Some of the most abused prescription drugs are painkillers. Demerol is the brand name for the synthetic opioid drug meperidine, which is a prescription-based medication used in pre-anesthesia, post-surgery, and for the relief of pain. The U.S. Food and Drug Administration (FDA) reports that meperidine has a similar method of action as another opioid narcotic: morphine.
How Abuse Starts
Opioid drugs are widely abused, as NIDA publishes that an estimated 26.4-36 million people all around the world abuse them.
Drugs like Demerol fill up opioid receptors in the brain and body, and cause a kind of backlog of some of the brain’s chemical messengers involved in regulating emotions and feeling pleasure. This can create the “high” that may be desired. Demerol not only blocks pain sensations, but also lowers the stress reaction by reducing some of the functions of the central nervous system, like respiration, blood pressure, and heart rate, thus decreasing anxiety and enhancing relaxation and sedation. In short, Demerol makes a person feel good.
Due to the interactions with brain chemistry, opioid drugs such as Demerol are considered to be highly addictive. The American Society of Addiction Medicine (ASAM) estimates that close to 2 million people in the United States suffered from a substance use disorder involving prescription opioid painkillers while rough another half-million people battled a heroin use disorder in 2014.
Meperidine (Demerol, Mepergan) is marketed in an injectable form, in tablets, and in syrups. It is considered a Schedule II controlled substance by the Drug Enforcement Administration (DEA), which is the highest level of control for a drug with an accepted medicinal use in the United States. Drugs with a high likelihood of being diverted from legitimate uses, used recreationally, or otherwise abused are more tightly regulated at the federal level.
Demerol may be abused by smoking, snorting, injecting, or swallowing the drug. On the street, it is called juice, dillies, D, and dust. Demerol abuse may quickly lead to drug dependence and onward to addiction, prompting the need for a specialized treatment plan. Demerol addiction may first require medical detox to safely remove the drug from the body while minimizing opioid withdrawal symptoms. Detox must be followed with either a residential or outpatient treatment program that will likely include addiction education, life skills training, therapy sessions, counseling, and supportive care. Treatment for Demerol abuse may improve all facets of life that may be negatively impacted by the disease of addiction.
The Epidemic of Prescription Opioid Drug Abuse
Around a quarter of all people admitted to public substance abuse treatment programs in 2011 cited opioid drugs as their primary substance of abuse, as indicated by the results of the Treatment Episode Data Set (TEDS) published by the Department of Health and Human Services (HHS). The 2014 National Survey on Drug Use and Health (NSDUH) reported that more than 4 million American adults (12 or older) were considered to be currently abusing prescription painkillers at the time of the survey, which means that they had used one for nonmedical purposes within the past 30 days.
Prescription opioid abuse spans all age, racial, social, economic, and gender demographic groups. The Centers for Disease Control and Prevention (CDC) calls the prescription opioid abuse issue in the United States an epidemic, as over 60 percent of all drug overdoses involved a prescription opioid drug in 2014. More people were killed by a drug overdose in the year 2014 than ever recorded previously.
The 2014 NSDUH reported prescription painkiller abuse in all age brackets; however, the highest percentage of abuse was for those between the ages of 18 and 25, as close to 3 percent of this population group used a prescription opioid for nonmedical purposes in the past month. Anytime someone uses a drug like Demerol for a purpose other than what the drug was prescribed for, it is considered drug abuse. Demerol may be commonly diverted from medical practices by medical professionals who have easy access to this powerful narcotic and therefore may be at a high risk for abusing it. In one example, a case in Washington, a nurse was found guilty of diverting Demerol to feed her personal addiction to the drug at the detriment of her patients, the United States Attorney’s Office publishes.
Demerol abuse may not always start out with someone looking to use the drug for recreational purposes to get “high,” but may instead begin with a legitimate prescription for the drug for pain relief. Information published by the FDA on meperidine warns individuals that the drug is not meant to be taken long-term or for chronic pain as the drug is known to be habit-forming. What this means is that when someone takes Demerol for a period of time, the brain becomes used to the way it alters brain chemistry, and some of the production and movement of the natural chemical messengers may be disrupted.
A tolerance develops to the drug, and an individual will have to take more of it each time in order for it to continue to be effective. Tolerance can quickly devolve into dependence wherein the brain now relies on the drug to stay balanced, and uncomfortable withdrawal symptoms and drug cravings may be common when the drug wears off. Individuals may then take more Demerol in order to stave off withdrawal. Compulsive drug-seeking behaviors and drug use that is beyond the person’s control may be the result of a Demerol addiction.
Demerol may be even more addictive than some other opioid drugs due to the way it takes effect quickly but also wears off rapidly, which may increase a person’s tolerance level sooner and therefore lead to dependence sooner as well, the Journal of Pediatric Pharmacology and Therapeutics publishes. Demerol interferes with the way dopamine and norepinephrine move around the brain, which may increase the “high” the drug can produce and make it more desirable to abuse. Regular abuse can then lead to dependence and addiction.
Drug dependence is one of the signs of a Demerol addiction, as are drug cravings and the onset of opioid withdrawal syndrome when the drug wears off. Demerol withdrawal, as published by the FDA, includes symptoms like tearing up, restlessness, runny nose, nausea, sweating, chills, pupil dilation, abdominal cramps, vomiting, diarrhea, loss of appetite and weight loss, irritability, anxiety, weakness, insomnia, and heightened blood pressure, heart rate, and respiratory rate.
Other signs of addiction to Demerol include:
- Drug tolerance and increased dosage
- Inability to stop taking Demerol and/or multiple unsuccessful attempts to stop
- Taking more of the drug and for longer than intended in a sitting
- Inventing pain symptoms to get more of the drug, or “doctor shopping” (i.e., visiting multiple doctors to try and obtain Demerol prescriptions)
- Lack of interest in things not revolving around obtaining Demerol, using it, or recovering from the drug
- Absenteeism at school or work and decreased productivity
- Unreliability fulfilling daily obligations
- Sleeping at odd times
- Weight loss and changes in appetite and eating habits
- Mood swings and a possible complete shift in personality
- Continued use of Demerol despite known negative consequences
- Using Demerol in situations that may be potentially risky or hazardous
- Potential legal or criminal issues
Behavioral therapies may be some of the most widely accepted forms of treatment for an opioid substance abuse disorder. Individuals in either an outpatient or
residential program can benefit from group and individual sessions where they will learn life skills and new methods for coping with stress and managing emotions.
Examples of behavioral therapies include Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI). CBT helps people to modify patterns of thought that may lead to negative behaviors. For instance, those with low self-esteem may not realize their own self-worth and therefore may be prone to destructive behaviors such as perpetuated substance abuse. CBT can help them to improve their self-image and therefore change patterns of detrimental behaviors.
MI is a nonconfrontational and nonjudgmental form of therapy that focuses on helping individuals recognize the need for change within themselves and helping to enhance their motivation to do so. Behavioral therapies can help individuals learn how to better control their impulses, anger, and cope with potential stressors.
Programs that cater to families as a whole may be helpful as well, such as the Family Systemic Intervention Model, which is a short-term intensive program designed to enhance communication skills within the family and improve the family unit. Peer support and 12-Step programs may enhance recovery by providing individuals with a group of likeminded people with similar goals and experiences by creating a healthy social network. These groups, in combination with other tools and education opportunities, can help to minimize relapse as well.
Medications Used during Treatment and Recovery
Demerol abuse is generally treated with a combination of pharmaceutical and therapeutic techniques. Medications may be helpful during medical detox for managing withdrawal symptoms and drug cravings, to support therapy and counseling sessions, and to help prevent relapse. Medical detox may commonly be the first line of treatment for Demerol addiction as it can provide a safe method for ridding the body of the drug while helping to minimize opioid withdrawal syndrome. During medical detox, individuals generally stay on site in a specialized facility that can provide medical care and supervision 24/7 for a few days to a week or so until the symptoms of withdrawal subside.
Medications like buprenorphine and methadone are sometimes used as part of opioid replacement therapy to help a person slowly wean off opioids via a longer-acting opioid drug that needs to be taken less frequently and in lower doses. Buprenorphine is often combined with the opioid agonist naloxone and used during opioid dependence treatment to prevent relapse. The way these combination drugs like Bunavail, Zubsolv, and Suboxone work is that the partial opioid agonist, buprenorphine, fills the opioid receptors at least partially to keep withdrawal symptoms to a minimum without producing the “high.” The naloxone component generally remains dormant unless the drug is altered and abused, or more opioid drugs are introduced. If this happens, the opioid agonist blocks these opioids and induces withdrawal. This may be enough of a deterrent to help people remain compliant and prevent a potentially dangerous overdose during substance abuse treatment and into recovery.
Other medications may be helpful to treat specific symptoms of withdrawal. These adjunct medications may include antidepressants, anti-anxiety medications or sleep aids (like benzodiazepines), anti-nausea drugs, non-opioid pain relievers, etc. Medications that are useful for other ailments, like clonidine for high blood pressure for example, may also be beneficial when used off-label to treat opioid dependence as well.
Any underlying medical or mental health disorders should also be treated simultaneously in an integrated fashion. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that close to 8 million Americans suffered from co-occurring mental health and substance use disorders in 2014, according to the NSDUH. When someone suffers from two disorders at the same time, the person has co-occurring disorders. The optimal method of treatment is to have a team of medical, mental health, and substance abuse treatment professionals all work together to devise and carry out an integrated care plan. With this type of plan, treatment methods can complement each other, and any prescribed medications can be carefully chosen and properly managed.
Substance abuse and mental health issues are often closely tied together, and by treating both at the same time, symptoms of both may be improved.
No two treatment methods are identical, and a detailed assessment and evaluation can help to find the right fit for each individual.
Recovery from Demerol Abuse
Demerol is a powerful narcotic drug that is commonly abused and highly addictive. Drug overdose rates continue to rise in the United States, with nearly 50,000 people dying from a fatal drug overdose in 2014, and prescription opioid overdoses helping to fuel the epidemic, the Washington Post reports.
In 2014, 21 years old was the average age of a person trying to get a prescription opioid drug like Demerol for nonmedical purposes, according to the results of the NSDUH as reported by SAMHSA.
Treatment for opioid dependence, abuse, and/or addiction often begins with medical detox and may involve medications to help purge Demerol from the body while continually monitoring vital signs and ensuring the individual is safe. Detox should be followed with a comprehensive treatment program that uses both counseling and behavioral therapy methods so the person can learn healthy ways to manage stress, control drug cravings, and positively influence thoughts and actions going forward. Co-occurring disorders are common with substance abuse issues and optimally treated with a group of professionals who are all on the same page working in an integrated fashion. Recovery from Demerol abuse and addiction is optimized with a detailed care plan carried out by highly trained professionals.