/005010s050lbl.pdf

Controlled Substance Schedules, the U.S. Drug Enforcement Agency of the U.S. Department of Justice, see http://www.deadiversion.usdoj.gov/schedules/index.html

Demerol, The DailyMed, the U.S. Substance Abuse and Mental Health Administration http://www.kap.samhsa.gov/products/manuals/advisory/pdfs/Prescription-Meds.pdf

Meperidine, Drugs.com, Drug Information Online, see http://www.drugs.com/pro/meperidine.html

Demerol, The DailyMed, the U.S. Substance Abuse and Mental Health Administration http://www.kap.samhsa.gov/products/manuals/advisory/pdfs/Prescription-Meds.pdf

Demerol, Monthly Prescribing Reference, see http://www.empr.com/narcotic-analgesics/demerol/drug/6532/

Demerol, the Web MD, see http://www.webmd.com/drugs/mono-5194-MEPERIDINE+TABLET+-+ORAL.aspx?drugid=4334&drugname=Demerol+Oral&pagenumber=2

Sandofi US website at http://www.sanofi.us/l/us/en/index.jsp.

Demerol, The DailyMed, the U.S. Substance Abuse and Mental Health Administration http://www.kap.samhsa.gov/products/manuals/advisory/pdfs/Prescription-Meds.pdf

“Demerol: Did it Cause Michael Jackson’s Death?” Fox News, June 26, 2009, see http://www.foxnews.com/story/0,2933,529168,00.html

Meperidine, the Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR603255

Brody, Jane. “A Mix of Medicines that Can be Lethal,” the New York Times, February 27,  2007.

Demerol/Meperidine, Pamphlet from the Federal Drug Administration, see http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/005010s050lbl.pdf

Meperidine, Drugs.com, Drug Information Online, see http://www.drugs.com/pro/meperidine.html

Demerol/Meperidine, Pamphlet from the Federal Drug Administration, see http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/005010s050lbl.pdf

Meperidine, PubMed Health, the National Institute of Health, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000583/

Ibid.

Meperidine, Drugs.com, Drug Information Online, see http://www.drugs.com/pro/meperidine.html

Ibid.

Meperidine, the Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR603255

Meperidine Hydrochloride Overdose, Health Topics in the New York Times, see http://health.nytimes.com/health/guides/poison/meperidine-hydrochloride-overdose/overview.html

Meperidine, Drugs.com, Drug Information Online, see http://www.drugs.com/pro/meperidine.html

Ibid.

James, Susan Donaldson. “Friend says Michael Jackson Battled Demerol Addiction,” ABC News, June 26, 2009.

Demerol/Meperidine, Pamphlet from the Federal Drug Administration, see http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/005010s050lbl.pdf

Opioid and Pain Reliever Facts, the National Institute of Drug Abuse, see http://teens.drugabuse.gov/peerx/prescription-drug-facts/opioids

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