Pethidine: Use of the Drug, Signs and Symptoms of Abuse

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Pethidine is a synthetic opioid analgesic that is considered to be the synthetic version of morphine [1,2]. Pethidine works by copying the function of endorphins, a ‘feel-good’ chemical that reduces the perception of pain – these are naturally released by the body during strenuous exercise, emotional stress, pain, and during orgasm, hence, a natural euphoric feeling [3].

Pethidine’s effects, however, are much more intense than that of endorphins, making it an effective analgesic [3]. Meperidine is the generic name for pethidine, while Demerol® is brand name, a common street name is ‘demmies’ [4].

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Historically, pethidine has been used for both acute and chronic pain management, including during labor and delivery. Pethidine has uses during and after surgical operations, however, is highly addictive and may not be the first line of treatment for longer medication treatment.

Thoughtful manAlthough pethidine is used for chronic conditions like back pain, literature suggests pethidine should not be used for chronic pain as other multi-modal options exist for long-term pain management, where the risk of dependency is lessened [1].

Specifically, the side effects and risks associated with pethidine use is high and there tend to be less dangerous alternatives [1, 5]. In fact, in 2003 the World Health Organization removed pethidine from the model essential drugs list stating that “morphine is the preferred potent opioid” [6].

Pethidine is considered a schedule I drug under the Controlled Drugs and Substances Act (CDSA), meaning pethidine is only legal when prescribed by a licensed professional. Drug seeking behaviour by ‘double doctoring’ and illegal possession can result in 7 years’ imprisonment while trafficking, exporting or importing can result in a life sentence [4].

Abuse, Tolerance, and Dependency

Like with many addictions, tolerance and dependency develops over time. What this means is that most individuals abusing pethidine would not begin by seeking out pethidine. These individuals might have been prescribed pethidine and had the unfortunate experience of developing tolerance and cravings for pethidine upon withdrawal.

Or, they might have found their pethidine prescription was no longer as effective and began misusing their prescription. Other opioid or opiate users might seek out other substances with similar effects – for instance someone seeking a substance with morphine-like effects, like pethidine.

Furthermore, regardless of socioeconomic status, age, gender or profession, any individual may be at risk for substance abuse and dependency, especially when considering a highly addictive substance like pethidine.

Take, for instance, a study examining use of pethidine among physicians found that a quarter of substance abuse cases reported to the Medical and Dental Professions board involved pethidine [6]. Clearly, professionals with increased access to substances like pethidine are at risk for substance abuse and dependency.

humility-before-changeRegular use of pethidine can result in dependency, drug seeking behaviours, and withdrawal when not using [1]. Specifically, regular or long-term use of pethidine leads to the development of tolerance, requiring a user to take more of a substance in an effort to match the initial high. As this cycle continues and tolerance builds, the potential for addiction increases.

Side Effects

Potential adverse effects of pethidine include [2]:

  • Nausea and vomiting
  • Dizziness
  • Drowsiness
  • Confusion
  • Hypotension
  • Bradycardia
  • Heart palpitations

Not only does high potential for addiction exist, but pethidine’s metabolite of norpethidine tends to accumulate within the body following repeated use, creating a potential for toxicity or poisoning [1, 2].

This toxic effect is known as ‘neurotoxicity’ and results in a variety of physical and psychological effects, as a result of increased serotonin and noradrenalin [5]. These include: restlessness, irritability, agitation (reportedly experienced as pain), tremors or ‘shakiness’, jerking movements, and seizures [5].

Furthermore, those using other substances need to be aware of drug interactions. Pethidine has several potentially deadly drug interactions with some antidepressants, like monoamine oxidase inhibitors, resulting in hypertension, respiratory depression, and coma if mixed [1].

Further to this, combining pethidine with theophylline, tricyclic antidepressants, and fluoroquinolones may result in a seizure [5].

Signs of Abuse and Overdose

Like with any addiction, signs of abuse span psychological, physical and social effects. Loved ones might notice a change in behaviours, like dishonesty, a change in routine or social habits, isolating oneself, unprecedented weight loss or weight gain. While physical signs of pethidine abuse might take into account route of administration (i.e. injection, intranasal use, etc.) some signs of abuse include:

  • Constricted pupils
  • Confusion
  • Difficulty staying awake or ‘nodding off’
  • Difficulty focusing
  • Stomach pain
  • Flu-like symptoms
  • Anxiety or nervous affect
  • Muscle and bone pain
  • Body aches

Overdose on pethidine results in respiratory depression, constricted pupils, cardiovascular collapse and cardiac arrest, or heart attack [2]. The risk of overdose and adverse effects increases when any nervous system depressant or stimulant is mixed with another stimulant or other depressant, such as alcohol.

lady sitting in forest in sunsetLike with any opioid or opiate, withdrawal from pethidine can range from more mild discomfort, flu-like symptoms, illness, irritability, paranoia, to seizures and risk of death. Thus, it is important if someone is experiencing physical dependency of a substance to have the support of medical professionals when halting regular use.

While for some people, withdrawal and recovery might be possible on their own, most people require support to begin recovery and maintain their changes. Gathering support from loved ones is an important part of recovery, as are the physical and psychological aspects.

Some individuals might be physically dependant on the substance and require medical detoxification, with monitoring completed by medical professionals, while others might be ready to look into treatment programs. Groups like Al-Anon or Narcotics Anonymous might appear the best fit for some, while others might prefer a more structured, longer-term program.

If you are struggling with an opioid dependency, or any form of addiction, and feel ready to make changes, speak with your physician about available programs and look into the kind of treatment programs available within your community. Most communities have a range of private, government-funded, or sliding-scale options available.

 


References

[1] Molloy, A. (2002). Does pethidine still have a place in therapy? Australian Prescriber, 25(1). Retrieved from http://www.australianprescriber.com/magazine/25/1/12/3
[2] World Health Organization. (1989). WHO model prescribing information: Drugs used in anaesthesia. Retrieved from World Health Organization website: http://apps.who.int/medicinedocs/en/d/Jh2929e/7.2.html
[3] Palmer, J. (2000, June 25). Pethidine for pain relief in labour. Retrieved from http://www.pregnancy.com.au/resources/topics-of-interest/labour-and-birth/pethidine-for-pain-relief-in-labour.shtml
[4] Canadian Centre on Substance Use. (2015). Canadian drug summary: Prescription opioids. Retrieved from http://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Prescription-Opioids-2015-en.pdf
[5] Kredo, T., & Onia, R. (2008). Pethidine-does familiarity or evidence perpetuate its use? South African Medical Journal, 95(2), 100.
[6] World Health Organisation Essential Medicines Library. Medicines withdrawn from the 13th model list, April 2003. http://mednet3.who.int/eml/withdrawnMedicinesList.asp
[7] Bateman, C. (2004). The drug-addicted doctor-who dares to care? South African Medical Journal, 94(9), 726.


About the Author:

Gabrielle CebuliakGabrielle Cebuliak is currently undertaking her Master of Arts in Counselling Psychology from Yorkville University in New Brunswick, Canada. She previously completed a B.A. in Psychology, which provided her the foundation to pursue her Master’s degree. She has been working in the field of mental health and addiction for 7 years.


The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 14, 2016
Published on AddictionHope.com

About Baxter Ekern

Baxter Ekern is the Vice President of Ekern Enterprises, Inc. He contributed and helped write a major portion of Addiction Hope and is responsible for the operations of the website.