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Reduced abstinence syndrome symptoms

Michele C Walsh, Moira Crowley, Scott Wexelblatt, Susan Ford, Pierce Kuhnell, Heather C Kaplan, Richard McClead, Maurizio Macaluso, Carole Lannon
OBJECTIVES: Neonatal abstinence syndrome (NAS) after an infant's in-utero exposure to opioids has increased dramatically in incidence. No treatment standards exist, leading to substantial variations in practice, degree of opioid exposure, and hospital length of stay. METHODS: The Ohio Perinatal Quality Collaborative conducted an extensive multi-modal quality improvement initiative with the goal to (1) standardize identification, nonpharmacologic and pharmacologic treatment in level-2 and 3 NICUs in Ohio, (2) reduce the use of and length of treatment with opioids, and (3) reduce hospital length of stay in pharmacologically treated newborns with NAS...
March 7, 2018: Pediatrics
Carmen Mannucci, Simona Pichini, Elvira Ventura Spagnolo, Fabrizio Calapai, Sebastiano Gangemi, Michele Navarra, Gioacchino Calapai
BACKGROUND: Gamma-hydroxybutyrate (GHB or sodium oxybate) is both an exogenous and endogenous molecule with neuromodulator properties. In the United States, GHB is an approved drug for the treatment of narcolepsy and narcolepsy with cataplexy in adults. In some European Union countries, sodium oxybate is applied for the treatment of opioid and alcohol withdrawal. OBJECTIVE: The aim of the present review was to describe the state of art of the pre-clinical research and the clinical evidence related to GHB used alone or in combination with other treatments in alcohol withdrawal syndrome and alcohol abstinence maintenance...
December 7, 2017: Current Drug Metabolism
Mohammed Akbar, Mark Egli, Young-Eun Cho, Byoung-Joon Song, Antonio Noronha
Patients who suffer from alcohol use disorders (AUDs) usually go through various socio-behavioral and pathophysiological changes that take place in the brain and other organs. Recently, consumption of unhealthy food and excess alcohol along with a sedentary lifestyle has become a norm in both developed and developing countries. Despite the beneficial effects of moderate alcohol consumption, chronic and/or excessive alcohol intake is reported to negatively affect the brain, liver and other organs, resulting in cell death, organ damage/failure and death...
December 2, 2017: Pharmacology & Therapeutics
Nicolas J Schlienz, Alan J Budney, Dustin C Lee, Ryan Vandrey
PURPOSE OF REVIEW: This report provides an updated overview of pre-clinical and clinical research on the etiology and biological substrates of the cannabis withdrawal syndrome. RECENT FINDINGS: Long-term cannabis use is associated with downregulation of type-1 cannabinoid receptors (CB1). Reduced CB1 receptor density is related to increased withdrawal during early abstinence, and the reduction in CB1 receptor density reverses with extended abstinence. Females have been shown to have increased rate and severity of a subset of cannabis withdrawal symptoms compared with men...
June 2017: Current Addiction Reports
Tran H Tran, Brooke L Griffin, Rebecca H Stone, Kathleen M Vest, Timothy J Todd
Pregnant women with opioid use disorder can be treated with methadone, buprenorphine, or naltrexone to reduce opioid use and improve retention to treatment. In this review, we compare the pregnancy outcomes of methadone, buprenorphine, and naltrexone in clinical trials and discuss the potential behavioral and developmental effects of these agents seen in offspring in animal studies. Important clinical considerations in the management of opioid use disorder in pregnant women and their infants are also discussed...
July 2017: Pharmacotherapy
Jessica W Cook, Stephanie T Lanza, Wanghuan Chu, Timothy B Baker, Megan E Piper
Introduction: Research shows that abstinence from tobacco leads to a withdrawal-related decrement in responsivity to nondrug rewards (ie, anhedonia). However, it remains unclear how anhedonia relates to other key withdrawal symptoms and withdrawal-related constructs over time. We analyzed ecological momentary assessment data to examine whether a decrement in response to rewards during a 10-day period following quitting shows a pattern of associations with other variables (ie, treatment, tobacco dependence, negative affect, and craving) that is consistent with anhedonia being a tobacco withdrawal symptom...
June 1, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
Randi Melissa Schuster, Madeleine Fontaine, Emily Nip, Haiyue Zhang, Ailish Hanly, A Eden Evins
Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol...
February 27, 2017: Preventive Medicine
Cheryl Cirillo, Kim Francis
BACKGROUND: The United States is in an opioid crisis with abuse among women on the rise over the past 10 years. Infants of opioid-dependent mothers are at risk for neonatal abstinence syndrome (NAS). Neonatal abstinence syndrome can affect multiple systems and disrupt normal growth and development. It is for this reason that strategies to promote health such as breastfeeding need to be explored. This brief evaluates current evidence regarding breast milk and the impact it has on NAS. PURPOSE: The question guiding this brief is: "Does provision of breast milk reduce NAS withdrawal symptoms, decrease length of stay, and decrease the need for pharmacologic therapy for infants whose mothers are maintained on methadone or buprenorphine?" SEARCH STRATEGY: CINHAL/MEDLINE Complete and PubMed databases were searched using key words-NAS and breastfeeding-and the search was limited to 10 years for English studies evaluating the effects of breast milk on severity of NAS, pharmacologic therapy, and length of stay whose mothers received methadone or buprenorphine during pregnancy...
October 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Alison Volpe Holmes, Emily C Atwood, Bonny Whalen, Johanna Beliveau, J Dean Jarvis, John C Matulis, Shawn L Ralston
BACKGROUND AND OBJECTIVE: The incidence and associated costs of neonatal abstinence syndrome (NAS) have recently risen sharply; newborns with NAS occupy 4% of NICU beds. We implemented a coordinated program for NAS including standardized protocols for scoring, medications and weaning, and a calm rooming-in environment, to improve family-centered care and to decrease both length of stay (LOS) and hospital costs. METHODS: In early 2013, a multidisciplinary quality improvement team began consecutive plan-do-study-act (PDSA) cycles...
June 2016: Pediatrics
Boris Gourévitch, Jun Cai, Nicholas Mellen
Neonatal abstinence syndrome (NAS) occurs in babies chronically exposed to opioids during pregnancy. NAS shares features with opioid withdrawal symptoms seen in adults, including autonomic dysregulation. Here, the effect of low-dose in utero methadone (MTD) exposure on respiration-modulated networks along the ventral respiratory column (VRC) in ventrolateral medulla was investigated in the neonate Sprague-Dawley rat. MTD was administered via drinking water (3mg/kg/day in drinking water of the mother E7-E21)...
March 20, 2016: Experimental Neurology
Llewellyn Mills, Robert A Boakes, Ben Colagiuri
BACKGROUND: Expectancies have been shown to play a role in the withdrawal syndrome of many drugs of addiction; however, no studies have examined the effects of expectancies across a broad range of caffeine withdrawal symptoms, including craving. AIMS: The purpose of the current study was to use caffeine as a model to test the effect of expectancy on withdrawal symptoms, specifically whether the belief that one has ingested caffeine is sufficient to reduce caffeine withdrawal symptoms and cravings in abstinent coffee drinkers...
April 2016: Journal of Psychopharmacology
F P Busardò, C Kyriakou, S Napoletano, E Marinelli, S Zaami
Gamma-hydroxybutyrate (GHB) is a short chain fatty acid endogenously produced within the central nervous system (CNS) and acts as a precursor and metabolite of the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Although, it is an illegal recreational drug of abuse, its sodium salt (sodium oxybate) has been utilized as a medication for a number of medical conditions. The first aim of this review was to focus on current applications of sodium oxybate for the treatment of narcolepsy, with a particular emphasis on the key symptoms of this disorder: cataplexy and excessive daytime sleepiness (EDS)...
December 2015: European Review for Medical and Pharmacological Sciences
Mallory E Young, Shanna J Hager, Darrell Spurlock
OBJECTIVE: The primary objective was to determine whether oral morphine sulfate contributed to decreased length of stay, both in the hospital and neonatal intensive care unit (NICU), when compared to oral methadone for the treatment of neonatal abstinence syndrome (NAS). Secondary objectives included evaluation of NAS scores, opioid requirements, use of adjuvant therapy, and total cost of hospital stay. METHODS: An equal number of neonates who received oral morphine sulfate and oral methadone as treatment for NAS were identified...
December 1, 2015: American Journal of Health-system Pharmacy: AJHP
Lindsey Asti, Jacqueline S Magers, Erin Keels, Jonathan Wispe, Richard E McClead
BACKGROUND AND OBJECTIVE: Neonatal abstinence syndrome (NAS), a self-limiting condition, is associated with clinical symptoms that may require pharmacological intervention. Optimal treatment of NAS remains undetermined, but the hospital length of stay (LOS) for patients with NAS is partially dependent upon a standard treatment protocol used. Prolonged LOS for patients with NAS can lead to adverse patient harm, impaired maternal-infant attachment, and significant health care costs. Therefore, we conducted a quality improvement study to reduce the LOS for infants with NAS...
June 2015: Pediatrics
Kenneth A Perkins, Joshua L Karelitz
INTRODUCTION: Acute cigarette smoking may relieve withdrawal and negative affect due to tobacco abstinence to a greater extent in women versus men. Yet, the relative contribution of the cigarette's nicotine content to this sex difference is not clear. METHODS: Non-quitting dependent adult smokers (N = 44; 21 males, 23 females) participated in 2 virtually identical sessions, each after abstaining overnight (CO < 10 ppm) and differing only in the nicotine content of the designated cigarette...
April 2015: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
Claudia B Padula, Tim McQueeny, Krista M Lisdahl, Jenessa S Price, Susan F Tapert
BACKGROUND: Amygdala volume abnormalities have been reported in relation to craving in substance-dependent adults, but it remains unclear if these effects are seen in adolescent marijuana (MJ) users, particularly following abstinence. OBJECTIVES: The aim of this study was to examine the relationship between amygdala volume and craving during 28 days of abstinence in adolescent MJ users. METHODS: MJ-using adolescents (n = 22) aged 16-19 were recruited as part of a larger study on brain function in teen drug users...
March 2015: American Journal of Drug and Alcohol Abuse
Thatsanee Limsanon, Rasmon Kalayasiri
BACKGROUND: Cigarette craving usually occurs in conjunction with unpleasant feelings, including stress, as part of a withdrawal syndrome. Progressive muscle relaxation (PMR), a behavioral technique used to reduce stress by concentrating on achieving muscle relaxation, may reduce levels of cigarette craving and other substance-related negative feelings and withdrawal symptoms. METHODS: Demographic and cigarette use data were collected from 32 experienced smokers at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand using the Semi-Structured Assessment for Drug Dependence and Alcoholism...
March 2015: Behavior Therapy
Katrin Janhsen, Patrik Roser, Knut Hoffmann
BACKGROUND: Benzodiazepine abuse and dependence have been recognized and widely discussed for more than 40 years. With more than 230 million daily doses prescribed in Germany per year, the burden of reimbursement on the statutory health insurance carriers is high, albeit with a slight decline from year to year. At present, about 50% of all prescriptions in Germany are issued privately, even for patients who have statutory health insurance. METHODS: We selectively review the literature on the epidemiology and treatment of benzodiazepine dependence and abuse in Germany...
January 5, 2015: Deutsches Ärzteblatt International
John J McCarthy, Martin H Leamon, Neil H Willits, Ruth Salo
OBJECTIVES: To evaluate the effects of a multiple daily dose methadone regimen in pregnancy on neonatal outcomes. METHODS: Although methadone maintenance has been the standard for the treatment of opioid dependence in pregnancy, there is no consensus on proper dosing. Single daily dosing is the most common strategy. Because of accelerated metabolism of methadone in pregnancy, this regimen may expose mother and fetus to daily episodes of withdrawal and possibly contribute to more severe Neonatal Abstinence Syndrome (NAS)...
March 2015: Journal of Addiction Medicine
Gabrielle Katrine Welle-Strand, Odd Kvamme, Andreas Andreassen, Edle Ravndal
Although opioid maintenance treatment (OMT) is the treatment of choice for pregnant opioid-dependent patients, some professionals argue that tapering the medication dose will reduce the severity of neonatal abstinence syndrome (NAS). This case description is based on the patient's detailed blog, and medical records from her general practitioner and the hospital. The patient is an employed, 32-year-old drug-abstinent woman in OMT. Her taper from 24 mg of buprenorphine started at 14 weeks' gestation and is slow, with withdrawal symptoms increasing gradually...
December 24, 2014: BMJ Case Reports
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