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

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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

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3201-Opioid Conversion Calculator | eviQ

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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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17 Jul 2023

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how to achieve the desired and lasting result

• Date: June 12, 2021

• Author: Yuliana Borisovna Ivashchenko

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9000 4 According to the latest statistics, 3% of the people on earth, which is approximately 200 million people, are drug addicts. With the advent of the Internet in our lives, the number of cases of distribution of drugs through the worldwide network has increased, about 600 sites that sell drugs have been recorded. The mass distribution of drugs and, accordingly, their use destroys not only moral and ethical principles, but also endangers the lives and health of countless people.

This situation and the results of research make the issue of prevention, which will be aimed at the younger generation, as well as the treatment of drug addicts, relevant.

You need to start with medication support – that’s where any drug addiction treatment begins.

Effective drug addiction treatment is a comprehensive approach using different types of methods, including: the use of medications, various rehabilitation centers and drug treatment dispensaries (labor centers, centers operating under the 12 step program, spiritual and Orthodox centers, the community of anonymous drug addicts , monasteries and church churches), coding, substitution therapy (replacement of a drug familiar to the patient with another drug – methadone, bublemorphine, methadol). It is also believed that Effective drug addiction treatment can be achieved with strict therapy in several stages. The first stage is the relief of acute withdrawal disorders. As part of this stage, detoxification agents are used that are aimed at relieving pain, autonomic disorders, somatic disorders (clophelin, cholecystokinin or pancreozymin). A similar effect of drugs was revealed – tacus-decapeptide and deltoran-peptide, which also normalize the level of dopamine.

The results of studies have shown that the problem of vegetative disorders copes with the inhibitor – aprotinin, which largely removes such disorders. In general, this type of treatment is successful, as it normalizes the psychological state of the patient, eliminates metabolic disorders, and normalizes sleep. To stop the craving for drugs, it is preferable to use antipsychotics and anticonvulsants, after which antidepressants (melipramine, lyudiomil and amitriptyline) are prescribed in case of apathetic and anxious mood of the patient. Also in therapeutic practice, to normalize the functioning of the central nervous system and form long-term remissions, nootropic drugs (phenibut, picamilon, pantogam) are used. An important drug in the treatment of dependence on psychostimulants is the dopamine agonist bromocriptine.

Medical treatment is only a stage. Psychological help is also important!

But an important condition for getting rid of drug addiction is not only drug treatment, but also the stage of anti-relapse therapy, which is the patient’s work with psychologists and psychotherapists in combination with psychotherapy and supportive pharmacotherapy (drug therapy). During this period, an antagonist, naltrexone, is used to prevent relapse in drug addicts. The stage is aimed at correcting the psychological state of the patient and is an indicator of whether effective drug addiction treatment during rehabilitation. A prerequisite for therapy is the resocialization of patients, during which the skills of preventing breakdowns are mastered, the process of transition to a society where there is no place for drug addiction.

Unfortunately, drug has not yet been created to cure this disease in a matter of minutes. Drug addiction treatment is a complex and multi-stage process that requires a full course of treatment, including the stage of resocialization. The formation of a patient’s motivation for recovery is an important task for a possible long-term remission. For a drug-free society, not only the treatment of drug addiction is important, but also its prevention is the work of all members of society.

Drug addiction diagram

Author: Ivashchenko Yuliana Borisovna

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From the code of silence to the impossible to leave the “family”: 8 myths about the Italian-American mafia

Life

January 12, 2022

Mafiosi do not eliminate everyone in a row and do not disdain selling drugs.

1. Mafia is any organized criminal group

Today almost every organized criminal group is called mafia: Mexican, Irish, Russian, Ukrainian, Albanian, Jewish and others. But in general, the mafia is a specific cultural and historical phenomenon.

Mafia, or cosa nostra (cosa nostra – from Italian “our business”), originated in the XIX century in Sicily. Its appearance is dictated by the complex history of the island, which was ruled by either the Arabs, or the French, or the Austrians. Because of this, many bandits appeared there, robbing foreigners. This is largely due to the emergence of omerta – the Sicilian code of silence and non-cooperation with the government.

Initially, mafiosi called those who have a negative attitude towards the state. Their orders largely “emigrated” to the United States along with the Italian settlers of the late 19th and early 20th centuries. One of the first such “visitors” was Giuseppe Esposito, who fled to New York after the assassination of the vice-chancellor of the Sicilian province, and 11 other wealthy landowners.

In Italy, the mafia is still alive and well. But it is the Cosa Nostra from the United States that first comes to mind when people talk about the mafia. Her main sources of income are drug trafficking, loansharking (something like microcredit), betting (including online), strip clubs, racketeering, as well as union control and money laundering with their help.

2. The mafia does not have a clear and well-organized structure

In fact, the structure of mafia clans is similar to the structure of a medieval feudal kingdom: the lower figures do all the dirtiest and most dangerous work and give part of the income “upstairs”.

At the head of the “family”, or clan, is the boss, he is also a don. Only he can order someone to be killed. Don usually distances himself as much as possible from those associated with crimes (“captains” and “soldiers”), in order to avoid trial if something happens. One step below is the underboss – the right hand and a possible successor to the boss. Next come the “captains” (capo, caporegime), who manage groups of 10-20 “soldiers” – ordinary fighters of the clan. All of them are considered official members of the Cosa Nostra: the murder of even an ordinary “soldier” carries major consequences, as it offends the entire mafia “family”.

The structure of the mafia “family”. Image: Talifero / Wikimedia Commons

Below in the Italian-American criminal hierarchy are all sorts of accomplices, partners and other criminals. They can be both people of Italian origin, who can later be accepted into the “family”, and other bloodlines.

The consigliere (advisor) is standing a little aside. Usually this is an elderly gangster who has no real power – only one bodyguard is assigned to the consigliere. The adviser helps the boss in resolving controversial and complex issues, dissuades from hasty decisions.

Above all the clans of the United States is the Commission of the “Five Families” of New York (Bonanno, Gambino, Genovese, Colombo, Lucchese), which controls common operations and helps resolve conflicts. True, founded in 1931, it has not met in full force since 1985. But the bosses continue to contact each other and sometimes hold personal meetings.

3. The Mafia does not deal in drugs

In the film The Godfather, Don Corleone refused on principle to sell drugs. But reality is more like the events of Scarface.

For example, the most influential gangster of the 1920s and 1930s, Lucky Luciano, was a drug dealer. Vito Genovese (Don Vito), whose last name is one of the New York families, and several smaller criminals in 1959 were convicted of heroin trafficking. His sale brought the gang billions of dollars for several decades.

Lucky Luciano in 1948. Photo: Remo Nassi / Wikimedia Commons

There was even a special network called the Pizza Connection (“Connection through pizza”), when, under the guise of Italian restaurants in the United States, mafiosi sold heroin from Sicily and Corsica.

However, there are cases when the bosses really forbade their followers to trade “nonsense”. For example, Vincent Gigante (Chin) from the Genovese clan or Paul Castellano (Big Paul) from the Gambino. Mobster Salvatore Gravano (Bull Sammy), testifying in 1993, claimed that anyone from the Gambino clan who dared to sell drugs risked his life.

Still from FBI footage with Louis Saccenti, Tomas Carbonaro, Jono Gammerano and Salvatore Gravano. Photo: FB*I / Wikimedia Commons

But, most likely, this was not due to a noble contempt for illegal substances, but to the high danger of this business – after all, it is very easy to get caught selling drugs. In addition, in the 1970s, the US government tightened its fight against drug trafficking.

4. The mafia never associates with other criminal gangs

In the movies, it is most often shown that mafiosi act on their own, without involving other criminal gangs. And this was true from the late 40s to the 70s of the XX century, when the Italian mafia was the largest player in the illegal business in the United States. An exception is the ties between Italian Americans and their Sicilian “colleagues” from their small homeland.

But those days are gone, and although the Italian-American mafia remains the largest criminal organization in the United States, it is no longer so closed and homogeneous. For example, Michael Franchise, who held a high position in the New York mafia “family” Colombo, in the 80s collaborated with Russian gangsters from Brighton Beach, conducting gas tax scams: they bought fuel in a tax-free zone and sold it exorbitantly. From these and other scams, Franzese sometimes earned up to eight million dollars a week.

Also, “families” in different US cities were often associated with the biker group Pagans (“Pagans”), which traded methamphetamine.

And if initially only immigrants from Italy could occupy key positions in Cosa Nostra, over time, this opportunity opened up for representatives of other ethnic groups. It was no longer just cooperation: the “strangers” were privy to the affairs of the mafia. For example, the Californian Japanese Ken Eto (Tokyo Joe) conducted underground games in the casinos of the Chicago mafia group. And the Polish Jew Jake Guzik (Fat Finger) was in charge of accounting and solved the political issues of Al Capone. Although it is worth saying that these and other “foreigners” who took high places in the Cosa Nostra did not become its full members. They can only be Italians.

5. Mafiosi would rather die than give away the secrets of the clan

The code of silence among the Italian mafiosi really existed, but gradually its effect came to naught.

As mentioned at the beginning of the article, the codex was called omerta and appeared in Sicily long before the mafia. It prescribed that a member of a criminal organization could not cooperate in any way with the state and the police. Therefore, the mafia is obliged to remain silent during interrogations, not to testify against anyone, not to cooperate with the investigation, and not even to recognize the existence of the mafia.

Omerta worked for a long time, but in 1963 Joseph Valachi (Joe Cargo) broke the code of silence. He was convicted of drug trafficking along with Vito Genovese. In 1962 they were in the same prison. Then Valachi killed a cellmate, mistaking him for an assassin sent by Genovese. Fearing for his life, Valachi testified before the US Senate at a special hearing. It was he who first said that the mafia itself is called by its members “Cosa Nostra”.

The American gangster Tommaso Buscetta, who at 19In 1986, he gave evidence that became the basis for 11 trials in New York alone.

In the more than 20 years since Valachi’s confession, six more gangsters from New York, Cleveland, Los Angeles and Boston entered into cooperation with the authorities, and by the end of the 80s, the omerta was effectively over. A significant role in this was played by the RICO law (“On Racketized and Corrupt Organizations”) of 1970, which made it possible to condemn entire organizations associated with criminal activity. Prosecutors can now enter into court agreements and convict the guilty for less serious crimes in exchange for his testimony against the leaders of criminal associations.

6. The ritual of initiation into the “family” is a huge secret, not known to anyone outside the mafia

Largely due to the confessions of some mafiosi and their cooperation with representatives of the law, the rite of passage into the “family” and the oaths of mafiosi are well known today. In 2011, New York mobster Joseph Massino, who faced a life sentence for involvement in eight murders, began to cooperate with the investigation. Among other things, he spoke about how the ceremony of his initiation took place in the distant 1977 year.

FBI live footage. To the right of the car is Joseph Massino. Photo: United States Department of Justice / Wikimedia Commons

But more revealing is the story of George Fresolone. He was an ordinary member of the Philadelphia-New Jersey mafia and went to prison in 1988. Due to the fact that the gang did not help his impoverished family in any way, Fresolone became an agent for the Organized Crime Division. In total, he recorded more than 400 gang talks, which allowed him to bring about 40 mafiosi to court, as well as his initiation ceremony in 1990 year. Fresolone co-authored The Blood Oath four years later and died in 2002 of a heart attack while in the Witness Protection Program.

So, the initiation ritual goes like this. To become an official member of the clan, you need to prove yourself and prove your loyalty. Therefore, it is not surprising that Fresolone, who had been involved in dark deeds from adolescence, was initiated only at the age of 36. The process begins with the candidate getting their finger pierced and formal questions being asked. The blood is then erased with a card depicting the saint. It is crushed, placed in the hands of the candidate and set on fire while he reads the oath, promising to live and die for “family” and “burn like this saint” if he betrays her. In different clans, the ritual may differ, but in general, the scheme is approximately the same everywhere.

7. Mafiosi easily eliminate all objectionable

In the US, mafiosi are much less likely to kill (especially policemen and judges), unlike their Sicilian counterparts. Also, members of the Cosa Nostra try to prevent casualties among ordinary citizens. And the point here is not at all in the high moral character of the mafia, but in the fact that the murder carries serious consequences.

So, because of the case of 18-year-old Matteo Speranza, who fell under a stray bullet, most of the Colombo “family” ended up behind bars.

It is also important that a person who testified against the mafia does not have to worry about his life, as the witness protection program works well in the USA. By the way, the correct name for this service is the Witness Security Program. Since its inception in 1971, it has successfully defended about 19,000 witnesses (not only on mafia cases) and their relatives.

US Marshals escorting the witness. Photo: United States Marshals Service / Wikimedia Commons

However, there are those whom the mafia leaves alone anyway. For example, Salvatore Gravano at 1995 came out of the security program and lives quietly under his own name in Arizona. He was the right hand (underboss) of Don Gambino. In the 90s, Salvatore Gravano testified, thanks to which the entire top of the Gambino clan was behind bars, including John Gotti, who was sentenced to life imprisonment.

A good example of the fact that the mafia is not at all omnipotent in eliminating its enemies is the story of Joseph Pistone, better known as Donnie Brasco. It was according to her, or rather according to the book of Pistone in 1997 film “Donnie Brasco” with Al Pacino, Johnny Depp and Michael Madsen.

Pistone was an FBI agent who worked undercover for the Bonanno and Colombo mafia in New York from 1976 to 1981. The result of his activities were hundreds of cases and sentences, as well as a reward of 500 thousand dollars for his head from the leaders of the mafia. But at the same time, he is still alive – now Pistone is 81 years old.

Operational frame captured during Operation Donnie Brasco. Photo: FB*I / Wikimedia Commons

However, the danger of the mafia should not be underestimated. In 1985, by order of John Gotti, Paul Castellano, then Gambino boss, was shot dead in his car right on the street. In 2003, Angelo Mugnolo, owner of a bakery shop in Queens, New York, was shot outside his home. He was “ordered” by Vincent Gotti, brother of John Gotti. Vincent suspected that his wife was cheating on him with the baker.

John Gotti. Photo: FB * I / Wikimedia Commons

Mafiosi still do not shun murders, but it is becoming increasingly difficult to commit them. In 2016, New York-based Lucchese mobster Joseph Datello (Joey Glasses) traveled to New Hampshire on assignment from his boss. There, he intended to find and kill a police informant, but was apprehended.

However, there are also “successful” examples. So, in 2019, due to intra-family squabbles, the head of the Gambino clan, Frank Cali (Frankie Boy), was shot dead.

8. Once you join a mafia “family”, you cannot return to civilian life

This traditional movie cliché is not entirely true. Yes, leaving the clan is difficult, but possible. In most cases, the mafia was left by turning to the authorities, and we cited such examples above.

But there is the case of the aforementioned Michael Franzese of the Colombo “family”, who retired without the cooperation of the FBI. At 19In 86, Fortune magazine included him in the list of “50 richest mafia bosses”, and at the same time, Franchise first went to prison. After being released in 1989, he was back behind bars two years later. During his second term, Francese became interested in reading the Bible. Released in 1994, he broke with the mafia and moved to California with his family.