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• All calculations must be confirmed before use. Significant inter/intra patient variability exists in the response to different opioid drugs and the dose of these agents. After changing an opioid drug or its dose, patients should be closely assessed and the dose or drug altered as necessary.
• Calculations used for opioid switching should be documented in the patients record.
• All conversions are made by first calculating the daily oral morphine equivalent of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. For conversion factors used in the calculator select here.
• It is the responsibility of the user to round up or down calculated results if required, to align with preparations available at individual workplaces.
• The eviQ opioid conversion calculator is only to be used for patients greater than 12 years old. For this reason the Date of Birth field is mandatory. For patients under this age consult with a pain or palliative care specialist

• Combination products: There is no conclusive evidence that combination analgesics containing lower doses of codeine with paracetamol, aspirin or ibuprofen have any benefits over these non-opioids alone.
• Buprenorphine transdermal patches: Calculator will only allow conversion FROM a buprenorphine patch and not TO a patch as there is limited evidence about, and experience of it’s use compared to other opioids.
• Methadone: Dose conversion to: from other opioids and methadone is complex; consultation with pain management specialists familiar with methadone use is recommended
• Fentanyl Lozenges: There is no dose equivalence between fentanyl lozenges and other opioid formulations. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. It should be individually titrated by starting at the lowest dose (200 micrograms)

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Disclaimer: The Cancer Institute NSW does not warrant or represent that the information is free from errors or omission. Furthermore, changes in circumstances after the time of publication of the information may impact on the accuracy of the information. The user agrees not to hold the Cancer Institute NSW or any of its officers, employees or contractors liable in any way for use and/or outcomes brought about through the use of any information obtained from the opioid calculator. The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. Clinical application of any information obtained from the opioid calculator is the sole responsibility of the user.

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Table A6.2, Approximate potency of opioids relative to morphine; PO and immediate-release formulations unless stated otherwisea – WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization; 2018.

WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents.

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Table A6.2Approximate potency of opioids relative to morphine; PO and immediate-release formulations unless stated otherwise

^a

Source: Adapted with permission from Twycross et al. 2017:371 (Table 4) (3).

a

Multiply dose of opioid in the first column by relative potency in the second column to determine the equivalent dose of morphine sulfate/hydrochloride; conversely, divide morphine dose by the relative potency to determine the equivalent dose of another opioid.

b

Dependent in part on severity of pain and on dose; often longer-lasting in very elderly and those with renal impairment.

c

The numbers in parenthesis are the manufacturers’ preferred relative potencies.

d

A single 5 mg dose of methadone is equivalent to morphine 7. 5 mg, but a variable long plasma half-life and broad-spectrum receptor affinity result in a much higher-than-expected relative potency when administered regularly – sometimes much higher than the range given above. Therefore, guidance from a specialist is recommended for conversions to regularly administered methadone.

From: ANNEX 6, Pharmacological Profiles and Opioid Conversion Tables

© World Health Organization 2018.

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Stages of addiction – 4 stages of development. Characteristic signs

The drug is a modern problem of the whole society. Due to the poor information content of people, it is growing every day. Many are convinced that nothing in their life will change from one drug test. To become addicted, you need to use drugs for a very long time. And also the idea that everyone can recognize the disease in themselves and quickly get rid of it on their own.

This is the catch of drug addiction. Addiction occurs after the first use and there is no need to create other beliefs for yourself. Pleasure always wants to be made long. But the high does not last forever, it must be extended. This is how psychological and physical dependence sets in.

There is no stereotyped scheme for the emergence of drug addiction. But experts distinguish three stages of drug addiction.

The first stage of drug addiction

The first stage has common features, which are identified by specialists with drug addiction.

• Tolerance to narcotic substances acquires a special level. Each time, the doses and the desired effect become larger.
• The perception of the environment and the emotional manifestation become completely different. Passes drowsiness, a sense of fear, little joys do not bring pleasure. There is a desire to constantly be in active movement.
• Receiving the next dose contributes to spiritual comfort, excellent health. If the dose is absent, sensations acquire opposite characteristics.
• The drug addict does not recognize his problem.
• Health has no significant deterioration, external signs do not distinguish it from a healthy environment.

Basically, the first stage is characterized by simple curiosity, which is how teenagers and young people show. The scheme of the beginning of the use of narcotic substances is very primitive.

Advertising, word of mouth about the buzz, which is so accessible to everyone. As well as advice from peers, a test for the company, the desire to be like everyone else. This is what promotes drug propaganda. A person with little will power who is influenced by others agrees to get high and unload his brain thanks to drugs.

Not realizing that no problem can be solved in this way leads to drug addiction.

Today’s youth does not care about their own lives and the lives of those around them. None of them think about the negative consequences of taking drugs. Young people think that if there are no visible deviations in health and mentality, then there is no influence of drugs. Few people think that it is already destroying the body from the inside.

The problem of drug addiction does not choose. People of any age, gender and status fall under its influence. The main purpose of the use is unknown sensations, drunken dope and new colors of life.

High is the very peak of getting sensations. This is an attractive pleasure that makes a person feel it again and again.

Having tried once, two ways open up:

• Refusal to further use. There are very few such cases.
• Repeated desire to repeat the high state. This path is chosen by the multitude.

Getting to know new sensations usually begins with light drugs such as marijuana. The first time is always unforgettable, and this state is very much appreciated. At first glance, this is the most harmless type of drug, but few people think that it is the first step into the abyss. Marijuana causes changes in the functioning of the body and affects the functioning of the brain. It’s good when it becomes the first and last drug that a person uses. But often this leads to a desire to increase the strength of the effect, which is accompanied by a trial of other drugs.

Second stage: the first stage of addiction

This stage is much richer than the previous one and has its own characteristics.

• The increase in dose is already becoming less noticeable. The body is already quite normal perceives harmful toxins.
• Kaif already has its own specifics. First comes a strong overexcitation, which is replaced by complete calm.
• Peace of mind is lost. After the end of the drug, there is a feeling of severe discomfort.
• Physical dependence begins to manifest itself. Breakdowns appear.
• Sharp weight loss, unwillingness to work, make friends – these are the characteristics inherent in this stage.
• Moral qualities are lost. Relatives and friends serve only as a source of money
• Planning to use drugs is already becoming a planned action.
• Justifications for one’s actions become permanent.
• Psychoactive substances are a guarantee of a normal rest for a drug addict.
• The drug becomes a panacea for all ailments. Replaces full communication and sex.

The dose increases again due to the lack of reaching the level of euphoria. Your own style of dress is established, music, hobbies, jokes are reduced to the topic of drugs. A similar company is selected.

If you do not set a pause in time, then the addiction will develop into the next stage of drug addiction.

The third stage: the second stage of drug addiction

Narcologists identify the main features of this stage.

• The body tolerates the drug worse, converting it into poison. In this case, a complete poisoning of the body already occurs.
• The effect is not the same. The result is only a faint feeling of high.
• Physical and psychological functions begin to degrade.
• A person begins to lose himself as a person.
• Relations with the outside world are destroyed.
• Breaks are permanent.
• High risk of contracting various infections, hepatitis and HIV.
• Actions become uncontrolled, often leading to criminal liability.
• The presence of promiscuous contacts entails illness and unwanted pregnancies.
• Frequent scandals, problems at work, at school – this is a common problem for this stage.
• Financial difficulties lead to debts, theft, criminal search for money to buy drugs.
• The circle of friends is replenished with drug addicts.

Physical dependence in the third stage intensifies, and the need for drugs increases dramatically. And with that comes problems. Drug use must be constant.

At this stage, the addict can no longer overcome the addiction on his own. It is urgent to contact the experts. If this is not done, then the stage will come when the addict will need stronger drugs, which will fully satisfy his needs.

The intake of new psychoactive substances is accompanied by a new surge of deceptive high. This infuriates drug addicts.

Many young people have a number of unreliable information that says that drugs are less harmful if they are taken in small doses. But this is far from true.

Fourth stage: third stage of drug addiction

This stage is characterized by the following features.

• Drugs instead of sleep instead of food, instead of everything that was previously present in a past life.
• The need to get a dose can lead to rash steps, even criminal ones.
• Degradation occurs throughout the organism.
• Apathy and loss of the meaning of life become the main accompaniments of a drug addict.
• Suicide attempts appear.
• Diseases become chronic.

During this period, physical dependence reaches its peak. A person cannot live without the constant use of a new dose. The psyche and nervous system cannot adequately perceive what is happening. The end result is death. Often the cause of death is a drug overdose.

During the fourth stage, the drug addict actively takes various types of drugs. Return to normal life and full recovery is almost impossible.

Getting a dose, drinking, getting high is a cycle that repeats itself constantly.

The faster a person realizes his problem and decides on treatment, the more likely it is to get rid of this addiction. The drug addict must turn to specialists and get the necessary help.

The harm of smoking, alcoholism and drugs

A lot has been and is being said about alcoholism and smoking, alcoholism and drug addiction – harmful factors for health. Sometimes they are very mildly called “bad habits”. Alcohol and nicotine were called “cultural” poisons. But it is they, these “cultural” poisons that bring a lot of trouble and suffering – in families, work collectives, they are a social evil for society. Moreover, as a result of bad habits, life expectancy is reduced, the mortality rate of the population increases, and defective offspring are born.

Much has been said about the dangers of smoking. However, the concern of scientists and doctors caused by the spread of this addiction is growing, as a significant number of people still do not consider smoking unhealthy. Smoking is not a harmless activity that can be quit effortlessly. This is a real addiction, and all the more dangerous because many do not take it seriously.

The problem of alcohol consumption is also very relevant today. Now the consumption of alcoholic beverages in the world is characterized by huge numbers. The whole society suffers from this, but first of all, the younger generation is at risk: children, adolescents, youth, as well as the health of expectant mothers. After all, alcohol has a particularly active effect on the unformed body, gradually destroying it.

Abuse of narcotic drugs and illegal trade in them in recent years in many countries, especially developed countries of the world, have assumed catastrophic proportions. The official press of the USA, Germany, France, England, Sweden almost daily reports the death of its citizens, which followed as a result of the abuse of narcotic and psychotropic substances. Drug addiction has captured in many countries even

The problem of “bad” habits is very relevant in our time. The main “weapon” in the fight against them is information. It is necessary that every person knows about the action, about the harm they bring to the human body.

Man is often his own worst enemy. (Cicero.)

Smoking is one of the worst habits. Studies have proven the harm of smoking. Tobacco smoke contains more than 30 toxic substances: Nicotine, Carbon dioxide, Carbon monoxide, Hydrocyanic acid, Ammonia, Resinous substances, Organic acids and others.

Nicotine is one of the most dangerous plant poisons. Birds (sparrows, pigeons) die if only a glass rod dipped in nicotine is brought to their beak. A rabbit dies from 1/4 drop of nicotine, a dog – from 1/2 drop. For humans, the lethal dose of nicotine is 50 to 100 mg, or 2-3 drops. It is this dose that enters the blood daily after smoking 20-25 cigarettes (one cigarette contains approximately 6-8 mg of nicotine, of which 3-4 mg enters the bloodstream). The systematic absorption of small, non-lethal doses of nicotine causes a habit, an addiction to smoking.

Nicotine is included in the metabolic processes occurring in the human body and becomes necessary In the children of smoking parents during the first year of life, the frequency of bronchitis and pneumonia increases and the risk of developing serious diseases increases. Tobacco smoke traps the sun’s ultraviolet rays, which are important for a growing child, affects metabolism, impairs the absorption of sugar and destroys vitamins. C, necessary for the child during the period of growth. At the age of 5-9 years, the child’s lung function is impaired. As a result, in families where children smoke, especially at an early age, frequent acute pneumonia and acute respiratory diseases are observed. In families where there were no smokers, the children were practically healthy.

Babies whose mothers smoked during pregnancy are prone to seizures. They are much more likely to develop epilepsy. Children born to smoking mothers lag behind their peers in mental development.

Nicotine contributes to the development of many allergic diseases in children, and the smaller the child, the more harmful tobacco smoke causes his body.

Teen smoking primarily affects the nervous and cardiovascular systems. At 12-15 years old, they already complain of shortness of breath during physical exertion.

Statistics show that compared to non-smokers, long-term smokers are 13 times more likely to develop angina pectoris, 12 times more likely to have myocardial infarction, and 10 times more likely to get stomach ulcers. Smokers make up 96 – 100% of all lung cancer patients. Every seventh long-term smoker suffers from obliterating endarteritis – a serious disease of the blood vessels. Statistical studies have shown that smokers often have cancerous tumors in other organs – the esophagus, stomach, larynx, kidneys. Smokers often develop cancer of the lower lip as a result of the carcinogenic effect of the extract that accumulates in the mouthpiece of the pipe.

Smoking plays an important role in the development of tuberculosis. So, 95 out of 100 people suffering from it, by the time the disease began, were smoking. Often smokers experience pain in the heart. This is due to a spasm of the coronary vessels that feed the heart muscle with the development of angina pectoris (coronary heart failure). Myocardial infarction in smokers occurs 3 times more often than in non-smokers.

Smoking can also be the main cause of persistent vasospasm of the lower extremities, contributing to the development of obliterating endarteritis, which affects mainly men. This disease leads to malnutrition, gangrene and eventually to amputation of the lower limb.

Smoking can cause nicotinic amblyopia. In a patient suffering from this disease, partial or complete blindness occurs. This is a very formidable disease in which even vigorous treatment is not always successful.

Smokers endanger not only themselves, but also those around them. In medicine, even the term “passive smoking” has appeared. In the body of non-smokers after staying in a smoky and unventilated room, a significant concentration of nicotine is determined.

Smoking is poison!

2. The effect of alcohol on the human body.

“Alcoholism does more havoc than the three historical scourges put together: famine, plague, and war.” (W. Gladstone)

Bad habits, apart from smoking, are even more pernicious – alcohol consumption. Unfortunately. In real life, they are very often combined with each other. Thus, among the non-drinking population there are 40% smokers, among those who abuse alcohol already 98%

The harm of alcohol is obvious. With the systematic use of alcohol, a dangerous disease develops – alcoholism. Alcoholism is dangerous to human health, but it is curable, like many other diseases.

Drunkenness ‘lights the green light’ on malignant neoplasms. The presence of carcinogens in alcoholic beverages is not excluded. Being a good solvent, alcohol helps their penetration into the body. Alcohol abusers, especially at a young age, have a 10 times higher risk of developing oral cancer, and if they also smoke, it is 15 times higher compared to non-drinkers.

Alcohol has a detrimental effect on brain cells (including cells that regulate the activity of the reproductive system) and on the reproductive centers located in the spinal cord, the activity of the mammary glands weakens, and in the future it may stop.

With a significant and frequent ingestion of alcohol into the body, the cells of various organs eventually die.

Under the influence of alcohol, almost all physiological processes in the body are disturbed, and this can lead to serious illnesses. The tissue of the liver, kidneys, heart, blood vessels, etc. is reborn.

Alcohol also affects the blood vessels that carry blood to the brain. First, they expand, and blood saturated with alcohol rapidly rushes to the brain, causing a sharp excitation of the nerve centers. This is where the overly cheerful mood and swagger of a drunk person comes from.

Scientists have found that under the influence of alcoholic beverages in the cerebral cortex, after increasing excitation, a sharp weakening of inhibition processes occurs. Each new portion of alcohol paralyzes the higher nerve centers more and more, as if connecting them and not allowing them to interfere with the chaotic activity of the sharply excited parts of the brain.

What we in everyday life complacently call intoxication is, in essence, nothing more than acute alcohol poisoning, with all the ensuing consequences.

Under the influence of alcohol, instincts gain space, will and self-control are weakened, and often people commit misdeeds and mistakes, which they repent of all their lives.

3. Narcotic substances and their characteristics

What is a “drug”? A drug should be considered any substance (with or without legal use in medicine) that is the subject of abuse for purposes other than medical.

900 02 Physiological the properties of drugs involved in a complex chemical process that occurs in the human body, have an attractive force and force the victim to turn to them repeatedly or continuously after the habit or addiction has firmly come into its own.0003

Narcotics, depending on their impact on the human body, can be conditionally divided into two large groups: 1) excitatory; 2) causing depression. At the same time, it should be borne in mind that each of the drugs has a large variety of hidden properties that affect the nervous system in different ways.

There are drugs that calm and anesthetize (they are called depressives), and there are others that have a stimulating effect, excite the body. Hallucinogenic drugs cause ecstasy and rage, nightmares, or feelings of agonizing restlessness.

The state of addiction is characterized by three properties:

1. an irresistible desire or need to continue taking drugs and get them by any means;
2. desire to increase doses;
3. dependence of a mental, and sometimes physical, nature on the effects of a drug.

The so-called drug addiction syndrome arises only as a result of taking a narcotic drug. The steps in this process, whether more slowly or more rapidly, are basically the following:

1. Initial euphoria, often very short-lived. It is typical for certain
2. Tolerance is temporary.
3. Dependency. Most researchers have come to the conclusion that addiction is a phenomenon both physical and mental. It is expressed by the classic symptoms of abstinence, or “withdrawal”, which the addict endures very hard and with the risk of severe organic or functional seizures.
4. Abstinence (withdrawal syndrome) usually occurs 12-48 hours after stopping the drug. At the same time, an obsessive desire appears to find a toxic substance – a drug – at any cost! Abrupt “withdrawal” of the addict leads to violent and extremely dangerous manifestations, which in some cases can cause real collapses.

In most countries involved in the fight against drugs, only a small part of the products are controlled, that is, drugs included in the list of prohibited drugs, so diverse in their properties that cause addiction. The stages of drug addiction lead lower and lower, determining the aggravation of the disaster, which, as the experts of the World Health Organization emphasize, is a great threat to public health on a global scale. This danger increases as factories and laboratories produce more and more new types of drugs, more and more powerful and harmful.

Conclusion.

Both smoking, and alcoholism, and, moreover, drug addiction, more and more make doctors, and just citizens who think about their future generation, think about how to warn people who have not yet succumbed to such harmful and harmful habits, from addiction to these three evils of modern society.

Smoking, alcoholism and drug addiction are not only the problem of the “sick” person himself (because I personally consider all three habits to be a disease from which it is necessary to treat and be treated), but also a problem of society as a whole.

Smoking is a social problem of society, both for its smokers and non-smokers. For the first – the problem is to quit smoking, for the second – to avoid the influence of the smoking society and not “get infected” by their habit, and also to maintain one’s health from smoking products, since the substances included in the smoke exhaled by smokers are not much safer than if a person he himself smoked and took in nicotine and much more that is included in a lit cigarette.

Alcohol “beats” not only the drinker himself, but also the people around him. Often men or women who are prone to alcoholism neglect their responsibilities, friends, family and children in order to satisfy their need. Addiction to alcohol is the cause of various crimes. It is known that 50 percent of all crimes are associated with the use of alcohol. Children often pay the price for their parents’ alcoholism. Studies of nervously ill children have shown that the cause of their illness is often the alcoholism of their parents. The fight against alcoholism is the largest social and medical problem of any state. The harm of alcohol has been proven. Even small doses of it can cause great troubles or misfortunes: injuries, car accidents, deprivation of working capacity, family breakdown, loss of spiritual needs and strong-willed traits by a person.

Drug abuse, known since ancient times, has now spread to a level that alarms the entire world community. Even with the narrowing, from the point of view of narcologists, the boundaries of drug addiction to legally acceptable in many countries, drug addiction is recognized as a social disaster. Drug mafias rule states (Latin America), have their own armies (Southeast Asia). The incomes of underground corporations from the drug trade exceed the known income from the oil trade and approach the world’s income from the arms trade.