America is in the throes of an opioid abuse epidemic, and opioid painkillers are the driving force behind this. The National Survey on Drug Use and Health (NSDUH) publishes that close to 4.5 million adults (aged 12 and older) abused an opioid pain reliever in the 30 days leading up to the 2014 survey. The Centers for Disease Control and Prevention (CDC) reports that opioid overdose deaths (including both prescription opioids and heroin) have risen 200 percent since 2000. Opioid drugs are highly addictive as they dull pain sensations, elevate moods, and decrease anxiety and stress.
Demerol is the brand name of the opioid drug meperidine, which is prescribed to treat moderate to significant pain, usually surgical pain or pain related to childbirth. It also may be used pre-anesthesia. Demerol comes in a syrup, tablet, or injectable form, and it is classified as a Schedule II controlled substance by the Drug Enforcement Administration, or DEA. Individuals who suffer from chronic or untreated pain, medical conditions, or mental health disorders, or who experience high levels of stress, may be at an elevated risk for abusing opioid drugs. Demerol may also be abused recreationally for the euphoric “high” it can produce.
Demerol can be smoked, snorted, swallowed, chewed up, or injected when abused. On the street Demerol, it is known as demmies, dust, dillies, juice, or D.
Abuse of Demerol
Because this drug is not popularly prescribed, the abuse of Demerol is no longer considered to be a major issue; however, the drug still carries significant risk for abuse. Behavioral issues that were previously identified as substance (drug) abuse and/or addiction are currently given the clinical designation of substance use disorders. Research has determined that the connection between what was once referred to as drug abuse and addiction is actually not well defined, and these concepts are actually ends of a continuum of issues with substance use.
Individuals who develop substance use disorders as a result of abusing Demerol may:
- Illegally obtain the drug
- Crush the pills and snort the powder, or mix it in water to inject the substance
- Use Demerol in conjunction with other drugs, such as alcohol, other narcotic medications, cannabis products, benzodiazepines, or stimulants
According to the Journal of Pain and Symptom Management, a decreasing trend of reported cases of Demerol abuse occurred from 1997 to 2002, but the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that the number of emergency room admissions associated with Demerol abuse increased from 2010 to 2011. SAMHSA estimated that in 2015, 106,000 individuals of the nearly 12.5 million individuals who abused narcotic medications abused Demerol (less than 1 percent).
The above findings indicate that even though the drug is not being prescribed to the extent that it once was, it is still finding its way into the hands of individuals who intend to abuse it. Even if there is an overall decrease in the number of people abusing it, the drug is still dangerous and its use/abuse is associated with significant health risks.
There are known risk factors associated with any type of substance use disorder. Risk factors represent certain conditions that increase the likelihood that an individual may abuse drugs or alcohol and develop a substance use disorder. These are not causes, and their presence does not ensure that an individual will develop a substance use disorder; instead, they raise the probability that a person may develop one. The most salient risk factors for developing an opiate use disorder as a result of Demerol abuse include:
- Genetic associations: Anyone who has a first-degree relative with a formally diagnosed substance use disorder is at a heightened risk to develop a personal substance use disorder. Having other relatives, such as cousins, uncles, aunts, etc., with diagnosed substance use disorders also increases the risk that one may develop a substance use disorder; however, the risk is much more salient in individuals with first-degree relatives with these issues.
There are no identified genes or methods to perform genetic screening on an individual that will determine if they are at significant risk for the development of a substance use disorder. In addition, having a first-degree relative with a substance use disorder might also in part reflect learned behaviors from these relatives as opposed to acquiring behaviors by means of biological transmission, especially if these relatives live together. While certain types of adoption studies where identical twins are adopted away from their parents at birth indicate that there is a strong genetic association with the development of substance use disorders, individuals who coexist with parents or other relatives who have a history of substance abuse may also learn substance-abusing behavior.
- Co-occurring mental health disorder: Having a formal diagnosis of a mental health disorder increases the risk that one will also develop a substance use disorder. Also, having a first-degree relative with a history of a mental health disorder results in an increased risk of developing a substance use disorder or other disorder.
- Certain medical conditions: Individuals who have certain types of medical conditions that are associated with chronic pain or that produce other forms of distress are also at risk to develop substance use disorders.
- Other experiences: Individuals who are abandoned a young age, have experienced stressful events, perceive that they lack support from family and have few friends, are exposed to drug use at an early age, and/or experience peer pressure to use drugs are at an increased risk to develop substance use disorders.
Side Effects of Demerol Abuse
As a potent opioid narcotic, Demerol is considered to have a short onset and duration of action, around 3-4 hours, EBM Consult publishes. The DEA reports that meperidine is similar in action to morphine. Demerol binds to opioid receptors in the brain and interferes with the transport of dopamine and norepinephrine, both of which are involved in feelings of pleasure.
Meperidine also inhibits the reuptake of serotonin, and The Journal of Pediatric Pharmacology and Therapeutics (JPPT) warns that especially in individuals taking an MAOI (monoamine oxidase inhibitor) or an SSRI (selective serotonin reuptake inhibitor) medication, this may lead to the potentially life-threatening serotonin syndrome. Serotonin syndrome may cause seizures, diarrhea, fever, and severe confusion. Meperidine may have similar euphoric effects as cocaine. Due to its rapid onset of action, it may be more likely to be abused and lead to drug dependence than other opioids.
Another significant risk for using or abusing Demerol is how meperidine is metabolized into normeperidine, which takes much longer to be eliminated from the body – as long as 15-30 hours, EBM Consult explains. So, in short, when the pain-dulling and feel-good part of the drug stops working, and a person takes more, normeperidine can build up in the body and cause neurotoxicity, a form of brain damage that may be irreversible, per the clinical guidelines set forth by the Office of Veterans Affairs (VA).
The way a person abuses Demerol can lead to specific side effects too. For instance, someone who injects it may be at a high risk for contracting an infectious disease from the sharing of dirty needles. They may also suffer from collapsed veins, infections at the injection site, and scarring or “track marks.” Snorting and smoking Demerol can cause respiratory issues and lung infections. Snorting it can also damage the nasal and sinus cavities and cause chronic nosebleeds, while smoking Demerol may create a perpetual cough.
Other side effects of meperidine, as published by Mayo Clinic, may include:
- Impaired cognitive abilities
- Shallow breathing
- Weak pulse
- Hives or skin rash
- Muscle weakness
- Chest pain
- Blurred vision
- Irregular blood pressure and heart rate
- Shaking and tremors
- Stomach pain
- Fainting spells
- Feeling lightheaded
- Clammy, cold skin
- Pain surrounding, and difficulties with, urination
- Redness and swelling of the face
- Trouble swallowing
- Nausea and/or vomiting
- Sensitivity to light and sound
A more serious side effect to Demerol abuse and misuse is a potentially life-threatening overdose. Drug overdose occurs when the drug reaches toxic levels in the bloodstream, and the body can no longer metabolize it. Close to 70,000 people are estimated to die from an opioid overdose globally each year, the World Health Organization (WHO) reports.
Opioids like Demerol act as central nervous system depressants, which means they slow down some of the vital life functions necessary for survival like breathing, blood pressure, and heart rate. Most opioid overdose fatalities are likely caused by breathing issues, wherein an individual’s body “forgets” to breath. A Demerol overdose can be recognized by severe confusion and drowsiness; a bluish tinge to the lips, nails, and skin; and a significant change in alertness or awareness. It may lead to a loss of consciousness, coma, or even death.
When Demerol tablets are chewed, or crushed to be snorted, smoked, or injected, the entire dosage is sent straight into the bloodstream at once, which can increase the odds for an overdose. Similarly, mixing Demerol with other drugs or with alcohol can also increase the risk for overdose as well as heighten the other side effects. The Drug Abuse Warning Network (DAWN) reports that the misuse of opioid painkillers resulted in over 350,000 visits to emergency departments (EDs) in 2011.
Spotting Demerol Addiction
When a person uses a drug like Demerol for a significant length of time, they may become tolerant to regular amounts of the drug and need to increase the dosage in order for it to continue working. The US Food and Drug Administration (FDA) publishes warnings on the labels of Demerol that the medication can be habit-forming and therefore should only be used for short periods of time.
Regular use or abuse of the drug can create a physical dependence, which is indicated by withdrawal symptoms when Demerol stops being active in the bloodstream. Addiction is more than just physical dependence, however. It is considered a brain disease, as it impacts regions of the brain related to motivation, impulse control, memory, and reward processing. Brain circuitry is physically altered with perpetuated Demerol abuse, as the drug interacts with the production, transportation, and reabsorption of many of its neurotransmitters. Certain pathways in the brain may be disrupted and even rerouted as a result, causing a kind of shortcut to happiness. This means that a person may not be able to feel happiness or pleasure without the drug once these changes have been made. Drug cravings and an inability to control drug use may result.
Someone who battles addiction to Demerol has likely tried to stop taking the drug at least once, and when they do take the drug, they may end up taking more of it at time than they initially intended or use it for longer than they meant to. Most of their time and energy are probably spent trying to ascertain where to get it, using it, and then recovering from the drug’s effects. Individuals may “doctor shop,” or see multiple doctors in an effort to get Demerol prescriptions, or they may invent symptoms to get the drug.
Individuals may struggle financially due to Demerol addiction and may be less productive at work and/or school. Activities that were important before may not be anymore. Legal issues may also be an indicator of problematic drug abuse and/or addiction as an individual may be more likely to engage in risky or even criminal behavior as a result of attempting to sustain a drug habit or because they are under the influence of drugs. Addiction can impact virtually all aspects of a person’s life, changing behavior as well as physical appearance.
Demerol Withdrawal and Detox Options
When a person is physically dependent on an opioid drug such as Demerol, uncomfortable withdrawal symptoms can begin when the drug wears off. Typically, opioid withdrawal syndrome starts around 8-12 hours after the last dose, although since Demerol is a short-acting opioid, it may start sooner. Early withdrawal, as explained by NLM, includes symptoms like anxiety, agitation, muscle aches, excessive tearing, uncontrollable yawning, sweating, and insomnia. Withdrawal symptoms likely peak within 24-48 hours.
Later symptoms of withdrawal include chills, anxiety, nausea, vomiting, diarrhea, dilated pupils, and stomach cramps. Blood pressure, heart rate, body temperature, and respiration levels may all become elevated during Demerol withdrawal, as some of the autonomic functions of the nervous system that have been suppressed by the drug experience a rebound effect. Difficulties feeling pleasure and depression may be side effects of opioid withdrawal as well. In general, the bulk of opioid withdrawal typically lasts around 5-7 days, although some of the psychological symptoms may not dissipate fully for several weeks.
Demerol can cause some intense withdrawal symptoms if stopped suddenly if someone has become dependent on it after using the drug regularly for a period of time. Withdrawal’s duration and severity are influenced by how dependent on the drug a person may be. Someone who has been taking large amounts of it for a long time may be significantly dependent, for example. Any polydrug abuse and the method by which the drug is abused can also influence drug dependence. Family history of addiction, any co-occurring medical or mental health concerns, and environmental factors like high levels of stress or traumatic events can also impact drug dependence and therefore withdrawal. Since Demerol withdrawal can be so significant, it is not recommended to stop taking it “cold turkey.” Instead, medical detox is the safest method.
Medical detox can provide medical monitoring and mental health supervision around the clock as well as help to manage withdrawal symptoms. The side effects of withdrawal can be minimized with the help of medications during detox. Methadone and buprenorphine are commonly used during opioid detox to reduce drug cravings and the negative impact of withdrawal symptoms. They are both long-acting opioid drugs that fill opioid receptors at low doses to keep withdrawal symptoms from being as significant.
Methadone is taken once a day in a tablet form, and it is dispensed at federally regulated clinics. As a long-acting opioid, the drug stays in the system longer, and it can be slowly tapered off until opioids are completely out of the system. Buprenorphine is a partial opioid agonist; therefore, it does not create euphoric effects at the same levels as other opioids, but it still fills the receptors in the brain to keep withdrawal symptoms at bay.
As published by the Substance Abuse and Mental Health Services Administration (SAMHSA), the FDA approves both single action buprenorphine products (Subutex and generic transmucosal products) and combination products that also contain naloxone (Bunavail, Suboxone, and Zubsolv). Naloxone is an opioid antagonist that mostly remains dormant unless a person tries to inject or abuse other opioids while taking the combination product. If this occurs, it can induce withdrawal symptoms. Other medications that act on specific symptoms of withdrawal can be useful during Demerol medical detox as well.
Getting Help for Demerol Abuse and Addiction
Medical detox is often the first stage of a Demerol addiction treatment program, providing physical stability and management of withdrawal symptoms. After detox, an individual should enter directly into either a residential (inpatient) or outpatient treatment program. Inpatient drug abuse treatment programs generally provide the most comprehensive and highest levels of care, addressing both the physical and psychological aspects of addiction. NIDA reports that opioid addiction treatment that includes both pharmacological and behavioral methods is ideal.
A residential program can provide a structured environment wherein an individual is given the time to work solely on their recovery, allowing the brain and body time to heal and new habits time to form. Behavioral therapies teach new coping mechanisms for stress and how to better regulate emotions. Individual counseling and group therapy help individuals to recognize stressors and potential triggers for relapse, as well as build self-reliance and other new life skills.
Any potential co-occurring mental health disorders, medical conditions, or polydrug abuse can be cared for in an integrated fashion during residential drug addiction treatment programs. Aftercare services, support groups, and relapse prevention techniques are all important aspects of a comprehensive drug abuse treatment model, and individuals may be able to move seamlessly through the differing levels of care as needs change and evolve.
Thorough assessments and evaluations are performed upon admission and throughout treatment in order to ensure that progress is made, and individuals are receiving exactly the right type of care. Complete treatment programs provide multiple benefits, amenities, and services in order to promote a long and healthy recovery.