Medications and Recovery An Important Piece of the Puzzle

Transcription

1

2

3 Medications and Recovery An Important Piece of the Puzzle Second Edition A guide to maintaining sobriety while receiving treatment for other health problems Renee Enstrom, Pharm.D., R.Ph. Richard Zinni, D.O. Copyright 2007, Glenbeigh 2015 All rights reserved. This publication may not be reproduced or quoted in whole or in part by any means whatsoever without written permission from the CEO of: Glenbeigh 2863 St Rt. 45 P.O. Box 298 Rock Creek, Ohio 44084

4 Table of Contents Table of Contents Introduction to Medications and Recovery... I Introduction to Medications and Recovery... I Chapter 1 Class Chapter A (alcohol, 1 anorexiants)... 1 Class A (antitussives/antihistamines/decongestants/expectorants/combo (alcohol, anorexiants)... products) Class A (ecstasy, (antitussives/antihistamines/decongestants/expectorants/combo gastrointestinal/anti-diarrheal, gastrointestinal/antispasmodic) products) Class A (hallucinogens, (ecstasy, gastrointestinal/anti-diarrheal, inhalants)... gastrointestinal/antispasmodic) 34 Class A (hallucinogens, (marijuana, neuropathic inhalants) pain,... opiates) Class A (marijuana, (opiates)...6 neuropathic pain, opiates) 5 Class A (opiates) Class A (opiates, (opiates) sedatives/analgesic/antimigraine,... sedatives/anti-anxiety) 78 Class A (opiates, (sedatives/barbiturates, sedatives/analgesic/antimigraine, benzodiazepines) sedatives/anti-anxiety) Class A (sedatives/barbiturates, (sedatives/hypnotic/sleep, sedatives/other benzodiazepines) central nervous... system depressants, 9 Class A (sedatives/hypnotic/sleep, skeletal muscle relaxants) sedatives/other... central nervous system depressants, 10 Class A (stimulants) skeletal muscle... relaxants) Class A (stimulants) Chapter 2 Chapter Class B (addiction 2 treatments, anabolic steroids/androgens) Class B (anabolic (addiction steroids/androgens, treatments, anabolic antihistamines/sedating, steroids/androgens)... antitussives/expectorants) Class B (anabolic (antitussives/expectorants, steroids/androgens, corticosteroids) antihistamines/sedating,... antitussives/expectorants) Class B (antitussives/expectorants, (decongestants/nasal sprays, corticosteroids) decongestants/phenylephrine) Class B (decongestants/nasal (decongestants/phenylephrine) sprays, decongestants/phenylephrine) Class B (decongestants/phenylephrine) Class B (decongestants/phenylephrine, (decongestants/phenylephrine) decongestants/pseudoephedrine, Class B (decongestants/phenylephrine, gastrointestinal/constipation)...18 decongestants/pseudoephedrine, Class B (gastrointestinal/constipation, gastrointestinal/constipation) gastrointestinal/nausea/vomiting, Class B (gastrointestinal/constipation, skeletal muscle relaxants, sleep gastrointestinal/nausea/vomiting, aids) Class B (sleep skeletal aids, muscle vertigo/motion relaxants, sleep sickness, aids) other) Class B (sleep aids, vertigo/motion sickness, other) Chapter 3 Chapter Alcohol-Free 3 Products Alcohol-Free Products Chapter 4 Chapter Non-Prescription 4 & Prescription Products That Contain Alcohol Non-Prescription & Prescription Products That Contain Alcohol... 25

5 Medications and Recovery Introduction Medications and Recovery Introduction I I There are many types of medications which may present a hazard to a person beginning the journey of There recovery are from many chemical types of dependency. medications These which may include present prescription a hazard andto over-the-counter a person beginning medications. the journey The of recovery danger is from not always chemical that dependency. a recovering These addict include may develop prescription a new and addiction over-the-counter thoughmedications. this certainly The can danger happen is not but always that one that can a recovering be led back addict into may dependence develop a on new their addiction drug of choice. though this Recent certainly scientific can research happen has but proven that one that can all the be dependence-producing led back into dependence drugs on act their on the drug brain of in choice. the same Recent way to scientific produce research addiction has despite proven having that all different the dependence-producing effects or a different drugs kind act of on high the when brain in taken. the same In addition, way to produce if urine addiction drug screening despite is part having of the different recovering effects person s or a different continuing kind treatment of high when program, taken. use In of addition, many types if urine of drug medications screening can is result part in of falsely the recovering positive tests person s for the continuing more highly treatment addictive program, classes use of drugs, of many resulting types of in medications negative consequences. can result in falsely positive tests for the more highly addictive classes of drugs, resulting in negative Therefore, consequences. it is very important for a recovering person to learn about the different types of medications and Therefore, drugs and it is which very important ones present for a recovering a special risk person to continuing to learn about recovery the different and sobriety. types of medications The commonly and drugs available and medications which ones and present drugs are a divided special into risk three to continuing classes recovery A, B and and C sobriety. to indicate The three commonly levels of risk. available medications and drugs are divided into three classes A, B and C to indicate three levels of risk. Class A drugs must be avoided completely, as they are well known to produce addiction and are the most dangerous Class A drugs of all. must Only be avoided under very completely, unusual as conditions they are can well the known Class to produce A drugs addiction be taken and by are recovering the most dangerous addict or alcoholic of all. Only and under only when very given unusual by conditions a physician can or dentist. the Class These A drugs exceptional be taken circumstances by a recovering can addict include: or severe alcoholic illness and and only injuries when given including by a physician major surgery, or dentist. car accidents These exceptional and other circumstances trauma, tests can or include: procedures severe which illness can only and injuries be doneincluding under sedation major surgery, or anesthesia. car accidents Medication and other treatments trauma, for tests certain or procedures psychiatric conditions which can are only in be this done category, under as sedation are medications or anesthesia. used for Medication drug detoxification. treatments The for certain street psychiatric drugs are also conditions included are in in Class this category, A. At times, as are a Class medications A medication used for may drug be necessary detoxification. for an The individual street drugs with an are addiction also included history in to Class take A. under At times, the supervision a Class A medication of a physician. may be It necessary is recommended for an individual that the individual with an addiction be proactive history and to have take someone under the else supervision be responsible of a physician. for the medication It is recommended that is needed that to the be individual given dose be by proactive dose and at appropriate have someone times. else This be responsible recommendation for the also medication includes that certain is needed Class to be B medications. given dose by dose at appropriate times. This recommendation also includes certain Class B medications. The medications in Class B are also potentially very dangerous especially when taken by recovering The persons medications without the in Class guidance B are of a also physician potentially or another very dangerous healthcare professional. especially when However, taken by under recovering certain persons circumstances, without the the Class guidance B group of a can physician be taken or safely another under healthcare a physician s professional. care. However, under certain circumstances, Class C medications the Class are generally B group can safe be from taken the safely point of under view a of physician s addiction recovery. care. However, overuse of any Class medication C medications even are the generally common safe over-the-counter from point of remedies view of addiction can result recovery. in unwanted However, side overuse effects. of any Class medication C medications even are the left common out of this over-the-counter pamphlet. remedies can result in unwanted side effects. Class People C who medications have struggled are left with out of drug this addiction pamphlet. or alcoholism must remain aware of the tendency to look People for external who have solutions struggled for internal with drug problems addiction and or alcoholism should avoid must taking remain ANY aware of these of the medications tendency on to their look for own, external in order solutions to medicate for internal emotions problems and feelings. and The should tools avoid of recovery taking ANY including of these participation medications 12-Step on their own, fellowship in order meetings, to medicate working emotions the and Steps feelings. or talking The tools with of a recovery sponsor, including counselor, participation doctor or at individual 12-Step fellowship counseling meetings, - provide safe working and healthy the Steps ways or to talking deal with with the a strong sponsor, feelings counselor, that can come doctor upor at individual any time counseling early sobriety. - provide safe and healthy ways to deal with the strong feelings that can come up at any time in early sobriety.

6 II II Medications and Recovery Introduction Medications and Recovery Introduction Many recovering people also have other chronic illnesses or mental health issues, such as depression, Many bipolar recovering disorder, diabetes people also or hypertension, have other chronic which require illnesses prescription or mental medications health issues, and such other as treatments depression, to bipolar remain disorder, healthy. diabetes Staying clean or hypertension, and sober which from drugs require and prescription alcohol often medications requires and continued other treatments use of these to remain medications. healthy. Stopping Staying the clean prescribed and sober treatments from drugs without and a alcohol doctor s often guidance requires can continued result a use relapse of these into medications. active addiction. Stopping the prescribed treatments without a doctor s guidance can result in a relapse into active The medications addiction. that appear on the following pages include both the BRAND NAME, listed first, (i.e.: The Valium ), medications followed that by appear the GENERIC on the following NAME pages (i.e.: diazepam ) include both in the parentheses BRAND NAME, as listed the majority first, (i.e.: of Valium ), prescription followed bottles are by labeled the GENERIC with the generic NAME name. (i.e.: diazepam ) For street drugs, in parentheses COMMON as the NAME majority is listed of prescription first, and the bottles (chemical are name labeled or with slang the name) generic is name. in parentheses. For street For drugs, each the drug COMMON group in Class NAME Ais and listed B, first, there and is also the a (chemical brief explanation name or of slang the dangers name) associated is in parentheses. with taking For the each medication drug group or street in Class drug. A and B, At there the is end also of a the brief document explanation there of the are dangers two tables. associated The first with is taking a list of the alcohol-free medication or products street drug. grouped by At therapeutic end of category. the document The manufacturer there are two is tables. listed next The to first each is a product list of alcohol-free name. The products second is grouped a table by of therapeutic alcohol-containing category. medications. The manufacturer is listed next to each product name. The second is a table of Use alcohol-containing of Class A andmedications. certain Class B medications listed should become a rarity for a recovering addict and alcoholic. Use of Class A and certain Class B medications listed should become a rarity for a recovering addict and alcoholic. Please remember, this information does not include all drugs and is only intended as a quick reference Please because remember, manufacturers this information change product does ingredients not include and all brand drugs names and is frequently. only intended as a quick reference because This guide manufacturers is not intended change to be product a substitute ingredients for and advice brand that names only your frequently. own personal physician can provide. This guide In is particular, not intended it is VERY to be a IMPORTANT substitute for that advice on the that basis only of your the information own personal contained physician in this can provide. guide, you In do particular, not suddenly it is VERY discontinue IMPORTANT or make that any on changes the basis in of the the doses information of medication contained that in you this guide, may have you been do not prescribed. suddenly discontinue Doing so may or make result any in changes unexpected in the problems doses of - medication such as withdrawal that you may reactions have -been whichprescribed. in some cases Doing can so be may life-threatening. result in unexpected You MUST problems check with - such your as doctor withdrawal before reactions making ANY - which medication in some changes. cases can be life-threatening. You MUST check with your doctor before making It is also ANY essential medication that you changes. inform ALL of your personal physicians, dentists and other health care It providers is also essential of your chemical that you inform dependency ALL of history your personal that medications physicians, dentists can be prescribed and other health safely care and providers appropriately of your when chemical they are dependency deemed necessary. history so that medications can be prescribed safely and appropriately The bottom line when is that they a recovering are deemed addict necessary. or alcoholic needs to become a good consumer, and ask a The healthcare bottom professional line is that if a there recovering are questions addict or about alcoholic taking needs ANY kind to become of medication a good consumer, BEFORE taking and ask it. a healthcare Remember professional that RECOVERY if there are IS ITS questions OWN about REWARD taking ANY being kind healthy of medication and regaining BEFORE a happy taking life it. is Remember YOUR responsibility! that RECOVERY IS ITS OWN REWARD being healthy and regaining a happy life is YOUR responsibility!

7 Chapter 1 Class A Chapter Avoid Completely Class Avoid Completely Alcohol (Ethanol) Sedative Hypnotic: Alcohol (Ethanol) Sedative Hypnotic: Ale Whiskey Ale Beer (including non-alcoholic forms) Whiskey Wine Beer Brandy (including non-alcoholic forms) Wine Cooler Brandy Liquor Wine Cooler Liquor Alcohol consumption initially reduces social inhibitions and produces pleasure and a sense of well-being Alcohol and relaxation. consumption Those initially effects reduces are replaced social inhibitions by drowsiness and produces as the alcohol pleasure leaves and the a sense system. of well-being Drinking and alcohol relaxation. initially increases Those effects the release are replaced of dopamine by drowsiness the reward as the centers alcohol of the leaves brain the which system. promotes Drinking the alcohol experience initially of pleasure. increases the Alcohol release increases of dopamine the inhibitory the reward activity centers of GABA of the receptors brain which promotes is likely the experience cause of the of sedating pleasure. effects Alcohol of alcohol. increases Alcohol the also inhibitory decreases activity the of excitatory GABA receptors activity of which NMDA is glutamate likely the cause receptors of the which sedating is responsible effects of alcohol. for the Alcohol memory also deficits decreases experienced the excitatory after drinking. activity of NMDA Chronic glutamate alcohol receptors consumption which compromises responsible memory for formation, the memory abstract deficits thinking, experienced problem after solving, drinking. attention, Chronic concentration alcohol consumption and perception compromises of emotion. memory Tolerance, formation, dependence abstract and thinking, withdrawal problem occur solving, with continued attention, use. concentration The nonalcohol perception or NA of forms emotion. of beer Tolerance, shoulddependence not be consumed and withdrawal because occur there with is a continued small amount use. of The alcohol non- and alcohol present and or NA research forms shows of beer that should smell not may be be consumed enough to because trigger cravings there is a and small a subsequent amount of relapse alcohol present among certain and research alcoholics. shows Please that note smell that may there be is enough a variety to of trigger coughcravings and cold and preparations a subsequent that relapse contain among alcohol certain and medications alcoholics. which Please can note be that taken there in tablet is a variety form will of not cough contain and cold ethyl preparations alcohol. Certain that contain topical alcohol products, and soft-gels medications and capsules which can that be contain taken ethyl in tablet alcohol form and will should not contain be avoided. ethyl alcohol and are safe to use. Certain topical products, soft-gels and capsules that contain ethyl alcohol should be avoided. Anorexiants: Anorexiants: Adipex-P (phentermine tablet & capsule) Qsymia ER (phentermine/ topiramate capsule) Adipex-P Also CNS (phentermine stimulant tablet & capsule) Qsymia Also CNS ER stimulant (phentermine/ topiramate capsule) Also CNS stimulant Also Regimex CNS (benzphetamine stimulant tablet) Belviq (lorcaserin tablet) Regimex Also CNS (benzphetamine stimulant tablet) Belviq (lorcaserin tablet) Also Suprenza CNS (phentermine stimulant tablet orally disintegrating) Bontril PDM ER (phendimetrazine capsule) Suprenza Also CNS (phentermine stimulant tablet orally disintegrating) Bontril PDM ER (phendimetrazine capsule) Also Tenuate CNS (diethylpropion stimulant tablet) Bontril PDM (phendimetrazine tablet) Tenuate Also CNS (diethylpropion stimulant tablet) Bontril PDM (phendimetrazine tablet) Desoxin (methamphetamine tablet) Also CNS stimulant Desoxin Also CNS(methamphetamine stimulant tablet) Also CNS stimulant The mechanism of action in reducing appetite for the stimulants appears to be secondary to the central The nervous mechanism system effects. of action All in reducing of these appetite medications for the have stimulants a high abuse appears potential to be secondary and prolonged to the use central may nervous lead to dependency system effects. and withdrawal. All of these See medications stimulant section have a for high further abuse information. potential and prolonged use may lead to dependency and withdrawal. See stimulant section for further information.

8 2 Chapter 1 Class A Avoid Completely Chapter 1 Class A Avoid Completely 2 Antitussives/Antihistamines/Decongestants/Expectorants/Combo Products: Codeine Allfen CD (codeine/guaifenesin tablet) Allfen CDX (codeine/guaifenesin tablet) Cheratussin DAC (codeine/ guaifenesin/pseudoephedrine syrup) Codar AR (codeine/chlorpheniramine liquid) Codar D (codeine/pseudoephedrine liquid) Codar GF (codeine/guaifenesin liquid) Dex-Tuss (codeine/guaifenesin liquid) Guaiatussin AC (codeine/guaifenesin syrup) Iophen C-NR (codeine/guaifenesin liquid) Lexuss 210 (codeine/chlorpheniramine liquid) Lortuss EX (codeine/guaifenesin/pseudoephedrine liquid) M Clear (codeine/guaifenesin capsule) M Clear WC (codeine/guaifenesin liquid) Mar-Cof CG (codeine/guaifenesin solution) Ninjacof-XG (codeine/guaifenesin liquid) Notuss-DC (codeine/pseudoephedrine liquid) Phenergan with Codeine (codeine/promethazine syrup) Phenergan VC with Codeine (codeine/promethazine/phenylephrine syrup) Codeine, continued Phenylhistine DH (codeine/ chlorpheniramine/pseudoephedrine elixir) Robafen AC (codeine/guaifenesin syrup) Robitussin AC (codeine/guaifenesin liquid) Tricode AR (codeine/chlorpheniramine/pseudoephedrine liquid) Tricode GF (codeine/guaifenesin/pseudoephedrine liquid) Tuzistra XR (codeine/chlorpheniramine suspension) Virtussin DAC (codeine/guaifenesin/pseudoephedrine liquid) Hydrocodone Hycofenix (hydrocodone/guaifenesin/pseudoephedrine solution, oral) Hydromet (hydrocodone/homatropine syrup) Obredon (hydrocodone/guaifenesin solution, oral) Rezira (hydrocodone/pseudoephedrine solution) TussiCaps ER(hydrocodone/ chlorpheniramine capsule) Tussigon (hydrocodone/homatropine tablet) Tussionex PennKinetic ER (hydrocodone/chlorpheniramine suspension) Vituz (hydrocodone/chlorpheniramine solution) Zutripro (hydrocodone/ chlorpheniramine/pseudoephedrine solution) Any cough medications containing narcotics such as codeine or hydrocodone should not be used. These medications bind to opiate receptors in the central nervous system, altering the perception of and response to pain and produce generalized central nervous system depression and may alter mood or cause sedation.

9 Chapter 1 Class A Avoid Completely 3 3 Chapter 1 Class A Avoid Completely Ecstasy: Adam (MDMA) Beans Eve (MDE) Love (MDA) Methylenedioxyamphetamine (MDA) Methylenedioxyethylamphetamine (MDE) Methylenedioxymethamphetamine (MDMA) Molly Rolls X XTC MDMA increases dopamine, norepinephrine and to a greater extent, serotonin. With high doses, users can experience jitteriness, teeth clenching, dry mouth, muscle cramping and nausea. MDMA can cause a distorted sense of perception, hallucinogen-like effects and hyperactivity. Overdose can occur leading to increased body temperature, hypertension and kidney failure. Ecstasy is often combined in tablet or powder form with other drugs of abuse such as: methamphetamine, dextromethorphan, ephedrine, pseudoephedrine, caffeine, cocaine, piperazine drugs (mcpp, TFMPP, BZP) and ketamine. This increases the risks of adverse effects. Gastrointestinal (Anti-Diarrheal): Donnatal (phenobarbital/atropine/hyoscyamine/ scopolamine elixir oral, tablet oral) Donnatal Extentabs (phenobarbital/atropine/hyoscyamine/ scopolamine tablet ER oral) Lomotil (atropine/diphenoxylate solution oral, tablet oral) Lonox (atropine/diphenoxylate tablet oral) Motofen (atropine/difenoxin tablet oral) Opium (morphine tincture oral) Also opiate Paregoric (morphine tincture oral) Also opiate Viberzi (eluxadoline oral) Diphenoxylate is a member of the opioid class of drugs. Atropine is added to discourage abuse for recreational purposes. At recommended doses, the atropine causes no effects but in larger doses, unpleasant symptoms are experienced. Prolonged use with high doses may cause physical and psychological dependence. Adverse reactions of euphoria and feeling drunk were reported in clinical trials with the use of Viberzi. Paregoric and Opium belong to the opiate class of medications. See opiates section for more information. Gastrointestinal (Antispasmodic): Librax (chlordiazepoxide/clidinium capsule oral) Chlordiazepoxide is also a benzodiazepine Librax can cause drowsiness, ataxia and confusion. Withdrawal can occur after prolonged use. See benzodiazepine section for more information.

10 4 Chapter 1 Class A Avoid Completely Chapter 1 Class A Avoid Completely 4 Hallucinogens: 4-bromo-2,5-dimethoxyphenethylamine (2-CB) Ayahuasca (caapi, yage, vegetal) Belladonna Alkaloids (atropine, scopolamine, belladonna, deadly nightshade, Jimsonweed, stink weed, mandrake) Dextromethorphan (CCC, robo, red devils, poor man s PCP, DXM, Dex) Dimethyltryptamine (DMT, businessman s special) Ketamine (Special K, K) Lysergic Acid Diethylamide (acid, blotter, California sunshine, LSD, microdot, paper, trip, yellow sunshine and many others) Mescaline (buttons, mesc, mescal, topi, peyote) Phencyclidine (PCP, angel dust, T, PeaCe pill) Psilocybin (boomers, magic mushroom, shrooms) Salvia Divinorum (ska, Maria, la Maria, ska Pastora) People using high doses of hallucinogens begin to perceive an experience as actually happening when it is not. Hallucinogen effects include feelings of detachment from one s surroundings, emotional swings and an altered sense of space and time. Hallucinations and a sense of separation from one s body can occur. Physical effects include jitteriness, racing or slowed heart rate, chills, nausea, numbness and changes in coordination. Belladonna alkaloids can stimulate the heart and increase body temperature. At the point where hallucinations occur, the user is at or very near a life-threatening level. PCP can cause seizures, coma, or psychosis lasting several days. Flashbacks of the original hallucination can occur. Inhalants: Aimes Anesthetics (nitrous oxide, Whippets, halothane, ether) Bolt Bullets Climax Fuels (butane, propane, gasoline) Glues Locker Room Nitrites (amyl, butyl) Paints Poppers Rush Snappers Solvents (benzene, toluene, methanol, chloroform, freon, coolants) Sprays Nitrites can cause visual distortions and sedation occurs as the dose increases. Solvent use can cause disorientation and loss of muscle coordination. Long term effects can include depression, hallucinations and damage to the brain, heart, liver, lungs and kidneys. All solvent use can lead to overdose at increased doses.

11 Chapter 1 Class A Avoid Completely 5 5 Chapter 1 Class A Avoid Completely Marijuana: Blanche Bhang Charas (extracted plant resin) Dagga Ganga Grass Hash (hash oil) Hashish (tar) Herb Marinol (dronabinol) Old Man Pot Reefer Sinsemilla Smoke (dried plant material) THC Weed Drowsiness and sedation follow the initial effects of marijuana. Eating marijuana can lead to hallucinations. Because it takes a long time to eliminate THC from the body, a person s cognitive function can be affected for a day or more after a single dose. Marijuana can impair judgement and coordination. The effects of marijuana on learning and memory can be long-lasting. Chronic marijuana smoking can lead to lung damage. Chronic usage can also lead to tolerance, dependence and withdrawal if stopped suddenly. Neuropathic Pain: Lyrica (pregabalin capsule oral, solution oral) Lyrica can lead to withdrawal symptoms upon discontinuation. It also produces euphoria, blurred vision, difficulty with attention and concentration and a drunk or high feeling in certain individuals. Opiates: Alfenta (alfentanyl solution injection) Belladonna & Opium (suppository rectal) Buprenorphine Bunavail (buprenorphine/naloxone film, buccal) Buprenex (buprenorphine injection solution) Butrans (buprenorphine transdermal patch) Suboxone (buprenorphine/naloxone film, sublingual) Buprenorphine, Continued Subutex (buprenorphine sublingual tablet) Zubsolv (buprenorphine/naloxone tablet, sublingual) Stadol (butorphanol solution nasal & injection) Codeine Trezix (dihydrocodeine/ acetaminophen/ caffeine capsule oral) Tylenol #2, #3 or #4 (codeine/ acetaminophen tablet oral)

12 6 Chapter 1 Class A Avoid Completely Chapter 1 Class A Avoid Completely 6 Opiates, Continued: Codeine, continued Tylenol with Codeine (codeine/ acetaminophen solution & suspension oral) Fentanyl Abstral (fentanyl tablet sublingual) Actiq (fentanyl lozenge, transmucosal) Duragesic (fentanyl patch, transdermal) Fentora (fentanyl tablet buccal) Ionsys (fentanyl iontophoretic transdermal system) Lazanda (fentanyl intranasal spray) Onsolis (fentanyl film, buccal) Sublimaze (fentanyl solution injection) Subsys (fentanyl sublingual spray) Heroin (down, dreck, H, horse, smack, mojo, white lady, brown) Heroin & Cocaine (speedball) Hydrocodone Hysingla ER (hydrocodone tablet ER oral) Hycet (hydrocodone/acetaminophen solution oral) Norco (hydrocodone/acetaminophen tablet oral) Verdrocet (hydrocodone/ acetaminophen tablet oral) Vicodin(hydrocodone/acetaminophen tablet oral) Vicodin ES (hydrocodone/ acetaminophen tablet oral) Vicodin HP (hydrocodone/ acetaminophen tablet oral) Xodol (hydrocodone/acetaminophen tablet oral) Hydrocodone, continued Zohydro ER (hydrocodone capsule ER oral) Hydromorphone Dilaudid (hydromorphone tablet oral, solution oral & injection, suppository rectal) Exalgo (hydromorphone tablet ER oral) Levo-Dromoran (levorphanol tablet oral) Meperidine Demerol (meperidine tablet oral, solution, injection) Meperitab (meperidine tablet oral) Methadone Morphine Dolophine (methadone tablet oral) Methadose (methadone tablet oral) Methadose (methadone solution concentrate oral) Methadone Intensol (methadone solution concentrate oral) Metadol (methadone solution oral) Astramorph/PF (morphine solution injection) Avinza (morphine capsule ER oral) Duramorph (morphine solution injection) Embeda (morphine/naltrexone capsule CR oral) Infumorph (morphine solution injection) Kadian (morphine capsule ER oral) Morphine (solution concentrate oral)

13 Chapter 1 Class A Avoid Completely 7 7 Chapter 1 Class A Avoid Completely Opiates, Continued: Morphine, continued Morphine (solution intramuscular) Morphine (solution intravenous) MS Contin (morphine tablet ER oral) Oramorph SR (morphine ) RMS (morphine suppository rectal) Roxanol (morphine solution oral) Nubain (nalbuphine solution injection) Opium (Chinese molasses, dreams, gong, O, skee, toys, zero) Oxycodone Combunox (oxycodone/ibuprofen tablet oral) Endocet(oxycodone/acetaminophen tablet oral) Endodan (oxycodone/aspirin tablet oral) Oxycodone (solution concentrate oral) Oxycodone (solution oral) Oxycontin (oxycodone ER tablet oral) OxyIR (oxycodone capsule oral) Percocet (oxycodone/ acetaminophen tablet oral) Percodan (oxycodone/aspirin tablet oral) Primlev (oxycodone/acetaminophen tablet oral) Roxicet (oxycodone/acetaminophen solution oral) Roxicodone (oxycodone tablet oral) Targiniq ER (oxycodone/naloxone tablet oral) Xartemis XR (oxycodone/ acetaminophen tablet oral) Oxymorphone Opana (oxymorphone solution injection) Opana (oxymorphone tablet oral) Opana ER (oxymorphone tablet oral) Opana ER (oxymorphone tablet oral) Pentazocine Talacen (pentazocine/acetaminophen tablet oral) Talwin (pentazocine solution injection) Talwin NX (pentazocine/naloxone tablet oral) Ultiva (remifentanul solution intravenous) Sufenta (sufentanil solution intravenous) Tapentadol Tramadol Nucynta (tapentadol tablet) Nucynta ER (tapentadol tablet) Active-Tramadol (cream external) ConZip (tramadol capsule ER oral) EnovaRX (tramadol cream external) Rybix (tramadol tablet orally disintegrating) Synapryn FusePaq (tramadol suspension oral) Ultram (tramadol tablet oral) Ultram ER(tramadol tablet oral)

14 8 Chapter 1 Class A Avoid Completely Chapter 1 Class A Avoid Completely 8 Opiates, Continued: Opiate use causes decreased sensitivity to pain as well as slowed breathing, skin flushing, pinpoint pupils, drowsiness, nausea, vomiting and constipation. Overdose can be lethal as the opiate suppresses the respiratory system. Tolerance or drug dependence may result from extended use. Buprenorphine binds to mu receptors in the brain leading to a suppression of withdrawal and cravings and a feeling of euphoria. Opiates have the potential for drug dependency and abrupt cessation may precipitate withdrawal. Sedatives: Increased doses of sedatives can cause dizziness, vertigo, drowsiness, slurred speech and muscle incoordination. Learning is impaired and there is a loss of memory for events occurring while under the influence. Unexpected effects of sedatives include: anxiety, nightmares, hostility and rage. Overdose of sedatives can lead to suppression of breathing, heart failure and death. Tolerance and dependence develop after a few weeks or more of use. Sudden withdrawal can produce seizures. Sedatives: Analgesic, Anti-Migraine: Midrin (acetaminophen/ dichloralphenazone/isometheptene capsule oral) Migragesic (acetaminophen/ dichloralphenazone/ isometheptene capsule oral) Nodolor (acetaminophen/ dichloralphenazone/ isometheptene capsule oral) Dichloralphenazone is converted to chloral hydrate which is a sedative. Dependence can occur leading to headaches which occur more frequently and more severe than before. Sedatives: Antianxiety: Equanil (meprobamate tablet oral) Quaalude, Sopor (methaqualone) Tolerance, psychological and physical dependence and withdrawal can occur with prolonged use. Central nervous system depression can occur with routine use. Equanil can also cause heart arrhythmias, decreased blood pressure, dizziness and weakness.

15 Chapter 1 Class A Avoid Completely 9 9 Chapter 1 Class A Avoid Completely Sedatives: Barbiturates: Alagesic LQ (butalbital/acetaminophen/ caffeine liquid, oral) Ascomp with Codeine (butalbital/codeine/aspirin/caffeine capsule, oral) Brevital (Methohexital solution, reconstituted, injection) Bupap (butalbital/acetaminophen tablet, oral) Butisol (butabarbital elixir & tablet oral) Esgic (butalbital/acetaminophen/caffeine capsule, oral) Fioricet (butalbital/acetaminophen/ caffeine capsule, oral) Fioricet with Codeine (butalbital/codeine/acetaminophen/ caffeine capsule, oral) Margesic (butalbital/acetaminophen/ caffeine capsule, oral) Dolgic Plus (butalbital/acetaminophen/ caffeine tablet, oral) Amytal (amobarbital solution, reconstituted, injection) Fiorinal (butalbital/aspirin/ caffeine capsule, oral) Fiorinal with Codeine (butalbital/codeine/aspirin/caffeine capsule, oral) Nembutal (pentobarbital solution, injection) Phrenilin Forte (butalbital/acetaminophen capsule, oral) Mysoline (primidone tablet oral) Phenobarbital (elixir oral, solution oral, solution injection, tablet oral) Seconal (secobarbital capsule oral) Zebutal (butalbital/acetaminophen/ caffeine capsule, oral) Sedatives: Benzodiazepines: Alprazolam Intensol (alprazolam concentrate oral) Ativan (lorazepam solution injection, tablet oral) Dalmane (flurazepam capsule oral) Diazepam Intensol (concentrate oral) Diastat (diazepam gel rectal) Doral (quazepam tablet oral) Halcion (triazolam tablet oral) Klonopin (clonazepam tablet oral & tablet orally disintegrating) Limbitrol (chlordiazepoxide/amitriptyline tablet oral) Lorazepam Intensol (concentrate oral) Niravam (alprazolam tablet orally disintegrating) Onfi (clobazam suspension oral & tablet oral) ProSom (estazolam tablet oral) Restoril (temazepam capsule oral) Rohypnol (flunitrazepam, roofies) Serax (oxazepam capsule oral) Tranxene-T (clorazepate tablet oral) Valium (diazepam solution injection, solution oral, tablet oral) Xanax (alprazolam tablet oral) Xanax XR (alprazolam tablet oral) Benzodiazepines can cause amnesia at therapeutic doses.

16 10 Chapter 1 Class A Avoid Completely Chapter 1 Class A Avoid Completely 10 Sedatives: Hypnotics (Sleep Medications): Ambien (zolpidem tablet oral) Ambien CR (zolpidem tablet CR oral) Belsomra (suvorexant tablet oral) Edular (zolpidem tablet sublingual) Intermezzo (zolpidem tablet sublingual) Lunesta (eszopiclone tablet oral) Somnote (chloral hydrate capsule oral, syrup oral) Sonata (zaleplon capsule oral) Zolpimist (zolpidem solution oral spray) Most drugs in this class act on a benzodiazepine receptor that induces sleep. These medications can cause amnesia for activities that occur during the time it is effective. These activities can include: sleep driving, sleep eating, sleep shopping, sleep sex, sleep ing and criminal activity. Daytime drowsiness, dizziness, hallucinations and agitation can occur. Belsomra can cause temporary paralysis during early sleep and early wake cycles. Sedatives: Other Central Nervous System Depressants: GHB (G, gamma-hydroxybutyrate, everclear, Xyre GHB can be added to drinks to cause sedation leading to rape or sexual assault. After ingestion, a person begins to feel weak, dizzy, lightheaded or confused. Abuse is common in teenagers and young adults. Overdose can occur leading to death. Tolerance and withdrawal occur with regular use. Skeletal Muscle Relaxants: Soma (carisoprodol tablet oral) Soma Compound (carisoprodol/aspirin tablet oral) Soma Compound with Codeine (codeine/carisoprodol/aspirin tablet oral) Also opiate Soma can impair physical and mental abilities and has been rarely associated with seizures. Tolerance, dependence and withdrawal are common. Withdrawal can include: insomnia, vomiting, abdominal pain, headache, tremors, ataxia, hallucinations or psychosis.

17 Chapter 1 Class A Avoid Completely Chapter 1 Class A Avoid Completely Stimulants: Adderall (dextroamphetamine/amphetamine tablet) Adderall XR (dextroamphetamine/amphetamine capsule) Amphetamine (crank, bennies, uppers) Aptensio XR (methylphenidate capsule, oral) Cathinone Cocaine (coke, blow, candy, crack, jack, jimmy, rock, nose candy, whitecoat) Concerta ER (methylphenidate tablet, oral) Daytrana (methylphenidate patch transdermal) Dexedrine ER (dextroamphetamine capsule, oral) Dexedrine (dextroamphetamine tablet, oral) Evekeo (amphetamine table, oral) Focalin (dexmethylphenidate tablet, oral) Focalin XR (dexmethylphenidate capsule, oral) MDPV (bath salts, ivory wave, bliss, bubbles, meow meow, explosion, vanilla sky) Mephedrone Metadate CD (methylphenidate capsule, oral) Metadate ER (methylphenidate tablet, oral) Methamphetamine (crystal meth, meth, crystal, ice) Methcathinone (cat, Khat, crank, goob) Methylin (methylphenidate solution oral & tablet chewable, oral) Methylone Nuvigil (armodafinil tablet, oral) Provigil (modafinil tablet, oral) Quillivant XR (methylphenidate suspension oral) Ritalin (methylphenidate tablet, oral) Ritalin LA (methylphenidate capsule, oral) Vyvanse (lisdexamfetamine capsule, oral) Heart rate and blood pressure are increased at therapeutic doses of stimulants. High doses can cause adverse cardiac effects, stroke, hyperthermia, seizures and death. Repeated high doses over days to weeks can cause a state of hostility and paranoia, similar to paranoid schizophrenia. Bizarre, repetitive movements (picking at imaginary insects under the skin leading to wounds, repeated conversations and sexual activity) can become extreme. Long term effects depend on how the drug is administered and include: nasal ulcerations, bleeding in the lungs, stomach ulcers, atherosclerosis, damage to the heart muscle and difficulties with memory and decision making. Tolerance, dependence and withdrawal can occur.

18 12 Chapter 2 Class B Take Only with Your Chapter Doctor s 2 Approval or Prescription Class B Take Only with Your Doctor s Approval or Prescription ***NOTE: Read all labels on OTC products. Many come in different dosage forms such as: tablets, capsules, gel capsules, liquids, suspensions and powders. Some stores also carry their own generic ***NOTE: formulation Read of brand all labels name products. on OTC products. Many cough Many and come cold in medications different dosage contain forms more such than one as: product. tablets, capsules, Caution should gel capsules, be used when liquids, taking suspensions more than and one powders. cough and Some cold stores medication, also carry changing their products own generic and formulation taking pain relievers of brand iname addition products. to these Many products cough for and this cold reason. medications Taking contain more than more one than product one product. can put Caution you at risk should of receiving be used higher when than taking recommended more than one daily cough doses and of medications. cold medication, Tylenol changing (acetaminophen) products and is taking a common pain pain relievers reliever in addition found in to combination these products products. for this *** reason. Taking more than one product can put you ***NOTE: at risk Although of receiving the higher medications than recommended listed below daily in the doses Addiction of medications. Treatments Tylenol section (acetaminophen) are specifically is a intended common to pain be taken reliever for found prevention in combination of relapse products. for dependence *** upon one or more drugs, none of them are habit-forming ***NOTE: Although or addictive the medications themselves, listed and should below in therefore Addiction be considered Treatments safe for section recovering are specifically people to take. intended However, to be taken their for proper prevention use in the of relapse context for of a dependence recovery program upon one requires or more monitoring drugs, none by a of health them care habit-forming professional, and or addictive it is for this themselves, reason that and we should place them therefore in Class be considered B.*** safe for recovering people to take. However, their proper use in the context of a recovery program requires monitoring by a health care professional, Addiction Treatments: and it is for this reason that we place them in Class B.*** Addiction Antabuse Treatments: (disulfiram) Revia (naltrexone) Campral (acamprosate) Symmetrel (amantadine) Antabuse Catapres (clonidine) (disulfiram) Revia Vivitrol (naltrexone) ER) Campral Chantix (varenicline) (acamprosate) Symmetrel Zyban (bupropion) (amantadine) Catapres (clonidine) Vivitrol (naltrexone ER) Naltrexone Chantix (varenicline) may precipitate intense withdrawal symptoms Zyban (bupropion) in patients addicted to opiates. Clonidine acts via autoreceptors in the locus coeruleus to suppress adrenergic hyperactivity that is involved in the expression Naltrexone of may the precipitate opioid withdrawal intense withdrawal syndrome. symptoms Disulfiram in is dangerous patients addicted if taken to with opiates. alcohol. Clonidine Amantadine acts can via autoreceptors cause decreased in the mental locus alertness coeruleus or to altered suppress coordination. adrenergic Chantix hyperactivity and Zyban that are is involved medications in the to expression help with nicotine of the (cigarettes, opioid withdrawal cigars, syndrome. chewing tobacco, Disulfiram snuff) is dangerous addiction. if taken with alcohol. Amantadine can cause decreased mental alertness or altered coordination. Chantix and Zyban are medications to help Anabolic with nicotine Steroids (cigarettes, (Androgens): cigars, chewing tobacco, snuff) addiction. Anabolic Fluoxymesterone Steroids (Androgens): Androxy Fluoxymesterone Methyltestosterone Androxy Android Methyltestosterone Methitest Testred Android Oxandrolone Methitest Testred Oxandrin Oxandrolone Testosterone Oxandrin Androderm Testosterone AndroGel Androderm Aveed AndroGel Aveed Testosterone, continued Axiron Testosterone, Depo-Testosterone continued First-Testosterone Axiron First-Testosterone Depo-Testosterone MC First-Testosterone Fortesta First-Testosterone Natesto MC Fortesta Striant Testim Natesto Testopel Striant Testim Vogelxo Testopel Vogelxo

19 Chapter 2 Class B Take Only with Your Doctor s Approval or Prescription 13 Chapter 2 Class B Take Only with Your Doctor s Approval or Prescription Chapter 2 Class B Take Only with Your Doctor s Approval or Prescription 13 Chapter 2 Class B Take Only with Your Doctor s Approval or Prescription Anabolic Steroids (Androgens), Continued: Anabolic Steroids (Androgens), Continued: Anabolic steroids is the familiar name for synthetic variants of the male sex hormone Anabolic testosterone. steroids Anabolic is refers the familiar to the drugs name ability for to synthetic promote muscle variants growth of the and male steroid sex refers hormone to the chemical testosterone. structure. Anabolic Androgens refers to the are drugs male ability hormones. to promote Anabolic muscle growth steroids and do steroid not refers take to effect the chemical immediately. structure. After several Androgens weeks of are use, male some hormones. people experience Anabolic euphoria, steroids increased do not energy take and effect an increase immediately. in combativeness After several weeks and competitiveness. of use, some people Depression, experience fatigue, euphoria, loss of increased appetite, energy insomnia and and increase headaches in can combativeness be seen when and the competitiveness. use of the anabolic Depression, steroid stops. fatigue, High-doses loss of appetite, and prolonged insomnia use and can headaches lead to an can increase be seen in when lipid levels the use in of the the blood, anabolic heart steroid attack, stops. stroke, High-doses decreased and prolonged libido, decreased use can lead sperm to production an increase and in breast lipid development levels in the in blood, men. The heart use attack, of certain stroke, anabolic decreased steroids libido, can lead decreased to liver sperm disease, production liver cancer and or breast blood-filled development cysts on in the men. liver. The Physicians use of certain may prescribe anabolic steroids anabolic can steroids lead to men liver disease, who have liver inadequate cancer or or blood-filled no testosterone cysts on production. the liver. Physicians Anabolic steroids may prescribe may also anabolic be used steroids in women to men to who treat have certain inadequate breast cancers, or no testosterone fibrocystic breast production. disease Anabolic and endometriosis. steroids may They also be may used also in be women used to in treat certain certain people breast for weight cancers, gain fibrocystic and to treat breast delayed disease puberty. and endometriosis. All anabolic steroids They may used also as be above used are in certain considered people Class for weight B. Anabolic gain and steroids to treat should delayed not puberty. used All anabolic to increase steroids muscle used mass above or are to considered improve athletic Class B. performance. Anabolic steroids There are should many anabolic not be steroids used to that increase are illegally muscle produced mass in bootleg or to improve labs or underground athletic performance. and are marketed There for are this many purpose. anabolic These steroids medications that are illegally may have produced different in bootleg names labs which or are underground not included and in are this marketed list. Anabolic for this steroids purpose. are These dangerous medications if used may in have this different way would names be which considered are not Class included A. in this list. Anabolic steroids are dangerous if used in this way would be considered Antihistamines Class (Sedating): A. Antihistamines (Sedating): Atarax (hydroxyzine hydrochloride) Periactin (cyproheptadine) Atarax Benadryl (hydroxyzine Allergy (diphenhydramine) hydrochloride) OTC Periactin Polarmine (cyproheptadine) (dexchlorpheniramine) Benadryl Chlorphen-12 Allergy (chlorpheniramine) (diphenhydramine) OTC OTC Polarmine Robitussin (dexchlorpheniramine) Nighttime Cough DM, Maximum Strength Chlorphen-12 (chlorpheniramine) OTC Chlor-Trimeton (chlorpheniramine) OTC Robitussin (dextromethorphan/doxylamine) Nighttime Cough DM, OTC Maximum Strength (dextromethorphan/doxylamine) Tavist (clemastine) OTC OTC Chlor-Trimeton Coricidin HBP Cold (chlorpheniramine) & Flu OTC Tavist Vicks Cough (clemastine) Nyquil (dextromethorphan/ OTC Coricidin (acetaminophen/chlorpheniramine) HBP Cold & Flu OTC (acetaminophen/chlorpheniramine) Coricidin HBP Multi-Symptom Cold OTC Night Vicks doxylamine) Cough OTC Nyquil (dextromethorphan/ doxylamine) OTC Coricidin (acetaminophen/chlorpheniramine/ HBP Multi-Symptom Cold Night (acetaminophen/chlorpheniramine/ dextromethorphan) OTC Vistaril (hydroxyzine pamoate) Vistaril (hydroxyzine pamoate) dextromethorphan) Karbinal ER (carbinoxamine) OTC Karbinal ER (carbinoxamine) Sedating antihistamines should be used with caution because they have the potential to alter judgment Sedating and cause antihistamines drowsiness, grogginess, should be dizziness used with or caution fatigue. because they have the potential to alter judgment and cause drowsiness, grogginess, dizziness or fatigue. Antitussives/Expectorants: Antitussives/Expectorants: Coricidin HBP Maximum Strength Flu Coricidin HBP Multi-Symptom Cold Coricidin (acetaminophen/chlorpheniramine/ HBP Maximum Strength Flu (acetaminophen/chlorpheniramine/ dextromethorphan) OTC dextromethorphan) Coricidin HBP Chest OTC Congestion & Cough Coricidin Nighttime(acetaminophen/ HBP Multi-Symptom Cold Nighttime(acetaminophen/ dextromethorphan/doxylamine) OTC dextromethorphan/doxylamine) Coricidin HBP Cough & Cold OTC Coricidin (dextromethorphan/guaifenesin) HBP Chest Congestion OTC & Cough (dextromethorphan/guaifenesin) OTC Coricidin (chlorpheniramine/dextromethorphan) HBP Cough & Cold OTC (chlorpheniramine/dextromethorphan) OTC

20 Coricidin HBP Multi-Symptom Cold Day Delsym Cough (dextromethorphan) OTC (dextromethorphan/guaifenesin) OTC Delsym Cough + Chest Congestion, DM, Max Diabetic Tussin DM 14 Chapter 2 Class B Take Only with Your Doctor s Approval or Prescription Strength (dextromethorphan/guaifenesin) OTC (dextromethorphan/guaifenesin) OTC Mucinex DM & DM ER Vicks Cough DayQuil (dextromethorphan) OTC (dextromethorphan/guaifenesin) OTC Vicks NyQuil Mucinex Fast-Max DM Max, Chapter Cough 2 & Class Chest B Take Only with Your Doctor s Approval or Prescription (acetaminophen/dextromethorphan/doxylamine) 14 Congestion (dextromethorphan/guaifenesin) OTC OTC Antitussives/Expectorants, Continued: Vicks NyQuil Cold & Flu Phenergan DM (dextromethorphan/promethazine) (acetaminophen/dextromethorphan/doxylamine) Coricidin HBP Multi-Symptom Cold Day Delsym OTC Cough (dextromethorphan) OTC (dextromethorphan/guaifenesin) OTC Robitussin Cough + Chest Congestion DM Delsym Cough + Chest Congestion, DM, Max Diabetic Vicks NyQuil Tussin Cough Regular and Maximum DM Strength (dextromethorphan/guaifenesin) OTC (dextromethorphan/guaifenesin) (dextromethorphan/doxylamine) OTC OTC Strength(dextromethorphan/guaifenesin) OTC Mucinex Robitussin DM DM & DM (dextromethorphan/guaifenesin) ER Vicks Cough DayQuil (dextromethorphan) OTC (dextromethorphan/guaifenesin) OTC OTC Vicks NyQuil Mucinex Fast-Max DM Max, Cough & Chest (acetaminophen/dextromethorphan/doxylamine) Congestion Perceptual (dextromethorphan/guaifenesin) distortions and a dissociative state OTC can also be seen in those people taking large doses of dextromethorphan, similar to symptoms as seen OTC in PCP and ketamine use. Toxic doses can cause confusion, disorientation, elevated body temperature, Vicks high NyQuil blood Cold pressure & Flu and nausea or vomiting. Phenergan Dextromethorphan DM (dextromethorphan/promethazine) mixed with decongestants can (acetaminophen/dextromethorphan/doxylamine) raise blood pressure. Dextromethorphan combined with chlorpheniramine can cause a serotonin syndrome-like OTC toxicity. Robitussin Cough + Chest Congestion DM Vicks NyQuil Cough Regular Corticosteroids: and Maximum (dextromethorphan/doxylamine) OTC Strength(dextromethorphan/guaifenesin) OTC Robitussin Cortisone DM (dextromethorphan/guaifenesin) Florinef (fludrocortisone) OTC Cortef (hydrocortisone) Medrol (methylprednisolone) Decadron (dexamethasone) Orapred (prednisolone) Perceptual Deltasone distortions (prednisone) and a dissociative state can also be seen in those people taking large doses of dextromethorphan, similar to symptoms as seen in PCP and ketamine use. Toxic doses can cause confusion, disorientation, elevated body temperature, high blood pressure and nausea or vomiting. It is important to take corticosteroids exactly as directed. Corticosteroids are similar to cortisol, a hormone Dextromethorphan mixed with decongestants can raise blood pressure. Dextromethorphan combined naturally made by the adrenal glands. If corticosteroids are taken for more than a few weeks, cortisol with chlorpheniramine can cause a serotonin syndrome-like toxicity. production is decreased in the adrenal glands. Gradually tapering the dosage of the corticosteroid gives the adrenal glands time to resume normal function. Corticosteroids suppress the immune system and can Corticosteroids: cause insomnia, nervousness, cataracts and bone loss. Cortisone Cortef (hydrocortisone) Decadron (dexamethasone) Deltasone (prednisone) Florinef (fludrocortisone) Medrol (methylprednisolone) Orapred (prednisolone) It is important to take corticosteroids exactly as directed. Corticosteroids are similar to cortisol, a hormone naturally made by the adrenal glands. If corticosteroids are taken for more than a few weeks, cortisol production is decreased. Gradually tapering the dosage of the corticosteroid gives the adrenal glands time to resume normal function. Corticosteroids suppress the immune system and can cause insomnia, nervousness, cataracts and bone loss.