Tag Archives: Drug

Role of Intravenous N-acetylcysteine (NAC) for Addiction Therapy

Role of Intravenous N-acetylcysteine for Addiction Therapy

Drug addiction is a vice that many people are fighting with today. In fact the world’s economy has been seriously affected by drug addiction due to the huge amounts of money that many governments and organizations spend in rehabs to help those who are fighting addiction. Addiction recovery has never been an easy procedure. It takes time and resources and most importantly the input of the addict matters a lot. Doctors have been involved in research in the past to try and come up with better ways of help addiction patients through addiction recovery. However, in most cases addicts are treated by using medication detoxification drugs which are chemically similar to the chemical being removed from the body. The patient is given this substance to manage the severity of withdrawal symptoms.

In most cases the substitutes for the chemical used is either Librium or Valium. These drugs are used because they can calm the nervous system. When using these drugs the dose is gradually reduced as symptoms subside. The drugs however do have a half-life for several days after the course is completed. During this process the patient can still experience severe discomfort with tremors, nausea, vomiting, and occasionally even delirium tremens (DTs). These are just some of the disadvantages of using advent pharmaceuticals in fighting addiction in patients besides medical detoxification in drug addiction patients take longer than the IV N-acetylcysteine therapy because the addicted person has also to withdraw from the substitute drug. The fight against addiction from a substance may get complicated when the patient become dependent on the substitute drug.

Intravenous N-acetylcysteine

What is NAC?

NAC or N-acetylcysteine is an acetylized version of the natural amino-acid cysteine that is a precursor to Glutamate, which affects the Glutamate system and is responsible for learning, memory, motivation and cognition. Though still unknown to many patients as an effective medicine in treatment of addicts, N-acetylcysteine has been used by many doctors in treatment of various diseases. This may be because it has psychiatric effects on the glutamate, dopamine and NMDA brain systems.

Effects of NAC on glutamate system

NAC is the most sought after type of Cysteine. N-acetylcysteine works in various ways to help in treating addiction, thanks to its effects on the glutamate system. When the level of N-acetylcysteine is altered it will not only have an effect on oxidative balance but will also modulate neuro-transmitter pathways, including glutamate and dopamine. NAC assists in the regulation of neuronal intra- and extracellular exchange of glutamate through the cysteine–glutamate antiporter. Whereas this antiporter is abundant throughout all cell types, in the brain it is preferentially located on glial cells. The dimer, cysteine, is taken up by astrocytes and exchanged for glutamate, which is released into the extracellular space. This free glutamate appears to stimulate inhibitory metabotropic glutamate receptors on glutamatergic nerve terminals and thereby reduce the synaptic release of glutamate. Given that relation, the amount of N-acetylcysteine in the system as well as the feedback via glutathione (GSH) production by neurons may directly regulate the amount of glutamate present in the extracellular space. Furthermore, GSH itself has been shown to potentiate brain N-methyl-d-aspartate receptor response to glutamate in rats. Changes in the levels of neuronal GSH may not only alter available glutamate levels, but also have direct consequences on glutamatergic function.

Research study on effectiveness of NAC in treatment of addiction

Intravenous N-acetylcysteineA research study done by Steven D. LaRowe, PhD, Pascale Mardikian, MD, Robert Malcolm, MD, Hugh Myrick, MD, Peter Kalivas, PhD, Krista McFarland, PhD, Michael Saladin, PhD, Aimee McRae, PharmD, and Kathleen Brady to investigate  the Safety and Tolerability of N-Acetylcysteine in Cocaine-Dependent Individuals, It was found that N-acetylcysteine (NAC) was safe and well tolerated in thirteen non-treatment-seeking cocaine-dependent adults. The report also showed that the side effects were rather mild. Despite the mild side effects of N-acetylcysteine, it’s effective in treatment of addiction as these mild side effects shown by those patients who were put on NAC therapy did not differ significantly with the side effects that were exhibited by the patients who were on placebo.

For this study; six males and seven females aged between 23 and 45 were used. Of the 13 participants, nine were of African-American origin while four were Caucasian, who met DSM-IV criteria for cocaine dependence but were non-treatment seeking. Of those subjects, eight were primarily crack smokers; two primarily used nasal powder, while the remaining subjects used a mixture of crack, powder, and freebase cocaine. Self-report accounts of cocaine use for the ninety days prior to study participation indicated that subjects used forty out of the ninety days on average or about 44% of the time, spending a daily average of $30 on the drugs. Subjects were recruited flyers, newspaper ads, and word-of-mouth. These research findings pointed out at the effectiveness of N-acetylcysteine in addiction treatment.  This study however was done on a smaller scope but its results may lay a great foundation for further research studies that might be done on this subject.

Finally, Drug Addiction is a vice that should be fought by all means that is why we at AWAREmed Health and Wellness Resource Center are committed to availing help to addicts and offering them a place to call home. It does not matter what kind of addiction you are wrestling with right now, just call on Dr. Dalal Akoury (MD) today and begin your journey to victory against addiction.

Role of Intravenous N-acetylcysteine for Addiction Therapy



It’s A Doctor’s Responsibility: Addiction Treatment

Life Time Risk of Imprisonment If Not Treated

The very existence of the medicine profession is to help find solution to patients who are suffering from various diseases. However in most situations the patients will have to pay for the services offered by the doctor. This is no crime; every profession exists so that those who specialize in those professions can make a living after offering their service. With this said it is good to note that there are times when a patient may need an emergent medical attention but may not be able to pay. During these times the patient should be able to be treated even if the doctor knows that he won’t pay. It is a responsibility of every doctor to tend his services to a patient who needs emergency care even without pay failure to which he will be imprisoned for failing to save a life that would have been saved had he offered his services to the patient on the right time.  Doctors know this and so they strive to give help when these situations pop up.

In medical laws any patient who needs an emergency response has a right to be treated and even a drug addict who is at the verge of losing his life as a result of addiction, withdrawal effects or drug overdose is termed an emergency case and so should be treated just like any other person who might have required a medical emergency from any unfortunate happening like road accident. Any person has a right to treatment at the times of emergency since without treatment the person may become disabled or may die.

Addiction treatment

Both public and private hospitals have a duty to administer medical care to a person experiencing an emergency. It is therefore in every doctor’s domain to treat a patient that needs emergency response failure to which he shall be legally responsible for the death of the patient.

If a hospital hasemergency facilities, it is legally required to provide appropriate treatment to a person experiencing an emergency. If the hospital is unableto provide emergency services, it must provide a referral for approriate treatment. Hospitals cannot refuse to treat prospective patient’s onthe basis of race, religion, or national origin, or refuse to treat someone with HIV or AIDS.

Emergency Medical Treatment and Active Labor Act 

In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C.A. § 1395dd), which establishedcriteria for emergency services and criteria for safe transfer of patients between hospitals. This statute was designed to prevent transferring an undesirable patient to another facility.The law applies to all hospitals receiving federal funds, such asMedicare. The law requires hospitals to provide a screening exam to determine if an emergency condition exists, providestabilizing treatment to any emergency patient or to any woman in active labor before transfer, and continue treatment until a patient can bedischarged or transferred without harm. It also delineates strict guidelines for the transfer of a patient who cannot be stabilized. A hospitalthat negligently or knowingly and willfully violates any of these provisions can be terminated or suspended from Medicare.The physician,the hospital, or both can also be penalized up to $50,000 for each knowing violation of thelaw.

Addiction TreatmentAny patient who needs emergency attention should receive it since if it is delayed there might be a loss of life. Therefore if a doctor is asked to attend to a medical emergency as defined in this statement, he must respond. This is both an ethical and legal obligation and therefore every doctor should abide. However rare there will be times when attending a medical emergency is impossible or unsafe for the doctor or patient. If a doctor chooses not to attend he or she may be required to defend that decision in the event of a charge of professional misconduct or criminal prosecution. The patient who needs medical attention is therefore catered for and should not be ignored.

A doctor is at risk of being professionally or criminally responsible of the death of a patient if he or she fails to render prompt and appropriate medical care to any person whether the patient is a current patient has just came in, in a medical emergency. A doctor who chooses not to attend must have good reason and be able to defend this position at a later time otherwise he will be charged in a court of law for medical negligence.

However there are situations when a doctor, may or should not attend a medical emergency. These scenarios may include;

  • if he or she is already attending another emergency
  • if it is more appropriate for an emergency service to attend (i.e. ambulance or rescue helicopter);
  • the geographical location of the doctor is such that another doctor or medical service can attend more promptly;
  • if he or she is off duty at the time of the call and has been drinking alcohol or taken medication or other substances to a level that may adversely influence the doctor’s level of competence;
  • If attending the emergency places the personal safety of the doctor at risk.
  • The doctor may also not attend to the patient if he is not in the right state of health himself or when he knows he is not competent enough to help the patient.

However a doctor should be able to take good care of the patient even if he is not able to offer any reasonable help to the patient. He should be able to assist the patient to access another health center where he can be helped. If a doctor fails to attend to emergency because of matters of inconvenience he will be charged and prosecuted.

Addicts just like anyone else have rights to emergency attention that is why we at AWAREmed Health and Wellness Resource Center are committed to availing help to patients by availing the needed information and offering them a place to call home. Just call on Dr. Dalal Akoury (MD) today and begin your journey to victory against addiction.

Life Time Risk of Imprisonment If Not Treated



Heroin Use on the Rise despite Its High Cost of Treatment

 Heroin on the Rise despite its High Cost of Treatment

Contrary to the common rule of demand and supply that the use of a product will be high when its price is at the lowest, heroin use has been on the rise in spite of the rise in its cost as well as the cost of treating those who are addicted to the drug.

To begin with, heroin is a highly addictive drug which is also illegal. Heroine is one of the drugs that are not very easy to stop using, thanks to its highly addictive nature and to its adverse withdrawal symptoms. Millions of those using heroine are too scared of its withdrawal effects to even attempt quitting it.  Heroin is made from the resin of poppy plants. Milky, sap-like opium is first removed from the pod of the poppy flower. This opium is refined to make morphine after further refined into different forms of heroin.

Being that the drug is mostly injected; those using this drug do not face its withdrawal side effects but also has high risks of acquiring other diseases that can be transmitted through sharing needles like HIV/AIDS.

How much do Heroin addicts spend on it heroin?

Heroine is one of the rare commodities whose increase in price do not interfere with its consumption. This drug is just as expensive as cocaine as or even slightly more than cocaine in other places but still people use it more in some places than even cocaine. Therefore, there must be some other reasons why people are turning to the use of heroine as opposed to other drugs. The factors that drive people to use of cocaine may not be new and we will explore them in this article. However, there is more than one way to look at the cost of heroine. Some people opine that the cost of heroine just like other goods and services depends on demand and supply and this may be true so it is better to stay away from using this drug even when it is being sold at a throw away price since you may not afford it later when you are now dependent on it. It is quite funny that when it comes to addictive drugs you will be able to access them for free from addicts who are ready to share them with you but when you have become dependent you shall have to find your own ways of getting your daily heroin.


There are some hidden costs of using heroin that most people do not even think of. Most people will only be wary of the price of acquiring their daily heroin dosages for their recreational use but they give a blind eye to the real cost that arises when you need to be cured from the side effects of this drug.  A 2000 survey by the U.S. Government found that the cost of heroin addiction to our country may be anywhere from $15 billion to $20 billion dollars per year. Most of this tremendous figure is due to the price tag on treating medical conditions associated with IV heroin use – specifically, HIV/AIDS and hepatitis. The use of heroin has another hidden cost– the societal ills cost. This is the cost that you and I pay when these addicts turn to crime just in a bid to find   money to buy their much needed heroine doses daily.

The cost of getting your daily dosage of heroin to fulfill your craving cannot be compared to the cost of treating all the ills that come with using the drug. The sad truth however is, most people who are using heroin cannot afford to cater for the cost to treat the side effects that come with it. The cost of treating a heroin addict is too expensive to be compared to the mere cost of obtaining a daily dosage no matter how long you are top use the drug before you seek medical attention.

Some of the side effects of heroin

Heroine is often used mainly because of the euphoria that sets in immediately it is used but afterwards a feeling of drowsiness sets in. Just like other drugs of abuse, heroin has myriads of side effects. These may include;

  • Shortness of breath
  • Dry mouth
  • Constricted (small) pupils
  • Sudden changes in behavior or actions
  • Disorientation
  • Cycles of hyper alertness followed by suddenly nodding off
  • Droopy appearance, as if extremities are heavy

Another serious problem with heroine is because of the way it is taken. Mostly heroin is injected. Unfortunately these needles are often shared increasing the spread of such diseases as HIV/AIDS and hepatitis among other diseases. Dependence on heroin is also dangerous.

Heroin overdose is dangerous

heroinOne of the serious problems that will arise in case of heroin overdose is death. Does that sound scary? Even as scary as it sounds many people still indulge in using heroin for mere recreational purposes. However there are measures that are put in place to treat heroin overdose.  Methadone (Dolophine, Methadose) and buprenorphine among other drugs are today used for treatment of heroin overdose. These drugs block the opioid receptors in the brain hence stops the effects of the heroin. However the use of these drugs is highly regulated in different states and hence may not be very accessible to a street user of heroin.

Finally, you need more information to stay away from dependence on heroin and other drugs as these have crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain or any type of addiction as well as other diseases.

 Heroin on the Rise despite its High Cost of Treatment



NAC, the Cystine-Glutamate Antiporter and Addiction

NAC, the Cystine-Glutamate Antiporter and Addiction

Addiction is one complex problem faced by many. There is no limit to how many things people can get addicted to. If you cannot go a day without watching a movie, and then it gets to a point when you must slot in a couple of hours in your daily schedule to watch movies then that is your addiction.

If you keep getting those cravings for soda or sugary meals, you try to stay without them but the urge is so much that you only calm down after satisfying that thirst then that is an addiction.

Addiction can be good or bad. You can be addicted to work, you love your work that you can’t spend time away from your job. That is addiction. Such positive addictions too may be unhealthy. If you are addicted to work for instance, you will hardly spare time for other essential activities, such as being with your family.

Other forms of addiction often associated with the term, such as drug and substance abuse are detrimental to your health. A person who is addicted to alcohol for instance cannot live without it. Their lives often revolve around the liquor. The same applies to coke, cigarettes, marijuana and all other recreational drugs. The substance of addiction gets to dictate how you live your life.

the Cystine-Glutamate Antiporter

Facts about addiction

The habit is a problem. You have to first admit it in order to be able to get over it. An addict who finds it difficult to get over the problem may often be tempted to blame it on someone, or something else. But that is not a solution, acceptance is key.

Giving in to one’s yearnings is a matter of choice. At the beginning of any addiction you often see yourself in control of the situation. You are not forced to do anything, you just do it because you enjoy the act. With time though, this control diminishes and you become increasingly more vulnerable to the substance of your addiction.

You are in a position to drop your addictions by saying ‘no’ to the substance. This is the premise under which psychosocial support for addiction recovery is usually built. Through guidance one is offered a way out of their drug or substance habit. At such point, it is upon you to decide whether or not you are going to adopt a clean lifestyle.


NAC and Addiction

N-Acetyl L-Cysteine is a chemically changed version of the non-essential amino acids in the body. NAC works by purifying your body by removing harmful toxins. It is highly essential in recovery from drug addiction. alcohol and other drugs commonly abused cause a lot of damage to the liver, lungs, kidneys and other organs and this is likely to result in chronic ailments that are life threatening.  This amino acid is essential as it protects cells from getting damaged in addition to its role in preserving functions of the liver.

It is a known precursor to Glutathione which is the most effective in destroying free radicals. The amino acid works to protect the brain and the liver from damages caused by toxins like alcohol, acidic mater, particles found in the air and cigarettes smoke. It also has other significant functions that are key to the wellbeing of an individual.

Among them, it helps the body to promote its burning of fat and aids the muscle building process. Studies also indicate that it can rid the body of copper by a chelating effect, and is used in the treatment of particular diseases including bronchitis, emphysema and certain respiratory problems among adults.

NAC plays a key role in the production of white blood cells necessary for body immunity. The white cells fight diseases that attack the body and help boost the natural immune response of the body. As such, the amino acid is essential for the defense of the body against disease attack.  It further helps in insulin metabolism and functions, which is key to the body’s blood sugar regulation.

the Cystine-Glutamate Antiporter

Sources of NAC

N-Acetyl L-Cysteine can always be naturally manufactured by the body on its own. The high-protein foods such as eggs and meat are however potent dietary sources of this amino acid. Other good sources include foods such as broccoli, garlic, wheat, onions and red peppers.

Other sources that can be recommended for this important amino acid for those who are recovering from the damage caused by drug addiction include nutritional supplements found in a number of nutrition outlets in different continents. It is however important to seek recommendations form a physician since this product is largely unregulated and health consumers are likely to purchase a product that contains incorrect amount of ingredients recommended for the particular patient.

NAC, the Cystine-Glutamate Antiporter and Addiction



Intoxication, Reward and Tolerance

Neurobiology of Intoxication, Reward and Tolerance

RewardAs stated earlier, neurobiology is the study of cells of the nervous system and how these cells are organized of these cells into functional circuits that process information and influence behavior. Neurobiology is a sub unit of both biology and neuroscience. Neuroscience is much broader as a scientific study of the nervous system than neurobiology. Neurobiology helps us to understand how the neurons are affected by whatever we ingest. The neurons as you and me now know are very crucial as they are the chemical messengers that transmit signals to initiate certain crucial responses. However these neurons are often affected by drugs of abuse that in most cases depletes them rendering them incapable to function normally. As studied earlier in our brain there are different neurotransmitters that perform different purposes to ensure that all functions of the brain are well attended to. There are inhibitory neurotransmitters as well as excitatory neurotransmitters and the balance between these neurotransmitters must be achieved for better functioning of the brain but these drugs of abuse interferes with these balance by causing depletion of certain neurotransmitters creating an imbalance between the different categories of the neurotransmitters in the brain. In this article we try to find out how intoxication, reward and tolerance come about to users of alcohol and other drugs.


According to World Health Organization (WHO) intoxication is a condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgment, affect, or behavior, or other psychophysiological functions and responses. The disturbances are related to the acute pharmacological effects of, and learned responses to, the substance and resolve with time, with complete recovery, except where tissue damage or other complications have arisen. They further explain that the term intoxication is a term that is commonly used in alcoholism and is the same in meaning to the common term drunkenness. Alcohol intoxication manifests in such symptoms as slurred speech, unsteady gait, disorderly conduct, impaired judgment, slowed reactions, loss of memory, vomiting, euphoria and insensibility among others. Alcohol has contents of ethanol among other fermented stuff. When taken ethanol will produce its depressive effects on certain areas of the brain resulting in physical and mental impairments. These problems will continue as the level of alcohol consumption is increased, therefore more alcohol means more intoxication.

Here is what happens in the brain

When alcohol is taken it increases the effect of the body’s naturally occurring neurotransmitter gamma amino butyric acid (GABA). As I mentioned earlier neurotransmitters are substances that chemically connect the signals from one nerve to the next allowing a signal to flow along a neural pathway. An inhibitory neurotransmitter (alcohol) reduces this signal flow in the brain. This explains how alcohol depresses both a person’s mental and physical activities. When you take alcohol 20% of ethanol will be absorbed into the bloodstream from the stomach while 80% is absorbed from the small intestines. However the more the ethanol stays in the stomach the slower it is absorbed into the bloodstream and the lower the peak in blood alcohol concentration. This is why when a person takes alcohol with empty stomach he will be intoxicated within such a short time. The food in the stomach normally slows the rate of alcohol absorption lowering the peak in blood alcohol concentration.

The reward system

The reward system is mainly dominated by the excitatory neurotransmitter known as dopamine. This hormone gives the brain its ‘high’, the euphoric feelings that is commonly sought by people who use drugs of recreation. Close to all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who use drugs and teaches them to repeat the behavior. The persistent release of dopamine during chronic drug use progressively recruits limbic brain regions and the prefrontal cortex, embedding drug cues into the amygdala through glutaminergic mechanisms and involving the amygdala, anterior cingulate, orbitofrontal cortex, and dorsolateral prefrontal cortex in the obsessive craving for drugs Despite dopamine being the dominant neurotransmitter in the reward system there are also other neurotransmitters that work to modulate both the reward system and the psychomotor effects of addictive drugs. However there is still little literature to support this and so dopaminergic system is still the biggest consideration when reward system is to be tamed. Naturally the balance between the excitatory neurotransmitter and the inhibitory neurotransmitters enables proper functioning of the brain but with drugs the drugs will suppress the inhibitory neurotransmitters flooding the brain with dopamine which is the fuel behind reward.

RewardUnderstanding tolerance

Tolerance refers to a situation when a person ceases to react to a drug in initial doses and therefore higher dosage is needed for the effects to be achieved. This normally happens when a person has been using the drugs for a long time. This is common in the use of opioids in pain management, the patient will cease to respond to initial dosages and therefore need higher dosages to calm the pain. For example, morphine is often used for pain. It works by binding to opiate receptors where it triggers the inhibition of an enzyme called adenylate cyclase that orchestrates several chemicals in the cell to maintain the firing of impulses. After repeated activation of the opiate receptor by morphine, the enzyme adapts so that the morphine can no longer cause changes in cell firing. Therefore higher dosages will have to be administered for the pain to be calmed.

Finally, Dr. Dalal Akoury (MD) of AWAREmed Health and Wellness Resource Center is committed to helping all people trapped in drug addiction. Call on her today at Myrtle Beach, South Carolina for help.

Neurobiology of Intoxication, Reward and Tolerance