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blood concentration was 140 ng/ml
(therapeutic range: 0.24–3.1ng/ml).
One study showed that, of calls to poison
centres, loperamide was discussed as an
option for self-treating opioid withdrawal
in a majority of cases. About a quarter
of these admitted that they abused
loperamide for its euphoric effects.
If in doubt
If anyone doubts that these practices
really occur they need simply to Google
search any drug name and search for the
words ‘Recreational Use Drug Forum’.
Sites like these supply detailed advice.
They disclose drug abuse and often
encourage illicit drug use.
The prime purpose of this article
is to highlight potential problems.
The possible abuse of these medications
does not provide evidence of a widespread
problem. When taken appropriately
medications are the foundation of
beneficial treatment. However, as
pharmacists we need to be aware that a
minority of customers may abuse certain
We need to expand our list of suspicions
to include all medications affecting
the central nervous system. Also, these
items should be prescribed with caution
to those with a history of drug abuse.
Frequently people abuse medications
as a way of coping with a situation.
Addicted people know more about the
pharmacology, pharmacodynamics, and
the economics of drugs than we’ll ever
hope to know.
Normally, we don’t think about
methadone or many CNS drugs as
having street value. It is believed
methadone cannot be abused to ‘get
a buzz.’ But what about other CNS
drugs? Methadone has a street value for
three reasons: addicts use it to prevent
withdrawal, they can’t afford their drug
of choice, or their drug of choice isn’t
available. So they use methadone until
their drug of choice becomes available.
They can resume taking it at a lower
dose. It’s good economics for them.
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So they do their own drug rotation.
It makes sense.
Always remember to watch for signs
of aberrant drug-related behaviour.
Some are very subtle.
Program reduces pressure
ulcers by 69%
Smith & Nephew has announced the
publication of a research paper showing
how a comprehensive ulcer prevention
program which included the use of Allevyn
Life can significantly decrease hospital
acquired pressure ulcers (HAPUs).
The study was conducted in an adult
intensive care unit (ICU) at Eskenazi
Health, Indianapolis, Indiana, US, between
2012 and 2013, and published in the
American Journal of Critical-Care Nurses.
The research emphasises that hospitals
who adopt a standardised protocol for
the prevention and treatment of HAPUs
may see potential cost benefit of such
prevention. At the end of the first year,
the prevention program demonstrated a
69% decrease in HAPUs.
potential cost saving for the Eskenazi
Health ICU was nearly $1 million, and the
results in the ICU have led to the approval
of a hospital‐wide rollout of the HAPU
Allevyn Life, a silicone foam dressing also
indicated for the treatment and prevention
of pressure ulcers, developed by Smith &
Nephew, was introduced to the protocol
as part of the standard prevention method
three months into the program. Eskenazi
Health, one of the largest essential health
systems in the US, based in Indianapolis,
Indiana, initiated a study in an adult ICU
with the goal of reducing the incidence of
HAPUs by 50%. The prevention program
A risk‐stratified approach to care, based
on Braden sources: high risk (≤ 12);
(12–14); at risk (15–18)
Use of a revised skincare protocol,
fluidised repositioners, staff education
Use of ALLEVYNTM LIFE adhesive
dressings over bony prominences,
heels, knees, sacrum and shoulders
1. Swafford K, Culpepper R, Dunn C. Use of a Comprehensive
Program to Reduce the Incidence of Hospital-Acquired
Pressure Ulcers in an Intensive Care Unit. Am J Crit Care. 2016
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