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Opiate strength chart: Opioid Conversion Calculator for Morphine Equivalents

Opioid (Opiate) Equianalgesia Conversion Calculator

Equianalgesic dosage conversion calculator

ClinCalc.com » Neurology » Opioid Equianalgesic Calculator

Press ‘Calculate’ to view calculation results.

About This Calculator

Equianalgesic conversions used in this calculator are based on the American Pain Society guidelines and critical review papers regarding equianalgesic dosing.4,5,6,7 When possible, chronic-dosing studies have been used, including bidirectional and dose-dependent conversions.

There is an overall lack of data regarding most equianalgesic conversions, and there is a significant degree of interpatient variability. For this reason, reasonable clinical judgment, breakthrough (rescue) opioid regimens, and dose titration are of paramount importance.


reasonable clinical judgment, breakthrough (rescue) opioid regimens, and dose titration are of paramount importance

As a clinician, it is important to note that there are significant limitations to equianalgesic conversions and tables. While these equianalgesic tables are current the “best” solution, their limitations should be emphasized:

  • Single-dose studies: Early studies determining equianalgesia were based on single doses, not chronic administation.8 Due to drug accumulation, half-life, tolerance, and active metabolites, subsequent chronic administration studies often vary greatly from the original single-dose data.
  • Bidirectional conversions: When converting between certain opioids, the direction of conversion (eg, morphine to hydromorphone versus hydromorphone to morphine) will produce a different conversion ratio. These bidirectional differences are not captured in a traditional equianalgesic table. 5,7
  • Dose-dependent conversions: The conversion ratio of certain opioids can be dependent on the dose of the original opioid. In the case of converting morphine to methadone, methadone has a relative potency of 4:1 at lower morphine doses, but becomes much more potent (12:1) in patients converting from very high morphine doses.5,7
  • Cross-tolerance: Many references recommend a cross-tolerance reduction between 25-50% when converting between unlike opioids.9 In patients with very high opioid requirements, the difference between 25% and 50% can be a very significant discrepancy.
  • Equianalgesic Discrepancies: There are significant discrepancies in equianalgesic dosing tables, with even FDA-approved drug labels not demonstrating agreement.10 These discrepancies are a factor of both references using old data (single-dose studies) and an overall paucity of data in chronic dosing studies.
  • Patient-specific factors: No equianalgesic table is able to take into account patient-specific factors — primarily hepatic function, renal function, and age. Opioid metabolism and excretion do differ among the opioids; therefore, alterations in drug disposition will alter the relative potencies of different opioids.
Cross-Tolerance Reduction

When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete cross-tolerance. Incomplete cross-tolerance can occur due to variability in opioid binding. There is no evidence-based recommendation for an appropriate reduction. The American Pain Society guidelines and most pain experts recommend a dose reduction between 25-50% when converting between different opioids,9,11 with a consideration for little or no cross-tolerance reduction in patients with poorly controlled pain.5

Breakthrough (Rescue) Opioid Dosing

In patients receiving long-acting opioid formulations (SR, transdermal), a “rescue” dose for breakthrough pain is recommended. 12 Generally, an immediate-release form of the same opioid is used (eg, morphine IR with morphine SR). The size of the breakthrough dose should be 5-15% of the patient’s 24-hour baseline dose. In an inpatient setting, rescue doses can be provided IV every 15-30 minutes. Oral rescue doses can be offered as needed over the normal dosing interval of the drug (typically every 4 hours). As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount.

Opioid Dose Titration

Because equianalgesic tables are inherently inaccurate, dose titration to optimal effect is essential. Most guidelines recommend a dose increase or decrease of 25-50% from the previous day.12,13 In patients with long-acting formulations (SR), the amount of rescue doses needed in the previous day may be added to the patient’s long-acting formulation. Because transdermal fentanyl has a delayed onset and onset of peak activity, consider titrating every 3 days. 3

References and Additional Reading

  1. Duragesic [package insert]. Titusville (NJ): Janssen Pharmaceuticals, Inc; 2012. DailyMed Monograph
  2. Skaer TL. Practice guidelines for transdermal opioids in malignant pain. Drugs. 2004;64(23):2629-38. PMID 15537367.
  3. Breitbart W, Chandler S, Eagel B, et al. An alternative algorithm for dosing transdermal fentanyl for cancer-related pain. Oncology (Williston Park). 2000;14(5):695-705. PMID 10853461.
  4. American Pain Society. Principles of analgesic use in the treatment of acute pain and cancer pain. 6th ed. Glenview, IL: American Pain Society; 2008.
  5. Anderson R, Saiers JH, Abram S, et al. Accuracy in equianalgesic dosing. conversion dilemmas. J Pain Symptom Manage. 2001;21(5):397-406. PMID 11369161.
  6. Pereira J, Lawlor P, Vigano A, et al. Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22(2):672-87. PMID 11495714.
  7. Patanwala AE, Duby J, Waters D, et al. Opioid conversions in acute care. Ann Pharmacother. 2007;41(2):255-66. PMID 17299011.
  8. Knotkova H, Fine PG, Portenoy RK. Opioid rotation: the science and the limitations of the equianalgesic dose table. J Pain Symptom Manage. 2009;38(3):426-39. PMID 19735903.
  9. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-30. PMID 19187889.
  10. Shaheen PE, Walsh D, Lasheen W, et al. Opioid equianalgesic tables: are they all equally dangerous? J Pain Symptom Manage. 2009;38(3):409-17. PMID 19735901.
  11. Levy MH. Pharmacologic treatment of cancer pain. N Engl J Med. 1996;335(15):1124-32. PMID 8813044.
  12. Cherny NI. Opioid analgesics: comparative features and prescribing guidelines. Drugs. 1996;51(5):713-37. PMID 8861543.
  13. Management of cancer pain: adults. Agency for Health Care Policy and Research. Am J Hosp Pharm. 1994;51(13):1643-56. PMID 7942889.

Dose equivalents and changing opioids

  • Switching from one opioid to another should only be recommended or supervised by a healthcare practitioner with adequate competence and sufficient experience. If uncertain, ask for advice from a more experienced practitioner.
  • Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects.
  • When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration.
  • An individualised approach is necessary.
  • Conversion factors are an approximate guide only because comprehensive data are lacking and there is significant inter-individual variation.
  • In most cases, when switching between different opioids, the calculated dose-equivalent must be reduced to ensure safety. The starting point for dose reduction from the calculated equi-analgesic dose is around 25-50%.
  • A dose reduction of at least 50% is recommended when switching at high doses (eg, oral morphine or equivalent doses of 500mg/24 hours or more), in elderly or frail patients, or because of intolerable undesirable effects.
  • The half-life and time to onset of action of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much opioid during the conversion period.
  • Once the conversion has occurred, the dose of new opioid should be titrated carefully according to individual response and the patient monitored closely for side effects and efficacy, especially when switching at high doses.
  • Withdrawal symptoms (eg, sweating, yawning and abdominal cramps, restlessness, anxiety) occur if an opioid is stopped/dose reduced abruptly.

 

Approximate equi-analgesic potencies of opioids for oral administration

(Reviewed August 2020 to reflect current BNF figures)

* The relative potency of methadone depends on the starting dose and the duration of administration. Conversions to and from methadone should always be undertaken with specialist advice

 

Transdermal Opioids

(Reviewed August 2020 to reflect current BNF figures)

A. Buprenorphine

Transdermal buprenorphine changed at weekly intervals

 

Transdermal buprenorphine changed every three or four days (twice weekly)

 

B. Fentanyl

 

 

Further Reading

  • British National Formulary.
  • Fine PG, Portenoy RK; Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. Establishing “best practices” for opioid rotation: conclusions of an expert panel. Journal of Pain and Symptom Management 2009 ;38: 418-25.
  • Twycross R, Wilcock A, Howard P. PCF 5Palliative Care Formulary. 2014. 
  • UK Medicines Information. Q&A 42.8 What are the equivalent doses of oral morphine to other oral opioids when used as analgesics in adult palliative care? 2016.
  • Webster LR, Fine PG. Review and critique of opioid rotation practices and associated risks of toxicity. Pain Medicine 2012; 13: 562-70.

     

The Dangerous List of Opioids Strongest to Weakest

Learn About The Villains of the Opioid Crisis

When opioid pain relievers were first marketed, they were sold as a safe and powerful pain reliever. Today, it’s understood that opioid pain relievers are dangerous drugs that can lead to addiction and potentially death. Every day in the United States, 130 people die to opioid overdose, according to the CDC.

There are many specific culprits among opioids that are driving the opioid epidemic. A list of opioids strongest to weakest will be discussed in this article to better understand which opioids are the most dangerous.

If you or a loved one is in need of help with addiction, call 888-509-1560 today to speak with a treatment specialist.

The list of opiates that will be examined will be ranked from strongest to weakest. The more powerful the opioid is, the greater the risk becomes of taking too much, and the more likely a person will become physically addicted to the drug.

 

1. Carfentanil – Carfentanil is an extremely dangerous opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl. Carfentanil is used to tranquilize elephants and other large animals, and is not intended for use in humans. Drug dealers may mix carfentanil into their drug supplies to provide their customers with a more potent, addictive high.

2. Fentanyl – Fentanyl is 50 to 100 times more potent than morphine and has been the main contributor to the rise in overdose deaths in recent years. The majority of fentanyl-related deaths involve synthetic fentanyl that is manufactured overseas and mixed with other illicit drugs including heroin, cocaine, and methamphetamine.

It is sold under brand names including Sublimaze, Duragesic, and Actiq. It also has many street names including China Death, TNT, Murder 8, Jackpot, Goodfella, Dance Fever, Apache, and China Girl.

3. Buprenorphine (Butrans) – Buprenorphine is an FDA-approved medication for the treatment of opioid use disorder. It is about 25 to 100 times more potent than morphine, but it does not provide a euphoric high like other opioids. Buprenorphine is used in drug detox to relieve and reduce opioid withdrawal symptoms.

4. Oxymorphone – Oxymorphone is sold under brand names such as Opana and Numorphone. It is an extended-release opioid that has many street names including O Bomb, Stop Signs, Biscuits, and Blues. Oxymorphone is used to relieve moderate to severe pain in patients who are unable to reduce or control pain with other medications. Oxymorphone is 3 times stronger than morphine when taken in tablet form, and 10 times stronger than morphine when received as an intravenous injection.

5. Hydromorphone – Hydromorphone is used to relieve moderate to severe pain and is about two to eight times more potent than morphine, reports the DEA. It is available as an injection, tablet, liquid, and rectal suppository.

6. Heroin – Heroin is an illicit drug classified as a Schedule I substance with a high potential for abuse. Heroin is usually two to five times stronger than morphine and commonly mixed with other potent substances such as fentanyl or carfentanil. In 2018, heroin was involved in 14,996 overdose deaths in the U.S.

7. Methadone (Dolophine, Methadose) – Methadone is another FDA-approved medication for the treatment of opioid addiction and is about three times stronger than morphine. Methadone is often used for long-term maintenance in people in recovery from opioid addiction, and can only be dispensed at an outpatient clinic under direct medical supervision.

8. OxyContin – OxyContin is a brand name for Oxycodone, a well-known extended-release opioid. Oxycodone is prescribed to treat moderate to severe pain and is about 50% stronger than morphine. The CDC reports that oxycodone is one of the most common drugs involved in prescription opioid overdose deaths. In 2018, prescription opioids like oxycodone contributed to 14,975 overdose deaths in the U.S.

It is usually sold as a tablet that is meant to last an entire day, which is often bypassed by drug abusers to quicken the release time. Street names include O.C., Oxy, Oxycet, Oxycotton, and Hillbilly Heroin.

9. Percocet – This drug is a combination of oxycodone and acetaminophen. It comes in tablet, liquid oral solution, and capsule form. Some of the street names for the drug include Percs and Hillbilly Heroin since it also contains oxycodone.

10. Hydrocodone – The next in the list of opioids strongest to weakest is hydrocodone, which is sold under many different brand names such as Norco, Vicodin, and Zohydro. It is usually sold as a way to manage pain after surgery, chronic pain, or pain from an injury. It comes in both a syrup and tablet form. Street names for hydrocodone include names such as Watson-387 and Vike.

Hydrocodone has about the same strength as morphine and is commonly combined with other pain relievers such as ibuprofen and acetaminophen.

11. Morphine – The drug that was known as the “soldier’s disease” due to addictions it caused during war times, is the next in our list of opiates. Brand names include MS Contin and Duramorph among others. It is often used as a pain-management solution for cancer patients. It is available in tablet, capsule, suppository, and injectable form. It has street names such as White Stuff, Monkey, and Miss Emma.

12. Tramadol (Ultram) – Tramadol is used to relieve moderate to moderately severe pain and has about one-tenth the potency of morphine. This drug is the only opioid categorized as a Schedule IV substance on the Controlled Substances Act.

13. Demerol (Meperidine) – The brand name opioid, Demerol, is most frequently used treat moderate to severe pain, and is about 7 to 10 times less potent than morphine.  It may also be used as anesthesia due to its potency. The drug comes in a variety of forms including an injectable solution, tablet, and liquid oral solution. Common street names include Pain Killer and Demmies.

Though meperidine is less potent than many other opioids, it is classified as a Schedule II narcotic along with oxycodone and fentanyl.

14. Codeine – This opioid is a relatively short-acting opiate. It is commonly prescribed along with aspirin and acetaminophen. Tablet, capsule and liquid forms of the drug are sold. Some of the names that Codeine goes by when sold illegally include Purple Drank, Lean, Cody, and Sizzurp.

The US opioid epidemic has been an ongoing public health emergency since October 26, 2017. In 2018, there were an estimated 67,367 drug-related deaths. The National Institute on Drug Abuse (NIDA) reported that, of those deaths, 46,802 (69%) were related to opioids.

Given the serious nature of the ongoing opioid epidemic, it’s important to know which drugs are opioids so you can stay informed and reduce your risk of dependence, addiction, and overdose. Opioid addiction can be safely treated with drug detox and evidence-based therapies at Dana Point Rehab Campus.

Contact us at Dana Point Rehab Campus by dialing 888-509-1560 today.

Equianalgesic Chart (Changes in italics)








Route

Starting Dose

(Adults > 50 Kg)

Onset

Peak

Duration

Metabolism

Half Life

Comments

Codeine

PO

IM

SQ

30
– 60 mg q 4 hr

15
– 30 mg q 4 hr

15
– 30 mg q 4 hr

30
min

15
– 30 min

30
– 60 min

1 hr

30
– 60 min

2
– 4 hr

6
hr

4
– 6 hr

4
– 8 hr

Liver

2
– 4 hr

IV use (even at low doses and when given very slowly)
may cause marked decrease in blood pressure; IV use is not recommended.

IM or SQ routes are the preferred
parenteral routes.

Fentanyl

(Sublimaze)

 

 

(Duragesic)

 

 

IM

IV

 

 

Trans-dermal

 

5
mcg/Kg q 1 – 2 hr

0.25
– 1 mcg/Kg as needed

 

25
mcg/hr

 

 

7
– 8 min

Immediate

 

 

12
– 24 hr

20
– 50 min

1
– 5 min

 

 

24
hr

1
– 2 hr

30
– 60 min

48
– 72 hr

Liver

1
– 6 hr*

Transdermal should NOT be used to treat
acute pain.

Transdermal patch should
be used only in opioid tolerant patients.
Effects of patch last for 18 – 24 hours after the patch is removed.

Use of IV fentanyl is
restricted to Oncology, Burn Service, Palliative Care, Intensive Care Units
or based on recommendation by the Pain Service. Appropriate monitoring is required. Refer
to Nursing Policies 8.021 and 8.025.

Hydrocodone with acetaminophen**

(Lortab, Vicodin)

PO

5
– 10 mg hydrocodone q 4 – 6 hr

60
min

2
hr

4
– 6 hr

Liver

4
hr

Available
at UIHC as:

Tablet with 5 mg hydrocodone and 500 mg
acetaminophen.

Elixir with 2.5 mg hydrocodone and 167 mg
acetaminophen

per 5 ml.

Hydromorphone

(Dilaudid)

 

 

PO

IM/SQ

Slow
IV

 

2
– 4 mg q 4 – 6 hr

2
mg q 4 – 6 hr

0.2
– 0.6
mg
q 2 – 3 hr

 

30
min

15
– 20 min

15
– 20 min


60
min

60
min

60
min

 

4
– 5 hr

4
– 5 hr

4
– 5 hr

 

Liver

2 – 3 hr

 

 

Chronic treatment may require q 3 – 4
hour dosing.

IV doses should be administered over at
least 2-3 minutes.

 

Meperidine

(Demerol)

IM/SQ

IV

50
– 150 mg q 3-4 hr

25
– 50 mg q 1-2 hr

10
– 45 min

2
– 5 min

30
– 60 min

20
min

2
hr

2
hr

Liver


More than 72 hr of continuous use can
cause accumulation of

normeperidine which can lead to
neuroexcitability (seizures).

Naloxone administration
will increase neuroexcitibility.

Use with caution in the
elderly and patients with renal


dysfunction.

Not for use in
chronic pain.
Do not exceed 600 mg
/ 24 hours.

 






Route

Dose
(Adults > 50Kg)

Onset

Peak

Duration

Metabolism

Half Life

Comments

Methadone

(Dolophine)

PO

 

2. 5
mg 1 to 4 times daily

 

30
– 240 min

 

2
– 4 hr

 

4
– 24 hr

 

Liver

24
hr

Used in chronic pain.

Continued dosing can result in
accumulation and respiratory

depression.

Morphine

 

 

 

 

(MS Contin)

 

(Avinza)

PO/SL

IM

IV

SQ

 

PO-SR

 

PO-SR

10
– 15 mg q 3 – 4 hr

4
– 10 mg q 3 – 4 hr

2
– 4 mg q 2 – 4 hr

4
-10 mg q 3 – 4 hr

 

MS
Contin: 15 mg q 12 hr

 

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 hr

 

 

 

 

2
– 4 hr

 

15
hr

Oral liquid concentrate is available.

Active metabolite renally
eliminated; use caution in elderly

and
patients with renal insufficiency.

Long-acting dosage forms should not be
crushed.

  Long-acting dosage forms
should not be used to treat acute pain.

  Avinzais not on the UIHC formulary, but is used by
Medicaid.

Oxycodone

(Percocet)**

 

(OxyContin)

 

 

PO/SL

 

 

PO-SR

5
-10 mg q 4 – 6 hr-alone

or
with acetaminophen

 

OxyContin:
10 mg q 12 hr

15
– 30 min

 

 

60
min

1
– 2 hr

 

 

2
– 3 hr

4
– 6 hr

 

 

12
hr

Liver

4 hr

Available at UIHC as an
immediate-release tablet and oral

liquid concentration

Percocet contains oxycodone
5mg / acetaminophen 325mg

Other strengths of Percocet are available outside UIHC.

OxyContin is a
sustained-release tablet. Do not
crush.

OxyContin
should not be used to treat acute pain.

 

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:

    1. 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).

  1. The patients current dose of 5 mg per
    day of parenteral hydromorphone is equal to 25 mg per day of oral
    hydromorphone.
  2. The next step is to convert 25 mg of
    oral hydromorphone to the daily oral morphine equivalent dose (DOMED).
  3. The equianalgesic chart indicates that
    7.5 mg of oral hydromorphone is equal to 30 mg of oral morphine.
  4. The patients calculated dose of 25 mg
    of oral hydromorphone is equal to 100 mg of oral morphine.
  5. 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.
  6. The recommended dosing frequency of
    long-acting morphine (MS Contin
    ) is every 12 hours (2 doses per
    day).
  7. 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

  1. Opioid-nave patients
    1. Recommended starting
      dose range is 2.5 mg daily to 2.5 mg TID.
    2. For frail and/or
      older patients, the starting dose is 2.5 mg daily.
  1. Patients taking
    opioids
    1. Determine the daily
      oral morphine equivalent dose of current opioids.
    2. Convert daily oral
      morphine equivalent dose (DOMED) to oral methadone.
    3. 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:

  1. Patient is taking 80 mg Oxycontin
    orally 3 times daily.
  2. The total daily dose of oxycodone is
    240 mg daily.
  1. The next step is to convert 240 mg of
    oral oxycodone to the daily oral morphine equivalent dose (DOMED).
  2. 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.

  1. 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.
  2. The patients DOMED of 360 mg is equal
    to 30 mg of methadone daily.
  3. 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.
  4. 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

 

 

 

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Statewide opiate trends: legal distribution

Statewide opiate trends: legal distribution



ARCOS data capture distribution of drugs to hospitals and pharmacies reported to the Drug Enforcement Administration. Data are presented in typical daily doses, described in detail at the bottom of the page.


All opioids can be used for pain, while methadone and buprenorphine can also be used in the treatment of opioid use disorder. Fentanyl here refers only to fentanyl itself, used most commonly in surgery or chronic pain management, and not any of the many fentanyl analogues, only some of which are legal. The different lines for methadone reflect the apparent addition after 2005 of methadone distributed to opiate treatment programs (OTPs) to methadone totals reported in ARCOS. The all Rx opioids series starts in 2005 because buprenorphine did not appear in ARCOS before then. That series assumes meperidine, missing until 2008, had essentially 0 distribution before then. The common opioid pain Rx series sums across all prescription opioids presented except methadone and buprenorphine, which is occasionally used for pain but mostly as a medication for opioid use disorder. Data are missing for some of the components in 2000 and 2002. These data represent the legal distribution of pharmaceutical opioids in the State. These opioids could subsequently be used as prescribed or beyond what was prescribed, go unused, or be illegally sold, given away, or stolen.

To see less common drugs in more detail, turn off aggregate series (e.g., all Rx opioids, which sums all the opioids shown) or more common series e.g., (hydrocodone) by clicking the series name(s) in the legend below the chart.


Data source: US Drug Enforcement Agency. Split in methadone series reflects ARCOS apparently including opiate treatment programs (OTPs) in distribution data beginning in 2006. All Rx opiates begins in 2005 due to prior inconsistent reporting of component drugs shown in ARCOS data.

Comparison with treatment admissions, deaths, and crime lab cases

To account for population change over time, we present the data for opiate distribution as doses per person in Washington (doses pp), here with rates (per 100,000 residents) of publicly-funded first-time treatment admissions, deaths, and crime lab cases associated with prescription-type and other opioids for comparison.





Data sources: Center for Health Statistics, Washington State Department of Health (deaths), Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services (admissions, OTP caseloads), Forensic Laboratory Services Bureau, Washington State Patrol (cases), US Drug Enforcement Agency (ARCOS sales to hospitals and pharmacies in Washington state), Washington State Office of Financial Management (population). 2020 death data are preliminary. Split in methadone series reflects ARCOS apparently including opiate treatment programs (OTPs) in distribution data beginning in 2006. All Rx opiates begins in 2005 due to prior inconsistent reporting of component drugs shown in ARCOS data.


Conversion from grams to daily doses and morphine equivalance

ARCOS is a DEA database for monitoring the flow of controlled prescription substances from manufacture up to the point of sale or dispensing. The data are generated from manufacturers and distributors, and reflect the amount of drugs legitimately distributed to (but not at) the retail level (i.e. to hospitals and pharmacies). Geography is assigned based upon the registration of the purchasing retail outlet.

For comparison across what to the body can be very different drugs, we convert weights to usual daily doses by dividing total grams reported by a usual grams per daily dose value (from the World Health Organization). For example, 100 grams of meperidine, divided by 0.4 g/dose (400mg/dose), results in 250 doses. The dosage information puts very potent drugs (e. g., fentanyl, 1.2 mg per day) on similar footing as less potent prescription-type opiates (e.g., codeine, 100 mg per day) in terms of usual daily dosage. Where multiple dosage equivalents are available, we use the most common route, usually oral. Note, of course, that individual doctors and users may select different dosages. Morphine equivalence is a different way to compare potency, provided for reference.


Produced by ADAI, with funding from the Washington State Department of Social and Health Services, Division of Behavioral Health and Recovery • Built with rCharts and Highcharts • Updated 27 September 2021 • Privacy • Terms

Opioid Facts

WHAT IS AN OPIOID?

  • Opioids are a class of drugs that includes the illegal drug heroin as well as power pain relievers available by prescription, such as oxycodone (Oxycontin), hydrocodone (Vicodin), codeine, morphine, fentanyl, methadone, and many others.
     
  • Opioids bind to mu-opioid receptors on the nerve cells in the brain and body to reduce pain and suppress coughs when used legitimately, but can also cause intense euphoria or intense high that can lead to dependence and/or addiction, whether the drug ingested is heroin or a legally prescribed drug.
     
  • The effects of opioids, particularly their rewarding, euphoric effects, are accentuated most when the drugs are delivered rapidly into the brain, thereby causing users “chasing the high” to snort or inject crushed prescription pills or heroin.
     
  • Opioid overdose effects include severe depression of the respiratory system, potentially causing respiratory arrest, coma, and death.Opioid dependence and withdrawal is characterized by constricted nausea, mental confusion, drowsiness, severe sweats and constipation.
     
  • Fentanyl, an opioid that is practically and effectively 50 and 100 times more potent than heroin or prescription opioids, is often used to adulterate heroin, cocaine, methamphetamine and other “street drugs. ” Overdose deaths often result from a user’s unwitting purchase and use of fentanyl when believing he or she is purchasing heroin or prescription pills. Fentanyl derivatives such as carfentanil, which is used to anesthetize elephants, is also being used to adulterate heroin, causing cluster overdose deaths.
     
  • Discussion of opioid prevention, treatment, enforcement, and deterrence in your community should address illicit drugs and prescription drugs, as opioids in all forms are present across the nation.

 

THE COLD, HARD TRUTH:

On an average day:

  • At least 78 people will die from an opioid-related overdose, and according to public health reports from the field, the 2016 overdose death statistics will far outnumber the 78-deaths-per-day statistic of 2014.

  • 3,900 people will use a prescription opioid outside of legitimate medical purposes and supervision.These prescription drugs are many times obtained through theft, fraud, or otherwise diverted from people with legitimate, medically-appropriate prescriptions.

  • 580 people will try heroin for the first time.

  • Heroin overdoses have increased 244% between 2007 and 2013. Many of the new heroin users are youths, with an average age of 24 ½ years old for first-time users.

  • The change in heroin administration routes to pill form, coupled with the rise of counterfeit pills often containing heroin, fentanyl, and fentanyl derivatives, has caused unwitting users who purchase drugs on the street to overdose and die in record numbers.

 

THE FALLACY OF HEROIN:

  • No longer restricted to the stereotypical “dirty needles” used in an alleyway, heroin has invaded rural towns and urban cities alike and does not discriminate among socio-economic lines, race, age, or gender.

  • It can appear as a dark black gummy tar or a brown or white powder. Many times, the dark black or brown powder heroin carries a strong vinegar smell.

  • Heroin in powder form can be injected, smoked, or inhaled. The drug is also made into counterfeit pills, tablets, and gel capsules, which can be swallowed or crushed and chewed.

     

FENTANYL

  • Fentanyl is a synthetic opioid. Fentanyl is 80-100 times more powerful than morphine, the substance to which heroin metabolizes, and is commonly used as an end of life sedative or during operational anesthesia.

  • Fentanyl has historically been marketed for end-stage cancer treatment and applied via patches on the skin. Illicit fentanyl now appears in powder form, and is often visually indistinguishable by law enforcement.

  • Fentanyl appears in counterfeit tablets, pills, and gel capsules attempting to mimic certain prescription drugs.

  • Fentanyl powder has the power to kill with the ingestion, inhalation, or skin absorption of just two milligrams. By comparison, a sweetener packet found on a restaurant tabletop generally contains 1,000 milligrams per packet.

  • Drug abusers, law enforcement officers, first responders, or family members who are unaware of its presence or lethality can be inadvertently exposed to fentanyl.

  • Drug traffickers are now combining fentanyl or fentanyl-related compounds with other drugs to increase their potency and profit. Many unsuspecting drug abusers who are abusing cocaine, methamphetamine, heroin, or other synthetic drugs have overdosed and died within days, hours, or minutes, of each other following the introduction into a community of fentanyl or heroin laced with fentanyl.

 

HOW DID THIS OPIOID PROBLEM GET TO MY COMMUNITY?

  • Opioids, particularly diverted prescription drugs, often enter the community through the family medicine cabinet, theft and robbery of local pharmacies, and through fraudulent prescriptions.

  • Heroin, fentanyl, and counterfeit prescriptions drugs are also sold by drug trafficking organizations and street gangs already operating in a community.

  • Additionally, many opioids can be purchased via the Internet; social media sites such as Facebook, Google, and Craigslist, among others; as well as a myriad of sites on the Dark Web. They are then shipped discreetly via commercial parcel delivery carriers such as the U.S. Post Office, FedEx, DHL, or UPS.

 

WHAT IS BEING DONE TO CURB THIS EPIDEMIC?

  • The government at all levels—career public servants, law enforcement, and public health officials—have partnered with educators, treatment professionals, and non-profit organizations, to bring awareness and develop strategies and solutions for your community.

  • Strategies include targeted and proactive drug law enforcement activity to dismantle the trafficking organizations; prevention programs and drug awareness and education campaigns; and intervention and treatment options that address the short and long-term health of addicts and recovering addicts.

  • Countless local, tribal, and regional efforts, tailored to the specific needs of a community, are underway and supported by national and international efforts which focus on various parts of this problem.

 

WHAT CAN YOU DO?

  • Have a meaningful conversation with your family. Reject the notion that “it can’t happen to you or your family.” Talk aloud about the threat opioid abuse brings to your family. Commit to asking the tough questions.

  • Invest in your family and community’s future. Many intensely affected regions routinely host public forums, town halls, prevention activities at schools, community vigils, walks, and fun runs. Get involved and participate.

  • Speak up. Contact law enforcement when you suspect drug-related activity in your neighborhood. Successful policing relies on a whole-community approach to identify and bring drug trafficking organizations to justice.

  • Keep any prescription drugs in your house secure and locked away, out of reach of others.

  • Take advantage of national or local take back days sponsored by law enforcement or your local pharmacy to discard any unneeded drugs.

Updated December 15, 2020

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Addiction

Drug addiction (from the Greek νάρκη / narkē / – numbness, sleep, and μᾰνία / mania / – madness, passion, attraction) – a total progressive disease caused by the use of drugs.

The term “substance abuse” is also used – usually this means dependence on substances that are not legally classified as drugs.

In the International Classification of Diseases (ICD-10), mental and behavioral disorders associated with substance use, including dependence and withdrawal, are described in block F11-F19 of class V (mental disorders).

Drug addiction is characterized by a phase course with the presence in its structure of several stage-by-stage syndromes:

  1. altered reactivity syndrome,
  2. mental addiction syndrome,
  3. physical dependence syndrome, these three syndromes combine into general drug syndrome ,
  4. syndrome of consequences of chronic anesthesia.

Features

The main symptom of drug addiction is the onset of withdrawal symptoms as a consequence of the presence of physical dependence on a particular substance.

Dependency

Drugs can cause physical and psychological dependence to varying degrees.

Irresistible attraction is associated with mental (psychological) and sometimes physical (physiological) drug addiction. There are positive attachment – taking a drug to achieve a pleasant effect (euphoria, feeling of cheerfulness, high mood) and negative attachment – taking a drug in order to get rid of tension and feeling unwell. Physical dependence means painful, and even painful sensations, a painful condition with a break in the constant use of drugs (that is, withdrawal symptoms, withdrawal ). Resuming drug use temporarily relieves these sensations.

The predisposition to addiction may be of a genetic nature, associated with the inheritance of structural features of the brain.

Narcotic substances

Diagram illustrating addiction to psychoactive substances.

The list of substances that can cause drug addiction is very large and expands as new drugs are synthesized.

The most common types of drug addiction are substance abuse (use of drugs that are not considered drugs, chemical and plant substances), alcoholism (addiction to drinks containing ethyl alcohol), tobacco smoking (addiction to nicotine) and the use of cannabis drugs (hashish, marijuana) …

The use of psychoactive substances such as poppy alkaloids (opium, morphine, heroin), coca (cocaine) and many others, including modern synthesized drugs such as LSD, amphetamines and ecstasy, is also widespread.

Drug addiction and society

From the point of view of generally accepted sociology, drug addiction is one of the forms of deviant behavior, that is, behavior that deviates from generally accepted moral and ethical norms.

Among the reasons for the emergence and development of drug addiction, most often called character traits, mental and physical disorders, the influence of various social factors. There are also frequent cases of drug addiction among patients who have to take drugs for a long time for medical purposes.Many drugs used in official medicine (mainly sleeping pills, tranquilizers, and narcotic analgesics) can cause severe types of drug addiction, which is a serious complication in their use.

In some countries, the use of psychoactive substances is associated with certain religious and cultural customs (drinking alcohol, chewing coca leaves by Indians, smoking hashish in some eastern countries). In Europe and America, the last rise in drug addiction began in the 1960s.From that time on, this phenomenon became a serious public issue.

Fight against drug addiction

The fight against drug addiction is carried out, first of all, at the legislative level: practically in all countries there are strict criminal sanctions for the production, transportation and distribution of a number of drugs. Measures of intimidation of drug addicts are of some importance. One of the reasons for the complication or awakening of the disease can be even one word spoken in certain conditions.Therefore, most authorities are inclined to believe that it is much more effective (albeit much more difficult) to provide preventive deterrence that affects doubters. This is especially true of the main risk group – young people.

To determine drug dependence, an immunochromatographic analysis is performed.

In Russia, according to the order of the Ministry of Health and Social Development of Russia No. 40 dated January 27, 2006 [4] “On the organization of chemical and toxicological studies in the analytical diagnosis of the presence in the human body of alcohol, narcotic drugs, psychotropic and other toxic substances”, to reliable methods that confirm the presence of narcotic intoxication include chromatography, enzyme immunoassay and chromatography-mass spectrometry.All other methods cannot be used to confirm the fact of drug intoxication, and their use in the examination of living persons has no legal force and is illegal.

Vegetative resonance testing (vegetative resonance test, the Voll method or electropuncture, for example with the Imedis and Lira-100 devices) is unscientific and does not allow the detection of drugs, although there are attempts to use them in Russia, probably for fraudulent or corrupt purposes and is recognized in the USA fraud , for its use faces criminal punishment.

Failure of the repression policy

The Global Commission on Drug Policy in 2011 stated the failure of the “war on drugs” (eng. War on drugs ), both by restricting supplies and by reprisals against consumers.

Despite the huge expenditures on criminal prosecutions and repressive measures against drug manufacturers, drug dealers and users of illicit drugs, it is now clear that it was not possible to reduce the supply or consumption of drugs in reality.Any alleged victory over one source of drug supply or over one distributing organization is almost instantly nullified by the emergence of other sources and traffickers.

In this connection, the Commission recommended:

  • Instead of prosecuting and punishing people who use drugs, offer preventive health care and treatment to those in need.
  • Encourage States to introduce experimental models of legal regulation of drugs (such as cannabis) in order to undermine the power of organized crime and protect the health and safety of citizens.
  • Expose, not reinforce, common misconceptions about drug markets, drug use and addiction.
  • Countries that continue to invest primarily in the use of force (contrary to the facts) should focus their repressive measures on violent crime by organized criminals and major drug traffickers in order to reduce the damage done to society by the illicit drug market.

The laws of the Russian Federation define drug addiction as: “a disease caused by dependence on narcotic drugs or psychotropic substances included in the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation. “Accordingly, pathological dependence on alcohol, tobacco or caffeine is not legally classified as drug addiction, although they, according to a number of criteria, refer to narcotic substances, and it is also the prerogative of doctors, not lawyers, to determine what is a disease and what is not. … Medicine considers dependence on these substances as narcotic.

Treatment (medical aspects)

Treatment of severe forms of drug addiction (for example, addiction to heroin) in most cases does not lead to success.The greatest difficulty in the treatment of drug addiction is a group of people suffering from drug dependence on drugs of the “opium group”: morphine, heroin, desomorphine and other drugs with similar pharmacological action. The period of abstinence in such patients can last from 21 to 40 days, which is explained by the strong physical dependence caused by drugs of the opium group. The techniques used in specialized clinics are effective only in the case of an active position of the patient himself. But even in such cases, after recovery, relapses are frequent.Therefore, projects for compulsory drug addiction treatment are highly questionable.

Prevention of drug addiction

Promotion of a healthy lifestyle is one of the strategic directions of hygienic education and upbringing.

A healthy lifestyle, strong natural motivations are important positive factors of health (they increase labor activity, create physical and mental comfort, activate life position, body defenses, strengthen the general condition, reduce the incidence of diseases and exacerbations of chronic diseases).A healthy lifestyle includes various components, but most of them are considered basic: the upbringing of healthy habits and skills from early childhood, programming of emotional reactions accepted in a given society; environment: safe and favorable for living, knowledge about the impact of surrounding objects on health; quitting bad habits: smoking, alcohol and drug use; nutrition: appropriate to the physiological characteristics of a particular person, awareness of the quality of the food consumed; movement: physically active life, including special physical exercises, taking into account age and physiological characteristics; the formation of interpersonal relations in work collectives, families, attitudes towards the sick and disabled; body hygiene: compliance with the rules of personal and public hygiene, first aid skills; a favorable mental environment, minimizing lingering negative stresses and depressive states in natural ways, confidence in the future.

Psychotherapy in the treatment of drug addiction

Combining efforts of psychology, medicine, sociology give good results in drug addiction treatment. The Addiction Recovery Program aims to help people in the physical, psychological, spiritual and social spheres. A prerequisite in psychotherapy for drug addiction is to work with the roots of addiction.

Pedagogical preventive measures

Principles of preventive maintenance

Organization of activities for the prevention of drug addiction is based on targeted programs, united by a common concept of preventive work.The purpose of this work is to create a situation in the youth environment that prevents drug abuse and reduces the harm from drug use. Any prevention program should include specific activities in each of the following areas:

  • Dissemination of information on the causes, forms and consequences of drug abuse.
  • Formation of adolescents’ skills in analyzing and critical assessment of information received about drugs, and the ability to make correct decisions.
  • Provision of alternatives to drug addiction.

The purpose of work in this direction is the correction of socio-psychological characteristics of the individual. Targeted work with a risk group – identifying risk groups and providing adequate assistance in overcoming problems leading to drug cravings. Interaction with organizations and structures carrying out preventive work. Work to change attitudes towards drug abusers – it must be more humane.However, any attempts to spread ideas about the legalization of drugs, the legitimacy of their use and the facilitation of access to them must be suppressed. These are the general principles of conducting preventive work. The school, as a social institution, has a number of unique opportunities for their successful implementation:

  • Opportunity to instill healthy lifestyle skills in the learning process and control their assimilation.
  • Influence on the level of aspirations and self-esteem.
  • Free access to the teenager’s family to analyze and control the situation.
  • Opportunity to attract prevention specialists.

A number of rules can be formulated for building preventive programs at school: Any work in the field of anti-drug education should be carried out only by specially trained personnel from among the school employees within the framework of comprehensive programs based on the approved concept of preventive work. Educational programs should be conducted throughout the entire period of the child’s schooling, starting in the lower grades and continuing until graduation.Programs should provide accurate and sufficient information about drugs and their effects on mental, psychological, social and economic well-being. The information must be relevant and provide knowledge about the consequences of drug abuse on society. Emphasis should be placed on promoting healthy lifestyles and building the life skills necessary to resist the urge to try drugs or “get close” to them in times of stress, isolation or life setbacks. Information should be provided taking into account the characteristics of the audience (gender, age and beliefs). Parents and other adults who play an important role in the child’s life should be involved in developing drug education strategies. To assess the effectiveness of any prevention program, regular sociological research conducted by independent experts is required.

Here’s what to avoid when working in drug education:

  • Use of intimidation tactics: proven ineffective.
  • Misrepresentation and exaggeration of the negative consequences of drug abuse in describing their effects.
  • One-off activities aimed at prevention. This approach prevents adolescents from developing drug resistance skills.
  • False information. Even after a single submission of it, all further information will be rejected by adolescents, who today are quite well informed.
  • References to the cultural background of drug use.
  • Excuses for drug use, whatever the reason.

Training of qualified personnel is one of the most important conditions for preventive work. According to German researchers, the effectiveness of preventive activities is only 20%, of drug treatment – 1%. These figures confirm that the disease is easier to prevent than to spend energy and money on its treatment.

Prevalence by type of drug

According to a UN document, cannabis is the most widely used drug (almost 150 million users), followed by amphetamine-type stimulants (approximately 30 million – mainly methamphetamine and amphetamine, and 8 million – ecstasy).Slightly more than 13 million people use cocaine and 15 million people use opiates (heroin, morphine, opium, synthetic opiates), including approximately 10 million people who use heroin.

At the same time, there has been a sharp rise in the popularity of the so-called “soft drugs” – especially marijuana, the world’s most widely used illegal drug. Over the past decade, high rates of abuse have also been reported for amphetamine-type stimulants (mainly ecstasy in Europe and methamphetamine in the United States), followed by cocaine and opiates.

Forecast of the development of the situation

According to UN experts, the development of the situation on the drug market depends entirely on the situation in Afghanistan, where the main crops of the opium poppy are concentrated and where three quarters of the world’s illicit opium have been produced in recent years.

At the same time, the general stabilization and reduction of coca crops (in Colombia, Peru and Bolivia) and cocaine production have been preserved for the fourth year already. The cannabis market continues to operate.Its consumption is growing in South America, Western and Eastern Europe, and Africa.

Head of OMP N.V. Mityusheva

01: GIS provides a universal visualization language

GIS aims to understand the meaning of data. They evolve rapidly, creating new systems and processes to understand. By simplifying and deploying GIS on the Internet and in the cloud, and integrating with real-time information (Internet of Things), they promise to become a platform for virtually all forms of human activity – the “nervous system” of the planet. This system is now not only possible, but, in many ways, inevitable. Why?

GIS integrates data about everything and, at the same time, provides a platform for intuitive understanding of the data in general. This “nervous system” of GIS provides a framework for advancing scientific understanding and integration and analysis of all types of spatial knowledge (related to sciences such as biology, sociology, geology, climatology, etc.).

GIS provides a platform for understanding processes at all levels: local, regional and global.GIS makes it possible to understand the complexity of our world, as well as to understand and solve the problems we face, using the common language of cartography. At Esri, we call this “The Science of Where”.

Our world is increasingly faced with the problems of overpopulation, loss of natural resources, environmental pollution and climate change. It seems to me that people are more than ever ready to solve these problems. I believe that GIS will not only allow us to improve our understanding of these problems, but also provide a platform for solving them, and most importantly, in cooperation with each other.This involves all our best people, our best practices and technologies: scientists in many scientific disciplines, our best thinkers, the most talented designers who will collaborate to create a sustainable future. GIS technology and GIS professionals will play an increasingly important role in how we respond to emerging problems and how we solve them.

We hope that by using GIS to implement the idea of ​​The Science of Where, we will be able to deeper research emerging problems, make the best decisions and put them into practice.

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90,000 Alcohol was recognized as more dangerous than heroin – Society – Kommersant

The International Public Organization “Global Commission on Drug Policy” has released a report on the problems of legislative regulation of drug use. In it, the commission called on the authorities to revise the UN classification, approved half a century ago. As an argument, a public organization cites studies according to which alcohol is much more harmful than cocaine and heroin.

The Global Commission on Drug Policy (GCDP) has released a report entitled Classification of Psychotropic Substances: When Science Left Behind. The international public organization includes well-known politicians, public figures and businessmen, for example, Richard Branson, ex-President of Poland Alexander Kwasniewski, former Prime Minister of New Zealand Helen Clark, former Prime Minister of Greece Georgios Papandreou, ex-President of Portugal Jorge Sampaio, ex-head of the US Federal Reserve Paul Volcker, as well as other former heads of state and international organizations.All of them have been trying for several years to get countries to change their drug policies towards liberalization.

The main claim of the organization is the UN classification of narcotic substances, which was first developed back in 1961. It became the basis for the United Nations Single Convention on Narcotic Drugs, which limited access to cannabis, cocaine and opium products, allowing their use only for medical purposes. But, according to the authors of the report, the classification is morally outdated, and laws based on it were developed without relying on modern scientific research.”Since the Single Convention was signed, countries have responded to international law with tables and classifications that are not in any way related to evidence or rational arguments about the harm and benefits of these funds, but rather are politically motivated and pursue the interests of those who passed these laws,” – says the report.

The authors of the report believe that extremely tough laws in this area have led to the fact that 83% of the world’s population, according to WHO, does not have access to opioid pain relievers.

The study also said that this led to the strengthening of drug cartels, increased corruption, overcrowding in prisons and manipulation of laws by law enforcement agencies. Former Swiss President Ruth Dreyfuss has called for a revision of the International Classification System for Narcotic Substances. Ms Dreyfuss noted that the degree of harm of cocaine, heroin, cannabis and its resin was last reviewed 30 years ago. However, as noted by the GCDP, in fact for society there are much more harmful substances that are not prohibited by law – these are alcohol and tobacco.

In its report, the commission draws on research conducted by British scientists David Nutt, Leslie King and Lawrence Phillips and published in the scientific journal The Lancet back in November 2010. Scientists have developed their own classification of harmful substances, evaluating them according to 16 criteria. Nine of the criteria related to the harm caused by the substance directly to the health of the person who uses it, and seven – to harm to others. As a result, scientists came to the conclusion that the most dangerous for society is alcohol, which scored a total of 72 points and was noticeably ahead of heroin (55 points) and crack (54). At the same time, only heroin and crack are banned. Commercially available tobacco ranked sixth in this classification, ahead of, for example, amphetamine, cannabis, ecstasy and LSD.

According to a 2010 study, alcohol ranked first in the classification primarily because of the harm it causes to others. We are talking about crimes – murder, bodily harm, as well as injuries while intoxicated. In addition, alcohol is often the culprit in the breakdown of families and the growth of homelessness.The leaders in terms of the degree of harm directly to the health of the users, according to scientists, were crack, heroin and methamphetamine, scoring 37, 34 and 32 points, respectively.

Kirill Sarkhanyants

13 tables and graphs on the anti-drug article of the Criminal Code

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main routes – Translation into Russian – examples English


These examples may contain rude words based on your search.


These examples may contain colloquial words based on your search.

main routes

main routes

main roads

main paths

main roads

main roads leading

main highways

main tracks

main routes

main routes

main roads

Other translations

Suggestions

However, a number of roads are commonly identified as the main routes .

The main routes to and with Europe were described.

The main issue is to increase the productivity of rail networks in order to reduce the cost of traction on main routes .

The main challenge is to improve the performance of rail networks to reduce the cost of using traction units on 90,037 main routes 90,038.

In the context of its protection mandate, UNAMID worked to increase its support for the early recovery efforts of the United Nations country team through the provision of a safe and secure environment on the main routes throughout Darfur and in areas emerging from conflict.

Consistent with its protection mandate, UNAMID has sought to increase its support for the early recovery efforts of the United Nations country team by promoting a secure environment on 90,037 major routes 9,038 throughout Darfur, in particular in areas emerging from conflict …

Regular passage of escorted humanitarian convoys on main routes helped improve the safety of those routes for civilians.

The regular passage of convoys accompanied by military convoys along main roads has increased the safety of these roads for the civilian population.

Escorted convoys enjoy freedom of movement on main routes , but Bosnian government forces have recently prevented United Nations escorts provided by the Russian contingent from entering Gorazde.

Escorted convoys enjoy freedom of movement on main roads , but Bosnian government forces recently barred a United Nations escort from the Russian contingent to enter Gorazde.

Stresses the need for humanitarian aid deliveries to be effected through unhindered access to all main routes to Kabul;

Stresses the need for the delivery of humanitarian assistance through unimpeded access to all main roads to Kabul;

The following diagram, which focuses on the main routes only, shows clearly the non-integration of the network in the current situation.

The diagram below, showing only of the main routes , clearly demonstrates the lack of network connectivity in the current situation.

The activities of the security forces continue, albeit at a reduced level from that of a few weeks ago, impeding the freedom of movement of the civilian population along the main routes .

Security operations continue, albeit not as intensely as a few weeks ago, obstructing the freedom of movement of civilians on 90,037 main roads 90,038.

Main routes : Khabarovsk – Moscow; Khabarovsk – Soul; Khabarovsk – Inagata; Khabarovsk – Petropavlovsk -Kamchatskiy.

Main routes : Khabarovsk – Moscow; Khabarovsk – Seoul; Khabarovsk – Niigata; Khabarovsk – Petropavlovsk-Kamchatsky.

The most demanding part of the specification was that the airliner would have to be capable of safely taking off from any airport on TWA’s main routes (and in particular Albuquerque, at high altitude and with severe summer temperatures) with one engine non-functioning …

The most serious requirement of the specification was that the aircraft had to be capable of a safe takeoff with one engine failed from any of the airports on main routes TSA, especially from the runway of Albuquerque airport, which is at high altitude and has high summer temperatures. …

The effort in roads is focused on 3 main routes : Tallinn-Tartu, Tallinn-Narva and the Via Baltica, totalling 16% of total investments in 1998.

Efforts in the field of roads are mainly concentrated on three main routes : Tallinn-Tartu, Tallinn-Narva and the Via Baltica motorway, which accounted for 16% of total investments in 1998.

The three main routes used for smuggling opiates originating in Afghanistan into illicit markets worldwide, remained more or less unchanged.

The three 90,037 major routes 90,038 smuggling opiates from Afghanistan into illicit markets around the world remain more or less unchanged.

Service stations, garages, roadside cafes on the main routes between here and Harrogate.

Service stations, garages, roadside cafes on main roads between this location and Herrogate.

This service consisted of nine main routes , and was to be operated by the mayor of Copenhagen and several guilds.

The service consisted of nine main routes and was operated by the Mayor of Copenhagen and several guilds.

In England and Wales there are two main routes into becoming a prison governor.

Roads that connect Pristina with others cities appear the main routes of Kosovo’s network.

Basic water supply and sanitation facilities will be provided along the main routes of returning refugees and at semi-permanent encampments of displaced people within Rwanda.

Basic water and sanitation facilities will be built along 90,037 main highways , along which refugees return, and in temporary camps for displaced persons in Rwanda.

The quality of life has also improved for residents of settlements located on main routes .

In addition, these measures have improved the quality of life in settlements located along the main highways .