Demerol: Prescription Drug Abuse & Testing

Demerol is the trade name of Pethidine / meperidine which is a fast-acting opioid analgesic drug used to treat pain. In the United States and Canada, Pethidine or meperidine is more commonly known by its brand name Demerol whereas in many parts of the world, it is also known as isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Demerol; Dispadol & Dolantin etc.

Chemically, Demerol is 4-Piperidinecarboxylic acid, 1-methyl-4-phenyl-ethyl ester hydrochloride.

Demerol Prescription, Dosage & Administration:

Demerol, a narcotic analgesic, is prescribed for the relief of moderate to severe pain. Dosage is adjusted by physician according to the severity of the pain and the response of the patient. The oral solution is often a pleasant-tasting, nonalcoholic solution containing 50 mg of meperidine hydrochloride per 5ml teaspoon. The tablets usually contain 50 mg or 100 mg of the analgesic. It is delivered as its hydrochloride salt in tablets, as a syrup, or by intramuscular or intravenous injection although it is less effective orally than on parenteral administration (as by intramuscular or intravenous injection).

For much of the 20th century, Demerol in the form of pethidine was the opioid of choice for many physicians, 60% of doctors prescribed it for acute pain and 22% for chronic severe pain.

Demerol Abuse:

Demerol contains meperidine, a mu-agonist opioid with an abuse liability similar to morphine and is a controlled substance. Abuse of Demerol poses a risk of overdose and death. This risk is increased with concurrent abuse of Demerol with alcohol and other substances. Intramuscular or intravenous abuse of crushed tablets can be expected to result in local tissue necrosis, infection, pulmonary granulomas, and increased risk of endocarditis and valvular heart disease. In addition, such sort of drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV.

Effects of Demerol Abuse:

The major hazards of Demerol, as with other narcotic analgesics, are respiratory depression and to a lesser degree, circulatory depression; respiratory arrest, shock, and cardiac arrest etc.

The most frequently observed adverse reactions include lightheadedness, dizziness, sedation, vomiting, nausea, & sweating. These effects seem to be more prominent in ambulatory patients and in those who are not experiencing severe pain. In such individuals, lower doses are advisable. Some adverse reactions in ambulatory patients may be alleviated if the patient lies down.

Miscellaneous:

There is a category of drugs called MAO Inhibitors. Drugs in this category include the antidepressants phenelzine & tranylcypromine. If you are taking these antidepressants or have used them in last 2-3 weeks, inform your physician well in advance because when taken with Demerol, these MAO Inhibitors can cause unpredictable, severe, & occasionally fatal reactions.The narcotic antagonist, naloxone hydrochloride, is a specific antidote against respiratory depression which may result from over dosage or unusual sensitivity to narcotics, including meperidine. Therefore, an appropriate dose of this antagonist should be administered, preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. An antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression.

To limit abuse of opioid drugs like Demerol, it is necessary to properly assess the patient, employ proper prescription practices, periodically re-evaluate the opioid therapy, and properly dispense and store the drugs.

Demerol Testing:

A diverse array of techniques is available to test for drug abuse and Demerol or Pethidine/meperidine containing compounds are no exception. As with other drugs, some amount of Pethidine/meperidine remains unchanged while rest of it forms different metabolites.

These unchanged Pethidine or meperidine compounds and their metabolized products can be detected using any of the following methods: