Narcotic strength chart. Opioid Equivalence Chart: Understanding Narcotic Strength and Potency
How do different opioids compare in strength. What factors influence opioid potency. Which opioids are most potent relative to morphine. How can opioid doses be safely converted.
Opioid Potency: Comparing Narcotic Strengths
Understanding the relative potency of different opioids is crucial for healthcare providers to ensure safe and effective pain management. The opioid equivalence chart provides a valuable reference for comparing the strength of various narcotics to morphine, which serves as the standard benchmark.
When examining opioid potency, it’s important to consider several key factors:
- Route of administration (oral, intravenous, etc.)
- Formulation (immediate-release vs. extended-release)
- Individual patient characteristics
- Tolerance levels
- Pain severity
These variables can significantly impact the effectiveness and appropriate dosing of opioid medications.
Morphine: The Gold Standard for Opioid Comparison
Morphine serves as the reference point for comparing the potency of other opioids. Its well-established pharmacological profile and extensive clinical use make it an ideal benchmark. When discussing opioid strength, the term “morphine milligram equivalents” (MME) is often used to standardize comparisons across different medications.
Why is morphine used as the standard? There are several reasons:
- Long history of clinical use
- Well-documented pharmacokinetics and pharmacodynamics
- Availability in multiple formulations
- Widely studied in various patient populations
By using morphine as a reference, healthcare providers can more easily estimate equivalent doses when switching between different opioids or adjusting treatment regimens.
Interpreting the Opioid Equivalence Chart
The opioid equivalence chart presents approximate potency ratios for various narcotics relative to morphine. To use this chart effectively, it’s essential to understand how to interpret the information provided:
- Identify the opioid of interest in the first column
- Locate the corresponding relative potency value in the second column
- Multiply the dose of the opioid by its relative potency to determine the equivalent morphine dose
- Conversely, divide a morphine dose by the relative potency to find the equivalent dose of another opioid
It’s important to note that these conversions are approximate and may require adjustment based on individual patient factors and clinical judgment.
Example Calculation:
If a patient is taking 10 mg of oxycodone, and the relative potency to morphine is 1.5, the equivalent morphine dose would be:
10 mg oxycodone × 1.5 = 15 mg morphine equivalent
Highly Potent Opioids: Fentanyl and Its Analogs
Among the opioids listed in the equivalence chart, fentanyl and its analogs stand out as particularly potent. Fentanyl is estimated to be 50-100 times more potent than morphine, depending on the route of administration and specific formulation.
Why are fentanyl and its derivatives so potent? Several factors contribute to their high potency:
- High lipid solubility, allowing rapid penetration of the blood-brain barrier
- Strong affinity for mu-opioid receptors
- Rapid onset of action
- Relatively short duration of effect
The extreme potency of fentanyl and its analogs necessitates careful dosing and monitoring to prevent potentially life-threatening adverse effects, including respiratory depression.
Methadone: A Unique Case in Opioid Conversion
Methadone presents a particularly challenging case when it comes to opioid conversion. While a single 5 mg dose of methadone is roughly equivalent to 7.5 mg of morphine, its potency increases significantly with regular administration. This phenomenon is due to several unique properties of methadone:
- Variable and often long plasma half-life
- Broad-spectrum receptor affinity
- Complex pharmacokinetics and pharmacodynamics
- Potential for drug interactions
As a result, the relative potency of methadone can be much higher than expected when administered regularly, sometimes exceeding the range provided in standard conversion tables. This unpredictability makes methadone conversion particularly complex and potentially dangerous if not managed properly.
Methadone Conversion Precautions:
Given the unique properties of methadone, healthcare providers should take the following precautions when considering methadone conversion:
- Seek guidance from a pain management specialist or addiction medicine expert
- Start with lower doses and titrate slowly
- Monitor patients closely for signs of opioid toxicity
- Consider factors such as prior opioid exposure, pain severity, and comorbidities
- Be aware of potential drug interactions that may affect methadone metabolism
Factors Influencing Opioid Potency and Effectiveness
While the opioid equivalence chart provides valuable guidance, it’s crucial to understand that various factors can influence the actual potency and effectiveness of opioids in individual patients. These factors include:
- Age: Elderly patients may be more sensitive to opioid effects
- Renal function: Impaired kidney function can lead to accumulation of opioid metabolites
- Hepatic function: Liver disease may affect opioid metabolism
- Genetic variations: Polymorphisms in opioid receptors and metabolizing enzymes can alter drug response
- Drug interactions: Concurrent medications may enhance or inhibit opioid effects
- Tolerance: Chronic opioid use can lead to decreased effectiveness over time
- Pain severity: The intensity of pain can influence the perceived effectiveness of opioids
Healthcare providers must consider these factors when interpreting the opioid equivalence chart and making clinical decisions regarding opioid therapy.
Safe Opioid Conversion Practices
Converting between different opioids or adjusting dosages requires careful consideration and adherence to safe practices. Here are some key principles to follow when using the opioid equivalence chart:
- Start low and go slow: Begin with conservative dose estimates and titrate gradually
- Consider incomplete cross-tolerance: Reduce the calculated equivalent dose by 25-50% when switching opioids
- Account for individual patient factors: Adjust conversions based on age, renal function, and other relevant clinical characteristics
- Provide rescue medication: Ensure patients have access to breakthrough pain relief during conversions
- Monitor closely: Frequently assess pain control and potential adverse effects during the conversion process
- Educate patients and caregivers: Provide clear instructions on the new medication regimen and potential side effects
- Document carefully: Maintain accurate records of opioid conversions and rationale for dosing decisions
By following these practices, healthcare providers can minimize the risks associated with opioid conversion and optimize pain management outcomes.
Limitations of Opioid Equivalence Charts
While opioid equivalence charts are valuable tools, it’s important to recognize their limitations and potential pitfalls. Some key considerations include:
- Approximate nature of conversions: Potency ratios are estimates and may not apply equally to all patients
- Variability in individual response: Genetic and physiological factors can lead to significant differences in opioid effectiveness
- Incomplete cross-tolerance: Patients may not have equal tolerance to all opioid effects when switching medications
- Route-specific differences: Potency ratios may vary depending on the route of administration
- Lack of consideration for non-opioid analgesic effects: Some opioids have additional mechanisms of action that aren’t captured by simple potency ratios
- Potential for calculation errors: Misinterpretation or miscalculation of conversions can lead to under- or over-dosing
Healthcare providers should use opioid equivalence charts as a starting point for clinical decision-making, rather than as absolute rules for opioid conversion.
Addressing Limitations in Clinical Practice:
To mitigate the limitations of opioid equivalence charts, consider the following strategies:
- Combine chart data with clinical judgment and patient-specific factors
- Consult with pain management specialists for complex cases
- Utilize electronic health record systems with built-in opioid conversion calculators
- Implement double-check procedures for opioid conversion calculations
- Provide ongoing education and training for healthcare providers on safe opioid prescribing practices
Beyond Potency: Other Considerations in Opioid Selection
While the opioid equivalence chart focuses on potency, there are numerous other factors to consider when selecting an appropriate opioid for a patient. These include:
- Onset of action: How quickly the medication takes effect
- Duration of action: How long the analgesic effect lasts
- Formulation options: Availability of immediate-release and extended-release versions
- Route of administration: Oral, transdermal, injectable, or other options
- Side effect profile: Tendency to cause constipation, nausea, or other adverse effects
- Drug interactions: Potential for clinically significant interactions with other medications
- Cost and insurance coverage: Accessibility and affordability for the patient
- Abuse potential: Risk of misuse or diversion, especially for patients with a history of substance use disorders
By considering these factors alongside potency, healthcare providers can make more informed decisions about opioid selection and optimize pain management strategies for individual patients.
Tailoring Opioid Therapy to Patient Needs:
To select the most appropriate opioid for a given patient, consider the following approach:
- Assess the patient’s pain characteristics (e.g., acute vs. chronic, nociceptive vs. neuropathic)
- Review the patient’s medical history, including comorbidities and previous opioid experiences
- Evaluate potential drug interactions with the patient’s current medication regimen
- Consider the patient’s lifestyle and preferences regarding dosing frequency and route of administration
- Assess the risk of opioid misuse or abuse based on patient history and validated screening tools
- Determine the most appropriate starting dose based on opioid naïvety or prior opioid exposure
- Develop a plan for monitoring effectiveness and adjusting therapy as needed
The Role of Non-Opioid Analgesics in Pain Management
While the opioid equivalence chart focuses on narcotic medications, it’s essential to recognize the importance of non-opioid analgesics in comprehensive pain management. Integrating non-opioid options can help minimize opioid use and associated risks. Some key non-opioid analgesics include:
- Acetaminophen (paracetamol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Gabapentinoids (e.g., gabapentin, pregabalin)
- Antidepressants (e.g., tricyclic antidepressants, SNRIs)
- Topical agents (e.g., lidocaine patches, capsaicin cream)
- Muscle relaxants
Incorporating these medications into multimodal pain management strategies can enhance overall pain control while potentially reducing opioid requirements.
Multimodal Analgesia Strategies:
To optimize pain management and minimize opioid use, consider the following approaches:
- Combine opioids with appropriate non-opioid analgesics based on pain type and severity
- Utilize adjuvant medications to target specific pain mechanisms (e.g., anticonvulsants for neuropathic pain)
- Incorporate non-pharmacological interventions such as physical therapy, acupuncture, or cognitive-behavioral therapy
- Regularly reassess the need for continued opioid therapy and adjust treatment plans accordingly
- Educate patients on the benefits of multimodal pain management and the risks associated with long-term opioid use
Future Directions in Opioid Potency Assessment
As our understanding of opioid pharmacology and individual patient factors continues to evolve, new approaches to assessing opioid potency and guiding safe conversions are emerging. Some promising areas of research and development include:
- Pharmacogenomic testing to predict individual response to opioids
- Advanced pharmacokinetic modeling to account for complex drug interactions
- Machine learning algorithms for personalized opioid dosing recommendations
- Development of abuse-deterrent opioid formulations
- Exploration of novel opioid receptor targets with improved safety profiles
- Integration of real-time monitoring systems to detect early signs of opioid toxicity
These advancements may lead to more precise and individualized approaches to opioid therapy in the future, potentially improving pain management outcomes while reducing risks associated with opioid use.
Preparing for Future Innovations:
Healthcare providers can prepare for emerging developments in opioid management by:
- Staying informed about new research and guidelines in pain management
- Participating in continuing education programs focused on opioid prescribing and safety
- Engaging in interdisciplinary collaborations to enhance pain management strategies
- Advocating for the integration of new technologies and approaches in clinical practice
- Contributing to research efforts aimed at improving opioid safety and effectiveness
By embracing these future directions, healthcare providers can continue to refine their approach to opioid therapy and optimize pain management for their patients.
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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Equianalgesic Chart (Changes in italics)
|
Route
|
Starting Dose
(Adults > 50 Kg)
|
Onset
|
Peak
|
Duration
|
Metabolism
|
Half Life
|
Comments
|
Codeine
|
PO
IM
SQ
|
30
15
15
|
30
15
30
|
1 hr
30
2
|
6
4
4
|
Liver
|
2
|
IV use (even at low doses and when given very slowly)
IM or SQ routes are the preferred
|
Fentanyl
(Sublimaze)
(Duragesic)
|
IM
IV
Trans-dermal
|
5
0.25
25
|
7
Immediate
12
|
20
1
24
|
1
30
48
|
Liver
|
1
|
Transdermal should NOT be used to treat
Transdermal patch should
Use of IV fentanyl is
|
Hydrocodone with acetaminophen**
(Lortab, Vicodin)
|
PO
|
5
|
60
|
2
|
4
|
Liver
|
4
|
Available
Tablet with 5 mg hydrocodone and 500 mg
Elixir with 2.5 mg hydrocodone and 167 mg
per 5 ml.
|
Hydromorphone
(Dilaudid)
|
PO
IM/SQ
Slow
|
2
2
0.2
|
30
15
15
|
60
60
60
|
4
4
4
|
Liver
|
2 – 3 hr
|
Chronic treatment may require q 3 – 4
IV doses should be administered over at
|
Meperidine
(Demerol)
|
IM/SQ
IV
|
50
25
|
10
2
|
30
20
|
2
2
|
Liver
|
|
More than 72 hr of continuous use can
normeperidine which can lead to
Naloxone administration
Use with caution in the
|
|
Route
|
Dose
|
Onset
|
Peak
|
Duration
|
Metabolism
|
Half Life
|
Comments
|
Methadone
(Dolophine)
|
PO
|
2. 5
|
30
|
2
|
4
|
Liver
|
24
|
Used in chronic pain.
Continued dosing can result in
depression.
|
Morphine
(MS Contin)
(Avinza)
|
PO/SL
IM
IV
PO-SR
PO-SR
|
10
4
2
4
MS
Avinza: 30 mg daily
|
15 min
15 – 60 min
2 – 5 min
15 – 30 min
N/A
N/A
|
1 – 2 hr
30 – 60 min
20 min
30 – 60 min
N/A
N/A
|
4 hr
4 hr
3 – 4 hr
4 – 7 hr
8 -12 hr
24 hr
|
Liver
|
1. 5
2
15
|
Oral liquid concentrate is available.
Active metabolite renally
and
Long-acting dosage forms should not be
Long-acting dosage forms
Avinzais not on the UIHC formulary, but is used by
|
Oxycodone
(Percocet)**
(OxyContin)
|
PO/SL
PO-SR
|
5
or
OxyContin:
|
15
60
|
1
2
|
4
12
|
Liver
|
4 hr
|
Available at UIHC as an
liquid concentration
Percocet contains oxycodone
Other strengths of Percocet are available outside UIHC.
OxyContin is a
OxyContin
|
Guidelines for Patient-Controlled
Intravenous Opioid Administration (PCA) for Adults with Acute Pain
The amount of opioid required to
achieve comfort varies from patient to patient.
Adjust dosing to achieve patient comfort with minimal side effects.
Drug#
|
Usual Loading
Dose
|
Usual PCA Demand Bolus (Range)
|
Usual Lockout
Range
|
Usual
Basal Rate
|
Morphine (1 mg/ml)
|
5 10 mg
|
1 mg (0. 5 – 2.5 mg)
|
5 – 10 min
|
None or 1 – 2 mg/hr
|
Hydromorphone (Dilaudid) (0.2 mg/ml)
|
0.5 1.5 mg
|
0.2 mg (0.05 – 0.4 mg)
|
5 – 10 min
|
None or 0.1 – 0.4 mg/hr
|
Partially
adapted from the Principles of Analgesic Use in the Treatment of Acute Pain and
Cancer Pain, American Pain Society, 5th Ed. 2003.
Standard concentrations are listed in parentheses.
Initial Fentanyl Transdermal
Dosage (use only when converting another opioid TO fentanyl patch)*
Oral 24-hour morphine equivalent
(mg/day)
|
(mcg/hr)
|
|
25
|
135-224
|
50
|
225-314
|
75
|
315-404
|
100
|
405-494
|
125
|
495-584
|
150
|
585-674
|
175
|
675-764
|
200
|
765-854
|
225
|
855-944
|
250
|
945-1034
|
275
|
1035-1124
|
300
|
*Note: Do not use this table to convert from
fentanyl transdermal system to other opioid analgesics because these conversion
dosage recommendations are conservative.
Use of this table for conversion from fentanyl to other opioids can
overestimate the dose of the new agent and may result in an overdosage.
Equianalgesic Chart
Doses listed are equivalent to 10
mg of parenteral morphine. Doses should be titrated according to individual
response. When converting to another opioid, the dose of the new agent should
be reduced by 30-50% due to incomplete cross-tolerance between opioids.
Analgesic
|
Dosage
| |
Parenteral
|
Oral
| |
Fentanyl (Sublimaze)
|
0. 1 – 0.2 mg
|
————–
|
Hydrocodone
|
————-
|
30 mg
|
Hydromorphone (Dilaudid)
|
1.5 mg
|
7.5 mg
|
Meperidine (Demerol)
|
75 – 100 mg
|
300 mg (N)
|
Morphine
|
10 mg
|
30 mg
|
Oxycodone
|
————-
|
20mg
|
Dosage in this range may lead to
neuroexcitability.
For a single dose, 10 mg IV morphine = 60 mg oral morphine. For chronic dosing, 10 mg IV morphine = 30 mg
oral morphine.
(N)
Non-formulary at UIHC.
Example of opioid conversion:
- Bolus doses administered by the
medical/nursing staff
2.
The
equianalgesic chart indicates that 1.5 mg of parenteral hydromorphone equals
7.5 mg of oral hydromorphone (a 5-fold
increase).
- The patients current dose of 5 mg per
day of parenteral hydromorphone is equal to 25 mg per day of oral
hydromorphone. - The next step is to convert 25 mg of
oral hydromorphone to the daily oral morphine equivalent dose (DOMED). - The equianalgesic chart indicates that
7.5 mg of oral hydromorphone is equal to 30 mg of oral morphine. - The patients calculated dose of 25 mg
of oral hydromorphone is equal to 100 mg of oral morphine. - The oral dose of morphine should be
reduced by 30% to 50% to prevent any risk of overdose after the
conversion, since opioids do not have complete cross-tolerance. A 33% dose reduction from the
calculated dose of 100 mg is equal to 67 mg of oral morphine per day. - The recommended dosing frequency of
long-acting morphine (MS Contin
) is every 12 hours (2 doses per
day). - MS Contin
is available in 15 mg, 30 mg, 100 mg and 200 mg controlled-release
tablets. The tablet strength
closest to the calculated dose is 30 mg. The proper starting dose should
therefore be 30 mg of sustained-release morphine every 12 hours.
Guidelines for
Administering Naloxone for Reversal of Opioid-Induced Respiratory Depression
Opioid
overdose:
0.4 mg 0.8 mg IV/IM/SQ,
titrated in accordance with the patients response; repeat as needed. If given IV, each 0.4 mg should be given over
15 seconds.
Opioid-induced
respiratory depression
0.04 mg/ml (40 mcg/ml)
dilution in syringe (mix 0.4 mg/1 ml of naloxone and 9 ml of normal saline in a
syringe for IV administration).
Administer
0.5 ml of diluted solution (0.02 mg or 20 mcg) every 2 minutes until a change
in alertness is observed.
Titrate
naloxone until patient is responsive or a total of 0.8 mg (20 ml of diluted
solution) has been given. Continue
looking for other causes of sedation and respiratory depression.
Discontinue
naloxone when patient is responsive to physical stimulation, respiratory rate
is > 8 breaths per minute, and
able to take deep breaths when told to do so.
Special
considerations
May need repeated doses or
continuous infusion. Depending on amount
and type of opioid given and time interval since last opioid administration,
the duration of action of some opioids may exceed that of naloxone.
Titrate dose cautiously to
avoid precipitation of profound withdrawal, seizures, and severe pain.
Use of Oral Methadone for Chronic Pain
- Opioid-nave patients
- Recommended starting
dose range is 2.5 mg daily to 2.5 mg TID. - For frail and/or
older patients, the starting dose is 2.5 mg daily.
- Patients taking
opioids - Determine the daily
oral morphine equivalent dose of current opioids. - Convert daily oral
morphine equivalent dose (DOMED) to oral methadone. - Methadone dose should be adjusted
every 5 days due to delayed onset of respiratory depression.
Methadone
Conversion Ratios
Current DOMED
|
Conversion ratio
(morphine : methadone)
|
Conversion factor
(approximate % of DOMED)
|
<30 mg
|
2 : 1
|
50%
|
30 99 mg
|
4 : 1
|
25%
|
100 299 mg
|
8 : 1
|
12. 5%
|
300 499 mg
|
12 : 1
|
8.3%
|
500 999 mg
|
15 : 1
|
6.6%
|
> 1,000 mg
|
20 : 1
|
5%
|
Example of conversion to oral methadone:
- Patient is taking 80 mg Oxycontin
orally 3 times daily. - The total daily dose of oxycodone is
240 mg daily.
- The next step is to convert 240 mg of
oral oxycodone to the daily oral morphine equivalent dose (DOMED). - The equianalgesic chart indicates that
20 mg of oral oxycodone is equal to 30 mg of oral morphine.
5. The patients current dose of 240 mg per day
of oral oxycodone is equal to 360 mg per day of oral morphine.
- The methadone conversion table
indicates that a conversion factor for a DOMED of 360mg equals 8.3% or a
12 to 1 ratio of morphine to methadone. - The patients DOMED of 360 mg is equal
to 30 mg of methadone daily. - The recommended dosing frequency of
methadone for chronic pain is 1 to 3 times daily, so the proper daily
methadone dose would be 10 mg three times daily. - May need to use breakthrough medication
as needed for the first week, while methadone achieves steady-state blood
levels.
Pain Medicine Service
For difficulties
with pain management, contact the Pain Medicine Service at 6-2320 (clinic) or 3832 (on call pager).
References:
American Hospital Formulary Service Drug
Information 2005. American Society of
Health-System Pharmacists.
American Pain Society (2003). Principles of analgesic use in the treatment
of acute pain and cancer pain (5th ed.) Glenview, IL: Author.
U.S. Department of Health and Human Services. (1992).
Acute pain management: Operative or medical
procedures and trauma
(AHCPR Publication No. 92-0032).
Rockville, MD: Author.
VA/DoD Clinical Practice Guideline for the
Management of Opioid Therapy for Chronic Pain.
Department of Veterans Affairs
and Department of Defense. Version
1.0 March 2003.
Written
1990
Revised
7/26/1999
Revised 9/2003
Revised
4/2005
5 most addictive substances and their effect on our brain
Health
March 1, 2021
About what some drugs, alcohol and nicotine do to our bodies.
This ranking was compiled by British psychiatrist and professor of neuropsychopharmacology David Nutt and his research team.
1. Heroin
Heroin is an opioid drug that causes severe mental and physical dependence. This is due to the fact that when injected, the substance quickly penetrates the brain, easily overcoming the blood-brain barrier between the circulatory and central nervous systems. In the brain, it causes an increased production of dopamine. Experiments on experimental animals have shown an increase in the level of this pleasure hormone by 200%.
Heroin mimics natural brain chemicals that nature has created to control pain and increase pleasure.
An additional addictive mechanism is increased production of the excitatory neurotransmitter glutamate. Combined with the severe withdrawal symptoms—pain, anxiety, cramps, insomnia—it leads to a severe addiction. Withdrawal begins 4-24 hours after taking the last dose, and the addict is in dire need of another portion of the drug. In addition, the body quickly develops tolerance to heroin – a person needs more and more dose each time.
Heroin addicts often die of heart attacks, strokes, as the drug affects the state of the cardiovascular system. Another cause of death is exhaustion, which leads to constant stimulation of the central nervous system. Experts assigned this drug three points out of three possible according to the degree of dependence formation.
2. Cocaine
Cocaine is an alkaloid found in plants of the genus Erythroxylum. In nature, it acts as an insecticide and protects the leaves of shrubs from being eaten by insects. Cocaine has a powerful stimulating effect on the central nervous system, causing a feeling of euphoria.
Normally, the reward system in the brain works according to certain rules. A neurotransmitter – in this case, dopamine – enters the space between neurons called the synapse. Specialized receptors transmit a signal to respond to its appearance, then remove the neurotransmitter from the synapse to stop its effect.
Cocaine blocks dopamine reuptake systems, causing it to work again and again, leading to a whirlwind of pleasure.
However, cocaine euphoria does not last forever, and after the end of the drug, a phase of depression begins. Other side effects include fatigue, anxiety, and insomnia.
Cocaine is dangerous for the cardiovascular system. It causes powerful spasms that can lead to cerebral hemorrhage, disrupt the heart or other organs. Another negative effect is the state of acute psychosis, in which a person has little control over himself. In addition, there is a myth that cocaine is not addictive, but this is not true.
3. Nicotine
Nicotine, like cocaine, is an alkaloid that naturally performs the function of fighting insects. This is the main component of tobacco, which is addictive. Nicotine is quickly absorbed by the lungs and transported to the brain. It increases the activity of nicotinic acetylcholine receptors, which leads to the release of adrenaline. This temporarily stimulates various systems of the body, and the person feels more alert and active. And the release of dopamine accompanies smoking with a feeling of pleasure.
Nicotine is toxic, long-term use contributes to the development of cancer, ischemia, angina pectoris, and so on. WHO claims that up to 50% of smokers die from smoking-related causes.
4. Barbiturates
Sedatives and hypnotics based on barbituric acid have a depressant effect on the central nervous system. Depending on the dosage, the drugs may have a mild relaxing effect or lead to coma.
Barbiturates stimulate receptors for the inhibitory neurotransmitter gamma-aminobutyric acid, resulting in slower transmission of impulses to the CNS. This leads to muscle relaxation, calming, eliminates anxiety. The problem of drug dependence was hushed up for a long time, but subsequently recognized and abandoned barbiturates in favor of benzodiazepines.
However, if cocaine and heroin are illegal, these drugs have been relatively available for a long time, which increases their danger.
5. Alcohol
Absolutely legal in most countries, alcoholic beverages are named the most dangerous drug in the world. They also become addictive fairly quickly. Animal studies have shown that alcohol increases dopamine levels by 40-360%.
Alcohol enhances the effect of gamma-aminobutyric acid (GABA) – the main inhibitory mediator of the nervous system. Therefore, the movements and speech of drunk people slow down, and a dose of alcohol relaxes. GABA gradually adapts to changes, reducing the activity of the corresponding receptors, which makes the brain dependent on alcohol.
If a person stops drinking alcohol, reduced activity of GABA receptors leads to a weakening of the nervous inhibition function, and the brain becomes more excitable.
At the same time, ethanol reduces the ability of another neurotransmitter, glutamate, to act on NMDA receptors. With long-term use of alcohol, the number of these receptors increases. The brain becomes less receptive to alcohol and more receptive to glutamate. This increases excitability, leading to withdrawal symptoms: seizures, anxiety.
Another reason for the formation of addiction is the ability to quickly get energy to feed the brain. This requires acetate, an intermediate product of ethanol metabolism. The brain sits down on a simple source of energy. In the body of a regular drinking person, alcohol replaces the usual source of energy – glucose.
According to the World Health Organization, 3.3 million people die every year due to alcohol consumption. The statistics include diseases and injuries associated with drunkenness.
Dr. Nutt himself noted that the legal status of a drug is not necessarily associated with dependence or harm from it. Tobacco and alcohol occupy high positions in the ranking, but remain legal.
However, the existence of this list does not mean at all that substances that are not included in it do not cause addiction. Therefore, the rating should not be taken as a tool for dividing drugs into harmful and harmless. The use of any psychoactive substance has consequences.
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Decree of the Government of the Russian FederationOrder of the Government of the Russian FederationOrder of the President of the Russian FederationDecree of the President of the Russian FederationFederal lawFederal constitutional lawCode
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July 10, Monday
Decree of the Government of the Russian Federation dated July 10, 2023 No.
1132
On the invalidation of the Decree of the Government of the Russian Federation of April 4, 1994 No. 279
Decree of the Government of the Russian Federation No. 1131 dated July 10, 2023
On the invalidation of subparagraph “a” of paragraph 11 of the Decree of the Government of the Russian Federation of March 16, 2022 No. 380
July 8, Saturday
Decree of the Government of the Russian Federation of 08.07.2023 No. 1124
On amendments to paragraph 13 of the Rules for the provision of information (information) on ongoing scientific research in the field of biological safety and monitoring of developments in the field of biological safety, as well as the development of products, including those created using genetic engineering technologies and synthetic biology technologies
Decree of the Government of the Russian Federation No.
1126 dated July 8, 2023
On the issuance of general licenses for the export of refined gold, silver, platinum and platinum group metals, on amendments to Decree of the Government of the Russian Federation dated December 12, 2007 No. 867 and invalidation of Decree of the Government of the Russian Federation dated April 17, 2020 No. 539
Decree of the Government of the Russian Federation No. 1125 dated July 8, 2023
On Amendments to the Rules for Providing Subsidies from the Federal Budget to the Autonomous Non-Commercial Organization “National Research and Education Center” Great Russian Encyclopedia “for the creation and operation of a nationwide interactive encyclopedia portal
Decree of the Government of the Russian Federation of 08.
07.2023 No. 1128
On the peculiarities of the application of the legislation of the Russian Federation in the field of gas supply (including the state regulation of prices (tariffs) in the territories of the Donetsk People’s Republic, the Luhansk People’s Republic, the Zaporozhye region and the Kherson region
Decree of the Government of the Russian Federation No. 1130 dated July 8, 2023
On the approval of the Rules for the decommissioning and decommissioning of heat sources and heating networks, the invalidation of certain acts of the Government of the Russian Federation and paragraph 7 of the amendments that are made to the acts of the Government of the Russian Federation on improving the procedure for decommissioning electric power facilities for repair and decommissioning, approved by Decree of the Government of the Russian Federation dated January 30, 2021 No. 86
Decree of the Government of the Russian Federation No. 1129 dated July 8, 2023
On Amendments to Certain Acts of the Government of the Russian Federation
Decree of the Government of the Russian Federation of 08.07.2023 No. 1123
On amendments to the Decree of the Government of the Russian Federation of December 31, 2022 No. 2565
July 7, Friday
Decree of the Government of the Russian Federation of 07.
07.2023 No. 1119
On amendments to the Decree of the Government of the Russian Federation dated October 13, 2011 No. 835
Decree of the Government of the Russian Federation of 07.07.2023 No. 1120
On introducing changes to the features of protection against acts of unlawful interference of transport infrastructure facilities around which security zones are being established
Decree of the Government of the Russian Federation of 07.07.2023 No. 1121
On the invalidation of certain acts of the Government of the Russian Federation
Decree of the Government of the Russian Federation of 07.
07.2023 No. 1118
On amendments to the Decree of the Government of the Russian Federation of December 26, 2013 No. 1291
July 6, Thursday
Decree of the Government of the Russian Federation No. 1111 dated July 6, 2023
On amendments to the Decree of the Government of the Russian Federation of August 25, 2015 No. 884
Decree of the Government of the Russian Federation No. 1109 dated July 6, 2023
On Amendments to the Regulations on the Federal State Information System “Unified Digital Platform “National System of Spatial Data”
Decree of the Government of the Russian Federation No.
1112 dated July 6, 2023
On introducing changes to the list of technological equipment (including components and spare parts for it), analogues of which are not produced in the Russian Federation, the import of which into the territory of the Russian Federation is not subject to value added tax
Decree of the Government of the Russian Federation of 06.07.2023 No. 1113
On the invalidation of certain acts of the Government of the Russian Federation
Decree of the Government of the Russian Federation of 06.