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The incidence of neonatal abstinence syndrome (NAS) has increased dramatically during the past 15 years, likely due to an increase in antepartum maternal opiate use. Optimal care of these patients is still controversial because of the available published literature lacking sufficient sample size, placebo control, and comparative pharmacologic trials. Primary treatment for NAS consists of opioid replacement therapy with either morphine or methadone. Paregoric and tincture of opium have been abandoned because of relative safety concerns. Buprenorphine is emerging as a treatment option with promising initial experience. Adjunctive agents should be considered for infants failing treatment with opioid monotherapy. Traditionally, phenobarbital has been used as adjunctive therapy; however, results of clonidine as adjunctive therapy for NAS appear to be beneficial. Future directions for research in NAS should include validating a simplified scoring tool, conducting comparative studies, exploring home management options, and optimizing management through pharmacogenomics.

Although a statement on Neonatal Drug Withdrawal was published in 1998 by the American Academy of Pediatrics, pharmacologic management of neonatal abstinence syndrome (NAS) remains a challenge. Published clinical trials are limited, restricting treatment decision making to practitioner's experience and preference rather than evidence-based medicine. To optimize withdrawal symptom prevention, drug selection is often based on the offending agent (opioids versus polysubstance exposure), clinical presentation, mechanism of action (agonist versus partial agonist/antagonist, receptor effects), pharmacokinetic parameters and available drug formulations. This review addresses risk factors and pathophysiology of NAS, summarizes parameters of common drugs used for the management of NAS, and reviews published literature of standard therapies as well as newer agents. Based on the current literature, paregoric is no longer recommended and oral morphine solutions remain the mainstay of therapy for opiate withdrawal. Other potential therapies include methadone, buprenorphine, phenobarbital and clonidine with the latter two agents as adjunctive therapies.

Paregoric elixir is a phytomedicinal product which is used widely as an analgesic, antispasmodic and antidiarrheal agent. Here, we investigated the pharmacological actions and some of the mechanisms of action of paregoric elixir and compared its action with some of its components, the alkaloids morphine and papaverine. The paregoric elixir given orally to mice did not present relevant toxic effects, even when administered in doses up to 2000-fold higher than those used clinically. However, it showed an antinociceptive action that was more potent, but less efficacious, than morphine. In contrast to morphine, its effect was not dose-dependent and not reversed by the non-selective opioid antagonist naloxone. Moreover, paregoric elixir produced tolerance, but did not cause cross-tolerance, with the antinociceptive actions of morphine. When assessed in the gastrointestinal motility in vivo, paregoric elixir elicited graduated reduction of gastrointestinal transit. Finally, like morphine and papaverine, paregoric elixir concentration-dependently inhibited electrically-induced contraction of the guinea pig isolated ileum. In vivo and in vitro gastrointestinal actions of paregoric elixir were not reversed by naloxone. Collectively, the present findings lead us to suggest that the pharmacological actions produced by paregoric elixir are probably due to a synergic action of its constituents.

Chronic pain (CP) is a very common problem in elders, due to bodily degenerations, worldwide. Studies carried out in various countries have shown that CP is associated with the elders’ quality of life, significantly limiting their activities and hampering them to maintain an independence lifestyle. What’s worse, elderly suffering from CP mostly also experience mental problems. Yet, there have been only a few such research done and reported on this topic, concerning the elderly ethnic montagnards in the rural southwest Guangxi of China. This study aimed to explore the statement and self-management of rural dwelling elders with CP. First, cross-sectional surveys were conducted and then interviews were carried out. 150 elder people experiencing CP -- pain suffered at least 4 to 5 days a week during the past 3 months, according to the criteria of the international Association for the study of Pain (IASP) -- were enrolled in this study by convenience sampling. They were asked to fill in 3 questionnaires; the first related to participants’ mental status, the second related to participants’ perception of pain intensity, and the third related to pain’s impact on participants’ daily life. Following the completion of questionnaires, individual interviews were conducted, with the help of some students who are fluent in local native languages as well as in Chinese. The results show that CP significantly affected participants’ quality of life. The prevalence of suffering from multifocal CP was 90%. In the management of CP, 64% people mainly relied on paregoric means; a wide range self-management techniques were mentioned such as hot compress application for which some plant material was used, collected from the surrounding environment; only a few people went to seek professional treatment. Moreover, most of them said that they had reconciled to the pain or consider it as part of their fate. Encourage older people to seek different ways to manage their pain, not just traditional but complementary and professional approaches. In such severely lacking professional high-level medical resource environment, the elder people should change their cognition of CP and choose pertinence approaches and instruments based on their own condition.

Several social or recreational drugs singly or together have demonstrated effects on the fetus and neonate, with those effects extending into adulthood. The use of recreational drugs during pregnancy remains a major health problem, with adverse effects including higher rates of fetal distress and demise, lower Apgar scores, growth retardation, and adverse neurodevelopmental outcome. Ethanol has the most profound effects, with physical stigmata of the drug seen in one third of exposed infants. In children without the affected physical appearance, profound neurodevelopmental sequelae have been demonstrated. Other drugs, such as cocaine, heroin, amphetamines, and nicotine, have been associated with impaired fetal growth and acute withdrawal during the neonatal period. Subsequently, these infants and children have an increased risk for altered neurodevelopment and long-term health status. Long-term follow-up and assessment are essential. The risk of neonatal withdrawal or abstinence syndrome is greatest with narcotic drugs but has been found to occur in neonates following exposure to cocaine, nicotine, and amphetamines. Early treatment with tincture of opium, paregoric, or phenobarbital is crucial. Assessment of the overall health status of the infant should include growth parameters, signs and symptoms of infection (especially hepatitis, syphilis, and immunodeficiency viruses), and neurobehavioral function. Such assessments should not be limited to the newborn period, as neurodevelopmental sequelae may not be manifest until later in infancy and childhood. In addition, evaluation of the social milieu is warranted because of the increased risk for neglect and abuse of drug-exposed infants and children. Early intervention, maternal drug rehabilitation treatment, and parenting classes are frequently prescribed, but their efficacy is variable. Further investigations should study the potential benefits of these recommendations.

Drugs and sexual function are intimately linked, and drug history and sexual history are essential components of psychosocial assessments. Obtaining a history of drug use, however, can be as complex as eliciting a sexual history. The complexity stems in part from associated taboos and the stigmatization of drug users across cultures. Drugs can be used ritualistically as part of sexual activity, perpetuating sexual taboos. Psychoactive substance use can be defensive in persons with preexisting sexual dysfunction or co-morbid mental disorders. Drug use can also generate or worsen sexual dysfunction. Psychoactive drugs are believed to have aphrodisiacal properties. They have been used as an instrument in religious practices and as a way to lift the taboos associated with sex and aggression. Descriptions of the behavioral effects of psychoactive drugs can be dated to 4000 B.c. Ethanol, opium, and derivatives of the Erythroxylum coca and Cannabis sativa plants are among the oldest psychoactive drugs known to man. As noted by Musto [1], opium was one of the earliest drugs imported to North America. The distribution of laudanum and paregoric, alcohol extracts of crude opium, became widespread. Morphine, a naturally occurring alkaloid, was isolated from Papaver somniferum, the opium poppy plant, in 1806. Codeine was isolated in 1832 and was marketed as a cough suppressant Heroin, or diacetylmorphine, was synthesized in 1898. At the

Objective: To systematically and critically analyse and summarise the published evidence for the rational choice of pharmacologic treatment of the neonatal abstinence syndrome (NAS), a frequently observed condition in neonates born to mothers who are dependent on physically addicting drugs. Design: Studies comparing different pharmacological agents for the treatment of NAS were identified utilising MEDLINE® and additionally the references cited in pertinent articles. The identified studies were critically analysed regarding their study designs and outcome measures. The reported data for the comparative efficacy of the drugs were summarised and evaluated. Results: Fourteen studies were identified, most of them comparing treatment of NAS with phenobarbital, paregoric or diazepam. However, none of these studies was conducted in a double-blind fashion. Frequently, treatment allocations were not properly randomised. Prenatal drug exposure varied and was often not sufficiently verified. Outcome measures and their evaluations differed widely. Due to the different study objectives and flaws in study design, a combined analysis of the published data in the form of a meta-analysis was not deemed possible. When attempting to compare efficacy, diazepam appears to be less efficacious in treating NAS than phenobarbital or paregoric. The relative efficacy of paregoric and phenobarbital appears to depend upon the antenatal exposure of the neonate and on the outcome measure of the study. Only two studies evaluate the efficacy of pure opioids, none of them in direct comparison to paregoric. It remains questionable whether paregoric, which contains the central stimulant camphor and a large amount of alcohol, should be the opioid of choice for the treatment of NAS. Conclusion: Most published studies were conducted prior to the development of clinical epidemiology and modern study design and thus yielded only very limited comparative data on the benefits of different treatment protocols. There is very little evidence regarding the efficacy of different pharmacological therapy regimens to treat NAS. More studies are required to produce the evidence needed to allow a rational choice between treatment modalities of NAS and thus to ensure optimal care of the neonates suffering from this condition.

The hypertonicity of liquid medications must be evaluated in conjunction with the required dosage volume. Some medications require a minimal dosing volume and can be adequately diluted in gastric fluids or tube-flush volumes to a tolerable osmotic load. Other medications such as diphenoxylate, loperamide, and paregoric have a pharmacologic influence on motility and can be administered undiluted into the small bowel. Still others can require dilution to a final volume of 4 to 10 oz to reduce osmolality to a level tolerable by the GI tract. Bolus administration of a large volume of medication is impractical for many patients, especially if it must be administered three or four times a day. For these patients, an alternate route of drug administration is often preferable. In some instances, the IV route is most appropriate. In others, crushing the appropriate oral form, mixing it in a slurry with a suitable diluent, and administering the slurry through the feeding or NG tube can be an acceptable alternative. Regardless of the method of drug delivery, one must be cognizant of the limitations of the administration strategy, the potential for complications that can result from the administration of a medication by the enteral route, and alternative means of medication administration, should complications ensue. A vast number of pharmaceutical products are marketed in a wide array of dosage forms. For these reasons, a pharmacist or other knowledgeable healthcare provider should be consulted for information regarding product availability, bioavailability, compatibility, and potential for drug-nutrient interactions when drugs are given in conjunction with enteral feeding.

Americans have something to learn from our extensive consumption of opium, heroin, and cocaine, that oc curred before World War I. Forgetting this era, we commonly act as if the heroin "epidemic" of the 1960s or the current cocaine "epidemic" is a new phenomenon in the United States. Some of us assume that the widespread use of a drug implies that legalization or "decriminalization" is the only reasonable response. The history of legislative con= trol in the United States suggests that other courses may be effective and that alternatives to legalization ap pear to have reduced opiate and co caine consumption in the United States earlier in this century. In spite of a heavy national addiction rate in 1920, the United States did reduce its number of addicts to a relatively small number. Clearly the social and legal factors affecting drug use are complex. There is no single influ ence that determines a particular level of drug use and abuse. Legislative control over dangerous drugs may be dated from attempts in the nineteenth century to prevent acute poi soning by certain substances that might be purchased in ignorance of their lethal po tential or might be too easily available to the suicidal. Opium was sold in a crude form containing about 10 percent mor phine, as well as in concoctions derived from crude opium: paregoric, laudanum, and a solution in acetic acid known as "black drop." Morphine had been isolated from opium in the first decade of nine teenth century. Consumption of opium in the United States rose steadily before and after the Civil War. Before the war, such prominent and progressive physicians as Oliver Wendall Holmes had complained about "opium drunkards." In the second half of the century, many more physicians, as well as the general public, widely deplored

The authors found that the course and treatment of narcotic withdrawal in two neonates was complicated by prenatal exposure to high doses of diazepam, or Valium (Roche Laboratories, Nutley, NJ). Both of the mothers were on methadone maintenance for narcotic dependency prior to the diagnosis of pregnancy. The authors documented maternal intake of diazepam in the range of 40-60 mg/day for a duration of 4-27 weeks prior to delivery. Both infants initially responded well to medical therapy for narcotic withdrawal, but at 7-14 days of age, withdrawal symptoms intensified, requiring an increase in the dosages of Paregoric (UDL Laboratories, Rockford, IL) and opium tincture in both infants and the addition of phenobarbital therapy in one infant. Both infants continued on medical therapy until they reached 1 month of age. Diazepam use by pregnant women can be associated with a later presentation of withdrawal symptoms in the neonate than that induced by the use of other drugs. Close follow-up during the first month of life is warranted for infants exposed to diazepam prenatally.

Neonatal opioid withdrawal often requires treatment but there have been few recent studies of current pharmacological interventions to guide treatment. This retrospective chart review provides an exploratory examination of newborns treated with either methadone or paregoric for opioid withdrawal and outlines dosage ranges and intervals, side effects, and clinical outcomes of the two regimens. The outcome variables examined were time to resolution of withdrawal symptoms, rate of decrease in symptom severity, and length of hospital stay. There were no observed differences in outcome variables between the two treatment groups and side effect profiles were similar. Dosages, dosage intervals, and tapering regimens were consistent with American Academy of Pediatrics recommendations. Although the sample size is small and standardized regimens were not used, this study provides preliminary data about dosing levels and dosing intervals of these two pharmacologic treatment agents. Both groups of infants had favorable outcomes, although given the variation in treatment regimens it is difficult to draw an equation of equivalency. These results are applicable to the design of future studies of pharmacological interventions.

Background: Treating opioid-addicted women with methadone in pregnancy increased the number of newborns suffering from neonatal abstinence syndrome (NAS). High-pitch crying, insomnia, tremor, myoclonic jerks, vomiting, diarrhoea and poor weight gain were reported symptoms, which were evaluated using the Finnegan (F)-score. Earlier phenobarbital or paregoric had been used to suppress symptoms. We surveyed the administration of pure -agonist morphine (MO) in comparison to the alcoholic opioid mixture in tincture of opium (TO). Thirty-three newborns were included in the survey, after informed consent by their parents. Results: NAS started 3–5 days after delivery and lasted for 27 or 30 days (mean) in the TO and MO groups, respectively. In either of the tested parameters, we found no significant differences between the two groups (2 P < 0.05). The maximum F-score was similar in both groups, but the dose to suppress NAS was higher in the MO group (0.6–0.5 mg/day; total dose 61.6–42.7 mg of morphine). The duration of the therapy was longer in the MO than in the TO group (37.5–32.4 days). On the other hand the weight gain was better in the MO group than in the TO group (25–19 g/day), but was reduced in both groups compared with healthy newborns. Conclusions:Morphine is suitable to treat NAS in a similar manner as tincture of opium, but avoids unwanted effects of the alcoholic extracts with various alkaloids in the tincture of opium and allows better weight gain of the newborns. © 2004 Elsevier Ireland Ltd. All rights reserved.

The Efficacy of Paregoric Versus Tincture of Opium in the Treatment of Neonatal Abstinance Syndrome (NAS)

In early 19th-century Britain, opium was the aspirin and benzodiazepine of its day. It was available, without medical prescription, from any corner shop in small quantities at a price that could be afforded by the poorest of the poor. Without ready access to medical care, opium and its derivatives (laudanum, paregoric) were sovereign remedies for fevers, aches, and pains, colicky and fractious infants, the dying, and the mad. Opium was used for its “stimulant properties” by beer drinkers in the fens of Norfolk and literary figures like Coleridge and de Quincey. The British government (involved in opium production in Bengal) fought two wars with China during the century to assert its right to sell opium to the Chinese.

Background: Although the number of cases of passively-addicted newborns is increasing, there has been scant development of treatment alternatives for these infants. Evidence from in vitro cell culture and in vivo animal studies by S. Crain and associates suggests that Naltrexone, an opiate antagonist, can inhibit opiate excitatory activity when given in microdoses. Naltrexone has also been used successfully in the treatment of adult addiction, but there are no reported studies using Naltrexone in the treatment of passively addicted newborns. The aims of this study were to test the hypothesis that Naltrexone microdose supplementation of paregoric treatment for neonatal withdrawal could reduce the duration of treatment required and to examine the safety of Naltrexone for these infants.

Our cohort (N=68) consisted of newborns treated for narcotic withdrawal with paregoric at University Hospital in Newark, NJ in 1994. Overall mean length of treatment, i.e., mean (standard deviation) was 18.5 (13.4) days. Scoring with the Finnegan Narcotic Abstinence Scale (FNAS) was initiated on average at 0.7 (1.2) days of life. Maximum FNAS score was obtained at a 3.6(5.1) days of life. Starting dose was given at mean 4.0 (4.9) days. Infants dosed initially with fewer than 6 drops (n=30) required a mean of 14.7 (13.3) days of treatment while those receiving 6 or more drops (n=37) needed 21.6(12.8) days, p=.03 by unpaired t-test, (i.e.), requiring an extra week of treatment). Contrary to expectation, there was, in general, little correlation between beginning or maximum FNAS vs beginning or maximum dosage of paregoric. For example, r=.15 between maximum FNAS and maximum dosage (p=.44 by Pearson correlation analysis). Starting FNAS was 4.9 (3.1) and maximum FNAS was 11.4(1.9). Starting paregoric dose was 5.5 (1.5) and maximum dose was 6.0 (1.7). In fact, the starting and maximum dose was the same for 47 infants (70.1%), indicating essentially little or no change in dosing regimen during a period of escalating withdrawal symptoms as measured by FNAS. Length of treatment was related to starting dose, maximum dose and maximum FNAS score, with correlations of r=.30 (P=.01), re=.58 (p=.0001) and r=.33 (p=.006) respectively.

Diarrhoeal diseases are the major cause of infant mortality in developing countries. Dehydration is the most common complication of diarrhoea, and severe dehydration causes up to 80% of diarrhoeal fatalities. For more than 100 years, physicians focused the treatment of diarrhoeal diseases on the symptom diarrhoea, and there were many 'antidiarrhoeal' drugs, such as water adsorbents (kaolin and pectin) and antiperistaltics (opium, paregoric elixir, diphenoxylate hydrochloride with atropine sulphate and loperamide). This approach focused on a non-dangerous symptom and diverted attention from the real killer, dehydration. A few decades ago, only severely dehydrated patients were treated by intravenous therapy. This treatment was prescribed by a group of professional health workers, administered intravenously by skilled nurses, and reserved for the few patients resident near health facilities. Oral rehydration therapy (ORT), developed 20 years ago, has several advantages over intravenous therapy; it can be administered at home, at health clinics or in modern hospitals, by parents or by nurses or physicians. Most serum disturbances in dehydrated neonates, infants, children, adults and the elderly are resolved by this treatment.

†(i) Multicultural Education—The Interminable Debate,edited by S. Modgil, G. K. Verma, K. Mallick and C. Modgil, Falmer Press, London (1986), pp. 350, £14.95, ISBN 1‐85000‐054‐9. (ii) Race, Equality and Schools,by R. Willey, Methuen, London (1984), ISBN 0‐416‐38310‐6.

A partition chromatographic method for the determination of morphine in paregoric and other opium preparations was subjected to collaborative study. The morphine is separated from associated opium alkaloids by successive elution through consecutive acidic and alkaline columns and is measured by UV absorbance. The isolated morphine was shown to have a high degree of purity. The method is rapid and the results of the collaborative study show good precision and accuracy. The method is recommended for adoption as official, first action.

An ultraviolet absorption spectrophotometric method is described for the determination of morphine in paregoric. Morphine is isolated from a 5 ml paregoric sample by a modification of the USP XVII extraction procedure and then measured by ultraviolet absorption spectrophotometry. Factors affecting the precision and accuracy of the method are discussed.

IN order to evaluate the accuracy of oral cholecystography, we have reviewed the radiographic findings in a group of patients studied after the oral administration of sodium tetraiodophenolphthalein and in whom the findings were subsequently checked at operation. Technic The oral method for the administration of the dye has been used routinely in the University Hospital since the test was first employed. In rare instances, for confirmation, the intravenous method has been utilized. With a light fat-free evening meal the patient is given 60 grains of sodium tetraiodophenolphthalein dissolved in distilled water and mixed with grape juice. This is followed in one-half hour by two drams of paregoric in order to control catharsis. Paregoric has not been given sooner because it is known to retard the emptying of the stomach, which might readily delay the absorption of the dye. This method has been described by Kirklin (5, 6) and needs no further description except to say that during the last eighteen months we ...

A synthetic drug, Diphenylacetyldiethylaminoethanol (Trasentin) has been tried on 32 patients. It was helpful in a number of cases of duodenal and marginal ulcer, gastritis, cholelithiasis, biliary dyskinesia and spastic colon in which usual therapy was of no or little help. In five patients it stopped postoperative diarrhea which was refractory to usual medication except paregoric. We therefore feel Trasentin is of value and has a place among the effective antispasmodic drugs, and that it may be invaluable in the treatment of diarrhea in the case of intestinal fistulas and after operations which shorten the small intestine and may upset its normal gradients.

Ten surgical neonates with postoperative intractable diarrhea and secondary weight loss were treated with combination cholestyramine and paregoric therapy. Within 3-5 days all infants except two showed significant clinical improvement with a decreasing number of stools, an increase in the consistency of the stool, and gradual weight gain. The exact mechanism of action of cholestyramine is not clear. It may act by binding with bile salts and/or endotoxins in the bowel lumen or decreasing the motility of the bowel. Used in combination with paregoric, a known bowel motility depressant, the doses of each medication can be kept quite low thus avoiding undesirable side effects. Medium chain triglyceride formula is helpful in some of these infants to improve fat absorption further. Medication in all of these infants has been discontinued without any adverse effects.

Among 302 neonates passively addicted to narcotics, 18 had seizures that were attributed to withdrawal. Of those 18 infants, 10 were among the 127 infants exposed to methadone (7.8%), whereas only one of them was among the 83 infants exposed to heroin (1.2%). Generalized motor seizures and myoclonic jerks were the predominant convulsive manifestations. Paregoric was more effective than was diazepam in controlling and preventing these seizures once they occurred. Electroencephalograms were obtained on 13 neonates in the interictal period; 12 of these ECGs were normal. Three infants, two with myoclonic jerks, had paroxysmal brain wave activity at the time of the seizures.

This report describes a 3-week-old infant with paregoric intoxication and pul monary edema. The pulmonary edema associated with opiod use is treatable even though the precise mechanism of its formation remains undefined. The report emphasizes that the medical rationale involved in the use of paregoric is unclear. The use of this preparation in pediatric patients should be abandoned in view of such serious complications.

A method is proposed for the determination of the morphine content of opium and paregoric. The method combines extractive and spectrophotometric procedures and results in a substantial saving of time when compared to most existing methods. Results thus far obtained indicate that the method is sufficiently accurate for routine analyses.

Publisher Summary This chapter describes the various aspects of abuse of central nervous system (CNS) agents. Abuse of drugs, both licit and illicit has been a worldwide epidemic and has involved agents as diverse as opiates, amphetamine, barbiturates, and other hallucinogens. An injection of a narcotic antagonist into a nondependent subject will block the subjective opiate-like effects of a subsequent injection of heroin or other opiate. It is suggested that a long-acting antagonist could immunize an addict from the subjective effects of opiate abuse. The existing antagonists like naloxone, cyclazocine, and naltrexone have certain drawbacks that may limit their usefulness as blocking agents in treating heroin. Oxilorphan has been subjected to parenteral chronic toxicity and Phase I oral and parenteral testing. In a double-blind comparison of oxilorphan with cyclazocine, oxilorphan was found to have a hallucinogenic potential one-fourth that of cyclazocine. The addition of 1 mg of naloxone to 100 ml of paregoric 230 produces a product, which is indistinguishable from paregoric alone when taken orally as intended. The development of totally synthetic analgesics and antitussives is also elaborated in the chapter.

PAREGORIC, which contains 130 mg of opium per ounce, is now the major narcotic used in Detroit. Its use as an illegal opium source has developed within the last four years (Table 1). Paregoric is ahydroalcoholic solution containing not more than 129.6 mg of powdered opium per 29.573 ml ( 1 fluid oz) or per 283 gm with anise oil, benzoic acid, and camphor. Until April 20, 1964, paregoric was an exempt narcotic in Michigan, and could be purchased at pharmacies without prescription. The drug is usually concentrated by boiling before intravenous instillation. Users often mix paregoric with the amphetamines, secobarbital, glutethimide, other barbiturates, or tripelennamine. The talcum filler of tripelennamine has been associated with diffuse pulmonary granuloma and subsequent pulmonary hypertension. 1 The benzoic acid, camphor, and anise of paregoric are irritants and lead to occlusive sclerosis after intravenous instillation. Therefore, the median cubital vein (most often used by

[Read in the Section on Diseases of Children, June, 1883.] Many of our most successful practitioners of medicine amongst the adult population have made signal failures when called upon to exhibit their skill in the treatment of tender children. We have often been pained by the remarks dropped from the lips of some physicians whom we were endeavoring to regard as sample practitioners, on account of the indifference manifested, and the slight degree of importance attached to their practice among the children, such as, “Well, you may give a few drops of ‘paregoric,’ or some ‘catnip tea,’ or most anything of that kind you may find convenient, as we cannot do much for children so young;” or, “Your mothers or ‘old women’ can treat young children as well as I or any physician can;” or, “I don't like to treat children, it is so unsatisfactory. They cannot tell how they

150 consecutive cases of diarrhea were treated empirically. The first 60 were divided into three groups, one receiving kaolin and pectin, one bismuth and paregoric and one Resion. Resion provided the most rapid and thorough relief and was used in failures on the other drugs. The other 90 patients also were treated with the Resion. The cases were classed as failures if diarrhea persisted after 36 hours. Prolongation of therapy after that time was of no value. 108 of 132 or 80% of the cases treated with Resion were controlled in less than 12 hours, and an additional 16 (12%) were controlled between 12 and 36 hours. 10 or 8% were not controlled within 36 hours, 4 of whom subsequently were found to have organic lesions.

Excerpt In 1955, records of the Narcotics Bureau in Detroit showed that no one among 1,267 persons arrested for the illicit use of drugs abused paregoric. During the next 8 years paregoric was used...

The quantitative determination of morphine in paregoric by reversed-phase high-pressure liquid chromatography is described. The method is simple, accurate, and fast compared to the USP method. Benzoic acid in paregoric also can be determined quantitatively with the same column. The method was applied to two commercial samples with excellent results.

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Newborns exposed in-utero to opiates and/or nonopiates frequently undergo NAS. This study evaluated:1)the relationship between the type of maternal drug use and the incidence of NAS and 2)which of 3 treatment drugs was most effective-- paregoric, phenobarbitol, or diazepam. NAS was assessed by a scoring system related to drug dose. Successful treatment was considered when one drug controlled the NAS. Of the 300 infants, 176(59%) were treated for NAS and 124(41%) required no treatment. Maternal drug use consisted of opiates(33%), non-opiates(14%)and varying combinations of both(53%). Infants exposed to non-opiates in-utero were less likely to undergo abstinence(36%) than those exposed to opiates(58%) or both(70%). The mean number of days to control symptoms of NAS was 7.6, and duration of treatment averaged 38,6 days, The efficacy of treatment drug for NAS depended upon the type of drug exposure in-utero. If maternal drug use included opiates alone, paregoric was the drug most successful in controlling NAS (87% of infants). In maternal non-opiate use, phenobarbital was most effective(100%). In maternal opiate and non-opiate use, paregoric was most effective(88%). Treating an infant with diazepam indicated the need for a second treatment drug in 70% of cases, regardless of maternal drug use (p=.001). These data suggest that:1)effective NAS treatment is related to the type of maternal drug use, 2)there is a higher incidence of NAS in infants prenatally exposed to opiates alone or in combinnation with non-opiates, and 3)diazepam is Ineffective as a treatment agent for NAS.

Measures of newborn sucking behavior were used to study effects on the infant's state of CNS arousal induced by maternal addiction. The sucking performance of 38 infants diagnosed and treated for narcotic withdrawal by a new symptom scoring system (Neonatal Abstinence Score) was compared with that of 50 infants whose withdrawal was regulated by acceptable clinical methods. The findings indicate the value of the scoring system in prescribing the dosage of drug therapy which resulted in better levels of CNS arousal and improved sucking performance. Also, using sucking performance as a criterion, it was found that paregoric was superior to phenobarbital in treating neonatal withdrawal. In addition, the severity of withdrawal as measured by sucking was directly related to the mother's length of time in the methadone maintenance program and her average dose of methadone. This finding may reflect the fact that patients enrolled in a maintenance program are assured of a continued supply of a long-acting narcotic drug, as compared to street addicts, whose supply is highly variable in quality and availability, and, that addicts who enter the methadone program during pregnancy tend to be given smaller doses than those who are not pregnant.