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Opioid withdrawal

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https://www.readbyqxmd.com/read/28635179/changing-trends-in-opioid-use-among-u-s-rheumatoid-arthritis-patients
#1
Jeffrey R Curtis, Fenglong Xie, Christian Smith, Kenneth G Saag, Lang Chen, Timothy Beukelman, Melissa Mannion, Huifeng Yun, Stefan Kertesz
Introduction Opioid prescribing recently has come under intense scrutiny. However, longitudinal patterns of opioid prescription receipt in a population-based cohort of patients who have chronic pain, such as those with rheumatoid arthritis (RA), have not been well characterized. Methods We identified a cohort of RA patients based on 2006-2014 Medicare data and evaluated longitudinal time trends in regular opioid use (>=3 filled prescriptions in each 12 month interval). A separate analysis in 2014 assessed rheumatologist-specific variability in regular opioid prescription for RA patients...
June 21, 2017: Arthritis & Rheumatology
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
#2
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/28631421/impact-of-synthetic-cannabinoids-on-the-duration-of-opioid-related-withdrawal-and-craving-among-patients-of-addiction-clinics-in-kazakhstan-a-prospective-case-control-study
#3
Mariya Prilutskaya, Francesco Saverio Bersani, Ornella Corazza, Sergey Molchanov
OBJECTIVE: The aim of the study was to prospectively assess whether regular use of synthetic cannabinoids (SCs) affects the duration of opioid-related withdrawal and craving symptoms in patients undergoing drug detoxification treatments. METHODS: Patients (n = 193) with opioid use disorder, among which 47 patients are regularly using SCs, underwent integrated drug detoxification therapies. The Clinical Opiate Withdrawal Scale and a specific visual analogue scale were used to assess opioid withdrawal and craving symptoms over time...
June 20, 2017: Human Psychopharmacology
https://www.readbyqxmd.com/read/28621702/short-duration-physical-activity-prevents-the-development-of-activity-induced-hyperalgesia-through-opioid-and-serotoninergic-mechanisms
#4
Lucas V Lima, Josimari M DeSantana, Lynn A Rasmussen, Kathleen A Sluka, Lucas Vasconcelos Lima
Regular physical activity prevents development of chronic muscle pain through modulation of central mechanisms that involve rostral ventromedial medulla (RVM). We tested if pharmacological blockade or genetic deletion of mu-opioid receptors in physically active mice modulates excitatory and inhibitory systems in the RVM in an activity-induced hyperalgesia model. We examined response frequency to mechanical stimulation of the paw, muscle withdrawal thresholds, and expression of phosphorylation of the NR1 subunit of the NMDA receptor (p-NR1) and serotonin transporter (SERT) in the RVM...
June 8, 2017: Pain
https://www.readbyqxmd.com/read/28620922/supraspinal-inhibitory-effects-of-chimeric-peptide-mcrt-on-gastrointestinal-motility-in-mice
#5
Chunbo He, Hailan Li, Jing Zhang, Yanping Kang, Fang Jia, Shouliang Dong, Lanxia Zhou
OBJECTIVES: Chimeric peptide MCRT, based on morphiceptin and PFRTic-NH2 , was a bifunctional ligand of μ- and δ-opioid receptors (MOR-DOR) and produced potent analgesia in tail-withdrawal test. The study focused on the supraspinal effects of morphiceptin, PFRTic-NH2 and MCRT on gastrointestinal motility. Moreover, opioid receptor antagonists, naloxone (non-selective), cyprodime (MOR selective) and naltrindole (DOR selective) were utilized to explore the mechanisms. METHODS: Intracerebroventricular administration was achieved via the implanted cannula...
June 16, 2017: Journal of Pharmacy and Pharmacology
https://www.readbyqxmd.com/read/28617422/reduced-narcotic-and-sedative-utilization-in-a-nicu-after-implementation-of-pain-management-guidelines
#6
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/28614197/sedation-management-in-children-supported-on-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure
#7
James B Schneider, Todd Sweberg, Lisa A Asaro, Aileen Kirby, David Wypij, Ravi R Thiagarajan, Martha A Q Curley
OBJECTIVES: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING: Twenty-one U.S. PICUs. PATIENTS: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome...
June 13, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28607934/opioid-addiction-social-problems-associated-and-implications-of-both-current-and-possible-future-treatments-including-polymeric-therapeutics-for-giving-up-the-habit-of-opioid-consumption
#8
REVIEW
M Cristina Benéitez, M Esther Gil-Alegre
BACKGROUND: Detoxification programmes seek to implement the most secure and compassionate ways of withdrawing from opiates so that the inevitable withdrawal symptoms and other complications are minimized. Once detoxification has been achieved, the next stage is to enable the patient to overcome his or her drug addiction by ensuring consumption is permanently and completely abandoned, only after which can the subject be regarded as fully recovered. METHODS: A systematic search on the common databases of relevant papers published until 2016 inclusive...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28605308/prevalence-of-heavy-alcohol-use-among-people-receiving-methadone-following-change-to-methadose
#9
Jan Klimas, Evan Wood, Ekaterina Nosova, M-J Milloy, Thomas Kerr, Kanna Hayashi
BACKGROUND: A recent switch in methadone formulation from methadone (1 mg/mL) to Methadose (10 mg/mL) in British Columbia (BC), Canada, was associated with increased reports of opioid withdrawal and increases in illicit opioid use. Impacts on other forms of drug use have not been assessed. Since alcohol use is common among people receiving Medication-Assisted Treatment (MAT), we assessed if switch was associated with increased prevalence of heavy alcohol use. METHODS: Drawing on data from two open prospective cohort studies of people who inject drugs in Vancouver, BC, generalized estimating equations (GEE) model examined relationship between methadone formulation change and heavy alcohol use, defined by National Institute for Alcohol Abuse and Alcoholism (NIAAA)...
June 12, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/28600725/tolerability-safety-and-effectiveness-of-oxycodone-deterx-in-elderly-patients-%C3%A2-65%C3%A2-years-of-age-with-chronic-low-back-pain-a-randomized-controlled-trial
#10
Ernest A Kopecky, Ben Vaughn, Scott Lagasse, Melinda O'Connor
TRIAL DESIGN: This was a phase III, randomized withdrawal, double-blind, placebo-controlled, enriched enrollment, parallel-group, multicenter study intended to demonstrate the safety, tolerability, and analgesic efficacy of oxycodone DETERx(®) (Xtampza™ ER) compared with matching placebo. METHODS: This post hoc analysis was performed using data from a subpopulation of enrolled patients who were ≥65 years of age. The study enrolled male and female patients with a clinical diagnosis of moderate-to-severe chronic low back pain for a minimum of 6 months prior to screening who required around-the-clock opioid therapy...
June 10, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28595427/challenging-equipotency-calculation-for-hydromorphone-after-long-term-intravenous-application
#11
Benjamin Luchting, Banafscheh Rachinger-Adam, Nikolai Hulde, Jens Heyn, Shahnaz Christina Azad
In advanced stages, most cancer patients suffer from pain which can usually be well controlled following the World Health Organization (WHO) level scheme. While the majority of patients report adequate pain relief by strong opioids (WHO III), some require an opioid rotation. Despite the existence of conversion tables, these rotations mea lead to inadequate pain control or life threatening events. Here, we report about a patient with urothelial cell carcinoma presenting in our Department of Pain Medicine with massive pain aggravation up to NRS values of 10/10 despite administration of the highest dose of intravenously applied hydromorphone...
March 16, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28595027/clinical-outcomes-of-start-low-go-slow-methadone-initiation-for-cancer-related-pain-what-s-the-hurry
#12
Pippa Hawley, Lawrance Chow, Gillian Fyles, Aria Shokoohi, Mary-Jane O'Leary, Matthew Mittelstadt
BACKGROUND: Methadone has been shown to be effective for cancer pain. Most published switching methods are complete in less than three days, requiring very close supervision, usually in an inpatient setting. This need for hospitalization is a barrier to access. We present a large retrospective study of slow outpatient methadone starts and describe our starting method. METHODS: Charts were reviewed of patients referred to the Pain and Symptom Management/Palliative Care clinics at the six BC Cancer Agency's regional centers that underwent initiation of methadone for analgesia over a 14-year period...
June 8, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28590258/opioid-induced-hyperalgesia-in-clinical-anesthesia-practice-what-has-remained-from-theoretical-concepts-and-experimental-studies
#13
Lena Weber, David C Yeomans, Alexander Tzabazis
PURPOSE OF REVIEW: This article reviews the phenomenon of opioid-induced hyperalgesia (OIH) and its implications for clinical anesthesia. The goal of this review is to give an update on perioperative prevention and treatment strategies, based on findings in preclinical and clinical research. RECENT FINDINGS: Several systems have been suggested to be involved in the pathophysiology of OIH with a focus on the glutaminergic system. Very recently preclinical data revealed that peripheral μ-opioid receptors (MORs) are key players in the development of OIH and acute opioid tolerance (AOT)...
June 5, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28577506/high-enhancer-downer-withdrawal-helper-multifunctional-nonmedical-benzodiazepine-use-among-young-adult-opioid-users-in-new-york-city
#14
Pedro Mateu-Gelabert, Lauren Jessell, Elizabeth Goodbody, Dongah Kim, Krista Gile, Jennifer Teubl, Cassandra Syckes, Kelly Ruggles, Jeffrey Lazar, Sam Friedman, Honoria Guarino
BACKGROUND: Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose...
May 31, 2017: International Journal on Drug Policy
https://www.readbyqxmd.com/read/28574864/methadone-management-of-withdrawal-associated-with-loperamide-related-opioid-use-disorder
#15
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/28574532/association-between-opioid-and-benzodiazepine-use-and-clinical-deterioration-in-ward-patients
#16
Patrick G Lyons, Ashley Snyder, Sarah Sokol, Dana P Edelson, Babak Mokhlesi, Matthew M Churpek
BACKGROUND: Opioids and benzodiazepines are frequently used in hospitals, but little is known about outcomes among ward patients receiving these medications. OBJECTIVE: To determine the association between opioid and benzodiazepine administration and clinical deterioration. DESIGN: Observational cohort study. SETTING: 500-bed academic urban tertiary-care hospital. PATIENTS: All adults hospitalized on the wards from November 2008 to January 2016 were included...
June 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28564576/the-endocannabinoid-system-as-a-target-for-addiction-treatment-trials-and-tribulations
#17
REVIEW
Matthew E Sloan, Joshua L Gowin, Vijay A Ramchandani, Yasmin L Hurd, Bernard Le Foll
Addiction remains a major public health concern, and while pharmacotherapies can be effective, clinicians are limited by the paucity of existing interventions. Endocannabinoid signaling is involved in reward and addiction, which raises the possibility that drugs targeting this system could be used to treat substance use disorders. This review discusses findings from randomized controlled trials evaluating cannabinergic medications for addiction. Current evidence suggests that pharmacotherapies containing delta-9-tetrahydrocannabinol, such as dronabinol and nabiximols, are effective for cannabis withdrawal...
May 28, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28562267/an-initiative-to-improve-the-quality-of-care-of-infants-with-neonatal-abstinence-syndrome
#18
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
#19
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/28559639/opium-withdrawal-delirium-two-case-reports
#20
Ravi C Sharma, Ramesh Kumar, Dinesh Dutt Sharma, Pankaj Kanwar
Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48-58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium.
January 26, 2017: Psychopharmacology Bulletin
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