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Demerol Abuse and Pain Management

Demerol is the trade name of the opioid painkiller meperidine (sometimes called meperidine hydrochloride), a drug similar to morphine. Historically, it was often prescribed by physicians for patients during surgery to enhance the effects of anesthesia, and to manage pain afterwards, after the anesthesia effects had worn off. It is not a comparatively long-lasting drug, however, which makes it less desirable for this purpose when compared with other painkillers such as Dilaudid and Vicodin. Demerol’s painkilling process is different from that of, for example, morphine. Morphine works by preventing nerve endings from sending messages of pain to the brain. Demerol, on the other hand, acts by suppressing the central nervous system. In doing so, it uses a form of “trickery”: it fools the brain into interpreting pain as a kind of euphoria instead. The pain of most patients can be better managed with other drugs. A minority of patients, however – those with an allergy to morphine or hydromorphone, for example – cannot obtain pain relief in any way except through Demerol.

The Three-Step Model of Pain Management

A key to understanding where Demerol fits in the pain reliever spectrum is found when one looks at its position in the World Health Organization’s Three-Step Model for Pain Management.

In 1986, the WHO developed a model to help physicians determine the best approach to managing the pain of their patients – in the original case, patients with cancer. The following stages or steps were defined:

  1. Mild pain. This level of pain can be controlled through the use of – usually over-the-counter – non-opioid analgesics, such as aspirin, acetaminophen and ibuprofen.
  2. Moderate pain. This level of pain requires one of the opioids. Identified as step 2 pain relievers are such drugs as codeine, hydrocodone and Vicodin. Generally, these drugs are classified as “weak opioids.”
  3. Severe pain. The final step includes morphine, Dilaudid, methadone, oxycodone and Demerol.

Yet, first on the WHO list of medications not recommended is Demerol, for the following reasons:

  • It is absorbed poorly in oral from.
  • It has a short half-life of about three hours.
  • It is prone to significant adverse effects such as tremors, dysphoria, spasms and seizures.
  • It is potentially damaging to the kidneys.

Also, the American Pain Society does not recommend the use of Demerol for either short-term or long-term maintenance of pain. For these reasons, Demerol has fallen from favor in hospitals and outpatient clinics.

Other drawbacks to the drug include:

  • Slowed respiration
  • Lowered blood pressure
  • Blurred vision
  • Dizziness
  • Convulsions
  • Rapid heart rate
  • Nausea

Legitimate Uses

If this painkiller is not used for pain except in rare cases, what are its legitimate uses? Today, the most common legitimate use of Demerol is for its sedative effect during procedures such as endoscopies and colonoscopies. Its comparatively short duration is an advantage here, though experts point out that intravenous fentanyl may be an even better choice. It is still occasionally used in hospitals and outpatient clinics as an adjunct to anesthesia during surgery. It is also used occasionally post anesthesia, not so much for its pain-relieving capacity as for the control of shivering that patients emerging for anesthesia sometimes experience. As with other opioids, Demerol is highly addictive and, except in those few cases where it is the only workable solution, it is not recommended for pain relief. In any case, it should not be used longer than 48 hours. Doctors warn that patients with either neurological problems or kidney disease should never be given Demerol at all. Patients with other conditions should only be administered Demerol with extreme care.

Those conditions include:

  • Sickle cell anemia
  • Alcoholism
  • Skeletal problems
  • Adrenal disorders
  • Lung disease problems
  • Impaired liver function

The Washington State Medical Association has issued a set of Opioid Prescribing Guidelines specifically recommending against the use of Demerol for common pain problems, primarily because of its tendency to induce seizures.

Demerol Abuse

Demerol’s euphoria-inducing properties make it a favorite among recreational drug users, however. It can be consumed in a variety of ways, including chewing, snorting or injecting. It appears that Demerol is most effective when administered by injection, which has prompted many physicians to cease prescribing the injectable form. This has, to a degree, moderated its abuse. These methods of consumption, of course, provide for an unpredictable and uncontrollable intake of the drug, which make an already dangerous substance even more so. Demerol is typically listed as one of the 10 most addictive painkillers, coming in fourth behind fentanyl, Stadol, and OxyContin. In addition, Demerol is also used in conjunction with alcohol, which adds greatly to its inherent risk factor.

William Burroughs on Demerol Abuse

In 1957, the British Journal of Addiction published a “Letter from a Master Addict to Dangerous Drugs,” by the novelist William Burroughs. In it, Burroughs, who had been addicted to heroin and a variety of other drugs, weighed in on his use of Demerol. He stated that he believes the drug is “probably less addicting” than morphine, which is most likely because it wasn’t as satisfying or as effective as an analgesic. He said that while Demerol addiction is probably easier to break than morphine dependence, he considered Demerol use as “more injurious” to the addict’s health, especially to the nervous system.

Burroughs recounted how he once used Demerol for a period of three months, the results of which were several “distressing symptoms,” including:

  • Trembling hands
  • Loss of coordination
  • Muscle spasms
  • Paranoia
  • Fear of going insane

Upon discontinuing Demerol use, Burroughs reported that his symptoms disappeared. Burroughs added that Demerol is just as prone to inducing constipation as morphine, and that it depresses the appetite and the sexual functions even more so. More disturbing, according to his experience, was the effect on the skin of injecting the drug. He had, he said, never had a problem with infections caused by intravenous drug use until using Demerol. With Demerol, he came down with ugly and painful abscesses that had to be medically treated. Burroughs summed up his letter to the Journal by asserting that, in his opinion, Demerol is a more dangerous drug than morphine.

Desmethylprodine (MPPP), the ‘Legal’ Analog

drugs Demerol Abuse and Pain ManagementDesmethylprodine is a designer drug first produced in 1977 by an underground chemist looking for a legal version of meperidine. The man, a 23-year-old graduate student in Maryland named Barry Kidston, based his work on research done in the 1940s at the Hoffmann-LaRoche labs. Unfortunately for Mr. Kidston, he was unaware that his process created a dangerous impurity called MPTP. The “Morbidity and Mortality Weekly Report” of June 22, 1984, published by the U.S. Center for Disease Control, explained this result. The powder produced by Mr. Kidston went onto the illicit drug market as “synthetic heroin.” Shortly after beginning to use the new drug, many users came down with irreversible symptoms of Parkinsonism, including:

  • Difficulty in moving
  • Muscular rigidity
  • Tremors
  • Loss of postural reflexes

Kidston himself and many of his friends contracted these symptoms after using the drug for only a short time. At least two deaths, both of them in Vancouver, British Columbia, were attributed to the drug. The experience of the unfortunate Mr. Kidston and his friends and followers, may have helped researchers indirectly to make progress in their Parkinson’s research. An article in the June 24, 2001, issue of Time Magazine entitled “Surprising Clue to Parkinson’s” mentions the MPPP/MPPT case as one of the first clues that Parkinson’s may have an environmental cause.

Declining Popularity

We have already mentioned the declining popularity of Demerol as a routine pain reliever and also the relative decline of it in the injectable form. Both of these factors have limited to some degree the availability of the drug, and many experts believe it is giving way among recreational users to such alternatives as oxycodone. Possibly indicative of this trend is the fact that from 1997 to 2002 there was a drop of 16 percent in Demerol-related visits to hospital emergency rooms in the US. During the same period, oxycodone-related visits shot up by more than 300 percent.

Overdose

Losing popularity or not, Demerol continues to take a toll, and users continue to be admitted to emergency rooms due to the effects of Demerol overdose.

Some symptoms of overdose include:

  • Constipation, nausea, stomach spasms
  • Low blood pressure, weak pulse
  • Breathing problems
  • Coma, convulsions, dizziness
  • Twitching muscles
  • Blue fingernails and lips, clammy skin

Treatment at the ER may include some or all of the following:

  • Naloxone (Narcan), a drug often given to counteract opiates
  • Breathing tube
  • Intravenous fluids
  • Laxatives

Numerous celebrity deaths and near deaths have been attributed to the drug, including:

  • David Kennedy, son of Robert F. Kennedy, died of an overdose of Demerol and cocaine.
  • Heidi Montag, reality television star and frequent recipient of plastic surgery, nearly died of a Demerol overdose, according to her own report.
  • Lou Reed, front man for the rock group Velvet Underground, was alleged to have died of a Demerol overdose in 2001. The story turned out to be a hoax.
  • Most famously, pop star Michael Jackson’s death was widely reported for months as having been caused by a Demerol overdose. More recent findings, however, concluded the death to have resulted from an overdose of the anesthetic drug Propofol. Jackson did, however, once write a song about Demerol, which goes, in part: “Oh God he’s taking Demerol / He’s tried hard to convince her / To be over what he had / Today he wants it twice as bad / Yesterday you had his trust / Today he’s taking twice as much … ”

Identifying Abuse of Demerol

Like all the opioid drugs, Demerol is addictive and dangerous. Unfortunately, even if the prescription comes directly from a doctor, there is no guarantee of safe usage or avoidance of the development of an addiction to the substance. Too often, people believe that a doctor’s prescription relieves them of all responsibility and that they can take it in any manner or for any reason without consequence. The fact is that any abuse of the drug can be deadly or addictive, including:

  • Taking more of the drug than prescribed
  • Taking it in a way that is not prescribed
  • Combining its use with the use of other drugs including alcohol or other prescription medications
  • Using Demerol for any reason if not in possession of a personalized prescription from a medical doctor

There are various behaviors that your loved one may exhibit if he or she is struggling with a prescription drug dependence.

In addition to any or all of the above, he or she may:

  • Go to multiple doctors to get multiple prescriptions that are similar in nature (e.g., multiple types of opiate painkillers like Demerol, OxyContin, and others)
  • Lie about losing medication in order to get an early refill or an emergency prescription filled
  • Steal to pay for more drugs
  • Steal medications from friends and family members
  • Use the name of a family member or friend in order to get more medication
  • Use heroin, also an opiate drug, to maintain their addiction because it is cheaper and provides similar effects

All of the listed signs are red flags that treatment for the issue is not only necessary but also an immediate need for your loved one.

Treatment for Opiate Abuse and Dependence

Because addiction to opiate drugs is a medical disease, medical treatments and therapies are available – and necessary – to successfully help your loved one get back on track and avoid overdose. Here at Futures, we offer an intensive addiction treatment program that is unique in that it offers high-end care specified to the needs of each patient. Each person will begin their stay with a diagnostic and evaluation process designed to identify all the issues and disorders that are causing problems. From there, a treatment plan is developed that addresses them therapeutically one by one until the patient is stable and ready to return home to a life of sobriety and stability. Contact us at the phone number listed above to get more information about our evidence-based treatment program here at Futures.