Terminology Matters: Patient Understanding of “Opioids” and “Narcotics”

Background: The terms “opioid” and “narcotic” are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding “narcotics” vs. “opioids.” Methods: A convenience sample of English‐speaking women (n = 188), aged 21–45 years, seeking care at a primary care clinic were asked (1) “What is an opioid/narcotic?” (2) “Give an example of an opioid/narcotic?” (3) “Why does someone take an opioid/narcotic?” and (4) “What happens when someone takes an opioid/narcotic for a long time?” Responses were recorded verbatim by a research assistant and then coded independently by two investigators. Results: More than half of respondents (55.9%) responded “don’t know” to all 4 opioid questions, while just 3.2% responded “don’t know” to all 4 narcotic questions (P < 0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two‐thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long‐term narcotic use (63.2%). Conclusions: While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.     

“Designer drugs” — A current perspective

Since the late 1970s, in an effort to quench the ever burgeoning appetite for pharmacological substances of abuse and to satiate their own need for profit, unscrupulous chemists have set up clandestine laboratories to produce and market new drugs for street sale. Using fairly common industrial chemicals, they have altered or modified preexisting controlled substances such as fentanyl, meperidine, mescaline, amphetamine, and phencyclidine, producing derivatives of these parent compounds that, up until 1986, were able to temporarily elude the guidelines of the Federal Controlled Substances Act due to their new and unique chemical structures. Unsuspecting users continue to use the drugs recreationally. This article will present a comprehensive review of these “Designer Drugs” looking at historical data, pharmacokinetics, treatment, abuse trends, and some of the more recent additions to the social pharmacopoeia.     

From “first” to “last” steps in life – Pressure patterns of three generations

Background

The human foot has to bear loads during all kinds of bipedal locomotion throughout the whole life. Rapid developmental changes of foot morphology and foot function occur during the first years of walking. Furthermore, disease dependent modifications can also have an influence on plantar loading. Therefore, it is reasonable to assume that foot function will undergo changes in life. However, the main differences between the pressure patterns in young and elderly have not been well described. The aim of the study was to evaluate age-dependent pressure patterns in different age-related stages.

Methods

Hundred and four healthy humans of four different age groups were retrospectively analysed by means of plantar pressure measurements (toddlers: mean age 1.0 (SD 0.2) year; 7-year olds: 7.0 (SD 0.4) years; adults: 31.9 (SD 2.1) years; seniors: 68.7 (SD 3.2) years). The emed^® pressure platform was used to evaluate peak pressure, maximum force, contact time, contact area and arch index.

Findings

Significant differences were found for each parameter between almost every age group. The highest peak pressure values were observed for the seniors’ (P < 0.001). Peak pressures are low in toddlers (145 kPa), high in 7-year olds and adults (400–600 kPa) and even higher in elderly (?800 kPa).

Interpretation

Elderly adults can still be functionally mobile even if pressures are high. The results for the investigated age groups can be used as normative foot loading data to compare to pathological foot function.     

Snapshot quiz – “Tattoo of Scheepers”

An ink marker at the descending part of the gastrojejunostomy or duodenojejunostomy after a pancreaticoduodenectomy or pylorus‐preserving pancreaticoduodenectomy prevents a misplacing of a postoperative endoscopic intervention.     

“Outside‐In” vs “Inside‐Out”: Revisiting Migraine's Vascular Hypothesis

The neurovascular contribution to migraine biogenesis should not be overlooked in the rush to embrace a central “generator.”