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Opioid use disorder | |
---|---|
Other names | Opioid addiction,[1] problematic opioid use,[1] opioid abuse,[2] opioid dependence[3] |
Molecular structure of morphine | |
Specialty | Psychiatry |
Symptoms | Strong desire to use opioids, increased tolerance to opioids, failure to meet obligations, trouble with reducing use, withdrawal syndrome with discontinuation[4][5] |
Complications | Opioid overdose, hepatitis C, marriage problems, unemployment[4][5] |
Duration | Long term[6] |
Causes | Opioids[3] |
Diagnostic method | Based on criteria in the DSM-5[4] |
Differential diagnosis | Alcoholism |
Treatment | Opioid replacement therapy, behavioral therapy, twelve-step programs, take home naloxone[7][8][9] |
Medication | Buprenorphine, methadone, naltrexone[7][10] |
Frequency | 27 million (c. 0.4%)[11][4] |
Deaths | 122,000 (2015)[12] |
Opioid use disorder is a problematic pattern of opioid use that causes significant impairment or distress.[3] Symptoms of the disorder include a strong desire to use opioids, increased tolerance to opioids, failure to fulfill obligations, trouble reducing use, and withdrawal syndrome with discontinuation.[4][5] Opioid withdrawal symptoms may include nausea, muscle aches, diarrhea, trouble sleeping, or a low mood.[5]Addiction and dependence are components of a substance use disorder.[13] Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, marriage problems, or unemployment.[4][5]
Opioids include substances such as heroin, morphine, fentanyl, codeine, oxycodone, and hydrocodone.[5][6] In the United States, a majority of heroin users begin by using prescription opioids.[14][15] These can be bought illegally or prescribed.[14] Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.[4] If more than two of eleven criteria are present during a year the diagnosis is said to be present.[4] If a person is appropriately taking opioids for a medical condition, issues of tolerance and withdrawal do not apply.[4]
Individuals with an opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine.[7] Being on such treatment reduces the risk of death.[7] Additionally, individuals may benefit from cognitive behavioral therapy, other forms of support from mental health professionals such as individual or group therapy, twelve-step programs, and other peer support programs.[8] The medication naltrexone may also be useful to prevent relapse.[10]Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial.[9]
In 2013, opioid use disorders affected about 0.4% of people.[4] As of 2016, about 27 million people are affected.[11] Long term opioid use occurs in about 4% of people following their use for trauma or surgery related pain.[16] Onset is often in young adulthood.[4] Males are affected more often than females.[4] It resulted in 122,000 deaths worldwide in 2015,[12] up from 18,000 deaths in 1990.[17] In the United States during 2016, there were more than 42,000 deaths due to opioid overdose, of which more than 15,000 were the result of heroin use.[18]
- 1Signs and symptoms
- 3Mechanism
- 3.3Opioid receptors
- 5Prevention
- 6Management
- 6.1Medications
- 6.2Behavioral therapy
- 7Epidemiology
Signs and symptoms[edit]
Material used for intravenous injection of opioids
Signs and symptoms include:[4][5]
- Drug seeking behavior
- Increased use over time
- Legal or social ramifications secondary to drug use
- Multiple prescriptions from different providers
- Multiple medical complications from drug use (HIV/AIDS, hospitalizations, abscesses)
- Opioid cravings
- Withdrawal symptoms
Addiction and dependence are components of a substance use disorder and addiction represents the more severe form.[13] Opioid dependence can occur as physical dependence, psychological dependence, or both.[19]
Withdrawal[edit]
Onset of withdrawal from opioids depends on which opioid was used last.[20] With heroin this typically occurs 5 hours after use, while with methadone it might not occur until 2 days later.[20] The length of time that major symptoms occur also depends on the opioid used.[20] For heroin withdrawal, symptoms are typically greatest at two to four days after cessation and can last for up to two weeks.[21][20] Less significant symptoms may remain for an even longer period, in which case it is known as a protracted abstinence syndrome.[20]
- Agitation[4]
- Anxiety[4]
- Muscle pains[4]
- Increased tearing[4]
- Trouble sleeping[4]
- Runny nose[4]
- Sweating[4]
- Yawning[4]
- Goose bumps[4]
- Dilated pupils[4]
- Diarrhea[4]
- Fast heart rate[20]
- High blood pressure[20]
- Abdominal cramps[20]
- Shakiness[20]
- Cravings[20]
- Sneezing[20]
Opioid intoxication[edit]
Signs and symptoms of opioid intoxication include:[5][22]
- Decreased perception of pain
- Confusion
- Nausea
- Hypokinesis (slowed movement)
- Head nodding
- Slurred speech
Opioid overdose[edit]
Fentanyl 2 mg. A lethal dose in most people.[23]
Signs and symptoms of opioid overdose include, but are not limited to:[24]
- Pin-point pupils may occur. Patient presenting with dilated pupils may still be suffering an opioid overdose.
- Altered level of consciousness. People may be unresponsive or unconscious.
- Pulmonary edema (fluid accumulation in the lungs)
Cause[edit]
Opioid use disorder can develop as a result of self-medication, though this is controversial.[25] Scoring systems have been derived to assess the likelihood of opiate addiction in chronic pain patients.[26] Prescription opioids are the source of nearly half of misused opioids and the majority of these are initiated for trauma or surgery pain management.[16]
According to position papers on the treatment of opioid dependence published by the United Nations Office on Drugs and Crime and the World Health Organization, care providers should not treat opioid use disorder as the result of a weak moral character or will but as a medical condition.[27][28] Additionally, detoxification alone does not constitute adequate treatment, as the problems with opioid use are frequently social as much as they are physical.
Mechanism[edit]
Addiction[edit]
Addiction is a brain disorder characterized by compulsive drug use despite adverse consequences.[13][29][30][31] Addiction is a component of a substance use disorder and represents the most severe form of the disorder.[13]
Overexpression of the gene transcription factorΔFosB in the nucleus accumbens plays a crucial role in the development of an addiction to opioids and other addictive drugs by sensitizing drug reward and amplifying compulsive drug-seeking behavior.[29][32][33][34] Like other addictive drugs, overuse of opioids leads to increased ΔFosB expression in the nucleus accumbens.[32][33][34][35] Opioids affect dopamineneurotransmission in the nucleus accumbens via the disinhibition of dopaminergic pathways as a result of inhibiting the GABA-based projections to the ventral tegmental area (VTA) from the rostromedial tegmental nucleus (RMTg), which negatively modulate dopamine neurotransmission.[36][37] In other words, opioids inhibit the projections from the RMTg to the VTA, which in turn disinhibits the dopaminergic pathways that project from the VTA to the nucleus accumbens and elsewhere in the brain.[36][37]
Neuroimaging has shown functional and structural alterations in the brain.[38] A 2017 study showed that chronic intake of opioids, such as heroin, may cause long-term effects in the orbitofrontal area (OFC), which is essential for regulating reward-related behaviors, emotional responses, and anxiety.[39] Moreover, neuroimaging and neuropsychological studies demonstrated dysregulation of circuits associated with emotion, stress and high impulsivity.[40]
Dependence[edit]
Drug dependence is an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake).[29][30][31] Dependence is a component of a substance use disorder.[13][41] Opioid dependence can manifest as physical dependence, psychological dependence, or both.[19][30][41]
Increased brain-derived neurotrophic factor (BDNF) signaling in the ventral tegmental area (VTA) has been shown to mediate opioid-induced withdrawal symptoms via downregulation of insulin receptor substrate 2 (IRS2), protein kinase B (AKT), and mechanistic target of rapamycin complex 2 (mTORC2).[29][42] As a result of downregulated signaling through these proteins, opiates cause VTA neuronal hyperexcitability and shrinkage (specifically, the size of the neuronal soma is reduced).[29] It has been shown that when an opiate-naive person begins using opiates in concentrations that induce euphoria, BDNF signaling increases in the VTA.[43]
Upregulation of the cyclic adenosine monophosphate (cAMP) signal transduction pathway by cAMP response element binding protein (CREB), a gene transcription factor, in the nucleus accumbens is a common mechanism of psychological dependence among several classes of drugs of abuse.[19][29] Upregulation of the same pathway in the locus coeruleus is also a mechanism responsible for certain aspects of opioid-induced physical dependence.[19][29]
Opioid receptors[edit]
A genetic basis for the efficacy of opioids in the treatment of pain has been demonstrated for a number of specific variations; however, the evidence for clinical differences in opioid effects is ambiguous. The pharmacogenomics of the opioid receptors and their endogenousligands have been the subject of intensive activity in association studies. These studies test broadly for a number of phenotypes, including opioid dependence, cocaine dependence, alcohol dependence, methamphetamine dependence/psychosis, response to naltrexone treatment, personality traits, and others. Major and minor variants have been reported for every receptor and ligand coding gene in both coding sequences, as well as regulatory regions.Newer approaches shift away from analysis of specific genes and regions, and are based on an unbiased screen of genes across the entire genome, which have no apparent relationship to the phenotype in question. These GWAS studies yield a number of implicated genes, although many of them code for seemingly unrelated proteins in processes such as cell adhesion, transcriptional regulation, cell structure determination, and RNA, DNA, and protein handling/modifying.[44]
118A>G variant[edit]
While over 100 variants have been identified for the opioid mu-receptor, the most studied mu-receptor variant is the non-synonymous 118A>G variant, which results in functional changes to the receptor, including lower binding site availability, reduced mRNA levels, altered signal transduction, and increased affinity for beta-endorphin. In theory, all of these functional changes would reduce the impact of exogenous opioids, requiring a higher dose to achieve the same therapeutic effect. This points to a potential for a greater addictive capacity in these individuals who require higher dosages to achieve pain control. However, evidence linking the 118A>G variant to opioid dependence is mixed, with associations shown in a number of study groups, but negative results in other groups. One explanation for the mixed results is the possibility of other variants which are in linkage disequilibrium with the 118A>G variant and thus contribute to different haplotype patterns that more specifically associate with opioid dependence.[45]
Non-opioid receptor genes[edit]
The preproenkephalin gene, PENK, encodes for the endogenous opiates that modulate pain perception, and are implicated in reward and addiction. (CA) repeats in the 3' flanking sequence of the PENK gene was associated with greater likelihood of opiate dependence in repeated studies. Variability in the MCR2 gene, encoding melanocortin receptor type 2 has been associated with both protective effects and increased susceptibility to heroin addiction. The CYP2B6 gene of the cytochrome P450 family also mediates breakdown of opioids and thus may play a role in dependence and overdose.[46]
Diagnosis[edit]
The DSM-5 guidelines for diagnosis of opioid use disorder require that the individual has significant impairment or distress related to opioid uses.[4] In order to make the diagnosis two or more of eleven criteria must be present in a given year:[4]
- More opioids are taken than intended
- The individual is unable to decrease the amount of opioids used
- Large amounts of time are spent trying to obtain opioids, use opioids, or recover from taking them
- The individual has cravings for opioids
- Difficulty fulfilling professional duties at work or school
- Continued use of opioids leading to social and interpersonal consequences
- Decreased social or recreational activities
- Using opioids despite it being physically dangerous settings
- Continued use despite opioids worsening physical or psychological health (i.e. depression, constipation)
The severity can be classified as mild, moderate, or severe based on the number of criteria present.[6]
Prevention[edit]
The CDC gives specific recommendations for prescribers regarding initiation of opioids, clinically appropriate use of opioids, and assessing possible risks associated with opioid therapy.[47] Large retail pharmacy chains in the US are implementing protocols, guidelines, and initiatives to take back unused opioids, providing naloxone kits, and being vigilant for suspicious prescriptions.[48][49] Insurance programs can help limit opioid use by setting quantity limits on prescriptions or requiring prior authorizations for certain medications.[50]
Opioid related deaths[edit]
Naloxone is used for the emergency treatment of an overdose.[51] It can be given by many routes (e.g., intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts quickly by displacing opioids from opioid receptors and preventing activation of these receptors by opioids.[52] Naloxone kits are recommended for laypersons who may witness an opioid overdose, for individuals with large prescriptions for opioids, those in substance use treatment programs, or who have been recently released from incarceration.[53] Since this is a life-saving medication, many areas of the United States have implemented standing orders for law enforcement to carry and give naloxone as needed.[54][55] In addition, naloxone could be used to challenge a person's opioid abstinence status prior to starting a medication such as naltrexone, which is used in the management of opioid addiction.[56]
Good Samaritan laws typically protect bystanders that administer naloxone. In the United States, at least 40 states have Good Samaritan laws to encourage bystanders to take action without fear of prosecution.[57] As of 2019, there are 48 states that allow for a pharmacist to have the authority to distribute naloxone without an individual prescription.[58]
Management[edit]
Opioid use disorders typically require long-term treatment and care with the goal of reducing risks for the individual, reducing criminal behaviour, and improving the long-term physical and psychological condition of the person.[28] Some strategies aim to reduce drug use and lead to abstinence from opioids, while others attempt to stabilize on prescribed methadone or buprenorphine with continued replacement therapy indefinitely.[28] No single treatment works for everyone, so several strategies have been developed including therapy and drugs.[28][59]'
As of 2013 in the US, there was a significant increase of prescription opioid abuse compared to illegal opiates like heroin.[60] This development has also implications for the prevention, treatment and therapy of opioid dependence.[61] Though treatment reduces mortality rates, the period during the first four weeks after treatment begins and the four weeks after treatment ceases are the times that carry the highest risk for drug related deaths. These periods of increased vulnerability are significant because many of those in treatment leave programs during these critical periods.[7]
Medications[edit]
Opioid replacement therapy (ORT) involves replacing an opioid, such as heroin, with a longer acting but less euphoric opioid.[62][63] Commonly used drugs for ORT are methadone or buprenorphine which are taken under medical supervision.[63] As of 2018 buprenorphine/naloxone is preferentially recommended, as the addition of the opioid antagonist naloxone is believed to reduce the risk of abuse via injection or insufflation.[64]
The driving principle behind ORT is the program's capacity to facilitate a resumption of stability in the user's life, while the patient experiences reduced symptoms of drug withdrawal and less intense drug cravings; a strong euphoric effect is not experienced as a result of the treatment drug.[63] In some countries (not the US, or Australia),[63] regulations enforce a limited time period for people on ORT programs that conclude when a stable economic and psychosocial situation is achieved. (People with HIV/AIDS or hepatitis C are usually excluded from this requirement.) In practice, 40–65% of patients maintain abstinence from additional opioids while receiving opioid replacement therapy and 70–95% are able to reduce their use significantly.[63] Along with this is a concurrent elimination or reduction in medical (improper diluents, non-sterile injecting equipment), psychosocial (mental health, relationships), and legal (arrest and imprisonment) issues that can arise from the use of illegal opioids.[63]Clonidine or lofexidine can help treat the symptoms of withdrawal.[65]
Participation in methadone and buprenorphine treatment reduces the risk of mortality due to overdose.[7] The starting of methadone and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies.[7] ORT has proven to be the most effective treatment for improving the health and living condition of people experiencing problematic illegal opiate use or dependence, including mortality reduction[63][66][7] and overall societal costs, such as the economic loss from drug-related crime and healthcare expenditure.[63] ORT is endorsed by the World Health Organization, United Nations Office on Drugs and Crime and UNAIDS as being effective at reducing injection, lowering risk for HIV/AIDS, and promoting adherence to antiretroviral therapy.[7]
Buprenorphine and methadone work by reducing opioid cravings, easing withdrawal symptoms, and blocking the euphoric effects of opioids via cross-tolerance,[67] and in the case of buprenorphine, a high-affinity partial agonist, also due to opioid receptor saturation.[68] It is this property of buprenorphine that can induce acute withdrawal when administered before other opioids have left the body. Naltrexone, a μ-opioid receptor antagonist, also blocks the euphoric effects of opioids by occupying the opioid receptor, but it does not activate it, so it does not produce sedation, analgesia, or euphoria, and thus it has no potential for abuse or diversion.[69][70]
Methadone[edit]
40 mg of methadone
Methadone maintenance treatment (MMT), a form of opioid replacement therapy, reduces and/or eliminates the use of illegal opiates, the criminality associated with opiate use, and allows patients to improve their health and social productivity.[71][72] Methadone is an agonist of opioids. If initial doses during the beginning of treatment are too high or are concurrent with illicit opioid use, this may present an increased risk of death from overdose.[7] In addition, enrollment in methadone maintenance has the potential to reduce the transmission of infectious diseases associated with opiate injection, such as hepatitis and HIV.[71] The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with opiates. Methadone maintenance has been found to be medically safe and non-sedating.[71] It is also indicated for pregnant women addicted to opiates.[71]For individuals who wish to completely move away from drugs, they can start a methadone reduction program. A methadone reduction program is where an individual is prescribed an amount of methadone which is increased until withdrawal symptoms subside, after a period of stability, the dose will then be gradually reduced until the individual is either free of the need for methadone or is at a level which allows a switch to a different opiate with an easier withdrawal profile, such as suboxone. Methadone toxicity has been shown to be associated with specific phenotypes of CYP2B6.[73]
Some impairment in cognition has been demonstrated in those using methadone.[40][74] Currently, 55 countries worldwide use methadone replacement therapy, while some countries such as Russia do not.[75]
Buprenorphine[edit]
Buprenorphine/naloxone tablet
Buprenorphine is a partial opioid receptor agonist. Unlike methadone and other full opioid receptor agonists, buprenorphine is less likely to cause respiratory depression due to its ceiling effect.[69] Treatment with buprenorphine may be associated with reduced mortality.[7] Buprenorphine under the tongue is often used to manage opioid dependence. Preparations were approved for this use in the United States in 2002.[76] Some formulations of buprenorphine incorporate the opiate antagonist naloxone during the production of the pill form to prevent people from crushing the tablets and injecting them, instead of using the sublingual (under the tongue) route of administration.[63]
Other opioids[edit]
Evidence of effects of heroin maintenance compared to methadone are unclear as of 2010.[77] A Cochrane review found some evidence in opioid users who had not improved with other treatments.[78] In Switzerland, Germany, the Netherlands, and the United Kingdom, long-term injecting drug users who do not benefit from methadone and other medication options may be treated with injectable heroin that is administered under the supervision of medical staff.[79] Other countries where it is available include Spain, Denmark, Belgium, Canada, and Luxembourg.[80]
Dihydrocodeine in both extended-release and immediate-release form are also sometimes used for maintenance treatment as an alternative to methadone or buprenorphine in some European countries.[81] Dihydrocodeine is an opioid agonist.[82] It may be used as a second line treatment.[83]
An extended-release morphine confers a possible reduction of opioid use and with fewer depressive symptoms but overall more adverse effects when compared to other forms of long-acting opioids. Retention in treatment was not found to be significantly different.[84] It is used in Switzerland and more recently in Canada.[85]
Naltrexone[edit]
Naltrexone is an opioid receptor antagonist used for the treatment of opioid addiction.[86][87] Naltrexone is not as widely used as buprenorphine or methadone for OUD due to low rates of patient acceptance, non-adherence due to daily dosing, and difficulty achieving abstinence from opioids before beginning treatment. Additionally, dosing naltrexone after recent opioid use could lead to precipitated withdrawal. Conversely, naltrexone antagonism at the opioid receptor can be overcome with higher doses of opioids.[88] Naltrexone monthly IM injections received FDA approval in 2010 for the treatment of opioid dependence in abstinent opioid users.[86][89]
Behavioral therapy[edit]
Cognitive behavioral therapy[edit]
Cognitive behavioral therapy (CBT), a form of psychosocial intervention that is used to improve mental health, may not be as effective as other forms of treatment.[90] CBT primarily focuses on an individual's coping strategies to help change their cognition, behaviors and emotions about the problem. This intervention has demonstrated success in many psychiatric conditions (e.g., depression) and substance use disorders (e.g., tobacco).[91] However, the use of CBT alone in opioid dependence has declined due to the lack of efficacy, and many are relying on medication therapy or medication therapy with CBT, since both were found to be more efficacious than CBT alone.[92]
Twelve-step programs[edit]
While medical treatment may help with the initial symptoms of opioid withdrawal, once the first stages of withdrawal are through, a method for long-term preventative care is attendance at 12-step groups such as Narcotics Anonymous.[93] Narcotics Anonymous is a global service that provides multilingual recovery information and public meetings free of charge.[94] Some evidence supports the use of these programs in adolescents as well.[95]
The 12-step program is an adapted form of the Alcoholics Anonymous program. The program strives to help create behavioral change by fostering peer-support and self-help programs. The model helps assert the gravity of addiction by enforcing the idea that addicts must surrender to the fact that they are addicted and to be able to recognize the problem. It also helps maintain self-control and restraint to help promote one's capabilities.[96]
Epidemiology[edit]
Globally, the number of people with opioid dependence increased from 10.4 million in 1990 to 15.5 million in 2010.[7] In 2016, the numbers rose to 27 million people who experienced this disorder.[11] Opioid use disorders resulted in 122,000 deaths worldwide in 2015,[12] up from 18,000 deaths in 1990.[17] Deaths from all causes rose from 47.5 million in 1990 to 55.8 million in 2013.[17][12]
United States[edit]
Overdose deaths involving opioids, United States. Deaths per 100,000 population by year.[97]
The current epidemic of opioid abuse is the most lethal drug epidemic in American history.[15] In 2008, there were four times as many deaths due to overdose than there were in 1999.[98] According to the CDC in 2017, in the US, 'the age-adjusted drug poisoning death rate involving opioid analgesics increased from 1.4 to 5.4 deaths per 100,000 population between 1999 and 2010, decreased to 5.1 in 2012 and 2013, then increased to 5.9 in 2014, and to 7.0 in 2015. The age-adjusted drug poisoning death rate involving heroin doubled from 0.7 to 1.4 deaths per 100,000 resident population between 1999 and 2011 and then continued to increase to 4.1 in 2015.'[99]
In 2012 it was estimated that 9.2 percent of the population over the age of 12 years old had used an illicit drug in the previous month.[100] In 2015, it was estimated the 20.5 million Americans had a substance use disorder.[98] Of these 20.5 million, two million used prescribed pain medications (most of those being opioids) and one-half of a million were using heroin.[98] About a quarter of people who use heroin proceed to have opioid addiction.[98]
In 2015, in the US there were 33,000 deaths due to drug overdose that involved opioid use.[101] Of these, about 15,000 were from prescribed opioids and 13,000 were from heroin use.[102][103] Approximately 4% of patients who received opioids for pain management following trauma or surgery continued using opioids for at least 2 months.[16]
Non-medical consumption of opioids peaked around 2010 and then started to decrease between 2011 and 2013.[104]
Among adults, the rate of inpatient hospital stays in the United States related to opioid overuse increased by an average of 5% annually from 1993–2012. The percentage of inpatient stays due to opioid overuse admitted from the emergency department increased from 43% in 1993 to 64% in 2005, but have remained relatively constant since 2005.[105]
In 2017, the U.S. Department of Health and Human Services (HHS) announced a public health emergency due to an increase in the misuse of opioids.[106] The administration introduced a strategic framework called the Five-Point Opioid Strategy, which includes providing access recovery services, increasing the availability of reversing agents for overdose, funding opioid misuse and pain research, changing treatments of people managing pain, and updating public health reports related to combating opioid drug misuse.[106][107]
The prevalence of opioid use and opioid or opiate dependency varies by age and gender, among a myriad of other factors. Men are at higher risk for opioid use and dependency than women,[108][109] and men also account for more opioid overdoses than women, although this gap is closing.[108] Women are more likely to be prescribed pain relievers, be given higher doses, use them for longer durations, and may become dependent upon them faster.[110]
Deaths due to opioid use also tend to skew at older ages than deaths from use of other illicit drugs.[109][111][112] This does not reflect opioid use as a whole, which includes individuals in younger age demographics. Overdoses from opioids are highest among individuals who are between the ages of 40 and 50,[112] in contrast to heroin overdoses, which are highest among individuals who are between the ages of 20 and 30.[111] 21 to 35-year olds represent 77% of individuals who enter treatment for opioid use disorder,[113] however, the average age of first-time use of prescription painkillers was 21.2 years of age in 2013.[114] Among the middle class means of acquiring funds have included Elder financial abuse through a vulnerability of financial transactions of selling items and international dealers noticing a lack of enforcement in their transaction scams throughout the Caribbean.[115]
- Charts of deaths involving specific opioids and classes of opioids
- US yearly deaths from all opioid drugs. Included in this number are opioid analgesics, along with heroin and illicit synthetic opioids.[116]
- US yearly deaths involving other synthetic opioids, predominately Fentanyl.[116]
- US yearly deaths involving prescription opioids. Non-methadone synthetics is a category dominated by illegally acquired fentanyl, and has been excluded.[116]
- US yearly overdose deaths involving heroin.[116]
History[edit]
Opiate misuse has been recorded at least since 300 BC. Greek mythology describes Nepenthe (Greek “free from sorrow”) and how it was used by the hero of the Odyssey. Opioids have been used in the Near East for centuries. The purification of and isolation of opiates occurred in the early 19th century.[24]
Levacetylmethadol was previously used to treat opioid dependence. In 2003 the drug's manufacturer discontinued production. There are no available generic versions. LAAM produced long-lasting effects, which allowed the person receiving treatment to visit a clinic only three times per week, as opposed to daily as with methadone.[117] In 2001, levacetylmethadol was removed from the European market due to reports of life-threatening ventricular rhythm disorders.[118] In 2003, Roxane Laboratories, Inc. discontinued Orlaam in the US.[119]
See also[edit]
References[edit]
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Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
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External links[edit]
Classification |
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Retrieved from 'https://en.wikipedia.org/w/index.php?title=Opioid_use_disorder&oldid=903288253'
Sabu | |
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Birth name | Terry Michael Brunk |
Born | December 12, 1964 (age 54) Staten Island, New York, New York, United States |
Residence | Escanaba, Michigan, United States |
Spouse(s) | Hitomi Brunk (m.1997) |
Professional wrestling career | |
Ring name(s) | Sabu Sabu the Elephant Boy Samu Terry S.R. Terry Snuka |
Billed height | 5 ft 11 in (1.80 m) |
Billed weight | 235 lb (107 kg)[1] |
Billed from | Saudi Arabia Bombay, India 'Bombay, Michigan'[1] |
Trained by | Ed Farhat |
Debut | 1985 |
Terry Michael Brunk (born December 12, 1964)[2] is an American professional wrestler, better known by his ring nameSabu. He is currently appearing on Impact Wrestling and on the independent circuit. He is known for his hardcore wrestling style. Sabu has most notably competed in Extreme Championship Wrestling, Total Nonstop Action Wrestling, World Championship Wrestling and WWE's ECWbrand.[3]Championships held by Sabu include the ECW World Heavyweight Championship and the NWA World Heavyweight Championship.[4]
- 1Professional wrestling career
- 1.8Total Nonstop Action Wrestling
Professional wrestling career[edit]
Early career (1985–1991)[edit]
Brunk was trained by his uncle, Ed Farhat (The Sheik),[5] and was initially trained to be a technical wrestler. He began his wrestling career in 1985 in the Sheik's promotion, Big Time Wrestling, and was billed as being from Saudi Arabia under the ring name 'Sabu the Elephant Boy' (use of 'The Elephant Boy' was dropped in his later days), as well as Terry S.R. (the S.R. standing for Sheik's Revenge). During the 1980s he wrestled for various independent promotions in Memphis, Michigan, Ohio, Canada and Hawaii. He was never billed under his real name, in order to avoid confusion with Terry Funk.
Frontier Martial–Arts Wrestling (1991–1994)[edit]
In 1991, Sabu made his first tour of Japan with Frontier Martial–Arts Wrestling (FMW). While wrestling for FMW, Sabu received many of the scars on his arms and torso for which he became famous. Brunk cleared rumors that the scars were self-induced in a shoot interview with RF Video, confirming that they were a result of numerous hardcore matches he was involved in, including participating in over two dozen no-rope barbed wire death matches. In May 1992, Sabu teamed with his uncle, the Sheik, in a 'Ring of Fire Deathmatch' against Atsushi Onita and Tarzan Goto. The match was set in a ring where the ropes were replaced with barbed wire with sheets soaked in gas wrapped around it. As the match started, the ring crew lit the sheets on fire using torches. They were in the ring for about a minute before all men got out of the ring due to the intense heat. The match ended with no winner. Sabu said in an interview that the ring burned for 19 hours.
Sabu often competed in Japanese hardcore matches, where he teamed with the Sheik, Tiger Jeet Singh and Horace Boulder. Sabu feuded with the likes of Tarzan Goto and Atsushi Onita in FMW. His final match in FMW was a loss to the debuting Hayabusa at the 1994 Summer Spectacular.
Extreme Championship Wrestling (1993–1995)[edit]
Brunk revealed in a shoot promo and in the documentary film Forever Hardcore that in fact it was not Paul Heyman that brought him into Extreme Championship Wrestling (ECW) but that he was at the right place at the right time. He was referred by a friend to Tod Gordon. According to the storyline, Sabu, who at that time often arrived to the ring by his handler 911, was an uncontrollable madman strapped to a gurney and with a Hannibal Lecter-style face mask while trying to break free (he claimed to hate this part of his gimmick as he was normally tired before he started his match). Sabu could only be released from his bonds to wrestle his matches. Sabu also quickly became synonymous with table-breaking at this time; if a table was not broken during the match, Sabu would break a table with his own body after the bell had sounded, sometimes leading to 911 having to restrain Sabu during backstage interviews if a table was present.
One of the most notable aspects of Sabu's early career was his refusal to speak,[5] a gimmick that he inherited from The Sheik (who never spoke English in public to protect kayfabe). In his early career, Sabu was billed as being from Saudi Arabia, or Bombay, India (in real life he is a second generation Lebanese American from Michigan). In ECW, however, he was clearly heard speaking in the ring on several occasions and it was fairly common knowledge that Brunk was an American citizen from birth. This led to a joke at kayfabe's expense when Sabu began to be billed as hailing from 'Bombay, Michigan'.
The most significant matches during the early part of Sabu's career in ECW by defeating Terry Funk to win the ECW World Heavyweight Championship and the ECW World Television Championship in a title versus title dream partner tag team match. Also, he was a part in the three way dance for the ECW World Heavyweight Championship at The Night the Line Was Crossed, against Terry Funk and Shane Douglas, which went to a one-hour time limit draw and his tag team feud with The Public Enemy in which Sabu and his partner The Tazmaniac captured the ECW World Tag Team Championship in a double tables match. Another notable event occurred in April 1995 when, after being scheduled for a three-way dance for the ECW World Tag Team title, Sabu no–showed the event to accept a booking in Japan for New Japan Pro-Wrestling (NJPW), which led Paul Heyman to publicly and legitimately fire Sabu at the event.[6][7] Sabu stated in the Forever Hardcore documentary that he had a career wrestling in Japan yet only wrestled once every so often for ECW; thus, he chose Japan over ECW.
New Japan Pro-Wrestling (1995)[edit]
Sabu wrestled for New Japan Pro-Wrestling throughout 1995, making a total of 64 appearances. He made his debut on January 4 in the Tokyo Dome, teaming with Masahiro Chono to defeat Junji Hirata and Tatsumi Fujinami. Sabu and Chono teamed together on several more occasions to face Heisei Ishingun.
On May 3, 1995, Sabu defeated Koji Kanemoto in the Fukuoka Dome to win the IWGP Junior Heavyweight Championship. He lost the title to Kanemoto on June 14, 1995 in Tokyo's Nippon Budokan in a bout where Kanemoto's UWA World Welterweight Championship was also on the line. He went on to face Gran Hamada in a series of matches, culminating in Sabu defeating Gran Hamada to win the UWA World Junior Light Heavyweight Championship on November 23, 1995 in the Todoroki Arena in Kawasaki. He held the championship for just over a week, losing to El Samurai on December 1, 1995 in Niigata.
Sabu made his final appearance with NJPW on December 11, 1995 in Osaka, teaming with Hiro Saito to defeat Dean Malenko and Wild Pegasus.
World Championship Wrestling (1995)[edit]
Sabu made his WCW debut on the September 11, 1995 episode of WCW Monday Nitro[8] against Alex Wright. Sabu won the match, but the decision was reversed when, after the match, he put Wright through a table. Sabu continued to wrestle some of the cruiserweights in WCW in the early days of the division, including a match against Mr. J.L. at Halloween Havoc. Sabu came out victorious against Mr. J.L. and following the match Sabu's uncle Sheik shot J.L. in the face with his trademark fireball. His last match in WCW was against Disco Inferno, which Sabu won.
Extreme Championship Wrestling (1995–2000)[edit]
Sabu at an ECW event in 1998
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Sabu returned to ECW on November 18, 1995 at November to Remember,[9] and eventually engaged in matches and feuds with the likes of Rob Van Dam, with whom he later teamed up with and won the ECW World Tag Team Championship twice. In the meantime, former tag team partner Tazmaniac (who had shortened his name to 'Taz') began to publicly challenge Sabu at every given opportunity, but got no response. After a year of call-outs and insults from Taz, Heyman revealed that he had asked Sabu, as a friend, to ignore Taz's challenge. This standoff culminated in a grudge match at ECW's first pay-per-view, Barely Legal, which Taz won.[1] Following the match, Taz's manager Bill Alfonso turned on him and sided with Sabu and Rob Van Dam, who then formed a tag team. Sabu and Taz continued to feud on and off for the remainder of Taz's ECW career.
Sabu was later included in the WWF invasion angle, in which ECW wrestlers invaded WWF's Monday Night Raw program and held ECW-style matches and angles on the show. One memorable moment occurred at this show when Sabu appeared during a match and prepared for an aerial move off the 'R' in the 'RAW' lettered entryway onto Team Taz members, but accidentally fell off the 'R'. This was not planned which led to Sabu landing on top of Team Taz members and becoming an inside joke between him and Taz backstage. This invasion angle also led to a heel turn for Sabu in ECW, along with Van Dam and Alfonso, who began promoting the virtues of the WWF product over ECW's. Sabu feuded with ECW loyalists Tommy Dreamer and The Sandman during this period.
One of Sabu's most infamous matches was the No-Rope Barbed-Wire match with Terry Funk at Born to be Wired, a match which was promoted as being 'too extreme even for ECW'.[10] In one of the most memorable moments in ECW history, Sabu attempted the 'Air Sabu' corner splash on Funk, Terry moved and Sabu ended up colliding violently into the wire which tore open his biceps.[1] He then asked his manager Bill Alfonso for some tape and after Alfonso went to get some Sabu began to tape the approximately 10 inch gash up.[1] Funk has stated that, to this day, he has never seen anything like what Sabu did that night. The match ended with both men so badly tangled up together in the barbed wire that it took several ring technicians armed with wire cutters to free them from the predicament (on the DVD Bloodsport – ECW's Most Violent Matches released by World Wrestling Entertainment, Paul Heyman said that the match was 'so gruesome, I never ever dared to schedule another one like it', and that they never had another Barbed-Wire match in ECW because 'no one could top that one – and in good conscience, I never wanted anyone to try').
Sabu delivering the Arabian Skullcrusher to Rhino
Brunk racked up an astounding catalog of injuries during his ECW tenure, including broken ribs, a broken jaw, and breaking his neck twice. The first time he broke his neck was during his match with Chris Benoit at the 1994 November to Remember. Benoit threw Sabu with the intention that he would take a flapjackbump but Brunk attempted to turn mid-air and take a back body drop bump instead, which he was not able to do and landed on his head causing the injury. The other was during a match against Taz in December 1998, when Brunk took a Taz–Plex through a table and landed incorrectly. Brunk was able to recover from the neck injuries and return to wrestling, and he even wore a neck brace in his return match in the United States a month following the injury at Taz's hands; by Brunk's account, however, he started actively wrestling in Japan with his partner on a short tour a little over two weeks after that injury. Brunk departed from ECW for the final time in early 2000.
World Wrestling All-Stars (2002, 2003)[edit]
Sabu competed for the World Wrestling All-Stars (WWA) in a number of events during 2002 and 2003. This included four appearances on PPV and a number of memorable matches. His first appearance was at Revolution PPV in Las Vegas in February 2002. He faced Devon Storm in a hardcore match. He was defeated in this match after his manager Bill Alfonso accidentally hit him with a chair after Storm moved out the way. After the match Sabu and Storm continued to fight onto the ring entrance way. Sabu placed Storm on a table and leaped from the entrance way through Storm and the table. This feud continued on the next PPV, the Eruption, in Australia in April. Sabu fought Storm in a steel cage match. The action spilled out of the ring and the cage with Sabu gaining the victory after leaping from the top of the cage through Storm, who was placed on top of two tables on top of each other.
Next up Sabu took part in WWA European tour of November–December 2002. This included the Retribution PPV in Glasgow, which was broadcast two months later in February 2003. On this tour and PPV he fought former fellow ECW stars Perry Saturn and Simon Diamond in a three-way hardcore match. Sabu took the victory in each of these matches, usually gaining the pinfall over Diamond after Saturn left the match to defend his companion. His final appearance for the WWA came in their last PPV, The Reckoning, in New Zealand. During this tour he first fought Shane Douglas but due to injury he did not face him at the PPV. Instead Douglas came to the ring and eventually allowed Joe E Legend to face Sabu instead. Sabu won this match, his second and last WWA match ever. When the All World Wrestling League began in April 2003 (a spin-off of Big Time Wrestling), which was run by Eddie & Tom Farhat, Sabu joined them for a while, before he left for another territory.
Total Nonstop Action Wrestling[edit]
Early appearances (2002–2004)[edit]
Sabu debuted in Total Nonstop Action Wrestling (TNA) on July 17, 2002, defeating Malice in a ladder match. The next week he faced Ken Shamrock in a ladder match which was declared a No Contest when Malice interfered.
In 2004, Sabu teamed with Raven to defeat Raven's former 'Gathering' protégés, CM Punk and Julio Dinero. In March he began feuding with Monty Brown and Abyss, who outnumbered him on several occasions after Raven failed to 'watch his back'. Eventually Raven challenged Sabu to an empty arena match to be held on June 9, but Sabu refused to wrestle him, claiming that he had promised his uncle, The Sheik, that he would never fight Raven. Raven then waged a campaign against Sabu, disrespecting the memory of his uncle and assaulting Sabu's friend Sonjay Dutt, until Sabu finally broke and attacked him on July 23. Raven defeated Sabu on August 4, and a scheduled return match on August 18 was canceled after Sabu legitimately suffered a serious back injury.
While injured, Brunk contracted a virus and was hospitalized, sidelining him for ten months. On December 12 a benefit show, A Night of Appreciation for Sabu, was held by the AWWL to raise funds for him. The show was considered a success, raising enough money for Brunk to cover the costs of his medical care and he was able to make a full recovery. In his first match back from the injury in the AWWL/BTW, he defeated N8 Mattson. Sabu then appeared at Hardcore Homecoming, where he defeated Terry Funk and Shane Douglas in a three-way no-ropes barbed wire match, and at ECW One Night Stand two days later, where he defeated Rhyno.
Recovery and departure (2005–2006)[edit]
Sabu returned to TNA on July 29, 2005. At Sacrifice Sabu teamed with his old enemy, and then NWA World Heavyweight Champion, Raven to face Jeff Jarrett and Rhino. Rhino and Jarrett won the match after Rhino gored Raven through a table and pinned him. The match saw Abyss interfering and attacking Sabu, starting a feud between the two of them. They went on to have a match at Unbreakable in September which Abyss won after performing his Black Hole Slam finisher on to a pile of tacks in the ring. Sabu once again found himself squaring off against Rhino and Abyss, as well as Jeff Hardy, during Bound for Glory in the Monster's Ball 2 match. Rhino won the match. On the same night, Sabu competed in a ten-man Gauntlet Match to decide a number one contender, which he also lost, once again to Rhino.
Sabu continued his feud with Abyss, once again losing to him at Genesis after taking a Black Hole Slam onto a barbed wire steel chair. They met up again, in the promotion's first ever Barbed Wire Massacre at Turning Point. Sabu finally beat Abyss, but following the match was not seen on TNA TV for several months. He made his return at Lockdown on April 23, 2006 in a match against Samoa Joe for Joe's TNA X Division Championship, despite Sabu having a broken forearm. Sabu was defeated in what would turn out to be his final TNA match. Sabu was released soon afterwards from TNA.
World Wrestling Entertainment/WWE (2006–2007)[edit]
Sabu in the ring at a WWE house show in 2006
Shortly after his TNA release, on April 24, 2006, Sabu's official website reported that he had signed a one-year contract with World Wrestling Entertainment. At the One Night Stand pay-per-view, Sabu faced Rey Mysterio for the World Heavyweight Championship. At the end of the match, Mysterio found himself standing on a ringside table with Sabu flying at him. Sabu caught the champ in a front facelock and nailed him with a DDT which caused both men to crash through the table. At this point, the WWE medical staff rushed to the injured men and declared neither man could continue and ordered the match stopped, resulting in a No Contest in which Mysterio kept his title.
On the June 13 premiere of ECW on Sci Fi, Sabu won a 10-man Extreme Battle Royal with the stipulation that the winner face John Cena at Vengeance. Sabu further fueled the feud during the next week's Raw, when he interfered in a Cena match and performed a Triple Jump Leg Drop on him, diving onto Cena and putting him through the announcers' table. Cena defeated Sabu in their 'Extreme Lumberjack match' at Vengeance. On July 2, Sabu, traveling with fellow ECW wrestler Rob Van Dam, was arrested and charged with possession of drug paraphernalia, and nine Vicodin tablets following a traffic stop in Hanging Rock, Ohio[11] following a house show in Huntington, WV. Brunk was fined $1,000 based on the guidelines of WWE's Wellness Policy.[12] He pleaded guilty to possession of a controlled substance and the charge of possession of drug paraphernalia was dropped. He was given a suspended sentence of 10 days in jail and a $500 fine.[13] Meanwhile, he defeated Stevie Richards in an Extreme Rules match at Saturday Night's Main Event.
Sabu wrestling C.W. Anderson at the ECW Arena in June 2006
Towards the end of July, Sabu began to talk on camera for himself – instead of using a go between – and demanded a shot at The Big Show's ECW World Championship which Paul Heyman refused to grant him in order to 'protect' his champion. Instead he forced him into a match against the returning Kurt Angle to determine a number one contender. When that match was interrupted by the returning Rob Van Dam another match was signed, Angle versus Van Dam versus Sabu, for the number one contendership (Angle then became too injured to compete and was pulled from the match). Sabu beat Rob Van Dam in their ladder match to win a shot at Big Show at SummerSlam, a match which he ended up losing.[14]
At Survivor Series, Sabu teamed up with John Cena, Bobby Lashley, Rob Van Dam and Kane to face the team of The Big Show, Test, Montel Vontavious Porter, Finlay and Umaga. Sabu eliminated Test following a Tornado DDT, but he was later eliminated by Big Show via pinfall after receiving a chokeslam. In the end, Team Cena gained victory. At December to Dismember, Sabu was originally set to appear in the main event, an extreme elimination chamber match against The Big Show, Test, Rob Van Dam, CM Punk and Bobby Lashley, but was 'taken out' and replaced by Hardcore Holly. The following episode on ECW, CM Punk and Rob Van Dam got on the mic before their match with Test and Hardcore Holly and dedicated the match to Sabu. When Punk and Van Dam won the match, Paul Heyman and his security team came out and had beaten down on the two. Sabu later made his return with a heavily wrapped arm to make the save. Sabu made his Royal Rumble match debut in the 2007 Royal Rumble on January 28, where he was eliminated by Kane after receiving a chokeslam over the top rope and through a table.[15]
Sabu joined the ECW Originals along with Rob Van Dam, Tommy Dreamer and The Sandman. The ECW Originals began a feud with the New Breed (Elijah Burke, Kevin Thorn, Marcus Cor Von and Matt Striker). The two teams faced off in a match at WrestleMania 23 in which the ECW Originals won.[16] On the April 3 edition of ECW, the ECW Originals faced the New Breed again in a rematch, which the New Breed won after Burke performed the Elijah Express on Sabu through a table.[17]
Sabu's final WWE match was on the May 1 episode of ECW, where he competed in a fatal four-way match against Dreamer, Van Dam and Sandman to determine the number one contender for the ECW Championship, which Van Dam won.[18] On May 16, 2007, Sabu was released from his WWE contract.[19]
Independent circuit (2007–2010)[edit]
Sabu performing his signature taunt in 2009
Sabu in 2008
On July 13, 2007, it was announced that Sabu would be working in Mexico's AAA promotion in Mexico for their Triplemanía XV event. Sabu came out during the main event and put La Parka through a table, joining forces with the heels X-Pack, Ron 'The Truth' Killings, and Konnan. Since then, he has made appearances on their major televised programs on Galavision as a minor part of Konnan's heel stable, La Legión Extranjera.[20]
Sabu has been noted as a member of the Australasian Wrestling Federation roster, where he has so far wrestled three matches during the Wrestlefest 2007 Tour in October 2007. Sabu Defeated Il Cognito at Fairy Meadow, New South Wales on October 5, Steve Ravenous at Cardiff, New South Wales on the October 6 and finally wrestling then for the AWF Australasian Championship against TNT to a no contest due to interference from The Platinum Players at Blacktown, New South Wales on the October 7.
On February 8, 2008, Sabu debuted as 'The Crazed Kamikaze' for a brief period in CWA Pro Wrestling in Columbia, South Carolina before going back to his Sabu ring name. Teaming with then-CWA Heavyweight Champion Timber, Sabu won the match for his team after he dove off the staging area onto his opponent Phil Shatter, putting him through a table. On May 10, he was scheduled to face the new CWA Heavyweight Champion Raven in Fayetteville, North Carolina but Sabu did not show up due to injuries.
In November 2009, Sabu completed a tour of the United Kingdom representing the AWWL/BTW. On November 29, 2009 Sabu faced RVD for his AWR heavyweight championship belt in an extreme rules match in Oberhausen Germany.
On October 30, 2010, Sabu defeated Damián 666 to win Xtreme Latin American Wrestling's International Championship.[21]
Juggalo Championship Wrestling (2007-2011)[edit]
In 2007, Sabu teamed with Insane Clown Posse to defeat Trent Acid and the Young Alter Boys at Juggalo Championship Wrestling's Bloodymania.[22] During the second season of the company's internet wrestling show SlamTV!, Raven was involved in a feud with JCW Heavyweight Champion Corporal Robinson.[23] In the third episode, Sabu appeared from out of the crowd and saved Robinson from an attack by Raven and his lackey Sexy Slim Goody.[24] Raven and Goody teamed up against Robinson and Sabu in the following episode, but Raven fled from the match.[25] At Bloodymania III, Sabu defeated Raven in a Raven's Rules match.[26] He returned as a full-time member of the roster at Oddball Wrestling 2010, where he defeated Officer Colt Cabana in an 'I Quit' match.[27] Following two victories, Sabu teamed with The Weedman to defeat Bull Pain and Isabella Smothers at Hardcore Hell.[28][29][30] After the match, per storyline, he aligned himself with villainous manager Charlie Brown.[30] Sabu defeated hero2 Tuff Tony at the next event, and continued to attack him after the match ended.[31] He and Tony wrestled again at Up in Smoke in a match where Rob Conway was hired by Brown to attack Tony.[32] After Rhino scared off Sabu and Conway, a tag team match was scheduled between the two and Rhino and Tony at St. Andrew's Brawl.[32]
Returns to TNA / Impact Wrestling (2010, 2019)[edit]
On August 2, 2010, it was confirmed that Sabu would be taking part in TNA's ECW reunion show against TNA World Heavyweight Champion Rob Van Dam in the main event Hardcore Justice on August 8.[33] At the event, he was defeated by former tag team partner and rival Rob Van Dam in a Hardcore Rules match.[34] On the following edition of Impact!, the ECW alumni, known collectively as Extreme, Version 2.0 (EV 2.0), were assaulted by A.J. Styles, Kazarian, Robert Roode, James Storm, Douglas Williams and Matt Morgan of Ric Flair's Fourtune stable, who thought they didn't deserve to be in TNA.[35][36] The following week, TNA president Dixie Carter gave each member of EV 2.0 TNA contracts in order for them to settle their score with Fourtune.[37] At No Surrender, Sabu unsuccessfully challenged Douglas Williams for the TNA X Division Championship.[38] At Bound for Glory Sabu, Tommy Dreamer, Raven, Rhino and Stevie Richards defeated Fortune members Styles, Kazarian, Morgan, Roode and Storm in a Lethal Lockdown match.[39] On the October 21 edition of Impact!, Sabu and Rob Van Dam were defeated in a tag team match by James Storm and Robert Roode, after Sabu accidentally hit his own partner with a chair. After the match, Van Dam and Sabu began shoving each other, before being broken up by the rest of EV 2.0.[40] At Turning Point, EV 2.0 faced Fortune in a ten-man tag team match, where each member of EV 2.0 put their TNA careers on the line. A.J. Styles won the match for his team by pinning Sabu, who as a result was fired from TNA.[41] It had been reported earlier that Brunk's release from TNA was legitimate.[42]
On February 8, 2019, it was revealed that Sabu would return to TNA, now named Impact Wrestling at their following pay-per-view, United We Stand. At the event on April 4, 2019, Sabu teamed with Rob Van Dam to face Lucha Bros (Pentagón Jr. and Fénix).[43]
Independent circuit (2012–present)[edit]
Sabu performing his Arabian Facebuster on Michael Elgin
On January 14, 2012, Sabu returned to the former ECW Arena, when he defeated Justin Credible at an Evolve event in the venue's final professional wrestling event.[44] In 2013, Sabu completed a UK tour, wrestling for a number of the UK's top promotions. Sabu entered the Extreme Rising World Championship tournament but was eliminated in the first round by Devon Storm.[45]
On March 30, 2013, Sabu made his Newfoundland wrestling debut when he wrestled in the Newfoundland and Labrador based company's CEW 'King Of The Rock' tournament. This was a two show event which saw Sabu defeat multiple CEW mainstays such as CEW headliners Psycho Mitch and Krys Krysmon. Sabu ultimately lost the tournament after a brutal match with Scott Gotch in which Sabu lost intentionally at the request of CEW owner Dennis Guthrie. As a reward, CEW owner enshrined Sabu as the new CEW Newfoundland Heritage Champion. He defended his title in a Fatal Four-Way elimination match on April 1, 2013 for CEW in St. Lawrence, NL against Justin Lock, Tony King and Brandon Flip. In Scotland, Sabu challenged Jack Jester for the ICW Heavyweight Championship but was defeated.[46]
Sabu has also worked for Pro Wrestling Holland, where he has held the PWH Championship.[47] On October 18, 2014, at Insurrection, Sabu defeated Balls Mahoney to win the WWL Extreme Championship. He lost the title against Monster Pain. He also currently wrestles for the Big Time Wrestling independent circuit.
On November 15, 2014, Melissa Coates began accompanying Sabu to the ring as the 'Super Genie'. Their partnership continues to this day.
On June 5, 2015, Sabu lost a match to his long-time partner Rob Van Dam in Scranton, Pennsylvania. At the end of the match, after pinning Sabu, RVD helped him up off the mat and both raised hands together.[48]
On August 17, 2018, Sabu lost to Nick Gage at a GCW event.[49]
Other media[edit]
He appeared in the video game ECW Hardcore Revolution, Legends of Wrestling, Legends of Wrestling II, Backyard Wrestling: Don't Try This At Home, Showdown: Legends of Wrestling, and WWE SmackDown vs. Raw 2008.[50] Sabu's likeness also appears, albeit unofficially, in several games within the Fire Pro Wrestling franchise including Fire Pro Wrestling, Fire Pro Wrestling 2, and Fire Pro Wrestling Returns.
Personal life[edit]
Brunk's father is half Irish and half German, and his mother is Lebanese. Brunk was married to a Japanese woman, Hitomi, on June 22, 1997, in Michigan, and had a separate Japanese ceremony on December 12, 1998, in Tokyo.[51] In Forever Hardcore, Brunk reveals he took his name 'Sabu' from actor Sabu Dastagir, of whom his uncle was a fan.
In July 2016, Brunk was named part of a class action lawsuit filed against WWE which alleged that wrestlers incurred 'long term neurological injuries' and that the company 'routinely failed to care' for them and 'fraudulently misrepresented and concealed' the nature and extent of those injuries. The suit was litigated by attorney Konstantine Kyros, who has been involved in a number of other lawsuits against WWE.[52] The lawsuit was dismissed by US District Judge Vanessa Lynne Bryant in September 2018.[53]
On September 8, 2016, Brunk guest starred on an episode of the Viceland television program, Traveling the Stars: Action Bronson and Friends Watch 'Ancient Aliens': Alien Devastation with his former tag team partner, Rob Van Dam and current manager The Super Genie.[54]
Professional wrestling style and persona[edit]
Sabu performing the Arabian Clutch on Dru Onyx
Sabu is nicknamed 'The Homicidal, Suicidal, Genocidal, Death–Defying Maniac' due to his mixed style of high-flying and hardcore wrestling.[1] Some of his moves includes using a steel chair, like the Air Sabu (a heel kick to a cornered opponent, with the assistance of a steel chair), the Arabian Facebuster (Jumping, diving or a somersault leg drop, driving a steel chair into the face of the opponent) or the Arabian Skullcrusher (jumping, diving or a somersault leg drop, driving a steel chair into the back of the opponent's head, usually through a table). Being trained by his uncle, The Original Sheik, he also uses his Arabian Clutch (a Camel clutch) as a move. His character has rarely spoke, however while working for WWE he had to do the most talking he ever did.[55]
Championships and accomplishments[edit]
Sabu's Hardcore Hall of Fame banner in the former ECW Arena.
- Asylum Championship Wrestling
- ACW Heavyweight Championship (1 time)
- Billtown Championship Wrestling
- BCW Heavyweight Championship (1 time, current)[56][57]
- Border City Wrestling
- BCW Can-Am Heavyweight Championship (1 time)[57]
- Cutting Edge Wrestling
- CEW Newfoundland Heritage Championship (1 time)
- Eastern Championship Wrestling/Extreme Championship Wrestling
- ECW FTW Heavyweight Championship (1 time)
- ECW World Heavyweight Championship (2 times)
- ECW World Television Championship (1 time)
- ECW World Tag Team Championship (3 times) – with Taz (1) and Rob Van Dam (2)
- Second ECW Triple Crown Champion
- Extreme Wrestling Alliance
- EWA Junior Heavyweight Championship (1 time)
- European Wrestling Association
- EWA Junior Heavyweight Championship (2 times)
- Frontier Martial-Arts Wrestling
- FMW World Martial Arts Tag Team Championship (1 time) – with Horace Boulder
- Hardcore Championship Wrestling
- HCW Heavyweight Championship (1 time)
- Hardcore Hall of Fame
- Class of 2009[58]
- Insane Wrestling Federation
- IWF Heavyweight Championship (2 times)
- Juggalo Championship Wrestling
- JCW Heavyweight Championship (1 time)
- Main Event Championship Wrestling
- MECW Heavyweight Championship (1 time)
- Motor City Wrestling
- MCW Heavyweight Championship (3 times)
- National Wrestling Alliance
- NWA World Heavyweight Championship (1 time)
- NWA Florida
- NWA World Heavyweight Championship (1 time)
- National Wrestling Conference
- NWC Heavyweight Championship (2 times)
- New Japan Pro Wrestling
- IWGP Junior Heavyweight Championship (1 time)
- UWA World Junior Light Heavyweight Championship (1 time)
- Pro Wrestling Holland
- Pro Wrestling Holland Championship (1 time)[47]
- Pro Wrestling Illustrated
- PWI ranked him #5 of the top 500 singles wrestlers in the PWI 500 in 1995[59]
- PWI ranked him #86 of the top 500 singles wrestlers of the PWI Years in 2003[60]
- Professional Championship Wrestling
- PCW Television Championship (1 time)
- Pro-Pain Pro Wrestling
- 3PW World Heavyweight Championship (1 time)[61]
- Stampede Wrestling
- Stampede Pacific Heavyweight Championship (1 time)
- Total Nonstop Action Wrestling
- Match of the Year (2005) vs. Abyss, Barbed Wire Massacre on December 11[62]
- Ultimate Championship Wrestling
- UCW Heavyweight Championship (1 time)
- UPW Pro Wrestling
- UPW American Championship (2 times, current)
- United States Xtreme Wrestling
- UXW United States Heavyweight Championship (2 times)[63]
- Universal Wrestling Alliance
- UWA Heavyweight Championship (1 time)
- Wawan Wrestling Championship
- WWC Hardcore Championship (1 time, current)[64]
- Wrestling Alliance Revolution
- WAR World Extreme Championship (2 times, current)[65]
- World Wrestling Council
- WWC Hardcore Championship (1 time)
- WWC Universal Heavyweight Championship (1 time)
- World Wrestling League
- WWL Extreme Championship (1 time)[66]
- Wrestling Observer Newsletter
- Readers' Favorite Wrestler (1994)
- Xtreme Intense Championship Wrestling
- XICW Xtreme Championship (1 time)
- Xtreme Latin American Wrestling
- X-LAW International Championship (1 time)[21]
- Xtreme Pro Wrestling
- XPW World Heavyweight Championship (1 time)
1Sabu's first reign occurred while the promotion was an NWA affiliate named Eastern Championship Wrestling, and was prior to the promotion becoming Extreme Championship Wrestling and the title being declared a world title by ECW. Sabu held the title again after these events.
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External links[edit]
Wikimedia Commons has media related to Terry Brunk. |
- Sabu on WWE.com
- Sabu's profile at Cagematch.net
- Sabu on IMDb
Retrieved from 'https://en.wikipedia.org/w/index.php?title=Sabu_(wrestler)&oldid=903171881'