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https://www.readbyqxmd.com/read/28646524/risk-factors-for-severe-respiratory-depression-from-prescription-opioid-overdose
#1
Lindsay M Fox, Robert S Hoffman, David Vlahov, Alex F Manini
BACKGROUND AND AIMS: Prescription opioid overdose is a leading cause of injury-related morbidity and mortality in the US. We aimed to identify characteristics associated with clinical severity in emergency department patients with prescription opioid overdose. DESIGN: This was a secondary data analysis of adult prescription opioid overdoses from a large prospective cohort of acute overdoses. We examined elements of a typical emergency department evaluation using a multivariable model to determine which characteristics were associated with clinical severity, specifically severe respiratory depression (SRD)...
June 23, 2017: Addiction
https://www.readbyqxmd.com/read/28642082/clinical-trial-of-the-effects-of-vitamin-d-supplementation-on-psychological-symptoms-and-metabolic-profiles-in-maintenance-methadone-treatment-patients
#2
Amir Ghaderi, Hamid Reza Banafshe, Maryam Motmaen, Morad Rasouli-Azad, Fereshteh Bahmani, Zatollah Asemi
BACKGROUND: Vitamin D deficiency may be associated with some complications including nonspecific musculoskeletal pain and periodontal disease in maintenance methadone treatment (MMT) patients. This study was designed to determine the effect of vitamin D supplementation on psychological symptoms and metabolic profiles in MMT patients. METHODS: This randomized, double-blind, placebo-controlled, clinical trial was carried out among 68 MMT patients. Participants were randomly allocated to receive either 50,000IU vitamin D supplements (n=34) or placebo (n=34) every 2weeks for 12weeks...
June 19, 2017: Progress in Neuro-psychopharmacology & Biological Psychiatry
https://www.readbyqxmd.com/read/28635521/assessment-of-an-innovative-voluntary-substance-abuse-treatment-program-designed-to-replace-compulsory-drug-detention-centers-in-malaysia
#3
Farrah Khan, Archana Krishnan, Mansur A Ghani, Jeffrey A Wickersham, Jeannia J Fu, Sin How Lim, Sangeeth Kaur Dhaliwal, Adeeba Kamarulzaman, Frederick L Altice
BACKGROUND: As part of an ongoing initiative by the Malaysian government to implement alternative approaches to involuntary detention of people who use drugs, the National Anti-Drug Agency has created new voluntary drug treatment programs known as Cure and Care (C&C) Centers that provide free access to addiction treatment services, including methadone maintenance therapy, integrated with social and health services. OBJECTIVES:   We evaluated early treatment outcomes and client satisfaction among patients accessing C&C treatment and ancillary services at Malaysia's second C&C Center located in Kota Bharu, Kelantan...
February 22, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/28631527/buprenorphine-naloxone-versus-methadone-and-lofexidine-in-community-stabilisation-and-detoxification-a-randomised-controlled-trial-of-low-dose-short-term-opiate-dependent-individuals
#4
Fergus D Law, Alison M Diaper, Jan K Melichar, Simon Coulton, David J Nutt, Judy S Myles
Buprenorphine/naloxone, methadone and lofexidine are medications with utility in the treatment of opiate withdrawal. We report the first randomised controlled trial to compare the effects of these two medications on withdrawal symptoms and outcome during opiate induction/stabilisation and detoxification. A double-blind randomised controlled trial was conducted in an outpatient satellite clinic of a specialist drug service. Eighty opiate dependent individuals meeting DSM-IV criteria for opiate dependence, using ⩽ ½ g heroin smoked/chased or ¼ g heroin injected or ⩽ 30mg methadone, with ⩽ 3 years of opioid dependency, underwent a short-term opiate treatment programme involving induction/stabilisation on methadone 30mg or buprenorphine/naloxone 4mg/1mg, followed by detoxification (where the methadone group was assisted by lofexidine)...
June 1, 2017: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/28617422/reduced-narcotic-and-sedative-utilization-in-a-nicu-after-implementation-of-pain-management-guidelines
#5
D Rana, B Bellflower, J Sahni, A J Kaplan, N T Owens, E L Arrindell, A J Talati, R Dhanireddy
OBJECTIVE: To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines. STUDY DESIGN: Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014). RESULTS: Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods...
June 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28609231/methadone-dose-selection-for-treatment-of-pain-compared-with-consensus-recommendations
#6
Parisa Karimian, Rabia S Atayee, Toluwalase A Ajayi, Kyle P Edmonds
BACKGROUND: Many factors make methadone an appealing option for treatment of pain in patients seen by palliative care; however, complex drug-related properties and variable patient response complicate appropriate conversion ratios from other opioids to methadone. Currently, there is no consensus regarding one accepted conversion method. OBJECTIVE: Current patterns of prescribing for clinicians at a three-hospital academic health system on initial rotation to methadone for the management of pain were compared with a series of consensus recommendations for methadone dose calculation...
June 13, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28601713/a-laplace-transform-based-technique-for-solving-multiscale-and-multidomain-problems-application-to-a-countercurrent-hemodialyzer-model
#7
Laurent Simon
An integral-based method was employed to evaluate the behavior of a countercurrent hemodialyzer model. Solute transfer from the blood into the dialysate was described by writing mass balance equations over a section of the device. The approach provided Laplace transform concentration profiles on both sides of the membrane. Applications of the final value theorem led to the development of the effective time constants and steady-state concentrations in the exit streams. Transient responses were derived by a numerical inversion algorithm...
June 4, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28596836/characterizing-qt-interval-prolongation-in-early-clinical-development-a-case-study-with-methadone
#8
Vincent F S Dubois, Meindert Danhof, Oscar Della Pasqua
Recently, we have shown how pharmacokinetic-pharmacodynamic (PKPD) modeling can be used to assess the probability of QT interval prolongation both in dogs and humans. A correlation between species has been identified for a drug-specific parameter, making it possible to prospectively evaluate nonclinical signals. Here, we illustrate how nonclinical data on methadone can be used to support the evaluation of dromotropic drug effects in humans. ECG and drug concentration data from a safety pharmacology study in dogs were analyzed using nonlinear mixed effects modeling...
February 2017: Pharmacology Research & Perspectives
https://www.readbyqxmd.com/read/28575519/a-comparison-of-daily-versus-weekly-electronic-cigarette-users-in-treatment-for-substance-abuse
#9
Noah R Gubner, Anna Pagano, Barbara Tajima, Joseph Guydish
Objective: This research examined electronic cigarette (e-cigarette) use by individuals in treatment for substance abuse, a population with a high prevalence of tobacco use and poor smoking cessation outcomes. Methods: We surveyed 1127 individuals from 24 substance abuse treatment centers across the United States. Bivariate analyses and logistic regression were used to examine factors associated with daily (N=87) versus weekly (N=81) e-cigarette use. Results: Among the full sample, 59...
June 1, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/28574864/methadone-management-of-withdrawal-associated-with-loperamide-related-opioid-use-disorder
#10
Raphael J Leo, Muhammad A Ghazi, Kelly S Jaziri
: Loperamide hydrochloride is an over-the-counter anti-diarrheal agent, acting via mu-opioid receptor agonist effects in the intestinal myenteric plexus. Although preclinical investigations suggested that abuse liability associated with loperamide use is low, there are increasing numbers of cases reported to the US Food and Drug Administration, of abuse, dependence, and withdrawal associated with loperamide use. A case of a patient with opioid use disorder, that is, in the form of protracted loperamide excess use, requiring management of withdrawal with methadone is presented...
June 1, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28562267/an-initiative-to-improve-the-quality-of-care-of-infants-with-neonatal-abstinence-syndrome
#11
Matthew R Grossman, Adam K Berkwitt, Rachel R Osborn, Yaqing Xu, Denise A Esserman, Eugene D Shapiro, Matthew J Bizzarro
BACKGROUND AND OBJECTIVES: The incidence of neonatal abstinence syndrome (NAS), a constellation of neurologic, gastrointestinal, and musculoskeletal disturbances associated with opioid withdrawal, has increased dramatically and is associated with long hospital stays. At our institution, the average length of stay (ALOS) for infants exposed to methadone in utero was 22.4 days before the start of our project. We aimed to reduce ALOS for infants with NAS by 50%. METHODS: In 2010, a multidisciplinary team began several plan-do-study-act cycles at Yale New Haven Children's Hospital...
May 18, 2017: Pediatrics
https://www.readbyqxmd.com/read/28561904/neonatal-abstinence-syndrome-neurobehavior-at-6-weeks-of-age-in-infants-with-or-without-pharmacological-treatment-for-withdrawal
#12
Nicole A Heller, Beth A Logan, Deborah G Morrison, Jonathan A Paul, Mark S Brown, Marie J Hayes
Use and abuse of prescription opioids and concomitant increase in Neonatal Abstinence Syndrome (NAS), a condition that may lead to protracted pharmacological treatment in more than 60% of infants, has tripled since 2000. This study assessed neurobehavioral development using the NICU Network Neurobehavioral Scale in 6-week old infants with prenatal methadone exposure who did (NAS+; n = 23) or did not (NAS-; n = 16) require pharmacological treatment for NAS severity determined by Finnegan Scale. An unexposed, demographically similar group of infants matched for age served as comparison (COMP; n = 21)...
May 31, 2017: Developmental Psychobiology
https://www.readbyqxmd.com/read/28554601/hepatitis-c-virus-core-antigen-a-potential-alternative-to-hcv-rna-testing-among-persons-with-substance-use-disorders
#13
Andrew H Talal, Yang Chen, Marija Zeremski, Roberto Zavala, Clewert Sylvester, Mary Kuhns, Lawrence S Brown, Marianthi Markatou, Gavin A Cloherty
BACKGROUND: The hepatitis C virus (HCV) core antigen (HCVcAg) may be an alternative diagnostic method to HCV RNA especially in populations such as substance users, the homeless or in resource-limited settings. AIMS: To evaluate performance of HCVcAg test in patients with opioid use disorder (OUD) on methadone in order to document its performance characteristics in the target population and to ensure that its specificity remains consistent across different populations...
July 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/28543191/methadone-buprenorphine-and-naltrexone-for-the-treatment-of-opioid-use-disorder-in-pregnant-women
#14
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...
May 24, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28540195/conversion-from-prolonged-intravenous-fentanyl-infusion-to-enteral-methadone-in-critically-ill-children
#15
Vijay Srinivasan, Daniel Pung, Sean P O'Neill
AIM: To describe our institutional experience with conversion from intravenous (IV) fentanyl infusion directly to enteral methadone and occurrence of withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation and analgesia. METHODS: With Institutional Review Board approval, we retrospectively studied consecutively admitted invasively mechanically ventilated children (0-18 years) sedated with IV fentanyl infusion > 5 d and subsequently converted directly to enteral methadone...
May 8, 2017: World Journal of Clinical Pediatrics
https://www.readbyqxmd.com/read/28537688/prevalence-of-alcohol-and-other-drugs-in-injured-drivers-and-their-association-with-clinical-outcomes
#16
F Cittadini, N De Giovanni, L Caradonna, G Vetrugno, A Oliva, N Fucci, C Zuppi, V L Pascali, M Covino
OBJECTIVE: Driving under the influence of alcohol or drugs is a risk factor for motor vehicle accidents (MVAs). This issue has become an increasing concern for the governments of many European and North American countries, thereby encouraging the adoption of preventive policies. The aim of this study was to investigate the associations between major clinical outcomes and alcohol or drug abuse among drivers involved in MVAs who were referred to an Italian Emergency Department. PATIENTS AND METHODS: The study population consisted of consecutive injured drivers who were admitted to the Emergency Department following an MVA during a period of one year...
May 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28514508/methadone-for-neuropathic-pain-in-adults
#17
REVIEW
Ewan D McNicol, McKenzie C Ferguson, Roman Schumann
BACKGROUND: This review replaces an earlier review, "Methadone for chronic non-cancer pain in adults". This review serves to update the original and includes only studies of neuropathic pain. Methadone belongs to a class of analgesics known as opioids, that are considered the cornerstone of therapy for moderate-to-severe postsurgical pain and pain due to life-threatening illnesses; however, their use in neuropathic pain is controversial. Methadone has many characteristics that differentiate it from other opioids, which suggests that it may have a different efficacy and safety profile...
May 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28513227/temporal-relationship-of-sex-risk-behaviors-and-substance-use-severity-among-men-in-substance-use-treatment
#18
Howard Newville, James L Sorensen, Mary Hatch-Maillette, Donald A Calsyn
Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index-Lite (ASI-Lite), controlling for treatment condition...
May 17, 2017: Journal of Sex Research
https://www.readbyqxmd.com/read/28503730/cardiopulmonary-and-sedative-effects-of-intravenous-or-epidural-methadone-in-conscious-dogs
#19
B H B Vieira, L T Nishimura, L L Carvalho, A Auckburally, E Mattos-Junior
Cardiopulmonary and sedative effects of intravenous or epidural methadone were compared. Six beagles were randomly assigned to group MIV (methadone 0.5 mg/kg IV + NaCl 0.9% epidurally) or MEP (methadone 0.5 mg/kg epidurally + NaCl 0.9% IV). Cardiopulmonary, blood gas and sedation were assessed at time (T) 0, 15, 30, 60, 120, 240 and 480 min after drug administration. Compared to T0, heart rate decreased at T15-T120 in MIV (p < .001) and T15-T240 in MEP (p < .05); mean arterial pressure was reduced at T15-T60 in MEP (p < ...
May 15, 2017: Journal of Veterinary Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28495454/intratesticular-and-incisional-line-infiltration-with-ropivacaine-for-castration-in-medetomidine-butorphanol-midazolam-sedated-dogs
#20
Yishai Kushnir, Noa Toledano, Liat Cohen, Tali Bdolah-Abram, Yael Shilo-Benjamini
OBJECTIVE: To evaluate whether intratesticular and incisional ropivacaine infiltration produces sufficient intra- and postoperative analgesia for castrating dogs under sedation. STUDY DESIGN: Randomized, blinded, controlled clinical study. ANIMALS: Twenty-three healthy dogs weighing 5.8-35.6 kg admitted for castration. METHODS: Dogs were sedated with medetomidine (0.01 mg kg(-1)), butorphanol (0.2 mg kg(-1)) and midazolam (0...
March 2017: Veterinary Anaesthesia and Analgesia
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