Journal of Addiction Medicine and Therapeutic Science eertechz Citation: Hariharan U, Garg R (2015) Update on Opioid Addiction for Perioperative and Critical Unit Care: Anaesthesiologists Perspective. J Addict Med Ther Sci 1(1): 027-030. 027 sugar, starch, acetaminophen, procaine, quinine, steroids, clenbuterol (a banned beta-2 agonist) and sometimes even synthetic opioids like fentanyl, leading to a multitude of unpredictable efects. Meperidine, dextropropoxyphene, fentanyl, alfentanil, sufentanil, carfentanil, pentazocine and butorphanol are synthetic opioids (prepared in laboratory). Meperidine has signiicant abuse liability [3]. Its neurotoxic byproduct (1-methyl-4-phenyl 1,2,3,6-tetrahydropyridine) has the potential to produce irreversible Parkinsonian-like syndrome. Fentanyl abuse was irst noted amongst the medical community. Due its very high potency, its abuse is less common in non-health care addicts, due to fear of fatal overdose. Fentanyl and its analogues (especially the transdermal or the transmucosal preparations) can be injected, snorted, swallowed or smoked. In order to decrease the abuse potential of pentazocine, it is mixed with naloxone (an opioid anatagonist) to counter the morphine-like efects if its tablets are dissolved and injected. Methadone was initially synthesized due to shortage of morphine and later utilized for narcotic de-addiction. Since in high doses it can block the efects of heroin, it is ideal for detoxiication and maintenance programs. It is being increasingly used for chronic pain management and it can be abused with other prescription agents like benzodiazepines and alcohol. Adverse effects and overdose of opioids Anesthesiologists may be frequently involved in the care of patients with acute drug-overdose or with chronic opioid addiction, presenting either for elective or emergency surgery or critical care. Not only do these drugs cause physiological damage to vital organs, but also permanent damage to immune system and brain areas responsible for memory and pain mediation. he lungs, heart and kidneys are at signiicant risk from the use of injected or inhaled illicit drugs. here increased incidence of pulmonary infections, granulomatous diseases, barotrauma, aspiration pneumonitis and non-cardiogenic pulmonary edema [4]. Heroin inhalation can produce severe and life-threatening exacerbations of asthma. here can be excessive sympathetic stimulation during drug-induced withdrawal from opioids, precipitating myocardial ischemia in susceptible population. In view of their central nervous system (CNS) depression, overdose can cause stuporous states, especially when abused with alcohol or sedatives. Coma can lead to pressure- induced muscle damage and rhabdomyolysis. Clinically, opioid overdose can be diagnosed by slow respiratory rate, increased tidal volume and miotic pupils [5]. It is treated with intravenous opioid- antagonist, Naloxone (0.4-0.8 mg, upto a maximum of 2 mg) for reversal of respiratory and CNS depression. Sometimes, endotracheal intubation with short-term mechanical ventilation is required to tide Introduction Drug addiction remains a challenge in perioperative management for a surgical procedure for anaesthesiologists. Anesthesiologists are increasingly encountering patients with current or previous history of drug abuse in their day-to-day practice, both in the ED (emergency department) or ICU (intensive care unit) and the OR (operating room) [1]. he understanding of such addiction is important not only for patients safer outcome but also better perioperative pain management. Hence, anesthesiologists need to be aware of the possibility of drug abuse and its adverse efects on various body systems and be adequately trained to efectively manage the crucial perioperative period. Greater precautions need to be taken in patients with multiple or combination drug addiction, as opioids are commonly abused with tobacco, alcohol, cocaine and marijuana. Opioids commonly abused he risk of opioid addiction increases if it is taken daily in escalating doses. In view of their euphoric and analgesic efects, their abuse continues unabated, leading to rapid development of tolerance, narcotic abstinence syndrome, physical and psychological dependence. he opiates commonly abused include either prescription opioids like morphine, fentanyl, sufentanil, meperidine, dextro- propoxyphene, codeine or hydrocodone; illicit drugs like heroin; and de-addiction opioids like buprenorphine and methadone. Heroin, also called diamorphine or di-acetylmorphine is commonly abused [2]. here are numerous ways in which heroin can be abused, with its diferent street-names: sniing (snorting); smoking (chasing the dragon); subcutaneous injection (skin popping); intravenous injection (Mainlining); oral intake; or in combination with cocaine (Speed Ball). Naturally-occurring opioids like opium, morphine and codeine are derivatives of the poppy plant, Papaver somniferum, grown in several parts of the world. Morphine is the main ingredient of opium. he break-down products of opium (phenanthrenes and isoquinolines) do not have abuse potential due to lack of central neural efects. Semisynthetic opioids which are derived from natural opioids include heroin, hydromorphone, oxycodone and hydrocodone. Heroin is oten mixed with additives or impurities (known as cutting agents) like Editorial Update on Opioid Addiction for Perioperative and Critical Unit Care: Anaesthesiologists Perspective Uma Hariharan 1 and Rakesh Garg 2 * 1 Specialist, Department of Anaesthesia and Intensive Care, Bhagwan Mahavir Hospital, Delhi Government Health Services, India 2 Assistant Professor, Department of Anaesthesiology, Pain and Palliative Care, Dr BRAIRCH, AIIMS, India Dates: Received: 07 April, 2015; Accepted: 07 April, 2015; Published: 09 April, 2015 *Corresponding author: Dr. Rakesh Garg, Room No. 139, Ist loor, Department of Anaesthesiology, Pain and Palliative Care, Dr BRAIRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India, Tel: +91 9810394950, +91 9868398335; E-mail: www.peertechz.com